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Animal studies have suggested that exposure of the middle ear to topical local anaesthesia may be ototoxic. This study aimed to report sensorineural hearing outcomes and patients’ satisfaction in those who underwent myringotomy and ventilation tube insertion using topical local anaesthesia.
Twenty-nine patients (32 ears) were operated on. Pre- and post-operative audiology findings were compared. A Likert-type questionnaire on treatment satisfaction was completed at the end of the procedure.
Median patient age was 55 years (range, 27–88 years). Pre- and post-operative bone conduction pure tone averages were 26.76 dB and 25.26 dB respectively (mean reduction of −1.22 dB, 95 per cent confidence interval of −5.91 to 8.13 dB; p = 0.7538). One ear (3 per cent) had a reduction in pure tone average of 10 dB.
The results suggest that sensorineural hearing loss is not a complication of ear exposure to topical local anaesthesia during myringotomy and ventilation tube insertion. The procedure was well perceived.
As founder of a religious movement emphasizing soteriological goals, Paramahansa Yogananda is at odds with the prevailing scholarly portrayal of yoga as a modern, syncretic bodily practice focused on mindfulness and physical well-being that, even when employing language of transcendence, magic, or the supernatural, typically has this-worldly perfection in mind. Yogananda, thus, offers an important counterpoint to the dominant historiography of yoga. Whereas more recent “global gurus” often remained in India and recruited among diaspora Indians, Yogananda was the first Indian to establish a thriving yoga-based Hinduism among white converts in the United States. He worked to make his message compelling in the often-hostile milieu of a dominant Christian culture. In this article, I consider Southern California's identity as a “spiritual frontier” that offered a uniquely conducive space to launch a Hindu religious movement in a virulently xenophobic era. I explore Yogananda's vision of the “science of religion,” language that reflected not a materialist reduction of yoga to somatic goals, but a precise, systematic meditation method designed to achieve God-contact. Yogananda offered various products in an effort to build brand loyalty for his yoga-based religion. Although he strategically promoted the very real health and energy benefits of his instruction, the heart of his commercial and spiritual enterprise was a yoga correspondence course that promised to train disciples in a devotional relationship with a God he often depicted as a personal Being. I conclude by examining Yogananda's role as the authoritative divine guru who mediated his religious products to devotees and remained present after his death to guide them toward ultimate bliss.
The spatial-intensity profile of light reflected during the interaction of an intense laser pulse with a microstructured target is investigated experimentally and the potential to apply this as a diagnostic of the interaction physics is explored numerically. Diffraction and speckle patterns are measured in the specularly reflected light in the cases of targets with regular groove and needle-like structures, respectively, highlighting the potential to use this as a diagnostic of the evolving plasma surface. It is shown, via ray-tracing and numerical modelling, that for a laser focal spot diameter smaller than the periodicity of the target structure, the reflected light patterns can potentially be used to diagnose the degree of plasma expansion, and by extension the local plasma temperature, at the focus of the intense laser light. The reflected patterns could also be used to diagnose the size of the laser focal spot during a high-intensity interaction when using a regular structure with known spacing.
Many Latin American countries have passed laws intended to address femicide and other forms of violence against women. Yet the implementation of these laws has been inconsistent at best. This article analyzes the case of Nicaragua, which passed a comprehensive law on gender-based violence (Law 779) in 2012. While celebrated by local women’s organizations, Law 779 was subsequently weakened through a series of legislative reforms and executive decrees. This article seeks to explain why state actors in Nicaragua initially supported Law 779 and later sought to undermine it. It argues that in contexts characterized by a high concentration of political power like Nicaragua, transnational governance structures are insufficient to ensure the success of gender violence legislation. Through an analysis of Law 779, this article contributes to broader debates about the nature of state legitimacy and the potential of legal advocacy to address violence against women.
The stable-isotopic signature of dissolved inorganic carbon (DIC) has been routinely used in temperate lake systems to investigate the biogeochemical dynamics of carbon. We studied seven perennially ice-covered lakes in the McMurdo Dry Valleys, Antarctica, to ascertain how carbon cycling affects the δ13C of DIC in water columns of these systems. Unlike temperate lakes and, in fact, most polar lake systems, the permanent ice covers of these lakes eliminate physical mixing (turnover) and hence redistribution of DIC in the lakes, as well as minimize CO2 exchange with the atmosphere. These important and unique physical constraints have significant impact on carbon dynamics in the lakes, and important consequences for the δ13C distribution. The geochemistry in these lakes is influenced in varying amounts by landscape position, hydrologic input and their evolutionary history. Five of these lakes (both lobes of Lake Bonney, and Lakes Fryxell, Miers and Vanda) have surface water δ13C ratios of 0–4‰, Lake Hoare has more negative values, while Lake Joyce, the highest-elevation lake, has a much higher value (10.5‰). All of the lakes have upper- to mid-depth δ13C maxima reflecting biological uptake of 12C. Only four of the lakes (Lakes Vanda, Joyce, Hoare and Fryxell) have deep waters with negative values of δ13C, implying rigorous remineralization of 12C at depth. Lake Miers, the only lake that is not closed basin, has the smallest δ13C variation with depth, indicating that hydrologic exchange greatly influences the δ13C signal.
Stable isotopes in ice cores are used as a proxy for the temperature at the time of snow formation. Where net accumulation rate is relatively high, snow is buried quickly and initial isotopic values are preserved. However, in low-accumulation areas, snow is exposed to lengthy vapor exchange with the atmosphere. the original isotopic signature of this snow may be modified by equilibration with atmospheric water vapor in the boundary layer over the snow surface in summer. We estimate the characteristic times for equilibration by using an electrical resistor network analogue. Warm, windy summers and low accumulation rate enhance equilibration. Although equilibration of the complete snowpack is unlikely, significant post-depositional change may occur in some Antarctic environments.
Persistent katabatic winds form widely distributed localized areas of near-zero net surface accumulation on the East Antarctic ice sheet (EAIS) plateau. These areas have been called 'glaze' surfaces due to their polished appearance. They are typically 2-200 km2 in area and are found on leeward slopes of ice-sheet undulations and megadunes. Adjacent, leeward high-accumulation regions (isolated dunes) are generally smaller and do not compensate for the local low in surface mass balance (SMB). We use a combination of satellite remote sensing and field-gathered datasets to map the extent of wind glaze in the EAIS above 1500 m elevation. Mapping criteria are derived from distinctive surface and subsurface characteristics of glaze areas resulting from many years of intense annual temperature cycling without significant burial. Our results show that 11.2 ± 1.7%, or 950 ± 143 × 103km2, of the EAIS above 1500 m is wind glaze. Studies of SMB interpolate values across glaze regions, leading to overestimates of net mass input. Using our derived wind-glaze extent, we estimate this excess in three recent models of Antarctic SMB at 46-82 Gt. The lowest-input model appears to best match the mean in regions of extensive wind glaze.
The late-Holocene trends in δ18O differ significantly in two ice cores (30 km apart) from the area of Taylor Dome, Antarctica. It is unlikely that the trend in the core from Taylor Mouth (the flank site) is due to a standard δ18O–surface temperature relationship. Assuming that the Taylor Dome (nearsummit) core records local climate variations common to both cores, we assess two leading possible causes for the observed differences: (1) Relative to Taylor Dome, Taylor Mouth may collect snow from more sources with distinct isotopic compositions. (2) Vapor motion during prolonged near-surface exposure may cause post-depositional isotope enrichment at Taylor Mouth, where the accumulation rate is low. Our model of firn pore-space vapor and sublimating ice grains suggests that post-depositional processes can modify δ18O values by several ‰. Isotopic samples from areas with significantly different accumulation rates near Taylor Mouth could differentiate between possibilities (1) and (2).
Ice deformation and basal motion characterize the dynamical behavior of the Greenland ice sheet (GrIS). We evaluate the contribution of basal motion from ice deformation measurements in boreholes drilled to the bed at two sites in the western marginal zone of the GrIS. We find a sustained high amount of basal motion contribution to surface velocity of 44–73% in winter, and up to 90% in summer. Measured ice deformation rates show an unexpected variation with depth that can be explained with the help of an ice-flow model as a consequence of stress transfer from slippery to sticky areas. This effect necessitates the use of high-order ice-flow models, not only in regions of fast-flowing ice streams but in all temperate-based areas of the GrIS. The agreement between modeled and measured deformation rates confirms that the recommended values of the temperature-dependent flow rate factor A are a good choice for ice-sheet models.
One of the unusual features of Lakes Fryxell and Hnare in Taylor Valley, southern Victoria Land, Antarctica, is their perennial ice cover. This ice cover limits gas exchange between the atmosphere and the lake water, and causesa very stable stratification of the lakes. We analyzed a series of water samples from profiles of these lakes and their tributaries for δ13C of the dissolved inorganic carbon (DIC) in order to qualify the carbon flux from the streams into the lakes, and to investigate the carbon cycling with in the lakes. Isotopic values in the uppermost waters (δ13C = +l.3‰ to 5.3‰ in Lake Hoare, +0.4‰ to +3.0‰ in Lake Fryxell) are close to the carbon-isotope values encountered in the streams feeding Lake Fryxell, but distinctively heavier than in streams feeding Lake Hoare (δ13C= — 2.3%n to 1.4%). These ratios are much heavier than ratios found in the moat that forms around the lakes injanuary February (δC = -10.1%). in the oxic photic zones of the lakes, photosynthesis clearly influences the isotopic composition, with layers of high productivity having enriched carbon-isotope signatures δ13C= +2.7‰ to +6.1‰). in both lakes, the isotopic values become lighter with depth, reaching minima of 3.2‰ and 4.0% in Lakes Fryxell and Hoare, respectively. These minima are caused by the microbial remineralization of isotopically light organic carbon. We present DIC flux calculations that help to interpret the isotopic distribution. For example, in Lake Hoare the higher utilization of CO2aq, and a substantially smaller inflow of CO2 from streams cause the heavier observed isotopic ratios. Differences in the hydrology and stream morphologies of the tributaries also greatly influence the carbon budgets of the basins.
The central region of M87 in the K′ (2.1 μm) - band was imaged using the 2.2m telescope on Calar Alto, Spain. In addition to the jet our K′ exposure (Fig. 1) shows an arclike structure ∼ 24 arcsec southeast of the nucleus. This is the IR counterpart to the feature detected by Stiavelli et al. (1992) in the optical and to the brightness maximum of the southeastern radiolobe designated as “theta” (Hines et al. 1989). Its radio to IR spectral index is α = −0.88 ±0.01 (Sv ∞ vα), consistent with the radio spectral index of α = −0.84 ± 0.07 (Salter et al. 1989) of the whole radio lobe measured between 5 GHz and 230 GHz.
Previously we have studied the jet of the quasar 3C 273 at optical and radio frequencies. In our first set of X-ray data with 17.2 ksec integration time obtained with the ROSAT HRI, the jet is easily visible extending out from the bright quasar core. The total number of counts in the jet lies in the range 200 to 300, depending on the details of the background model. This corresponds to an X-ray flux fv(2.9 × 1017 Hz) = 65 … 140 nJy (lower limit, synchrotron radiation α = −0.8 … upper limit, bremsstrahlung α = 0, NHI = 1.8 × 1020 cm−2), in good agreement with the value derived from the EINSTEIN observations.
Objectives: The Centers for Medicare and Medicaid Services (CMS) issues National Coverage Determinations (NCDs) for medical interventions expected to have a significant impact on Medicare, the health insurance program for US citizens aged 65 years and older and certain people with disabilities under the age of 65 years. The objective of this study was to evaluate NCDs issued from 1999 to 2013 to identify key trends, and to discuss implications for future CMS policy.
Methods: We used the Tufts Medical Center Medicare National Coverage Determination Database to examine characteristics of NCDs from 1999 through 2013. We examined various characteristics of NCDs, including: whether the intervention under review is used for prevention or treatment of disease, the type of intervention considered, evidence limitations cited by CMS, and coverage determination outcome. We evaluated longitudinal trends in categorical and continuous variables in the database, using Cochran-Armitage trend tests and linear regression, respectively.
Results: We found that NCDs increasingly focus on preventive care (p = 0.072), pertain to diagnostic imaging (p = 0.033), and evaluate health education/behavioral therapy interventions (p = 0.051). CMS increasingly cites the lack of relevant outcomes (p = 0.019) and the lack of applicability of study results to the Medicare population (p < 0.001) as evidence limitations. CMS less often restricts coverage to certain population subgroups in NCDs (p < 0.001), but increasingly applies coverage with evidence development policies (p < 0.001).
Conclusions: Identified trends reflect broader changes in Medicare as CMS shifts its focus from treatment to prevention of disease, addresses potentially overutilized technologies, and attempts to issue flexible coverage policies.
The British Society of Audiology has produced clear guidelines as to how otoscopy should be undertaken; however, no nationally recognised guidelines exist for the wider clinical community. Images of otoscopy appear in many books, journals, magazines and websites.
This study aimed to determine the rate of non-compliance with good practice in images of otoscopy, the seriousness of the breach, and whether this is more common in sites for professionals or the general public.
Google Images was searched using the terms ‘otoscopy’ and ‘ear examination’. A total of 200 images were identified and collated. The images were reviewed for compliance with good practice standards.
Only 12.75 per cent of the images were graded as having no breach of good practice standards.
Professional websites have a responsibility to show best practice. When choosing an image, the source of the image needs to be carefully considered.
Objectives: In recent years, there has been growth in the use of health technology assessment (HTA) for making decisions about the reimbursement, coverage, or guidance on the use of health technologies. Given this greater emphasis on the use of HTA, it is important to develop standards of good practice and to benchmark the various HTA organizations against these standards.
Methods: This study discusses the conceptual and methodological challenges associated with benchmarking HTA organizations and proposes a series of audit questions based on a previously published set of principles of good practice.
Results and Conclusions: It is concluded that a benchmarking exercise would be feasible and useful, although the question of who should do the benchmarking requires further discussion. Key issues for further research are the alternative methods for weighting the various principles and for generating an overall score, or summary statement of adherence to the principles. Any weighting system, if developed, would need to be explored in different jurisdictions to assess the extent to which the relative importance of the principles is perceived to vary. Finally, the development and precise wording of the audit questions requires further study, with a view to making the questions as unambiguous as possible, and the reproducibility of the assessments as high as possible.
The Tufts Cost-Effectiveness Analysis (CEA) Registry (www.cearegistry.org) is a publicly available comprehensive database of cost-utility analyses of health interventions published in the peer-reviewed medical and public health literature. This article discusses the database structure, methodology of data extraction, current trends in cost-utility analyses and impact of the Registry.
As in the past, the primary activity of the IAU Working Group on Cartographic Coordinates and Rotational Elements has been to prepare and publish a triennial (“2009”) report containing current recommendations for models for Solar System bodies (Archinal et al. (2011a)). The authors are B. A. Archinal, M. F. A'Hearn, E. Bowell, A. Conrad, G. J. Consolmagno, R. Courtin, T. Fukushima, D. Hestroffer, J. L. Hilton, G. A. Krasinsky, G. Neumann, J. Oberst, P. K. Seidelmann, P. Stooke, D. J. Tholen, P. C. Thomas, and I. P. Williams. An erratum to the “2006” and “2009” reports has also been published (Archinal et al. (2011b)). Below we briefly summarize the contents of the 2009 report, a plan to consider requests for new recommendations more often than every three years, three general recommendations by the WG to the planetary community, other WG activities, and plans for our next report.