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Redundant supraglottic and laryngeal mucosa associated with obstructive sleep apnoea is a rare pathology with limited representation in the literature. This article presents the novel case of a 40-year-old male patient with obstructive sleep apnoea for whom previous conservative treatments proved ineffective.
Methods
Drug-induced sleep endoscopy identified excess mucosa around the aryepiglottic folds leading to laryngeal inlet occlusion during inspiration and resulting in apnoeic episodes.
Results
Following drug-induced sleep endoscopy, targeted ablation of the redundant mucosa was performed, leading to improvements in their obstructive sleep apnoea and subjective quality of life. This case represents the first report with videographic evidence of drug-induced sleep endoscopy used both for pre-treatment phenotyping and post-treatment assessment of this condition.
Conclusion
Although the pathophysiological mechanisms linking redundant supraglottic mucosa to obstructive sleep apnoea remain poorly understood, drug-induced sleep endoscopy has proven to be a valuable diagnostic tool. The authors advocate for routine airway examination extending to the larynx to identify patients with this condition.
We investigate the effects of thermal boundary conditions and Mach number on turbulence close to walls. In particular, we study the near-wall asymptotic behaviour for adiabatic and pseudo-adiabatic walls, and compare to the asymptotic behaviour recently found near isothermal cold walls (Baranwal et al. 2022. J. Fluid Mech.933, A28). This is done by analysing a new large database of highly-resolved direct numerical simulations of turbulent channels with different wall thermal conditions and centreline Mach numbers. We observe that the asymptotic power-law behaviour of Reynolds stresses as well as heat fluxes does change with both centreline Mach number and thermal condition at the wall. Power-law exponents transition from their analytical expansion for solenoidal fields to those for non-solenoidal field as the Mach number is increased, though this transition is found to be dependent on the thermal boundary conditions. The correlation coefficients between velocity and temperature are also found to be affected by these factors. Consistent with recent proposals on universal behaviour of compressible turbulence, we find that dilatation at the wall is the key scaling parameter for these power-law exponents, providing a universal functional law that can provide a basis for general models of near-wall behaviour.
High-fat food intake is associated with atopic dermatitis (AD), but the role of habitual dietary habits related to the frequency of high-fat food intake remains unclear. To address this, we developed a frequency-based dietary index, Diet Quality based on Dietary Fat Score, to assess high-fat food intake and examined its association with AD in 13 561 young Chinese adults (mean age = 22·51 years, (sd 5·90)) from Singapore and Malaysia. Using an investigator-administered questionnaire aligned with the validated International Study of Asthma and Allergies in Childhood protocol, we conducted multivariable logistic regression analysis, adjusting for demographics, body mass index, genetic predisposition and lifestyle factors, with false discovery rate correction for multiple comparisons. Frequent high-fat food intake was associated with higher odds of AD (adjusted OR (AOR): 1·53; 95 % CI: 1·31, 1·77; P< 0·001). The association remained significant regardless of total fat intake (AOR: 1·45; 95 % CI: 1·05, 1·80; P< 0·001) and among individuals with high fruit and vegetable intake (AOR: 1·49; 95 % CI: 1·19, 1·86; P< 0·001) or low energy intake (AOR: 1·40; 95 % CI: 1·05, 1·86; P< 0·05). No synergistic effects were observed between dietary factors. These findings highlight that frequent intake of high-fat foods is independently associated with AD, emphasising the potential of dietary moderation in AD risk management.
Dietary intervention is a key strategy for preventing and managing chronic kidney disease (CKD). However, evidence on specific foods’ effects on CKD is limited. This study aims to clarify the impact of various foods on CKD risk. We used two-sample Mendelian randomisation to analyse the causal relationships between the intake of eighteen foods (e.g., cheese, processed meat, poultry, beef and non-oily fish) and CKD risk, as well as estimated glomerular filtration rate (eGFR)cr and eGFRcys levels. The inverse variance weighting method, weighted median method, MR-Egger regression, simple mode and weighted mode were employed. The sensitivity analysis included Cochran’s Q test and the Egger intercept test. According to the main method, the IVM results indicated that frequent alcohol intake was linked to higher CKD risk (P= 0·007, 0·048). Protective factors included cheese (OR = 0·71, (95 % CI: 0·53, 0·94), P= 0·017), tea (OR = 0·66, (95 % CI: 0·43, 1·00), P= 0·048) and dried fruit (OR = 0·78, (95 % CI: 0·63, 0·98), P= 0·033). Oily fish (β = 0·051, (95 % CI: 0·001, 0·102), P= 0·046) and dried fruit (β = 0·082, (95 % CI: 0·016, 0·149), P= 0·014) were associated with elevated eGFRcys. Salad/raw vegetables (β = 0·024, (95 % CI: 0·003, 0·045), P= 0·028) and dried fruit (β = 0·013, (95 % CI: 0·001, 0·031), P= 0·014) were linked to higher eGFRcr, while cereal intake (β = –0·021, (95 % CI: −0·033, −0·010), P < 0·001) was associated with lower eGFRcr. These findings provide insights for optimising dietary strategies for CKD patients.
Effective communication is central to the majority of activities in care settings. In many English-speaking countries, carers working in care settings are increasingly from multilingual and multicultural backgrounds, with many growing up in countries where English is not the primary language. Communication difficulties may impede carers creating meaningful relationships with residents or successful working relationships with colleagues. Misunderstanding may also result in safety issues. To date, however, few studies have investigated what aspects of communication carers from culturally and linguistically diverse (CALD) backgrounds find difficult; nor have these difficulties been modelled theoretically.
This article presents the findings of an interview-based study exploring communication difficulties in care settings in Australia. Three groups of participants were interviewed: (1) 30 personal care assistants (PCAs) from CALD backgrounds, (2) 20 supervisors of PCAs and (3) 18 older people who were receiving care and/or nominated support people who participated on behalf of an older person. The data were thematically analysed. The findings show that the communicative challenges facing new PCAs from CALD backgrounds are numerous, ranging from specific linguistic challenges to more workplace-specific problems. Based on the findings, the article proposes a model of communicative competence of personal care workers. The study has implications for the training of personal care workers from CALD backgrounds.
This study aimed to compare permeatal and post-aural tympanoplasty techniques, focusing on scar perception, post-operative symptoms, return to work and quality of life.
Methods
A retrospective study was conducted in a secondary care hospital, with 54 patients undergoing tympanoplasty via permeatal or post-aural approaches. Outcome measures reported were scar perception, post-operative symptoms, quality of life using the Chronic Otitis Media Benefit Inventory score and time off work reported by patients.
Results
Scar perception was favourable in both groups. In the post-aural group, 96 per cent of patients were content with their scar, while 83 per cent in the permeatal group were unconcerned about having a scar behind the ear. Long-term post-operative symptoms, return to work and quality of life measures were comparable. Chronic Otitis Media Benefit Inventory scores showed no significant difference between techniques.
Conclusion
Patient experiences and perspectives were similar between permeatal and post-aural techniques. Surgeons should consider individual patient factors and outcomes when selecting a surgical approach.
What factors explain Latino support for conspiracy theories? Contemporary scholarship offers valuable insights on how psychological, social, and political factors shape support for conspiracy theories. At the same time, scholarly understanding of the dynamics that foster conspiracy beliefs among racial and ethnic minorities is much more limited. Utilizing survey responses from more than 1,000 Latinos, we theorize explicitly about the factors that explain their support for conspiracies. Consistent with the scholarship highlighting in-group diversity among Latinos, we reveal significant differences among Latinos in their propensity to harbor conspiracy beliefs. Some of the factors that influence their support for conspiratorial statements align with the broader literature, other results appear unique to Latino Americans. Religiosity, lack of trust in institutions, and conservative political ideology are associated with higher levels of conspiracy beliefs among Latinos. We also find that Latinos from later generations, those who consume Spanish media, and who disagree that Latinos face discrimination and White privilege exists are more likely to believe in certain conspiracy theories.
INCUS (INvestigation of Convective UpdraftS) is a NASA Earth Science mission scheduled to launch in 2026. The goal of the mission is to study in detail how water vapor and droplets move inside tropical storms and thunderstorms and understand their effects on weather and climate models. To carry out this study, the mission will use three almost identical SmallSats, each equipped with a Raincube-heritage Ka-band radar. The deployable mesh reflector antenna is a new 1.6 m design provided by Tendeg, which is fed using a seven-horn feed assembly to generate overlapping secondary beams. This paper discusses the approach used to design and fabricate the feed assembly and presents the measured and calculated RF performance parameters.
Many people with rheumatoid arthritis (RA) believe that certain foods may influence disease activity. Elimination reintroduction diets and oral food challenges are dietary strategies used to identify foods that may exacerbate symptoms. This review summarises and appraises the literature on elimination diet interventions that include food reintroductions or oral food challenges in adults with RA. It describes study design, measures used to assess the effects of food exclusion and challenge, foods identified that may affect RA symptoms, and the measures used to assess the outcome of excluding those foods. A search of five databases, two thesis repositories and Open Grey was conducted to identify records published from inception to January 2025, using terms related to RA, elimination diets and food sensitivity. Eligible records were screened independently by two reviewers, and data extraction followed Joanna Briggs Institute guidelines. Data are presented using a narrative synthesis approach with descriptive data analysis. In total, forty-eight records met inclusion criteria comprising twenty intervention studies (sample sizes 4–94) and seventeen case studies, conducted across twelve countries (1949–2024). Interventions included single-food exclusions, few-food diets, low-allergen meal replacements and fasting protocols. Reintroduction methods varied from a single-food challenge to multiple reintroductions, with five studies using blinded challenges. Outcome measures included physician- or participant-observed symptom changes, clinical assessments and laboratory measures, though these were heterogeneous. Findings reveal a lack of standardised protocols, dated methodologies and limited contemporary research. Controlled studies are needed to establish evidence-based protocols, investigate mechanisms, and guide dietary strategies as adjuncts to RA pharmacological treatment.
Using a relational leadership lens, this study aims to gain a deeper understanding of empathic conversations with a focus on leadership ethics. It adopts an entitative perspective in relational leadership and examines leadership conversations as a two-way influence relationship, highlighting their interdependencies and collective role in the co-construction of meaning. Data from facial expression software and perception surveys are analyzed. The results of this study reveal the influence of gendered leadership on emotions, emotional bonding moments triggered by humor, and cultural dynamics in leadership conversations. Leaders’ feeling-based questions and participants’ willingness to share their emotions, coupled with emotion synchronization, create a constructive space where both feel invited, cared for, and valued. The study shows that emotional bonds foster the expression of generosity, care, and responsibility, enhancing satisfaction for both leaders and participants. Overall, this study enriches relational leadership theory and practice by underscoring the connection between empathy and leadership ethics.
This contribution aims to relate an important topic of the Hegelian philosophy, that of second nature, to the gender question developed by Simone de Beauvoir. The core of the emancipation process described in The Second Sex lies in Beauvoir’s revolutionary idea of the artificial character of gender: the latter belongs to the culturally constructed sphere of social norms and not to mere fixed nature. In this assumption the French philosopher seems to recover the Hegelian theory of second nature: Hegel believes that through an individual and social Bildungsprozess, subjects liberate themselves from the immediate level of natural necessity and reach the free horizon of spiritual existence, in which they become self-conscious actors. Beauvoir accepts in her own existentialist view this extra-natural becoming and realizes that also gender participates in it: women are not by nature ‘immanent’ creatures that lack ‘transcendence’. Hegel, however, does not recognize the second nature of gender and falls into that same essentialism, denounced by Beauvoir, which relegates the woman to the biological plane, thus excluding her from the dialectic of second nature and self-consciousness. For this reason, Hegel’s understanding of freedom through second nature will initially be introduced, and then, employing this concept against Hegel himself, the path of emancipation from gender essentialism in Beauvoir’s account of biology and culture will be addressed. In the second part of the paper it will be shown how gender, in acting as a second nature, replays the same ambiguity of Hegel’s theory: are second nature and gender something that we individuals freely shape or are we victims of an externally imposed necessity just like in first nature? A dialectical solution will be presented in both thinkers, whose work aims to conciliate spirit and nature beyond any Cartesian dualism.
Cartographic representations of Kashmir and Taiwan act as sites upon which Indian and Chinese state power is exercised to govern the logics of visibility and legibility for these two regions. Despite the differences in regime type, these major non-Western powers represent Kashmir and Taiwan respectively as internal and integral parts of their sovereign territorial form. In this article, we consider two cases that have not hitherto been studied together in International Relations (IR), putting forward ‘cartographic imaginaries’ as a framework to reveal systematic analytical dynamics in relation to representation, nationalism, and diaspora. Cartographic imaginaries are sites of productive power that evoke certain emotions and carry a set of ideas relating to territory that can be naturalised through repeated exposure. We present in-depth investigations providing a range of examples to trace Indian and Chinese states’ efforts, both domestic and international, involved in constructing and controlling cartographic imaginaries of Kashmir and Taiwan. Our analysis relates to significant current concerns in IR about critiques of imperial cartography, impact of rising powers on global order dynamics, and transnational governance of diaspora. Our framework thus demonstrates the connexions between affect, visuality, and state power and offers empirical insights into non-Western projections of imperialism on a global scale.
This article uses letters from BL, ms Lansdowne 99 to explore how a diverse group of individuals experiencing mental and emotional distress utilised religious ideas as a primary means of interpreting their experience and expressing themselves to those in authority in Elizabethan England. It shifts emphasis away from the causes and towards the construction and experience of distress. It argues that such letters shed important light on the character and progress of the English Reformation by the closing decades of the sixteenth century, as well as on the operation of the process of Reformation itself.
Bone-conduction hearing devices provide good hearing outcomes for conductive/mixed hearing losses. Complications post-insertion can lead to additional procedures. Identifying factors that may increase likelihood of developing complications can mitigate risk and inform patients.
Method
A retrospective cohort analysis of 166 adults receiving bone-anchored hearing aid connect operations from 2016–2021 was performed assessing complication rate and contributing factors causing revision procedures.
Results
Twenty-nine per cent of patients had post-operative complications. In total, 17.5 per cent needed additional procedures. Skin overgrowth/infection, granulation and traumatic extrusion were most common reasons. No difference was found in complication rate between different surgical techniques, surgeon grade or general versus local anaesthetic. More complications were observed in decreasing age, male gender and severity of skin reaction.
Conclusion
Revision procedure and complication rates are similar to those reported in published literature. Patient characteristics are important in identifying those likely to develop complications. Non-patient factors did not seem to affect complication rate.
Using a recent result of Bowden, Hensel and Webb, we prove the existence of a homeomorphism with positive stable commutator length in the group of homeomorphisms of the Klein bottle which are isotopic to the identity.
In this article, we discuss the behavioral modeling of the power amplifier (PA) for system-level simulations through its most advanced approach, named TPM model, based on a simplification of the Volterra series following the method of separation of the low and high frequency memory effects present in PA. The model, relying on frequency domain CW characterization of the PA, shows a limitation when applied to high-power radar applications, for which this article investigates an alternate solution based on time-domain pulsed RF characterization.
Recent debates on age-dissimilar romantic relationships have centred on newly formed relationships, asking whether they reflect shifts towards more equal and individualistic love, or more malleable and self-determined understandings of age. Yet, in a global context where age dissimilarities are shifting and populations are ageing, little attention has been paid to how these understandings of love and age might play out in couples’ futures, particularly in relation to care and gender. While median marital age differences have decreased in Australia and worldwide in recent decades, there has been a rise in larger gaps. In such cases, one partner will reach old age markedly earlier than the other. This article therefore examines how age-dissimilar couples imagine their futures together. It draws on 24 in-depth interviews with women and men in heterosexual, age-dissimilar relationships in Australia, with age differences of seven to 30 years. Talking about their love relationships, interviewees – especially those in older woman relationships – avoided discussing ageing or described age as meaningless or relative. For them, they argued, appearance, experience, personality and felt age took precedence over chronology. Conversations with older interviewees exposed gaps in this logic, however, and gendered anxieties about old age and responsibility for care. Interviewees’ discussions of their futures thus highlighted tensions in understandings about age(ing), gender, care and love. Love was thought to transcend age differences and facilitate care responsibilities for some but not others. Utilising the concepts of democratisation, responsibility and gendered double standards of ageing and care, this article complicates conceptions wherein age dissimilarities are seen to typify the growing meaninglessness of age and gendered equality of love.
The methodology and impact of independent inquiries of homicides by people in care of mental health services have been questioned.
Aims
To analyse characteristics of patients who committed homicide, their victims and inquiries published in England between 2010 and 2023.
Method
Documentary and thematic analysis of 162 mental health homicide inquiries. We compared characteristics of perpetrators with those from the National Confidential Inquiry into Suicide and Safety (2018), and characteristics of victims with those in the general population of England and Wales. We examined methodology used by inquiries and thematically analysed root causes, contributory factors, recommendations, action plans, predictability and preventability.
Results
Fifty-two per cent of perpetrators had a diagnosis of schizophrenia and 52% had a history of non-adherence to medication and follow-up; 71% of victims in mental health homicides were family, friends or partners compared with 44% in the general population; 77% of inquiries used no clear methodology. The most frequent root causes and contributory factors related to deficits in assessment, treatment, follow-up or discharge, and risk assessment. There was no direct link between putative causes and resulting recommendations. The most frequent recommendations related to changing policy, improving clinical governance and training. Only 4% of inquiries deemed the homcide to be predictable and preventable.
Conclusions
There is considerable variation in the methodology of mental health homicide inquiries, with little use of human factors and systems theory. Inquiries repeatedly identify the same themes, and most mental health homicides are found to be neither predictable nor preventable. We make recommendations for improving consistency and usefulness.
The concept of security, with its various dimensions, is fundamental to the field of ageing literature. However, feeling safe does not always equate to feeling at ease or being comfortable with people and places. Building on these premises, this article presents and analyses the factors involved in the perception of security and social safeness among women ageing in a top-down co-housing project and a nursing home in Italy. This country has one of Europe’s oldest populations, and the ageing population phenomenon is particularly notable in the Veneto region. In response to changing demographics, the search for alternative housing solutions and associated innovative paradigms of care and support has been gaining ground in recent years. Our study analysed data gathered from women who decided not to age in place. Fieldwork was carried out in one of the most densely populated provinces in the Veneto region during 2022 and 2023. The methodology was qualitative and consisted of in-depth interviews, a focus group and a workshop. Participants were 11 self-sufficient older women, aged 75 and over, living in these facilities. Among the elements that contribute to the perception of social safeness, the following stood out: material and structural factors, physical and emotional factors, relational factors and factors linked to independence and autonomy. Finally, the article stresses the need to study social safeness in greater depth, as it could become a new line of social science research capable of providing relevant information on the housing needs of older adults.