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This study evaluates the safety and utility of Eustachian tube balloon dilatation in treating Eustachian tube dysfunction symptoms in adults without middle-ear disease.
Methods
A prospective cohort study was performed. Adults with dilatory Eustachian tube dysfunction symptoms and no middle-ear disease underwent Eustachian tube balloon dilatation. A clinical assessment including tympanometry, pure tone audiometry, otoscopy, ability to Valsalva, and Eustachian Tube Dysfunction Questionnaire-7 was performed pre-operatively and repeated during a 12-month follow-up period.
Results
Fifteen participants were enrolled. The mean pre-operative Eustachian Tube Dysfunction Questionnaire-7 score of 4.6 reduced to 2.5 at six weeks (P < 0.01), 3.0 at six months (P = 0.02) and 2.6 at 12 months (P < 0.01) post-operatively. All patients without evidence of negative middle-ear pressure had Eustachian Tube Dysfunction Questionnaire-7 score improvements. There were no post-operative complications.
Conclusion
Eustachian tube balloon dilatation is safe and effective at treating Eustachian tube dysfunction in patients with no middle-ear disease or evidence of negative middle-ear pressure.
The aim of this study is to investigate hearing outcomes in patients who have undergone cerebrospinal fluid (CSF) leak repair via a middle cranial fossa (MCF) approach and to identify any variables that influence post-operative hearing outcomes.
Methods
This is a multi-centre study. A total of 65 patients who underwent an MCF approach CSF leak repair were included. Retrospective case review was conducted to collect patient demographic and clinical data including pre- and post-operative audiometry.
Results
A total of 65 patients were included: 9 patients (9.2per cent) had an encephalocele confirmed on magnetic resonance (MR) imaging, whilst the remaining patients had biochemically confirmed, beta-trace protein positive CSF leaks. Post-operatively, there was a statistically significant improvement in both bone conduction (Z = -3.71, p < 0.001) and air conduction thresholds (Z = -5.82, p < 0.001). None of the studied variables were found to be associated with the degree of hearing improvement.
Conclusion
The MCF approach for CSF leak repair yields favorable audiological outcomes.
Sea ice is the major constraint on human activities in the Southern Ocean. Depending on a vessel's ice class, human mobility may be restricted or even prevented altogether by sea-ice conditions. This may imply limited access to research or monitoring stations, preferred fishing grounds or attractive tourist sites. Here, we introduce a statistical model that evaluates the sea-ice cover with two measures: 1) accessibility (i.e. the probability that a given area is navigable by vessels at a given time) and 2) repeated accessibility (i.e. the probability that a given area is navigable by vessels at a given time and again at least once within a defined timespan). We use daily sea-ice concentration data from 2002 to 2020 to demonstrate this tool and its functioning regarding the spatiotemporal variability of sea-ice cover in the wider Weddell Sea region. These findings reflect known characteristics of sea-ice distribution and dynamics in the Weddell Sea, confirming the functionality of our simple tool for determining repeated accessibility of certain areas. Such a tool may facilitate the planning of research and monitoring activities in the Southern Ocean, as well as in Arctic seas.
In modern social thinking, norms are generally thought of in opposition to a space of freedom that is more or less curtailed by and through processes of normalization. ‘Transgression’ thereby becomes an implicit or explicit act of resistance against the norm. This is particularly clear in Western Queer Theory, where a political and analytical investment in anti-normativity has – paradoxically – become a field-defining norm. Yet such strong anti-normativity can become a liability when trying to do justice to actually existing queer dynamics in past and present African realities. Drawing from ethnographic fieldwork among sexually dissident young men who call themselves ‘fioto’ in urban Democratic Republic of Congo, this article shifts the always already oppositional relationship between queerness and normativity – not by arguing that queer is normal too or by showing that queer lives produce their own norms alongside heteronormativity, but by suggesting that queerness is a potential of normativity, rather than an opposition to it. It specifically thinks with two groups of fioto friends in Kisangani to show how and why norms generated their own queerness – as something that was already there as an inherent dimension of their own dynamism and multiplicity.
Metabolites are small molecules involved in cellular metabolism where they act as reaction substrates or products. The term ‘metabolomics’ refers to the comprehensive study of these molecules. The concentrations of metabolites in biological tissues are under genetic control, but this is limited by environmental factors such as diet. In adult mono- and dizygotic twin pairs, we estimated the contribution of genetic and shared environmental influences on metabolite levels by structural equation modeling and tested whether the familial resemblance for metabolite levels is mainly explained by genetic or by environmental factors that are shared by family members. Metabolites were measured across three platforms: two based on proton nuclear magnetic resonance techniques and one employing mass spectrometry. These three platforms comprised 237 single metabolic traits of several chemical classes. For the three platforms, metabolites were assessed in 1407, 1037 and 1116 twin pairs, respectively. We carried out power calculations to establish what percentage of shared environmental variance could be detected given these sample sizes. Our study did not find evidence for a systematic contribution of shared environment, defined as the influence of growing up together in the same household, on metabolites assessed in adulthood. Significant heritability was observed for nearly all 237 metabolites; significant contribution of the shared environment was limited to 6 metabolites. The top quartile of the heritability distribution was populated by 5 of the 11 investigated chemical classes. In this quartile, metabolites of the class lipoprotein were significantly overrepresented, whereas metabolites of classes glycerophospholipids and glycerolipids were significantly underrepresented.
This article offers a new perspective on contemporary ‘whiteness’ in Africa by looking at the ambiguous ways in which it affects everyday life in and around the labour compounds of a multinational timber firm in the Congolese rainforest. As a foreign investment enclave, the logging concession is home to a small isolated community of European expatriate men whose ‘white’ faces evoke a set of ambivalent memories of colonial exploitation in the area. Through a carefully contextualized understanding of how these contemporary expats are perceived in the labour compounds and how they construct their own racialized male selves, this article pushes the discussion on whiteness in Africa beyond the conventional analysis of (post-)settler identities and whites of African nationalities. It argues that, as a permanent fixture in the present neoliberal moment but also as an uncanny repetition of a colonial past, the European loggers construct and embody very specific ‘expat’ masculinities whose internalized dynamics of self-exoticization make them ‘African’ in their own right. Mobilizing the problematic trope of ‘darkness’, both in expat self-making practices and in popular narratives about their presence, this article illustrates how whiteness in Africa comes in many shades.
Paleolimnological techniques were used to identify environmental changes in and around Lake Dudinghausen (northern Germany) over the past 4800 yr. Diatom-inferred total phosphorus (DI-TP) changes identify four phases of high nutrient levels (2600–2200 BC, 1050–700 BC, 500 BC–AD 100 and AD 1850–1970). During these high DI-TP phases, fossil pollen, sediment geochemistry and archaeological records indicate human activities in the lake catchment. Although the same paleo-indicators suggest increased human settlement and agriculture activity during the late Slavonic Age, the Medieval Time and the Modern Time (AD 1000–1850), DI-TP levels were low during this period. In the sediments, iron and total phosphorus were high from ∼AD 100 to 1850, likely due to increased inflow of iron-rich groundwater into the lake. Increased iron input would have lead to a simultaneous binding and precipitation of phosphate in the upper sediment and overlying water column. As a result, anthropogenic impact on Lake Dudinghausen was masked by these phosphorus-controlling processes from AD 1000 to 1850 and was not evident by means of DI-TP. In accordance with fossil pollen, sediment geochemistry and limited archaeological records, DI-TP levels were low from AD 100–1000. Groundwater levels likely rose during this period as the climate gradually changed toward colder and/or moister conditions. Such climate change likely led to reduced settlement activities and forest regeneration in the catchment area. Our results are concordant with similar studies from central Europe which indicate rapid decreasing settlement activities from AD 100 to 1000.
Within the ‘earliest phases of star formation’ (EPoS) Herschel project, we observed the NH3 inversion lines of 6 very young high-mass star-forming regions at high spatial resolution (3-5″) with the JVLA. While the Herschel data provide details about the dust continuum, the ammonia data reveal the kinematics and temperatures. Here we present the exciting star-forming clump ISOSS23053 that shows multiple velocity components. We observe a prominent velocity step within the clump, which could be a sign of colliding or converging flows that triggers star formation. Furthermore, we used the JVLA in the C-array configuration to study this source in more detail and we present the first results from the new data. They support the idea of converging flows, as we observe two components in the NH3(1,1) and (2,2) line, whereas the higher excited NH3(3,3) line shows one component that links the two lower excited lines.
New wireless wearable monitoring systems integrated in professional garments require a high degree of reliability and autonomy. Active textile antenna systems may serve as platforms for body-centric sensing, localisation, and wireless communication systems, in the meanwhile being comfortable and invisible to the wearer. We present a new dedicated comprehensive design paradigm and combine this with adapted signal-processing techniques that greatly enhance the robustness and the autonomy of these systems. On the one hand, the large amount of real estate available in professional rescue worker garments may be exploited to deploy multiple textile antennas. On the other hand, the size of each radiator may be designed large enough to ensure high radiation efficiency when deployed on the body. This antenna area is then reused by placing active electronics directly underneath and energy harvesters directly on top of the antenna patch. We illustrate this design paradigm by means of recent textile antenna prototypes integrated in professional garments, providing sensing, positioning, and communication capabilities. In particular, a novel wearable active Galileo E1-band antenna is presented and fully characterized, including noise figure, and linearity performance.
Sinks in a new long-stay hospital (LSH) were cultured weekly during 4 consecutive months to evaluate the microbial profile before and after occupancy of the hospital. From the elderly patients admitted to the patient care rooms oral and rectal specimens were collected to examine the contribution of the patients' flora to the sink contamination. Isolates were typed biochemically, serologically and by susceptibility pattern. Before occupancy Gram-negative bacilli were not isolated. Once the elderly patients, who were highly colonized on admission, occupied their rooms identical strains gradually contaminated the sinks. Escherichia coli, Klebsiella, Pseudomonas and Acinetobacter species were the major correlating strains. The mean concentration of the correlating isolates was higher in throat and intestines compared to the mean concentration of the non- correlating strains. These strains seem to have a greater chance to be shed and then transferred via the hands of personnel to sinks. This resport shows that the major route of environmental contamination is from patient carriers to sinks, and not the reverse way.
There is a large body of research investigating the nutritional needs of the dog at different life-stages and the use of different feed ingredients in commercial diets (Clapper et al, 2001; Schroeder & Smith, 2008). Despite this, though there has been relatively little published work looking at the role the large intestine plays in nutrient digestion in the dog. The dog’s gastro-intestinal tract has been compared to the cat’s in terms of relative length. However the cat is a true carnivore and has little need to ferment fibre from the diet, whereas the dog is a scavenger and will consume a much wider range of food, and therefore may need to ferment fibrous material from the diet. The dog may therefore require a more developed large intestine to harbour a microbial population to aid in the digestion of this fibrous material. This study was performed to determine differences in digestion of nutrients in this segment of the canine gastrointestinal tract.
Digestibility trials enable researchers to determine the amount of nutrients an animal absorbs and utilises from feed. There are a number of methods available, with the most common being the measurement of total feed intake and total collection of faeces. However, in situations where it is not practical to conduct a total collection trial, indigestible markers are used in conjunction with grab-sampling or sub-sampling techniques. To date, the most common marker used in dog studies has been chromium oxide (Cr2O3; Hill et al., 1996), with little data available on the suitability of other markers such as titanium dioxide (TiO2). A major problem in using Cr2O3 as an indigestible marker is poor repeatability and agreement between laboratories in the determination of Cr2O3. This has led to variable results due to incomplete and inconsistent recovery in excreta (Sales and Janssens, 2003). However work on other species comparing the use of TiO2 and Cr2O3, has demonstrated that TiO2 was a more accurate marker (Jagger et al., 1992). This study was performed to determine the digestibility of two diets, a low (LN) and a high nutrient (HN) diet using TiO2 or Cr2O3 as indigestible markers. The two different quality diets were used to investigate if digestibility affected marker recovery.
There is broad agreement that randomized controlled double-blind trials (RCTs) do reveal only small effects of the cholinesterase inhibitors donepezil, rivastigmine and galantamine in the treatment of Alzheimer's disease (AD) (Perras et al., 2005; Cummings et al., 2002; Schneider, 2004). Furthermore, it is controversial whether the small effects shown in the RCTs are reliable or due to bias. In 2005 we published a systematic review of all RCTs on cholinesterase inhibitors which came to the conclusion that the scientific basis for a general recommendation of cholinesterase inhibitors in the treatment of AD is questionable because of the methodological shortcomings of the studies (Kaduszkiewicz et al., 2005). Following numerous debates on this topic at congresses and enriched through reviews of the U.K. National Institute for Health and Clinical Excellence (NICE, 2006) and the German Institute for Quality and Efficiency in Health Care (IQWiG, 2007), we will here present our actual view on this controversy. The main part of this article focuses on the methodology of cholinesterase inhibitor trials and on the interpretation of their results. We conclude by discussing briefly the three Cochrane reviews on cholinesterase inhibitors for AD.
A series of AMS radiocarbon determinations have been obtained from the site of Khirbet-en-Nahas, Jordan. An initial suite of samples dated in Oxford and a subsequent and much larger suite from Groningen were obtained to determine the onset of copper and iron production in the Faynan district. The determinations came from two different areas at the site. Bayesian modeling was used to improve the chronometric resolution. This showed that copper production expanded from ca. 950 BCE. The challenge at sites such as this is to obtain samples of short-lived age and thereby avoid ‘inbuilt age’. Several of the AMS determinations were, in all likelihood, affected by this, and the Bayesian modeling enabled us to determine outliers and question their reliability. Further work is planned.
Introduction
This chapter concerns the analysis of the radiocarbon chronology of Khirbat en-Nahas (hereafter KEN), Jordan, the largest Iron Age copper production site in the Faynan district. It is, therefore, a partial contribution to the Jabal Hamrat Fidan Project, which is engaged in extensive archaeological investigations in this region. Details of the archaeology of the site is discussed elsewhere in this volume (Levy et al. [Chapter 10, this volume]) and in a recent publication (Levy et al. 2004). The aims of the radiocarbon dating program were initially focussed upon two key areas. First, to date one of the large buildings and part of a gate complex at the site.
This study explores the chronological assumptions that underlie the past 40 years of Iron Age archaeological investigations in southern Jordan and offers an alternative framework based on the application of high precision radiocarbon dating. The 2002 University of California, San Diego—Department of Antiquities of Jordan (UCSD—DOAJ) archaeological excavations at the copper production center of Khirbat en-Nahas (KEN) demonstrate monumental building and industrial scale copper production in two major phases dating to the 12th–11th and 10th–9th centuries BCE. Stratigraphic excavations, new high precision radiocarbon dating using short-life samples, and small finds such as ceramics, scarabs, and arrowheads from the site show the centrality of the Iron Age landscape in the copper ore-rich lowlands of Edom for the formation of complex societies in this part of the southern Levant. The new data presented here challenge previous assumptions about the Iron Age in Jordan, such as (a) the formation of the Iron Age kingdom of Edom only took place in the 7th and 6th centuries BCE and (b) no monumental building activities took place in Transjordan during the 10th century BCE. Bayesian statistical analyses of the radiocarbon dates from KEN are presented by Higham et al. (Chapter 11, this volume).
Introduction
This study discusses some of the archaeological and historical implications of the latest suite of high precision radiocarbon dates obtained from the Oxford and Groningen radiocarbon laboratories from the recent excavations at the Iron Age metal production center at Khirbat en-Nahas in Jordan.
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