Effet d’une orthèse d’avancement mandibulaire neutre combinée à un masque facial et nasal dans le traitement de l’apnée obstructive du sommeil par CPAP

Le traitement de première ligne de l’apnée obstructive du sommeil est l’appareil à pression positive, soit le CPAP, qui est le plus souvent utilisé avec un masque nasal. Certains patients, incapables de tolérer le masque nasal, doivent se tourner vers le masque facial, qui peut parfois requérir une pression supérieure à celle utilisée avec le masque nasal pour éliminer tous les événements respiratoires. Nous supposons que l’ajustement serré du masque facial, dans le but de réduire les fuites, entraîne une pression de recul sur la mandibule; ceci diminuerait le calibre des voies aériennes supérieures, nécessitant donc une pression effective thérapeutique supérieure pour rétablir un passage de l’air. Nos objectifs étaient : 1) de démontrer s’il y avait une différence de pression effective entre le masque nasal et le masque facial, 2) de quantifier la fuite entre les deux masques, 3) d’évaluer l’effet d’une orthèse de rétention mandibulaire neutre (OMN), qui empêche le recul mandibulaire, sur la pression effective des deux masques et 4) d’évaluer s’il existait un lien entre la céphalométrie et les réponses variables des individus. Méthodologie : Lors de cette étude expérimentale croisée, huit sujets (2 femmes, 6 hommes) avec une moyenne d’âge de 56,3ans [33ans-65ans] ont reçu un examen orthodontique complet incluant une radiographie céphalométrique latérale. Ils ont ensuite passé deux nuits de polysomnographie au laboratoire du sommeil en protocole « split-night » où les deux masques ont été portés, seuls, la première nuit, et avec l’OMN, la deuxième nuit. Résultats : Nous avons trouvé que la pression effective thérapeutique était supérieure avec le masque facial comparativement au masque nasal de manière statistiquement significative. Nous avons observé une fuite supérieure avec le masque nasal, ce qui permet de dire que la fuite n’explique probablement pas cette différence de pression entre les deux masques. L’OMN n’a pas donné d’effet statistiquement significatif lorsque combinée au masque nasal, mais il aurait probablement été possible de trouver un effet positif avec le masque facial si le Bi-PAP avait été inclus dans le protocole de recherche. Conclusion : Nos résultats ne permettent pas de confirmer le rôle du recul mandibulaire, causé par la force exercée avec le masque facial, dans l’obtention de pressions supérieures avec ce masque, mais nous ne pouvons toutefois pas éliminer l’hypothèse. Les résultats suggèrent également que ce phénomène est peut-être plus fréquent qu’on ne le croit et qu’il pourrait y avoir un lien avec certains facteurs anatomiques individuels.

Re-assessing streetkids : a critique of subculture theory

Focusing on the notion of street kids, the paper suggests that youth be viewed in an alternative way to the subculture theory associated with the Center for Contemporary Cultural Studies in Birmingham (CCCS). It is argued that not only is subculture theory an unsuitable mechanism for understanding homeless youth but also, and more importantly, is itself fundamentally problematic. It is suggested that the work of Michel Foucault necessitates a reevaluation of the domain assumptions underlying subculture theory and offers in its place a model that relocates street kids, and youth itself, as artifacts of a network of governmental strategies.

Marx as critical discourse analyst : the genesis of a critical method and its relevance to the critique of global capital.

In this paper we identify elements in Marx´s economic and political writings that are relevant to contemporary critical discourse analysis (CDA). We argue that Marx can be seen to be engaging in a form of discourse analysis. We identify the elements in Marx´s historical materialist method that support such a perspective, and exemplify these in a longitudinal comparison of Marx´s texts.

Troubling Empowerment : A feminist critique of a rural women and communication technology project

Participatory research methodologies and interactive communication technologies (ICTs) are increasingly seen as offering ways of enhancing women’s empowerment and rural community development. However, some researchers suggest the need for caution about such claims. This book details findings from an evaluation of a feminist action research project that explored the impacts of ICTs for rural women in Queensland, Australia, in terms of personal, business and community development. Using praxis and poststructuralist feminist theories and methodologies, this innovative study presents a rigorous analysis and critique of women's empowerment and participation. This study demonstrates the value of adopting a critical yet pragmatic approach that takes diversity and difference, power-knowledge relations, and the contradictory effects of participation into account. This is argued to enable the development of more effective strategies for women’s empowerment, participation and inclusion. This book should be of particular interest to researchers, postgraduate students, and others working in the fields of communication, gender, and rural development, and feminist evaluation and ethnography.

Theoretical critique of the work of art : co-producers in research

The ways in which the "traditional" tension between words and artwork can be perceived has huge implications for understanding the relationship between critical or theoretical interpretation, art and practice, and research. Within the practice-led PhD this can generate a strange sense of disjuncture for the artist-researcher particularly when engaged in writing the exegesis. This paper aims to explore this tension through an introductory investigation of the work of the philosopher Andrew Benjamin. For Benjamin criticism completes the work of art. Criticism is, with the artwork, at the centre of our experience and theoretical understanding of art – in this way the work of art and criticism are co-productive. The reality of this co-productivity can be seen in three related articles on the work of American painter Marcia Hafif. In each of these articles there are critical negotiations of just how the work of art operates as art and theoretically, within the field of art. This focus has important ramifications for the writing and reading of the exegesis within the practice-led research higher degree. By including art as a significant part of the research reporting process the artist-researcher is also staking a claim as to the critical value of their work. Rather than resisting the tension between word and artwork the practice-led artist-researcher need to embrace the co-productive nature of critical word and creative work to more completely articulate their practice and its significance as research. The ideal venue and opportunity for this is the exegesis.

Critique groups : a technique for the author’s toolbox?

With a lack of places to gain an education in the craft of romance writing, novelists have few places to turn to gain real feedback. This paper investigates an alternative to textbooks, conferences, and workshops through an examination of the role provided to the writer by critique groups. How these groups work, how they benefit an author, and the critique groups as a whole are discussed. This work studies the form of Peer Assessment and Learning (PAL) and compares the technique used by educational institutions all over the world with the practice of author groups critiquing their own work. The research shows how a critique group can assist a writer to learn, grow and develop, helping to enhance the writer’s skills through constructive feedback, which gives them confidence to sell their work.

Use of expert panels in highway safety: A critique

Expert panels have been used extensively in the development of the "Highway Safety Manual" to extract research information from highway safety experts. While the panels have been used to recommend agendas for new and continuing research, their primary role has been to develop accident modification factors—quantitative relationships between highway safety and various highway safety treatments. Because the expert panels derive quantitative information in a “qualitative” environment and because their findings can have significant impacts on highway safety investment decisions, the expert panel process should be described and critiqued. This paper is the first known written description and critique of the expert panel process and is intended to serve professionals wishing to conduct such panels.

The coming of post-reflexive society : a critique of the political economy of digital capitalism

Language is a unique aspect of human communication because it can be used to discuss itself in its own terms. For this reason, human societies potentially have superior capacities of co-ordination, reflexive self-correction, and innovation than other animal, physical or cybernetic systems. However, this analysis also reveals that language is interconnected with the economically and technologically mediated social sphere and hence is vulnerable to abstraction, objectification, reification, and therefore ideology – all of which are antithetical to its reflexive function, whilst paradoxically being a fundamental part of it. In particular, in capitalism, language is increasingly commodified within the social domains created and affected by ubiquitous communication technologies. The advent of the so-called ‘knowledge economy’ implicates exchangeable forms of thought (language) as the fundamental commodities of this emerging system. The historical point at which a ‘knowledge economy’ emerges, then, is the critical point at which thought itself becomes a commodified ‘thing’, and language becomes its “objective” means of exchange. However, the processes by which such commodification and objectification occurs obscures the unique social relations within which these language commodities are produced. The latest economic phase of capitalism – the knowledge economy – and the obfuscating trajectory which accompanies it, we argue, is destroying the reflexive capacity of language particularly through the process of commodification. This can be seen in that the language practices that have emerged in conjunction with digital technologies are increasingly non-reflexive and therefore less capable of self-critical, conscious change.

Butterpaper, sweat & tears : the affective dimension of engaging students during the architectural critique

Considering how dominant a feature of architectural education the critique has been, and continues to be, little has been written about the affective dimension of engaging students during this key final stage of the design or documentation process. For most students, the critique is unlike any previous educational or life experience that they have ever confronted, and the abrupt change in the instructor’s role, from tutor to judge, can be disconcerting at a time when the student is feeling their most vulnerable. The fact that the period immediately leading up to the critique habitually entails not only a focused and sustained effort, but also sleepless nights of intensive work, further exacerbates this. The purpose of this paper is to recognise the affective phenomena influencing student engagement, during the critique. The participants of this research were second to fourth year architecture students at a major Australian university. Following the implementation of trials in alternative modes of critique in architectural design and technology studios, qualitative data was obtained from students, through questionnaires and interviews. Six indicators of engagement were investigated through this research: motivation and agency, transactional engagement with staff, transactional engagement with students, institutional support, active citizenship, and non-institutional support. This research confirms that affective phenomena play a significant role in the events of the critique; the relationship between instructor and student influences student engagement, as does the choreography and spatial planning of the critique environment; and these factors ultimately have an impact on the depth of student learning.