Injection laryngoplasty with autologous fascia for treatment of unilateral vocal fold paralysis

The purpose of this dissertation was to study the applicability of minced autologous fascia graft for injection laryngoplasty of unilateral vocal fold paralysis (UVFP). Permanence of augmentation and host versus graft tissue reactions were of special interest. The topic deals with phonosurgery, which is a subdivision of the Ear, Nose and Throat-speciality of medicine. UVFP results from an injury to the recurrent or the vagal nerve. The main symptom is a hoarse and weak voice. Surgery is warranted for patients in whom spontaneous reinnervation and a course of voice therapy fails to improve the voice. Injection laryngoplasty is a widespread surgical technique which aims to restore glottic closure by augmenting the atrophied vocal muscle, and also by turning the paralyzed vocal fold towards midline. Currently, there exists a great diversity of synthetic, xenologous, homologous, and autologous substances available for injection. An autologous graft is perfect in terms of biocompatibility. Free fascia grafts have been successfully used in the head and neck surgery for decades, but fascia had not been previously applied into the vocal fold. The fascia is harvested from the lateral thigh under local anesthesia and minced into paste by scissors. Injection of the vocal fold is performed in laryngomicroscopy under general anesthesia. Three series of clinical trials of injection laryngoplasty with autologous fascia (ILAF) for patients with UVFP were conducted at the Department of Otorhinolaryngology of the Helsinki University Central Hospital. The follow-up ranged from a few months to ten years. The aim was to document the vocal results and possible morbidity related to graft harvesting and vocal fold injection. To address the tissue reactions and the degree of reabsoprtion of the graft, an animal study with a follow-up ranging from 3 days to 12 months was performed at the National Laboratory Animal Center, University of Kuopio. Harvesting of the graft and injection was met with minor morbidity. Histological analysis of the vocal fold tissue showed that fascia was well tolerated. Although some resorption or compaction of the graft during the first months is evident, graft volume is maintained well. When injected deep and laterally into the vocalis muscle, the fascia graft allows normal vibration of the vocal fold mucosa to occur during phonation. Improvement of voice quality was seen in all series by multiple objective parameters of voice evaluation. However, the vocal results were poor in cases where the nerve trauma was severe, such as UVFP after chest surgery. ILAF is most suitable for correction of mild to moderate glottic gaps related to less severe nerve damage. Our results indicate that autologous fascia is a feasible and safe new injection material with good and stable vocal results. It offers a practical solution for surgeons who treat this complex issue.

Introducing the multi-faceted teaching experiment

A mathematics classroom is comprised of many mathematicians with varying understanding of mathematics knowledge, including the teacher, students and sometimes researchers. To align with this conceptualisation of knowledge and understanding, the multi-faceted teaching experiment will be introduced as an approach to study all classroom participants’ interactions with the shared knowledge of mathematics. Drawing on the experiences of a large curriculum project, it is claimed that, unlike a multi-tiered teaching experiment, the multi-faceted teaching experiment provides a research framework that allows for the study of mathematicians’ building of knowledge in a classroom without privileging the experience of any one participant.

Planar Edgeless Detectors for the TOTEM Experiment at the LHC

The TOTEM experiment at the LHC will measure the total proton-proton cross-section with a precision better than 1%, elastic proton scattering over a wide range in momentum transfer -t= p^2 theta^2 up to 10 GeV^2 and diffractive dissociation, including single, double and central diffraction topologies. The total cross-section will be measured with the luminosity independent method that requires the simultaneous measurements of the total inelastic rate and the elastic proton scattering down to four-momentum transfers of a few 10^-3 GeV^2, corresponding to leading protons scattered in angles of microradians from the interaction point. This will be achieved using silicon microstrip detectors, which offer attractive properties such as good spatial resolution (<20 um), fast response (O(10ns)) to particles and radiation hardness up to 10^14 "n"/cm^2. This work reports about the development of an innovative structure at the detector edge reducing the conventional dead width of 0.5-1 mm to 50-60 um, compatible with the requirements of the experiment.

Warm pool thermodynamics from the Arabian Sea Monsoon Experiment (ARMEX)

Before the onset of the south Asian summer monsoon, sea surface temperature (SST) of the north Indian Ocean warms to 30–32°C. Climatological mean mixed layer depth in spring (March–May) is 10–20 m, and net surface heat flux (Q net ) is 80–100 W m−2 into the ocean. Previous work suggests that observed spring SST warming is small mainly because of (1) penetrative flux of solar radiation through the base of the mixed layer (Q pen ) and (2) advective cooling by upper ocean currents. We estimate the role of these two processes in SST evolution from a two-week Arabian Sea Monsoon Experiment process experiment in April–May 2005 in the southeastern Arabian Sea. The upper ocean is stratified by salinity and temperature, and mixed layer depth is shallow (6 to 12 m). Current speed at 2 m depth is high even under light winds. Currents within the mixed layer are quite distinct from those at 25 m. On subseasonal scales, SST warming is followed by rapid cooling, although the ocean gains heat at the surface: Q net is about 105 W m−2 in the warming phase and 25 W m−2 in the cooling phase; penetrative loss Q pen is 80 W m−2 and 70 W m−2. In the warming phase, SST rises mainly because of heat absorbed within the mixed layer, i.e., Q net minus Q pen ; Q pen reduces the rate of SST warming by a factor of 3. In the second phase, SST cools rapidly because (1) Q pen is larger than Q net and (2) advective cooling is ∼85 W m−2. A calculation using time-averaged heat fluxes and mixed layer depth suggests that diurnal variability of fluxes and upper ocean stratification tends to warm SST on subseasonal timescale. Buoy and satellite data suggest that a typical premonsoon intraseasonal cooling event occurs under clear skies when the ocean is gaining heat through the surface. In this respect, premonsoon SST cooling in the north Indian Ocean is different from that due to the Madden-Julian oscillation or monsoon intraseasonal oscillation.

The effects of the 2004 reduction in the price of alcohol on alcohol-related harm in Finland : A natural experiment based on register data

Changes in alcohol pricing have been documented as inversely associated with changes in consumption and alcohol-related problems. Evidence of the association between price changes and health problems is nevertheless patchy and is based to a large extent on cross-sectional state-level data, or time series of such cross-sectional analyses. Natural experimental studies have been called for. There was a substantial reduction in the price of alcohol in Finland in 2004 due to a reduction in alcohol taxes of one third, on average, and the abolition of duty-free allowances for travellers from the EU. These changes in the Finnish alcohol policy could be considered a natural experiment, which offered a good opportunity to study what happens with regard to alcohol-related problems when prices go down. The present study investigated the effects of this reduction in alcohol prices on (1) alcohol-related and all-cause mortality, and mortality due to cardiovascular diseases, (2) alcohol-related morbidity in terms of hospitalisation, (3) socioeconomic differentials in alcohol-related mortality, and (4) small-area differences in interpersonal violence in the Helsinki Metropolitan area. Differential trends in alcohol-related mortality prior to the price reduction were also analysed. A variety of population-based register data was used in the study. Time-series intervention analysis modelling was applied to monthly aggregations of deaths and hospitalisation for the period 1996-2006. These and other mortality analyses were carried out for men and women aged 15 years and over. Socioeconomic differentials in alcohol-related mortality were assessed on a before/after basis, mortality being followed up in 2001-2003 (before the price reduction) and 2004-2005 (after). Alcohol-related mortality was defined in all the studies on mortality on the basis of information on both underlying and contributory causes of death. Hospitalisation related to alcohol meant that there was a reference to alcohol in the primary diagnosis. Data on interpersonal violence was gathered from 86 administrative small-areas in the Helsinki Metropolitan area and was also assessed on a before/after basis followed up in 2002-2003 and 2004-2005. The statistical methods employed to analyse these data sets included time-series analysis, and Poisson and linear regression. The results of the study indicate that alcohol-related deaths increased substantially among men aged 40-69 years and among women aged 50-69 after the price reduction when trends and seasonal variation were taken into account. The increase was mainly attributable to chronic causes, particularly liver diseases. Mortality due to cardiovascular diseases and all-cause mortality, on the other hand, decreased considerably among the-over-69-year-olds. The increase in alcohol-related mortality in absolute terms among the 30-59-year-olds was largest among the unemployed and early-age pensioners, and those with a low level of education, social class or income. The relative differences in change between the education and social class subgroups were small. The employed and those under the age of 35 did not suffer from increased alcohol-related mortality in the two years following the price reduction. The gap between the age and education groups, which was substantial in the 1980s, thus further broadened. With regard to alcohol-related hospitalisation, there was an increase in both chronic and acute causes among men under the age of 70, and among women in the 50-69-year age group when trends and seasonal variation were taken into account. Alcohol dependence and other alcohol-related mental and behavioural disorders were the largest category in both the total number of chronic hospitalisation and in the increase. There was no increase in the rate of interpersonal violence in the Helsinki Metropolitan area, and even a decrease in domestic violence. There was a significant relationship between the measures of social disadvantage on the area level and interpersonal violence, although the differences in the effects of the price reduction between the different areas were small. The findings of the present study suggest that that a reduction in alcohol prices may lead to a substantial increase in alcohol-related mortality and morbidity. However, large population group differences were observed regarding responsiveness to the price changes. In particular, the less privileged, such as the unemployed, were most sensitive. In contrast, at least in the Finnish context, the younger generations and the employed do not appear to be adversely affected, and those in the older age groups may even benefit from cheaper alcohol in terms of decreased rates of CVD mortality. The results also suggest that reductions in alcohol prices do not necessarily affect interpersonal violence. The population group differences in the effects of the price changes on alcohol-related harm should be acknowledged, and therefore the policy actions should focus on the population subgroups that are primarily responsive to the price reduction.

Novel application of a discrete choice experiment to identify preferences for a national healthcare-associated infection surveillance programme: A cross-sectional study

Objective: To identify key stakeholder preferences and priorities when considering a national healthcare-associated infection (HAI) surveillance programme through the use of a discrete choice experiment (DCE). Setting: Australia does not have a national HAI surveillance programme. An online web-based DCE was developed and made available to participants in Australia. Participants: A sample of 184 purposively selected healthcare workers based on their senior leadership role in infection prevention in Australia. Primary and secondary outcomes: A DCE requiring respondents to select 1 HAI surveillance programme over another based on 5 different characteristics (or attributes) in repeated hypothetical scenarios. Data were analysed using a mixed logit model to evaluate preferences and identify the relative importance of each attribute. Results: A total of 122 participants completed the survey (response rate 66%) over a 5-week period. Excluding 22 who mismatched a duplicate choice scenario, analysis was conducted on 100 responses. The key findings included: 72% of stakeholders exhibited a preference for a surveillance programme with continuous mandatory core components (mean coefficient 0.640 (p<0.01)), 65% for a standard surveillance protocol where patient-level data are collected on infected and non-infected patients (mean coefficient 0.641 (p<0.01)), and 92% for hospital-level data that are publicly reported on a website and not associated with financial penalties (mean coefficient 1.663 (p<0.01)). Conclusions: The use of the DCE has provided a unique insight to key stakeholder priorities when considering a national HAI surveillance programme. The application of a DCE offers a meaningful method to explore and quantify preferences in this setting.

Large latitudinal gradients and temporal heterogeneity in aerosol black carbon and its mass mixing ratio over southern and northern oceans observed during a trans-continental cruise experiment

Extensive, and collocated measurements of the mass concentrations (M-B) of aerosol black carbon (BC) and (M-T) of composite aerosols were made over the Arabian Sea, tropical Indian Ocean and the Southern Ocean during a trans-continental cruise experiment. Our investigations show that MB remains extremely low(<50 ng m(-3)) and remarkably steady (in space and time) in the Southern Ocean (20 degrees S to 56 degrees S). In contrast, large latitudinal gradients exist north of similar to 20 degrees S; M-B increasing exponentially to reach as high as 2000 ng m(-3) in the Arabian Sea (similar to 8 degrees N). Interestingly, the share of BC showed a distinctly different latitudinal variation, with a peak close to the equator and decreasing on either side. Large fluctuations were seen in M-T over Southern Ocean associated with enhanced production of sea-salt aerosols in response to sea-surface wind speed. These spatio-temporal changes in M-B and its mixing ratio have important implications to regional and global climate.

2(n)-SEMA-a robust solid state nuclear magnetic resonance experiment for measuring heteronuclear dipolar couplings in static oriented systems using effective transverse spin-lock

Separated local field (SLF) spectroscopy is a powerful technique to measure heteronuclear dipolar couplings. The method provides site-specific dipolar couplings for oriented samples such as membrane proteins oriented in lipid bilayers and liquid crystals. A majority of the SLF techniques utilize the well-known Polarization Inversion Spin Exchange at Magic Angle (PISEMA) pulse scheme which employs spin exchange at the magic angle under Hartmann-Hahn match. Though PISEMA provides a relatively large scaling factor for the heteronuclear dipolar coupling and a better resolution along the dipolar dimension, it has a few shortcomings. One of the major problems with PISEMA is that the sequence is very much sensitive to proton carrier offset and the measured dipolar coupling changes dramatically with the change in the carrier frequency. The study presented here focuses on modified PISEMA sequences which are relatively insensitive to proton offsets over a large range. In the proposed sequences, the proton magnetization is cycled through two quadrants while the effective field is cycled through either two or four quadrants. The modified sequences have been named as 2(n)-SEMA where n represents the number of quadrants the effective field is cycled through. Experiments carried out on a liquid crystal and a single crystal of a model peptide demonstrate the usefulness of the modified sequences. A systematic study under various offsets and Hartmann-Hahn mismatch conditions has been carried out and the performance is compared with PISEMA under similar conditions.

Expected Performance of the ATLAS Experiment - Detector, Trigger and Physics

A detailed study is presented of the expected performance of the ATLAS detector. The reconstruction of tracks, leptons, photons, missing energy and jets is investigated, together with the performance of b-tagging and the trigger. The physics potential for a variety of interesting physics processes, within the Standard Model and beyond, is examined. The study comprises a series of notes based on simulations of the detector and physics processes, with particular emphasis given to the data expected from the first years of operation of the LHC at CERN.

Slow rotation of a sphere in a non-Newtonian fluid with or without suction or injection

The flow generated by the rotation of a sphere in an infinitely extending fluid has recently been studied by Goldshtik. The corresponding problem for non-Newtonian Reiner-Rivlin fluids has been studied by Datta. Bhatnagar and Rajeswari have studied the secondary flow between two concentric spheres rotating about an axis in the non-Newtonian fluids. This last investigation was further generalised by Rajeswari to include the effects of small radial suction or injection. In Part A of the present investigation, we have studied the secondary flow generated by the slow rotation of a single sphere in non-Newtonian fluid obeying the Rivlin-Ericksen constitutive equation. In Part B, the effects of small suction or injection have been studied which is applied in an arbitrary direction at the surface of the sphere. In the absence of suction or injection, the secondary flow for small values of the visco-elastic parameter is similar to that of Newtonian fluids with inclusion of inertia terms in the Oseen approximation. If this parameter exceeds Kc = 18R/219, whereR is the Reynolds number, the breaking of the flow field takes place into two domains, in one of which the stream lines form closed loops. For still higher values of this parameter, the complete reversal of the sense of the flow takes place. When suction or injection is included, the breaking of the flow persists under certain condition investigated in this paper. When this condition is broken, the breaking of the flow is obliterated.

Steady laminar flow with suction or injection and heat transfer through porous pipe

Following the method due to Bhatnagar (P. L.) [Jour. Ind. Inst. Sic., 1968, 1, 50, 1], we have discussed in this paper the problem of suction and injection and that of heat transfer for a viscous, incompressible fluid through a porous pipe of uniform circular cross-section, the wall of the pipe being maintained at constant temperature. The method utilises some important properties of differential equations and some transformations that enable the solution of the two-point boundary value and eigenvalue problems without using trial and error method. In fact, each integration provides us with a solution for a suction parameter and a Reynolds number without imposing the conditions of smallness on them. Investigations on non-Newtonian fluids and on other bounding geometries will be published elsewhere.

Tests of a Roman Pot Prototype for the TOTEM Experiment

The TOTEM collaboration has developed and tested the first prototype of its Roman Pots to be operated in the LHC. TOTEM Roman Pots contain stacks of 10 silicon detectors with strips oriented in two orthogonal directions. To measure proton scattering angles of a few microradians, the detectors will approach the beam centre to a distance of 10 sigma + 0.5 mm (= 1.3 mm). Dead space near the detector edge is minimised by using two novel "edgeless" detector technologies. The silicon detectors are used both for precise track reconstruction and for triggering. The first full-sized prototypes of both detector technologies as well as their read-out electronics have been developed, built and operated. The tests took place first in a fixed-target muon beam at CERN's SPS, and then in the proton beam-line of the SPS accelerator ring. We present the test beam results demonstrating the successful functionality of the system despite slight technical shortcomings to be improved in the near future.

Transfer of saline tolerance from one strain of rice to another by injection of DNA

Direct injection of genomic DNA from salt tolerant cv. Pokkali into developing floral tillers on IR20 produced transgenic seeds similar to Pokkali in husk colour and which germinated well in 0.2 M NaCl and had a 4-6-fold higher proline content.