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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.
Schizophrenia (SZ) is a severe neuropsychiatric disorder associated with disrupted connectivity within the thalamic-cortico-cerebellar network. Resting-state functional connectivity studies have reported thalamic hypoconnectivity with the cerebellum and prefrontal cortex as well as thalamic hyperconnectivity with sensory cortical regions in SZ patients compared with healthy comparison participants (HCs). However, fundamental questions remain regarding the clinical significance of these connectivity abnormalities.
Resting state seed-based functional connectivity was used to investigate thalamus to whole brain connectivity using multi-site data including 183 SZ patients and 178 matched HCs. Statistical significance was based on a voxel-level FWE-corrected height threshold of p < 0.001. The relationships between positive and negative symptoms of SZ and regions of the brain demonstrating group differences in thalamic connectivity were examined.
HC and SZ participants both demonstrated widespread positive connectivity between the thalamus and cortical regions. Compared with HCs, SZ patients had reduced thalamic connectivity with bilateral cerebellum and anterior cingulate cortex. In contrast, SZ patients had greater thalamic connectivity with multiple sensory-motor regions, including bilateral pre- and post-central gyrus, middle/inferior occipital gyrus, and middle/superior temporal gyrus. Thalamus to middle temporal gyrus connectivity was positively correlated with hallucinations and delusions, while thalamus to cerebellar connectivity was negatively correlated with delusions and bizarre behavior.
Thalamic hyperconnectivity with sensory regions and hypoconnectivity with cerebellar regions in combination with their relationship to clinical features of SZ suggest that thalamic dysconnectivity may be a core neurobiological feature of SZ that underpins positive symptoms.
To investigate the effectiveness and usability of automated procedural guidance during virtual temporal bone surgery.
Two randomised controlled trials were performed to evaluate the effectiveness, for medical students, of two presentation modalities of automated real-time procedural guidance in virtual reality simulation: full and step-by-step visual presentation of drillable areas. Presentation modality effectiveness was determined through a comparison of participants’ dissection quality, evaluated by a blinded otologist, using a validated assessment scale.
While the provision of automated guidance on procedure improved performance (full presentation, p = 0.03; step-by-step presentation, p < 0.001), usage of the two different presentation modalities was vastly different (full presentation, 3.73 per cent; step-by-step presentation, 60.40 per cent).
Automated procedural guidance in virtual temporal bone surgery is effective in improving trainee performance. Step-by-step presentation of procedural guidance was engaging, and therefore more likely to be used by the participants.
To investigate the importance of anatomical variation in acquiring skills in virtual reality cochlear implant surgery.
Eleven otolaryngology residents participated in this study. They were randomly allocated to practice cochlear implant surgery on the same specimen or on different specimens for four weeks. They were then tested on two new specimens, one standard and one challenging. Videos of their performance were de-identified and reviewed independently, by two blinded consultant otolaryngologists, using a validated assessment scale. The scores were compared between groups.
On the standard specimen, the round window preparation score was 2.7 ± 0.4 for the experimental group and 1.7 ± 0.6 for the control group (p = 0.01). On the challenging specimen, instrument handling and facial nerve preservation scores of the experimental group were 3.0 ± 0.4 and 3.5 ± 0.7 respectively, while the control group received scores of 2.1 ± 0.8 and 2.4 ± 0.9 respectively (p < 0.05).
Training on temporal bones with differing anatomies is beneficial in the development of expertise.
The Durban Diabetes Study (DDS) is a population-based cross-sectional survey of an urban black population in the eThekwini Municipality (city of Durban) in South Africa. The survey combines health, lifestyle and socioeconomic questionnaire data with standardised biophysical measurements, biomarkers for non-communicable and infectious diseases, and genetic data. Data collection for the study is currently underway and the target sample size is 10 000 participants. The DDS has an established infrastructure for survey fieldwork, data collection and management, sample processing and storage, managed data sharing and consent for re-approaching participants, which can be utilised for further research studies. As such, the DDS represents a rich platform for investigating the distribution, interrelation and aetiology of chronic diseases and their risk factors, which is critical for developing health care policies for disease management and prevention. For data access enquiries please contact the African Partnership for Chronic Disease Research (APCDR) at firstname.lastname@example.org or the corresponding author.
At the present moment, zinc oxide is primarily being used as an electronic material for low-field thin-film transistor and transparent conducting oxide device applications. In this paper, we present some recent results on the steady-state electron transport within zinc oxide suggesting that this material may also be considered as an alternative material to gallium nitride for high-power and high-frequency electron device applications. The expected device performance that may be obtained from zinc oxide-based devices is then projected and contrasted with that expected from gallium nitride-based devices. It is shown that zinc oxide-based devices have a slight advantage when compared with the case of gallium nitride.
Hospitalizations for acute bacterial skin and skin structure infection (ABSSSI) are common. Optimizing antibiotic use for ABSSSIs requires an understanding of current management. The objective of this study was to evaluate antibiotic prescribing practices and factors affecting prescribing in a diverse group of hospitals
Multicenter, retrospective cohort study.
Seven community and academic hospitals.
Children and adults hospitalized between June 2010 and May 2012 for cellulitis, wound infection, or cutaneous abscess were eligible. The primary endpoint was a composite of 2 prescribing practices representing potentially avoidable antibiotic exposure: (1) use of antibiotics with a broad spectrum of activity against gram-negative bacteria or (2) treatment duration greater than 10 days.
A total of 533 cases were included: 320 with nonpurulent cellulitis, 44 with wound infection or purulent cellulitis, and 169 with abscess. Of 492 cases with complete prescribing data, the primary endpoint occurred in 394 (80%) cases and varied significantly across hospitals (64%–97%; P < .001). By logistic regression, independent predictors of the primary endpoint included wound infection or purulent cellulitis (odds ratio [OR], 5.12 [95% confidence interval (CI)], 1.46–17.88), head or neck involvement (OR, 2.83 [95% CI, 1.17–6.82]), adult cases (OR, 2.20 [95% CI, 1.18–4.11]), and admission to a community hospital (OR, 1.90 [95% CI, 1.05–3.44]).
Among patients hospitalized for ABSSSI, use of antibiotics with broad gram-negative activity or treatment courses longer than 10 days were common. There may be substantial opportunity to reduce antibiotic exposure through shorter courses of therapy targeting gram-positive bacteria.
Infect Control Hosp Epidemiol 2014;35(10):1241–1250
To assess the epidemiology of vestibular vertigo, including the new entity of vestibular migraine, in a neuro-otology clinic population in the biggest public hospital in Thailand.
Study design and setting:
A prospective study involving all patients presenting to the neuro-otology clinic in the Rajavithi Hospital in Bangkok between November 2007 and November 2008.
Subjects and methods:
The population studied consisted of adults referred to the neuro-otology clinic. Accepted international criteria and standardised otological and, when necessary, psychiatric assessment were applied to establish each diagnosis. The association between diagnoses and potential triggers was explored.
Of the 167 patients assessed, the most prevalent conditions encountered were benign paroxysmal positional vertigo and vestibular migraine. The prevalence of vestibular migraine was 29.3 per cent. No cases of Ménière's disease were encountered. An association was found between vestibular migraine and inadequate sleep, insomnia and changes of head position.
This study provides current data on the epidemiology of vestibular vertigo in a Thai neuro-otology out-patient population. The results include data on the prevalence of the new diagnostic entity of vestibular migraine, and on its association with potential triggers.
Numerous techniques have been described to manage the skin and other soft tissues during bone-anchored hearing aid insertion. Previously, generally accepted techniques have sometimes led to distressing alopecia and soft tissue defects. Now, some surgeons are rejecting the originally described split skin flap in favour of a less invasive approach.
To investigate bone-anchored hearing aid placement utilising a single, linear incision with either no or minimal underlying soft tissue reduction.
Patients and methods:
Thirty-four adults were prospectively enrolled to undergo single-stage bone-anchored hearing aid placement with this modified technique. A small, linear incision was used at the standard position and carried down through the periosteum. Standard technique was then followed with placement of an extended length abutment. Patients were reviewed regularly to assess wound healing, including evaluation with Holgers' scale.
Only 14.7 per cent of patients had a reaction score of 2 or higher. Most complications were limited to minor skin reactions that settled with silver nitrate cautery and/or antibiotics. None required revision surgery for tissue overgrowth, and there were no implant failures.
Our results suggest this to be a simple and effective insertion technique with favourable cosmesis and patient satisfaction.
Strong short electric field pulses are used to generate broadband terahertz radiation. Understanding the transport properties under such conditions is very important for the understanding of numerous terahertz photonic and electronic devices. In this paper, we report on transport simulations of the electrons within bulk wurtzite zinc oxide for pulsed high electric fields, with pulse durations of up to 400 fs. We focus on how key electron transport characteristics, namely the drift velocity and the corresponding average energy, vary with time since the onset of the pulse. For sufficiently high-field strength selections, we find that both of these parameters exhibit peaks. In addition, an electron drift velocity undershoot is observed following this peak. A contrast with the case of gallium nitride is considered; undershoot is not observed for the case of this material. Reasons for these differences in behavior are suggested.
We employ Monte Carlo simulations of the electron transport that occurs within the two-dimensional electron gas formed at a ZnO/ZnMgO heterojunction. Steady-state and transient electron transport results are presented. We find that at high fields, increases in the free electron concentration result in decreases in the electron drift velocities.
We review some recent results related to the steady-state and transient electron transport that occurs within bulk wurtzite zinc oxide. We employ three-valley Monte Carlo simulations of the electron transport within this material for the purposes of this analysis. Using these results, we devise a means of rendering transparent the electron drift velocity enhancement offered by transient electron transport over steady-state electron transport. A comparison, with results corresponding to gallium nitride, indium nitride, and aluminum nitride, is provided. The device implications of these results are then presented.
We have performed an analysis on three hydrogenated nanocrystalline silicon (nc-Si:H) based solar cells. In order to determine the impact that impurities play in shaping the material properties, the XRD and Raman spectra corresponding to all three samples were measured. The XRD results, which displayed a number of crystalline silicon-based peaks, were used in order to approximate the mean crystallite sizes through Scherrer's equation. Through a peak decomposition process, the Raman results were used to estimate the corresponding crystalline volume fraction. It was noted that small crystallite sizes appear to favor larger crystalline volume fractions. This dependence seems to be related to the oxygen impurity concentration level within the intrinsic nc-Si:H layers.
From January 2009 to May 2010, 436 faecal samples from patients with diarrhoeal illness in Southern Ireland were identified as Campylobacter genus-positive by an automated multiplex PCR; however, 204 (46·8%) of these samples were culture-negative for campylobacters. A combination of Campylobacter-specific uniplex PCR and 16S rRNA sequencing confirmed the presence of Campylobacter DNA in 191 (93·6%) of the culture-negative samples. Species-specific PCR identified C. jejuni (50·7%) C. ureolyticus (41%) and C. coli (5·7%) as the most prevalent species while C. fetus, C. upsaliensis, C. hyointestinalis and C. lari accounted for 10% of culture-negative samples; mixed Campylobacter spp. were detected in 11% of samples. We conclude that non-culturable Campylobacter spp. are responsible for a considerable proportion of human enteritis and the true incidence of infection is likely to be significantly underestimated where conventional Campylobacter culture methods are used in isolation.
The antimicrobial resistance profiles of Campylobacter isolates recovered from a range of retail food samples (n=374) and humans (n=314) to eight antimicrobial compounds were investigated. High levels of resistance in food C. jejuni isolates were observed for ceftiofur (58%), ampicillin (25%) and nalidixic acid (17%) with lower levels observed for streptomycin (7·9%) and chloramphenicol (8·3%). A total of 80% of human C. jejuni isolates were resistant to ceftiofur, while 17% showed resistance to ampicillin and nalidixic acid, 8·6% to streptomycin and 4·1% to chloramphenicol. Resistance to clinically relevant antimicrobials such as erythromycin, ciprofloxacin and tetracycline was 6·7, 12, and 15% respectively for all food isolates and was similar to corresponding resistance prevalences observed for human isolates, where 6·4, 12 and 13% respectively were found to be resistant. Comparisons of C. jejuni isolates in each location showed a high degree of similarity although some regional variations did exist. Comparison of total C. jejuni and C. coli populations showed minor differences, with C. jejuni isolates more resistant to ampicillin and ceftiofur. Multidrug resistance patterns showed some profiles common to human and clinical isolates.
The purpose of this study was to determine the effect of baroreceptor unloading on the sensitivity of the cardiovagal and sympathetic arms of the baroreflex during upright posture. Beat-by-beat R-R interval, arterial blood pressure and cardiac output (Doppler ultrasound), as well as muscle sympathetic nerve activity (MSNA) were recorded during periods in supine (Supine) and 60 deg head-up tilt (HUT) positions (n = 8 volunteers). Cardiovagal baroreflex sensitivity (BRS) was measured by the spontaneous sequence analysis method using systolic blood pressure and R-R interval, while sympathetic BRS was determined using the slope of the linear relationship between decreasing segments of diastolic blood pressure (DBP) and corresponding increases in MSNA. On changing to HUT, mean R-R interval and cardiac output decreased, while mean measures of MSNA, DBP and total peripheral resistance increased (P < 0.05). Cardiovagal BRS decreased from Supine to 60 deg HUT (19 ± 2 ms mmHg-1 versus 7.6 ± 1.2 ms mmHg-1; P < 0.01). In contrast, sympathetic BRS increased from -6.1 ± 1.4 a.u. mmHg-1 in Supine to -14 ± 2 a.u. mmHg-1 in HUT (P < 0.01). Thus, HUT produced differential effects on cardiac versus sympathetic BRS. The data suggest that dynamic baroreflex-mediated cardiovascular control is dominated by sympathetic control during baroreceptor unloading. Experimental Physiology (2003) 88.6, 769-774.
Typhoid fever is endemic in the South Pacific. We investigated an outbreak in Nauru. Through interviews and medical records, we identified 50 persons with onset between 1 October 1998 and 10 May 1999, of fever lasting [ges ]3 days and one other symptom. Salmonella Typhi was isolated from 19 (38%) cases. Thirty-two (64%) patients were school-aged children, and 17 (34%) were in four households. Case-control studies of (a) culture-confirmed cases and age- and neighbourhood-matched controls; and (b) household index cases and randomly selected age-matched controls implicated two restaurants: Restaurant M (matched OR [MOR] = 11, 95% confidence interval [CI] = 1·3–96) and Restaurant I (MOR = 5·8, 95% CI = 1·2–29). Food-handlers at both restaurants had elevated anti-Vi antibody titres indicative of carrier state. The annual incidence was 5·0/l000 persons. Outbreak-associated costs were $46000. Routine or emergency immunization campaigns targeting school-aged children may help prevent or control outbreaks of typhoid fever in endemic disease areas.
We produce a novel form of amorphous silicon through ultra-high-vacuum molecular beam epitaxy. By depositing silicon atoms onto a fused quartz substrate at temperatures between 98 and 335°C, we obtain a silicon-based material that lacks the characteristic periodicity of crystalline silicon but nevertheless has 98% of its density. The impurity content of this material is studied through infrared and secondary ion mass spectroscopies. The primary impurity found is oxygen, with hydrogen and carbon atoms also being found at trace levels. The Raman spectra of the amorphous silicon films are measured and the results, as they relate to the presence of disorder, are interpreted. We also use this molecular beam epitaxy method to fabricate a number of amorphous silicon superlattices, comprised of thin layers of amorphous silicon separated with even thinner layers of SiO2. The optical properties of the films and superlattices are contrasted.