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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.
To analyse publication and citations trends of case reports within otolaryngology – head and neck surgery literature, with specific attention to the most-cited reports.
Web of Science was searched for article type ‘case reports’ published in the leading otolaryngology – head and neck surgery journals since 1945. Variables including publication dates, citation dates and numbers, author, author number, and others were recorded and analysed for trends. The reports with the most citations (classics) were further studied.
Of nearly 67 000 published articles in leading otolaryngology – head and neck surgery journals, the overall number of case reports as a percentage of the total has substantially decreased over time. A total of 110 case report classics were identified for which citations have increased.
Although the case report may not be worthy of its tarnished record, declining trends in publication suggest a limited future for this valuable research and educational resource.
To explore the link between nasal polyposis, refractory otitis media with effusion and eosinophilic granulomatosis with polyangiitis.
A retrospective observational study was carried out of patients diagnosed with refractory otitis media with effusion necessitating grommet insertion and who had nasal polyps. Patients were evaluated to determine if they fulfilled the diagnostic criteria of eosinophilic granulomatosis with polyangiitis.
Sixteen patients (10 males and 6 females) were identified. The mean age of grommet insertion was 45.4 years. The mean number of grommets inserted per patient was 1.6. The mean number of nasal polypectomies was 1.7. All 16 patients had paranasal sinus abnormalities and otitis media with effusion, 14 had asthma, 9 had serological eosinophilia and 7 had extravascular eosinophilia. Nine patients met the diagnostic criteria for eosinophilic granulomatosis with polyangiitis.
The co-presence of nasal polyps and resistant otitis media with effusion should raise the possibility of eosinophilic granulomatosis with polyangiitis.
Two major types of terrain that formed at or near the bed of Pleistocene continental ice sheets are widespread throughout the prairie region of Canada and the United States. These are (1) glacial-thrust blocks and source depressions and (2) streamlined terrain.
Glacial-thrust terrain formed where the glacier was frozen to the substrate and where elevated pore-water pressure decreased the shear strength of the substrate to a value less than that applied by the glacier. The marginal zone of ice sheets consisted of a frozen-bed zone, no more than 2 to 3 km wide in places, within which glacial-thrust blocks are large and angular. Up-glacier from this zone the thrust blocks are generally smaller and smoothed. Streamlined terrain begins 2 to 3 km behind known ice-margin positions and extends tens of kilometres up-glacier. Streamlined terrain formed in two ways: (1) erosion of the substrate as a consequence of basal sliding in the sub-marginal thawed-bed zone and (2) erosional smoothing accompanied by emplacement of till in the lee of thrust blocks where they were deposited and subsequently exposed to thawed-bed conditions as a result of further advance of the glacier.
This paper has been accepted for publication in full in a future issue of the Journal of Glaciology.
The Universities of Adelaide and Tasmania (UAT) have now collaborated in the preparation of four experiments on British Skylark rockets. Two independent X-ray detectors of total sensitive area 40 cm2 were flown on each of two rocket flights launched in April, 1967. The most significant result of these measurements was the discovery of Cen XR-2 and the measurement of the variation in its intensity and spectrum. The third flight, launched in December 1967, carried three X-ray detectors of total area 140 cm2. One of the main results from this flight, evidence for a new X-ray source at high galactic latitude, will be presented in the following paper.
Most of the recent advances in X-ray astronomy have resulted from satellite observations in the low energy (< 20 keV) range. The Einstein X-ray Observatory in particular has been responsible for a dramatic increase in our knowledge of the X-ray sky, in that all major classes of astronomical objects have been detected.
The University of Tasmania balloon-borne large area X-ray telescope was flown from Alice Springs on 20 November 1978. A number of known X-ray sources were observed and a transient increase believed to be a gamma ray burst was detected.
The binary X-ray source GX 1 + 4 was observed during a balloon flight in 1986, November. The source was in a relatively high intensity state. Time analysis of the data shows that the pulsation period was 111.8 ± 1.0 s indicating that one or more episodes of spin-down occurred between 1980 and 1986. Folded pulse profiles are very broad with an indication of a notch at the peak. Evidence has been found for a correlation between hard X-ray intensity and phase of the proposed 304 day orbital period. The time averaged intensity since 1980 is an order of magnitude lower than during the 1970’s. A survey of the post 1980 data shows that several reversals of the period derivative have occurred. Spin-up at the rates typical of the 1970’s has been followed by a dramatic spin-down episode with dP/dt>2.4 × 10−7 s/s.
Primary cosmic rays passing through the solar system carry with them valuable information about solar and astrophysical phenomena in the form of intensity and spectral variations. In order that this information be efficiently extracted from observations of the directional cosmic-ray flux at the surface of the Earth, it is essential to have accurate information available to enable the relating of the observed secondary cosmic-ray directions of motion and intensity to those outside the range of the disturbing terrestrial influences.
We propose that the ancestors of bats were small, nocturnal, sylvatic gliders that used echolocation for general orientation. Their echolocation calls were short, low intensity, broadband clicks, which translated into a very short operational range. In the lineage that gave rise to bats, a switch to stronger, tonal signals permitted the use of echolocation to detect, track, and assess flying insects in subcanopy settings. We propose that these animals hunted from perches and used echolocation to detect, track, and assess flying insects, which they attacked while gliding. In this way, the perfection of echolocation for hunting preceded the appearance of flapping flight, which marked the emergence of bats. Flapping flight had appeared by the Eocene when at least eight families are known from the fossil record. Stronger signals and adaptations to minimize self-deafening were central to the perfection of echolocation for locating flying prey. Echolocation constituted a key innovation that permitted the evolution and radiation of bats. At the same time, however, its short effective range imposed a major constraint on the size of bats. This constraint is associated with flight speed and the very small time intervals from detection of, and contact with a flying target. Gleaning and high duty cycle echolocation are two derived approaches to hunting prey in cluttered situations, places where echoes from background and other objects arrive before or at the same time as echoes from prey. Both had appeared by the Eocene.
Anterior Cervical Discectomy and Fusion (ACDF) is the gold standard treatment for cervical spondylosis but there is a lack of consensus in the literature regarding which type of bone graft is superior: autograft or allograft. The purpose of this study is to evaluate fusion after ACDF using a stand-alone intervertebral cage packed with autologous cervical bone shavings acquired during the procedure. Twenty patients that underwent single-level ACDF from 2011 to 2014 using a stand-alone polyetheretherketone (PEEK) cage were recruited. Patients were evaluated for evidence of bone fusion by plain films and CT scan. Fusion was primarily assessed by grading the level of trabecular bridging bone across the bone-graft interface. Odom’s criteria were used to assess clinical outcome. All interbody disc spaces achieved successful fusion at follow-up. A total of 80% (16/20) of patients had radiographic evidence of trabecular bone present both within and around the cage. The other 20% exhibited bridging bone within the cage but had evidence of minor radiolucent gaps and lack of bridging bone completely surrounding the cage. Eighty percent of patients reported excellent/good clinical outcomes. ACDF using a PEEK stand-alone cage with autograft bone shavings has a high rate of fusion and avoids potential complications of classic autograft harvesting and decreased allograft fusion rates.
This study aimed to evaluate the changes in impact factors of otorhinolaryngology journals over the past 15 years.
Using the online edition of Journal Citation Reports, standard (2-year) and 5-year impact factors were calculated for the leading 15 journals.
The results were compared with the impact factors for 1998. The average standard impact factor and 5-year impact factor increased by 2.72 and 2.05 fold respectively when compared with 1998. The average 2012 standard impact factor and 5-year impact factor were 1.82 and 1.99 respectively, reflecting a 9.3 per cent difference. The average 1998 standard impact factor and 5-year impact factor were 0.67 and 0.97 respectively, reflecting a 44.8 per cent difference. The Journal of the Association for Research in Otolaryngology had the highest standard and five-year impact factors.
These data may indicate changing clinical and research interests within our field, as well as increased speed and ease with which the internet has allowed citation. As a result, five-year intervals may no longer be necessary to adequately gauge journal impact.
Mineralized soil nitrogen (N) is an important source of N for grassland production. Some soils can supply large quantities of plant-available N through mineralization of soil organic matter. Grass grown on such soils require less fertilizer N applications per unit yield. A reliable, accurate and user-friendly method to account for soil N supply potential across a large diversity of soils and growing conditions is needed to improve N management and N recommendations over time. In the current study, the effectiveness of chemical N tests and soil properties to predict soil N supply for grass uptake across 30 Irish soil types varying in N supply potential was investigated under controlled environmental conditions. The Illinois soil N test (ISNT) combined with soil C : N ratio provided a good estimate of soil N supply in soils with low residual mineral N. Total oxidized N (TON) had the largest impact on grass dry matter (DM) yield and N uptake across the 30 soil types, declining in its influence in later growth periods. This reflected the high initial mineral N levels in these soils, which declined over time. In the current study, a model with ISNT-N, C : N and TON (log TON) best explained variability in grass DM yield and N uptake. All three rapid chemical soil tests could be performed routinely on field samples to provide an estimate of soil N supply prior to making N fertilizer application decisions. It can be concluded that these soil tests, through their assessment of soil N supply potential, can be effective tools for N management on grassland; however, field studies are needed to evaluate this under more diverse growing conditions.
Nitrous oxide (N2O) emissions associated with urine nitrogen (N) deposition during grazing are a major component of greenhouse gas emissions from domestic livestock. The present study investigated the relationship between urine N loading rate and the efficacy of a nitrification inhibitor, dicyandiamide (DCD), on cumulative N2O emissions from a grassland soil in Ireland over 80 and 360-day periods in 2009/10 and 2010/11. A diminishing curvilinear relationship between urine N rate and cumulative N2O emissions was observed in both years. Despite this increase in cumulative N2O emissions, the emission factor (EF3) for N2O decreased with increasing urine N rate from, on average, 0·24 to 0·10% (urine applied at 300 and 1000 kg N/ha, respectively), during an 80-day measurement period. This was probably the result of a factor other than N, such as carbon (C), limiting the production of N2O. The efficacy of DCD varied with urine N loading rate, and inter-annual variability in efficacy was also observed. Dicyandiamide was effective at reducing N2O production for 50–80 days after urine application, which accounted for the major period of elevated daily flux. However, DCD was ineffective at reducing N2O production after this period, which was likely a result of its removal from the soil via degradation and leaching.
The current study investigated the coupling of groundwater and surface water nitrogen (N) dynamics over 3 years, and considered intensive agricultural land-management influences over this period where the risk of N loss to water was considered high. Groundwater N (as nitrate) was monitored monthly in different strata and zones in four hillslopes, two in each of two agricultural catchments of c. 10 km2, and stream water N flux was monitored sub-hourly in the catchment outlets. Field nutrient sources were connected to surface water via groundwater; the groundwater along hillslopes was seen to be influenced spatially and temporally by management, geology and weather as observed in the concentration variability of nitrate in groundwater. Based on spatio-temporal averages of nitrate-N concentration, groundwater status was considered good (at least below a maximum acceptable concentration (MAC) of 11·3 mg/l). However, zones coincident with land-use change (ploughing and reseeding, typical of a management event in intensive landscapes), showed high spatio-temporal variability in nitrate-N concentration, exceeding the MAC temporarily, before recovering. This spatio-temporal variability highlighted the need for insight into these differences when interpreting groundwater quality data from a limited number of basin-scale sampling points and occasions. In both catchments the 3-year mean nitrate-N concentration in stream water was similar to the spatio-temporal mean concentration in groundwater. The magnitude and variability of loads, however, were more related to changes in annual runoff rather than changes in annual groundwater nitrate-N status. In one wet year, nitrate-N loads exceeded 48 kg/ha from an Arable catchment and 45 kg/ha from a grassland catchment (close to double the loss in a dry year).
A considerable expansion of biogas production in Germany, paralleled by a strong increase in maize acreage, has caused growing concern that greenhouse gas (GHG) emissions during crop substrate production might counteract the GHG emission saving potential. Based on a 2-year field trial, a GHG balance was conducted to evaluate the mitigation potential of regionally adapted cropping systems (continuous maize, maize-wheat-Italian ryegrass, perennial ryegrass ley), depending on nitrogen (N) level and N type. Considering the whole production chain, all cropping systems investigated contributed to the mitigation of GHG emissions (6·7–13·3 t CO2 eq/ha), with continuous maize revealing a carbon dioxide (CO2) saving potential of 55–61% compared with a fossil energy mix reference system. The current sustainability thresholds in terms of CO2 savings set by the EU Renewable Energy Directive could be met by all cropping systems (48–76%). Emissions from crop production had the largest impact on the mitigation effect (⩾50%) unless the biogas residue storage was not covered. The comparison of N fertilizer types showed less pronounced differences in GHG mitigation potential, whereas considerable site effects were observed.