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To identify the intracochlear electrode position in cochlear implant recipients and determine the correlation to speech perception for two peri-modiolar electrode arrays.
Post-operative cone-beam computed tomography images of 92 adult recipients of the ‘CI512’ electrode and 18 adult recipients of the ‘CI532’ electrode were analysed. Phonemes scores were recorded pre-implantation, and at 3 and 12 months post-implantation.
All CI532 electrodes were wholly within scala tympani. Of the 79 CI512 electrodes intended to be in scala tympani, 58 (73 per cent) were in scala tympani, 14 (17 per cent) were translocated and 7 (9 per cent) were wholly in scala vestibuli. Thirteen CI512 electrodes were deliberately inserted into scala vestibuli. Speech perception scores for post-lingual recipients were higher in the scala tympani group (69.1 per cent) compared with the scala vestibuli (54.2 per cent) and translocation (50 per cent) groups (p < 0.05). Electrode location outside of scala tympani independently resulted in a 10.5 per cent decrease in phoneme scores.
Cone-beam computed tomography was valuable for demonstrating electrode position. The rate of scala tympani insertion was higher in CI532 than in CI512 electrodes. Scala vestibuli insertion and translocation were associated with poorer speech perception outcomes.
This article investigates the use of payments for environmental services to support a wildlife corridor between two Priority Tiger Conservation Landscapes in central Sumatra, Indonesia. Several hundred smallholders operate within a Protection Forest linking the Tiger Conservation Landscapes. This study explores the willingness of these smallholders to accept a payment requiring them to forgo access to their land for five years. In addition to asking households directly what they would be willing to accept (WTA), we also ask them to infer what their neighbour would accept. The study finds evidence of hypothetical bias in the conventional WTA values, with a statistically significant difference between what people say they would be willing to accept when surveyed, compared to what they say would actually be willing to accept in a ‘real life’ situation. We show how inferred valuation techniques can mitigate against this.
Currently policies enabling cattle herds to regain Official Tuberculosis Free (OTF) status after a bovine tuberculosis (bTB) herd incident vary between individual parts of the British Isles from requiring only one negative single comparative intradermal tuberculin test (SCITT) herd test when bTB infection is not confirmed to needing two consecutively negative SCITT herd tests after disclosure of two or more reactors, irrespective of bTB confirmation. This study used Kaplan–Meier curves and univariable and multivariable Cox Proportional Hazard models to evaluate the effect of the number of SCITT reactors and bTB confirmation on the risk of future bTB herd incident utilising data extracted from the national animal health database in Northern Ireland. Based on multivariable analyses the risk of a future bTB herd incident was positively associated with the number of SCITT reactors identified during the incident period (hazard ratio = 1.861 in incidents >5 SCITT reactors compared to incidents with only one SCITT reactor; P < 0.001), but not with bTB confirmation. These findings suggest that the probability of residual bTB infection in a herd increases with an increasing number of SCITT reactors disclosed during a bTB herd incident. It was concluded that bTB herd incidents with multiple SCITT reactors should be subjected to stricter control measures irrespective of bTB infection confirmation status.
This volume has its genesis in a two-day conference held at Durham University in January 2012, which was organised by the late Richard Britnell under the auspices of Durham's Institute of Medieval and Renaissance Studies. The aim was to explore shared elements in the development of socio-political institutions, landscape and agriculture on either side of the Anglo-Scottish Border before the onset of the Wars of Independence in 1296. As Richard Britnell expressed it, his desire was to encourage ‘focused exchanges of knowledge between historians of Scotland and northern England concerning common or cognate features of the two regions’. To that end, he invited scholars specialising in particular fields to re-visit the primary evidence in the light of the latest scholarship, taking a comparative approach across ‘middle Britain’, the region bisected by the Anglo-Scottish Border. Before he fell ill, he had secured the agreement of speakers at the Durham conference to develop their papers with a view to publishing a volume of collected essays. The present editors took over responsibility for the volume after Richard Britnell's death in December 2013. Since then some changes have been made to its scope by commissioning additional chapters from Janet Burton on religious institutions and culture, David Ditchburn on towns and trade, and Philip Dixon and Chris Tabraham on fortifications, in order to ensure more comprehensive thematic coverage.
The book's development has also resulted in a shift of emphasis from similarities to similarities and differences. Although the ‘common foundations’ that underlie medieval middle Britain, be they institutional, environmental or otherwise, are carefully investigated in the pages that follow, there is also much discussion of how far and why northern England and southern Scotland developed differently from one another, not least in the context of the gradual emergence of two independent medieval ‘nation-states’ and their distinctive trajectories. Common foundations were a pervasive and striking aspect of middle Britain, but they tell only one part of its story in the formative centuries of the central Middle Ages.
We would like to acknowledge Richard Britnell's initiative in organising the conference from which this volume stems, and to express our appreciation to our fellow contributors for their support and patience. We are likewise much obliged to the Department of History, Lancaster University, and to the Institute of Medieval and Renaissance Studies, Durham University, for funding the production of the maps by Cath D'Alton.
Point of care ultrasound in the emergency department (ED) is increasingly being used to diagnose time-sensitive, vision-threatening conditions. We present a case of a 64-year-old female who presented to the ED with a three-day history of worsening left eye floaters. Point of care ocular ultrasound demonstrated a posterior chamber containing many echogenic opacities of varying size without acoustic shadowing. Movement of the eye resulted in significant after-movement of these opacities, giving the classic “washing machine” appearance seen with vitreous hemorrhage (VH). Based on these ultrasound findings, the patient was diagnosed with a VH and was referred to ophthalmology. The consulting ophthalmologist ultimately diagnosed the patient with asteroid hyalosis without VH. Asteroid hyalosis is a benign condition of the vitreous resulting in calcium phosphate and lipid deposits that can mimic more serious VH on point of care ultrasound. Knowledge of this mimic is helpful for communication with specialists and for awareness of the potential for misdiagnosis with ocular ultrasound.
The past two decades have seen a significant advancement in the detection, classification and understanding of exoplanets and binary star systems. The vast majority of these systems consist of stars on the main sequence or on the giant branch, leading to a dearth of knowledge of properties at early times (<50 Myr). Only one transiting planet candidate and a dozen eclipsing binaries are known among pre-main sequence objects, yet these are the systems that can provide the best constraints on stellar and planetary formation models. We have recently completed a photometric survey of 3 young (<50 Myr), nearby (D<150 pc) moving groups with a small-aperture instrument, nicknamed “AggieCam”. We detected 7 candidate Hot Jupiters and over 200 likely pre-main sequence binaries, which are now being followed up photometrically and spectroscopically.
To develop a regime of care for patients with head and neck cancers undergoing intensity-modulated radiotherapy (IMRT), with the support of a health advisor (HA) and temporary access to the mouth care product Caphosol™.
Materials and methods
A HA was temporarily employed to assess, monitor and refer patients as appropriate and ensure patients received and utilised supplies of Caphosol™. A retrospective audit was undertaken to provide a gap analysis of current service. The data were used to develop a pro forma for documenting assessments and monitoring lifestyle factors for IMRT patients. Assessments referrals and compliance, plus hospital admissions owing to treatment-related issues, were documented during the baseline audit and the temporary HA service and provision of Caphosol™.
The presence of a HA facilitated 100% compliance with appropriate assessments, referrals and adherence to treatment. The data suggests that the additional provision of Caphosol™ may have reduced levels of mucositis and associated pain.
It is recommended that a HA role be established within radiotherapy departments to facilitate lifestyle assessments, referrals and compliance with positive behaviour changes (e.g., stopping smoking). The use of Caphosol™ as a routine part of mouth care regime for IMRT patients also warrants further investigation.
To review the currently available literature on iatrogenic injury of the adult chorda tympani.
Systematic literature review.
Five electronic databases and one search engine were used to access available English language literature on the chorda tympani, focusing on iatrogenic injury.
The chorda tympani is most often injured during middle-ear surgery, after which at least 15–22 per cent of patients experience symptoms, mostly changes in taste and dryness of the mouth. Numerous factors influence whether injury to the chorda tympani causes symptoms, including the extent of injury, type of surgery, age of the patient, anatomical variables and subjective adaptation. Although most patients experience gradual symptomatic recovery, complaints can be persistent and troublesome.
Care should be taken to preserve the chorda tympani during middle-ear surgery, and to warn patients pre-operatively about this potential complication. This is particularly important if surgery is bilateral.
The chorda tympani is at risk of iatrogenic injury throughout its course. This paper reviews the clinical anatomy of the nerve in adults.
Systematic literature review.
Relevant English-language articles were identified using five electronic databases and one search engine. Data from approximately 70 scientific papers were supplemented with information from selected reference texts.
The anatomy of the chorda tympani differs from standard descriptions, particularly regarding its exit from the middle ear and area of lingual innervation. Whilst it is known to convey taste sensation from the anterior two-thirds of the tongue and parasympathetic innervation to the submandibular and sublingual salivary glands, the chorda tympani probably has additional sensory and secretomotor functions.
A detailed understanding of the anatomy of the chorda tympani may help to reduce the risk of iatrogenic injury during head, neck and middle-ear surgery, and to explain the variable consequences of such injury.