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While "ears-and-eyes" and "mouthpieces" are two normative roles of Chinese journalists, the latter has long been more emphasized in the mobilization model of disaster reporting. Based on in-depth interviews with Chinese journalists who witnessed city lockdowns during the COVID-19 pandemic, this study examines how they performed the two roles to determine the extent to which their witnessing experiences could be transformed into media discourses. It argues that journalists' bearing witness on disaster sites presupposed not only eyewitnessing but also earwitnessing in the form of survivor interviewing, fact checking, and truth investigation. While the "mouthpiece" orientation of news media may have obscured the potential of journalistic witnessing for timely exposing public suffering, there existed journalist-media negotiations on performing the two roles. Highlighting the role asymmetry between "ears-and-eyes" and "mouthpieces", this study examines the veracity gap in Chinese journalists' witnessing practice that derives from the tension between journalistic autonomy and structural restraints, which may contribute to the further theorization of journalistic witnessing. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the effect of skill modifications on head motion experienced during women's artistic gymnastics skills. Nine gymnasts (four beginner and five advanced) completed three trials of up to 24 skill progressions, each consisting of a skill and two progressive safety modifications. Gymnasts were instrumented with mouthpiece sensors embedded with an accelerometer and gyroscope collecting motion data at 200, 300, and 500 Hz during each skill performance. Peak-to-peak linear and rotational kinematics during contact phases and peak rotational kinematics during non-contact phases were computed. A mixed-effects model was used to compare differences in modification status nested within skill categories. Timer skills (i.e. drills that simulate performance of a gymnastics skill) resulted in the highest median ΔLA and ΔRA of all skill categories, and 132 skill performances exceeded 10 g ΔLA during a contact phase. Modifications were associated with significant reductions in head kinematics during contact phases of timers, floor skills, bar releases, and vault skills. Gymnasts can be exposed to direct and indirect head accelerations at magnitudes consistent with other youth contact sports, and common safety modifications may be effective at reducing head motion during contact and non-contact phases of gymnastics skills. [ABSTRACT FROM AUTHOR]

Against the assumption that their literary form precludes Plato from expressing views in his dialogues, this paper argues that it is legitimate to read certain utterances of characters also as expressions of Plato’s views or to infer Plato’s views from his characters’ speech. Ancient hermeneutical practice, including the practice of Plato’s characters themselves, shows mimetic literature’s reception as “double speech” on two registers, a story register and a rhetorical register. Although aware of the distinction between character and author, ancient readers attribute ideology in characters’ speeches directly to the author. Plato’s contemporaries did this with his dialogues. This practice creates the presumption that philosophical dialogues began as a genre both mimetic and assertoric. Evidence from Cicero and Plutarch supports this presumption, and modern examples show writers and artists weaving ideology into their works. Distinctions in modern literary theory help posit “mouthpiece” as a formal property of characters, “turned on” in order for the author to convey ideology at places in the work. I argue that the “mouthpiece” assumption does not entail fallacy and that the theoretical gains of the “author’s mouthpiece” construct outweigh its risks. Without vitiating dialogues’ status as fiction, the “mouthpiece” assumption serves the history of philosophy and enriches our engagement with the texts.

Research assessing the effects of mouthpieces on an individual's aerobic, anaerobic, or muscular performance have attributed cited improvements to the participant's ability to jaw clench. Jaw clenching research finds positive outcomes with the task of jaw clenching with targeted muscle groups in a controlled laboratory setting. Thus, the study's goal was to determine if the addition of a mouthpiece would positively affect performance outcomes in a field-based whole-body muscle movement. Fourteen participants (8=F and 6=M) NCAA softball and baseball athletes completed 5 maximal bat swings with and without a mouthpiece in 4 conditions: no jaw clenching (NC), mouthpiece and jaw clenching (MP+C), mouthpiece only (MP), and jaw clenching only (C). Significant differences occurred in conditions, with the highest velocity noted in the combined condition of MP+C (71.9 mph) as compared to NC (67.9 mph), MP (68.6 mph), and C (70.9 mph). A repeated measures ANOVA demonstrated significant differences with bat swing velocity (F = 13.19, df 3, p < 0.0001). Pairwise comparisons revealed significant differences in MP+C with MP (p = 0.007); MP+C with NC (p = 0.001), and C with NC (p = 0.009). The results of this study provide evidence of jaw clenching's positive effects on the dynamic, whole-body explosive activity of a bat swing. [ABSTRACT FROM AUTHOR]

Soccer players are regularly exposed to head impacts by intentionally heading the ball. Evidence suggests repetitive subconcussive head impacts may affect the brain, and females may be more vulnerable to brain injury than males. This study aimed to characterize head impact exposure among National Collegiate Athletic Association women's soccer players using a previously validated mouthpiece-based sensor. Sixteen players were instrumented during 72 practices and 24 games. Head impact rate and rate of risk-weighted cumulative exposure were compared across session type and player position. Head kinematics were compared across session type, impact type, player position, impact location, and ball delivery method. Players experienced a mean (95% confidence interval) head impact rate of 0.468 (0.289 to 0.647) head impacts per hour, and exposure rates varied by session type and player position. Headers accounted for 89% of head impacts and were associated with higher linear accelerations and relational accelerations than nonheader impacts. Headers in which the ball was delivered by a long kick had greater peak kinematics (all P<.001) than headers in which the ball was delivered by any other method. Results provide increased understanding of head impact frequency and magnitude in women's collegiate soccer and may help inform efforts to prevent brain injury. [ABSTRACT FROM AUTHOR]

Blood oxygen saturation (SpO2) is an essential indicator of a patient's general condition. However, conventional measurement methods have some issues such as time delay and interference by ambient light. Improved measurement methods must be developed, and there are no reports on intraoral measurements of SpO2 using wearable devices. Therefore, we aimed to establish an intraoral SpO2 measurement method for the first time. Twelve healthy adults participated in this study. The following steps were taken: (1) to identify the optimal measurement location, mid-perfusion index (PI) values were measured at six places on the mucosa of the maxilla, (2) to validate the optimal measurement pressure, PI values were obtained at different pressures, and (3) using the proposed mouthpiece device, SpO2 values in the oral cavity and on the finger were analyzed during breath-holding. The highest PI values were observed in the palatal gingiva of the maxillary canine teeth, with high PI values at pressures ranging from 0.3 to 0.8 N. In addition, changes in SpO2 were detected approximately 7 s faster in the oral cavity than those on the finger, which is attributed to their proximity to the heart. This study demonstrates the advantage of the oral cavity for acquiring biological information using a novel device. [ABSTRACT FROM AUTHOR]

Against the assumption that their literary form precludes Plato from expressing views in his dialogues, this paper argues that it is legitimate to read certain utterances of characters also as expressions of Plato's views or to infer Plato's views from his characters' speech. Ancient hermeneutical practice, including the practice of Plato's characters themselves, shows mimetic literature's reception as "double speech" on two registers, a story register and a rhetorical register. Although aware of the distinction between character and author, ancient readers attribute ideology in characters' speeches directly to the author. Plato's contemporaries did this with his dialogues. This practice creates the presumption that philosophical dialogues began as a genre both mimetic and assertoric. Evidence from Cicero and Plutarch supports this presumption, and modern examples show writers and artists weaving ideology into their works. Distinctions in modern literary theory help posit "mouthpiece" as a formal property of characters, "turned on" in order for the author to convey ideology at places in the work. I argue that the "mouthpiece" assumption does not entail fallacy and that the theoretical gains of the "author's mouthpiece" construct outweigh its risks. Without vitiating dialogues' status as fiction, the "mouthpiece" assumption serves the history of philosophy and enriches our engagement with the texts. [ABSTRACT FROM AUTHOR]

Background/Objective: The possible mechanisms supporting the relationship between the masticatory and the musculoskeletal systems have been recently investigated. It has been suggested that jaw clenching promotes ergogenic effects on prime movers through the phenomenon of concurrent activation potentiation (CAP). The purpose of this study was to analyse the effects of jaw clenching and jaw clenching while wearing mouthguard (MG) on muscle activity and force output during three upper body isometric strength tests. Methods: Twelve highly trained rink-hockey athletes were recruited for the study. A randomized, repeated measures within study design was carried out to compare the acute effects of three experimental conditions: jaw clenching while wearing MG (MG), jaw clenching without MG (JAW) and non-jaw clenching (NON-JAW). Results: Statistical analyses revealed significant higher force output (p

The errors on the stopping power ratio (SPR) of mouthpiece samples from ERKODENT were evaluated. Erkoflex and Erkoloc‐pro from ERKODENT and samples that combined Erkoflex and Erkoloc‐pro were computed tomography (CT)‐scanned using head and neck (HN) protocol at the East Japan Heavy Ion Center (EJHIC), and the values were averaged to obtain the CT number. The integral depth dose of the Bragg curve with and without these samples was measured for 292.1, 180.9, and 118.8 MeV/u of the carbon‐ion pencil beam using an ionization chamber with concentric electrodes at the horizontal port of the EJHIC. The average value of the water equivalent length (WEL) of each sample was obtained from the difference between the range of the Bragg curve and the thickness of the sample. To calculate the difference between the theoretical and measured values, the theoretical CT number and SPR value of the sample were calculated using the stoichiometric calibration method. Compared with the Hounsfield unit (HU)‐SPR calibration curve used at the EJHIC, the SPR error on each measured and theoretical value was calculated. The WEL value of the mouthpiece sample had an error of approximately 3.5% in the HU‐SPR calibration curve. From this error, it was evaluated that for a mouthpiece with a thickness of 10 mm, a beam range error of approximately 0.4 mm can occur, and for a mouthpiece with a thickness of 30 mm, a beam range error of approximately 1 mm can occur. For a beam passing through the mouthpiece in HN treatment, it would be practical to consider a mouthpiece margin of 1 mm to avoid beam range errors if ions pass through the mouthpiece. [ABSTRACT FROM AUTHOR]

Brass instruments mouthpieces have been historically built using metal materials, usually brass. With the auge of additive manufacturing technologies new possibilities have arisen, both for testing alternative designs and for using new materials. This work assesses the use of polymers for manufacturing trombone mouthpieces, specifically PLA and Nylon. The acoustical behavior of these two mouthpieces has been compared with the obtained from a third one, built from brass. Both additive and subtractive manufacturing techniques were used, and the whole manufacturing process is described. The mouthpieces were acoustically assessed in an anechoic chamber with the collaboration of a professional performer. The harmonic analysis confirmed that all the manufactured mouthpieces respect the harmonic behavior of the instrument. An energy analysis of the harmonics revealed slight differences between the mouthpieces, which implies differences in the timbre of the instrument. Although these subtle differences would not be acceptable when performing with the instrument in an orchestra, they could be perfectly valid for early learners, personal rehearsals or any kind of alternative performance. [ABSTRACT FROM AUTHOR]

The possible mechanisms supporting the relationship between the masticatory and the musculoskeletal systems have been recently investigated. It has been suggested that jaw clenching promotes ergogenic effects on prime movers through the phenomenon of concurrent activation potentiation (CAP). The purpose of this study was to analyse the effects of jaw clenching and jaw clenching while wearing mouthguard (MG) on muscle activity and force output during three upper body isometric strength tests. Twelve highly trained rink-hockey athletes were recruited for the study. A randomized, repeated measures within study design was carried out to compare the acute effects of three experimental conditions: jaw clenching while wearing MG (MG), jaw clenching without MG (JAW) and non-jaw clenching (NON-JAW). Statistical analyses revealed significant higher force output (p < 0.05) in all tests for MG conditions with respect to NON-JAW. When comparing JAW and NON-JAW conditions an increased peak force was found in handgrip (p = 0.045, d = 0.26) and bench press (p = 0.018, d = 0.43) but not in biceps curl (p = 0.562, d = 0.13). When comparing MG and JAW conditions, no differences were observed in any force output. In terms of muscle activity, significant differences were found in the agonist muscles of the handgrip test for MG with respect to NON-JAW (p = 0.031–0.046 , d = 0.25–1.1). This study demonstrated that jaw clenching, with and without MG, may be a good strategy to elicit the CAP phenomenon, which seems to promote ergogenic effects in upper body isometric force production. The non-significant differences observed between JAW and MG suggested that the use of MG doesn't make a difference in enhancing the isometric force production neither the muscle activity in upper body isometric strength. [ABSTRACT FROM AUTHOR]

Work-related exposures affecting oral health are important factors of morbidity and decreased quality of life, which may emerge from numerous physical, chemical, or mental occupational exposures. Copper (Cu) is an important trace element, however, it may also cause allergies, depose and accumulate in the body, leading to acute and chronic toxicity. In the present report, we describe a rare phenomenon found during the examination of two professional brass players, after incidentally noting an artefact during magnetic resonance imaging (MRI) scans, which were performed to monitor bone healing after bone augmentation procedures in an unrelated clinical study. During a detailed workup of patient characteristics, data on medical history, lifestyle, professional habits related to playing the instrument, and oral health status were collected. Overall, both patients presented with similar histories, and the differences from the context of this study were not relevant; however, both brass players were using an uncoated Cu mouthpiece for over 15 years. Based on the imaging findings (a shadow in the area of the lips on the MRI images) and the organoleptic evaluation of the lips and mucosa of the individuals (temporary faint green discoloration), it is most likely that the brass players were affected by oxidized Cu accumulation in the lip. In contrast to several professions, musicians are usually not required by law to attend obligatory occupational health check-ups, which may facilitate the occurrence of such exposures in musicians. Clinicians should be on the lookout for brass players involved in the profession for a long time, who may have used the mouthpieces for an extended period of time, in addition to musicians affected by Wilson's disease. In patients affected by this phenomenon, diagnostics of oral cancer and prosthodontic procedures may be cumbersome, due to the detrimental impact on the utility of MRI imaging from artefact-formation and scattering. [ABSTRACT FROM AUTHOR]

Background/objectives: The potential advantages of wearing customized bite-aligning mouthguards on several performance parameters such as muscular strength, power and reaction time have been reported. Literature shows that the concurrent activation potentiation phenomenon, elicited by a powered and balanced jaw clenching, can provide athletes with several neuromuscular advantages. The aim of the present study was to investigate the acute effects of jaw clenching while wearing a customized bite-aligning mouthguard on swimming start, countermovement jump and swim bench test, in contrast to two other conditions: non-jaw clenching and jaw clenching without mouthguard. Methods: A randomized, repeated measure within study design was used to compare the condition effect on eight highly trained elite male and female swimmers. Results: Statistical analysis revealed a significant increase in the countermovement jump height (p = 0.041) when comparing the use of mouthguards with the non-jaw condition. In the swim bench, a significant greater time to peak force (p = 0.049) was found when comparing the use of mouthguards with the jaw condition. Although, non-significant effects, small differences were found in the start reaction time and 15-m freestyle swimming when comparing the use of mouthguards with the non-jaw condition. Conclusion: This study demonstrated that wearing customized, bite-aligning mouthguards had an ergogenic effect on specific measures of vertical jump and swim bench test, whereas non-meaningful but small differences were found in swimming start.

The burial traditions that began as a special farewell ceremony in the Sanidar Cave were shaped around the thought that the end was actually a beginning and thusly retained their importance in both pagan and theistic religions. The class distinctions created by production, trade, and technological advancements were reflected in burial traditions in the form of variety in grave goods and tomb architecture. Advancements in the military and politics triggered intercultural exchanges that further increased this variety. When described in relation to burial traditions, mouth/eye bands and decorative appliques are referred to as Funeral/Burial Jewelry in this article. Made of gold leaf, the fact that these objects were unfit for use in daily life supports this identification. These bands, made of gold leaf and appearing in Mesopotamia during the Bronze Age, spread from there to Anatolia, Cyprus, Greece, and the entire Mediterranean Basin. In terms of both form and decoration, some of the richest examples of this group of artifacts, which were preserved in situ in the tombs at Kültepe, were recovered from the necropolises of Cyprus. While death masks were preferred in Mycenaean burial traditions, mouth and eye bands came into fashion in Greece during the Iron Age. Gold leaf appliques, decorated with motifs and cut into various forms, were once again used within the framework of burial traditions as clothing decorations from the Classical Period to the Roman Era. In this article we have examined 17 artifacts consisting of gold leaf mouth and eye bands, decorative appliques, and a fragment of diadem found in the collection of the Adana Museum. The 10 gold leaf appliques with an oval shape suitable for covering the mouth and eyes were categorized in to two groups: decorated and undecorated. The remaining samples, shaped like equilateral rectangles, lack decoration and are therefore identified as mouth bands. The decorated group consists of seven mouth bands with three having their form and decoration previous defined in the literature. The four strip-shaped samples (cat. no. 5-7), with measurements varying from 3 cm to 6 cm, are unique in that they are shaped to minimize their diadems. Stylistic similarities were reflected in the pattern repertoire and like on the diadems, scenes depicting large gatherings of auxiliary figures together with main figures were preferred. The lip decorations featured on the four mouth bands of standard form (cat. no. 1-4) include depictions of bee and plant motifs. Of the undecorated samples, four are oval shaped (cat. no. 8-11), and one is an equilateral rectangle (cat. no. 12). The only round gold leaf sample was identified as an eye band (cat. no. 13). The other groups of artifacts analyzed are the rhombus and square appliques made of gold leaf. One of the appliques depicts Nemea and Young Hercules holding the coat of a lion (cat. no. 14), the other depicts Fortuna sitting on a diphros while a female figure presents her with an offering (cat. no. 15). The applique featuring Hercules is exactly the same as the pattern used on Alexander’s silver coins. The other applique depicts one of Fortuna’s characteristic narrations that was used extensively during the Roman Period yet left unrecorded in the literature. The last applique to be analyzed is rectangular and features a row of six central holes sitting one on top of another (cat. no. 16). On the last example, which is thought to belong to the edge of the diadem, there are groups of couple figures (female-male) given face-to-face (cat. no. 17). Since we do not know the location and context in which these artifacts were found, they have been dated using the analogy method. The lip-shaped mouth bands from Cyprus were dated to the Late Bronze Age/Early Iron Age for their resemblance to period samples. The sharp-edged oval mouth bands have been dated Classical and Hellenistic Periods, and equilateral rectangle-shaped mouth bands have been dated to the Late Roman Imperial Period. For Gorgo/Medusa and Athena Parthenos with female figures mouth band has been suggested Late Hellenistic and Early Roman Period. The applique with the bust of Hercules was dated to the end of the 4th century BCE, and the gold leaf applique depicting the figure of a woman presenting an offering to Fortuna was dated to the 1st century BCE. The fragment of diadem is dated to 3th and 2nd and BCE.

Purpose: The mouthpiece is the standard interface for spirometry tests. Although the use of a mouthpiece can be challenging for patients with orofacial weakness, maintaining a proper seal with a facemask can be an issue for healthy individuals during forceful efforts. We compared respiratory muscle activity and tests using a mouthpiece and facemask in healthy adults to investigate whether they can be used interchangeably. Methods: In this observational study, subjects (n = 12) completed forced vital capacity, maximal respiratory pressure, and peak cough flow with a mouthpiece and facemask. Root mean square values of the genioglossus, diaphragm, scalene, and sternocleidomastoid were compared between conditions. Results: When switching from a mouthpiece to a facemask, significantly higher values were seen for peak cough flow (average bias = -54.36 L/min, P <.05) and the difference seen with maximal expiratory pressure (MEP) and maximal inspiratory pressure (MIP) were clinically significant (average bias: MEP = 27.33, MIP = -5.2). In addition, the submental activity was significantly greater when MIP was conducted with a mouthpiece. No significant differences were seen in respiratory muscle activity during resting breathing or spirometry. Conclusions: There are clinically significant differences with cough and MEP tests, and neck muscles are activated differently based on interface. Considering the small sample size, our findings suggest a facemask may be used to complete some pulmonary function tests. [ABSTRACT FROM AUTHOR]

Operating microscopes and adjunctive technologies are continually refined to advance microneurosurgical care. How frequently these advances are used is unknown. In the present study, we assessed the international adoption of microneurosurgical technologies and discussed their value. A 27-question electronic survey was distributed to cerebrovascular neurosurgeon members of U.S., European, and North American neurosurgical societies and social media networks of cerebrovascular and skull base neurosurgeons. The survey encompassed the surgeons' training background, surgical preferences, and standard microneurosurgical practices. Of the respondents, 56% (53 of 95) were attendings, 74% (70 of 95) were in their first 10 years of practice, and 67% (63 of 94) practiced at an academic teaching hospital. Vascular, endovascular, and skull base fellowships had been completed by 38% (36 of 95), 27% (26 of 95), and 32% (30 of 95) of the respondents, respectively. Most respondents did not use an exoscope (78%; 73 of 94), a mouthpiece (61%; 58 of 95), or foot pedals (56%; 55 of 94). All 95 respondents used a microscope, and 71 (75%) used Zeiss microscopes. Overall, 57 neurosurgeons (60%) used indocyanine green for aneurysms (n = 54), arteriovenous malformations (n = 43), and dural arteriovenous fistulas (n = 42). Most (80%; 75 of 94) did not use fluorescence. The respondents with a vascular-focused practice more commonly used indocyanine green, Yellow 560 fluorescence, and intraoperative 2-dimensional digital subtraction angiography. The respondents with a skull base–focused practice more commonly used foot pedals and an endoscope-assist device. The results from the present survey have characterized the current adoption of operative microscopes and adjunctive technologies in microneurosurgery. Despite numerous innovations to improve the symbiosis between neurosurgeon and microscope, their adoption has been underwhelming. Future advances are essential to improve surgical outcomes. [ABSTRACT FROM AUTHOR]

The potential advantages of wearing customized bite-aligning mouthguards on several performance parameters such as muscular strength, power and reaction time have been reported. Literature shows that the concurrent activation potentiation phenomenon, elicited by a powered and balanced jaw clenching, can provide athletes with several neuromuscular advantages. The aim of the present study was to investigate the acute effects of jaw clenching while wearing a customized bite-aligning mouthguard on swimming start, countermovement jump and swim bench test, in contrast to two other conditions: non-jaw clenching and jaw clenching without mouthguard. A randomized, repeated measure within study design was used to compare the condition effect on eight highly trained elite male and female swimmers. Statistical analysis revealed a significant increase in the countermovement jump height (p = 0.041) when comparing the use of mouthguards with the non-jaw condition. In the swim bench, a significant greater time to peak force (p = 0.049) was found when comparing the use of mouthguards with the jaw condition. Although, non-significant effects, small differences were found in the start reaction time and 15-m freestyle swimming when comparing the use of mouthguards with the non-jaw condition. This study demonstrated that wearing customized, bite-aligning mouthguards had an ergogenic effect on specific measures of vertical jump and swim bench test, whereas non-meaningful but small differences were found in swimming start. [ABSTRACT FROM AUTHOR]

Several case studies and anecdotal reports have shown assorted motor and quality of life benefits from use of a dental mouthpiece among people with Parkinson disease (PD). A larger exploratory study is necessary to assess potential efficacy and feasibility of this treatment strategy. If shown to be effective and feasible in a larger sample of people with PD, mechanistic studies may be warranted to examine a potential relationship between orofacial sensory input and motor function in people with PD. This study was registered on clinicaltrials.gov (NCT: 04082663). Twenty people with PD, Hoehn and Yahr stages I-III, participated in this study. Each participant completed various baseline motor and quality of life assessments before being fitted with a custom mouthpiece. Motor assessments were completed a second time after 25 min of mouthpiece wear. Participants were asked to wear the mouthpiece for 1 month before completing follow-up quality of life assessments and providing feedback about the mouthpiece. Wilcoxon signed-rank tests were used to compare results across conditions. Gait velocity and cadence showed significant (p <.05) improvement while wearing the mouthpiece. However, these changes were not significant after correcting for multiple comparisons. Thirteen participants indicated they would be unlikely to continue wearing the mouthpiece. These results do not provide adequate evidence to pursue further this type of mouthpiece as a treatment strategy for motor signs and symptoms or quality of life in people with PD. [ABSTRACT FROM AUTHOR]

Purpose: We investigated the immobilization accuracy of a new type of thermoplastic mask—the Double Shell Positioning System (DSPS)—in terms of geometry and dose delivery. Methods: Thirty‐one consecutive patients with 1–5 brain metastases treated with stereotactic radiotherapy (SRT) were selected and divided into two groups. Patients were divided into two groups. One group of patients was immobilized by the DSPS (n = 9). Another group of patients was immobilized by a combination of the DSPS and a mouthpiece (n = 22). Patient repositioning was performed with cone beam computed tomography (CBCT) and six‐degree of freedom couch. Additionally, CBCT images were acquired before and after treatment. Registration errors were analyzed with off‐line review. The inter‐ and intrafractional setup errors, and planning target volume (PTV) margin were also calculated. Delivered doses were calculated by shifting the isocenter according to inter‐ and intrafractional setup errors. Dose differences of GTV D99% were compared between planned and delivered doses against the modified PTV margin of 1 mm. Results: Interfractional setup errors associated with the mouthpiece group were significantly smaller than the translation errors in another group (p = 0.03). Intrafractional setup errors for the two groups were almost the same in all directions. PTV margins were 0.89 mm, 0.75 mm, and 0.90 mm for the DSPS combined with the mouthpiece in lateral, vertical, and longitudinal directions, respectively. Similarly, PTV margins were 1.20 mm, 0.72 mm, and 1.37 mm for the DSPS in the lateral, vertical, and longitudinal directions, respectively. Dose differences between planned and delivered doses were small enough to be within 1% for both groups. Conclusions: The geometric and dosimetric assessments revealed that the DSPS provides sufficient immobilization accuracy. Higher accuracy can be expected when the immobilization is combined with the use of a mouthpiece. [ABSTRACT FROM AUTHOR]

Abstract Background It is essential to understand, characterize, and measure the embouchure mechanism of a wind instrumentalists, where the applied forces on the perioral tissues can usually promote discomfort or pain. Methods The sample consisted of five clarinet players and five saxophone players. The embouchure force measurements at the lower lip area were assessed using a piezoresistive sensor (FlexiForceTM, Tekscan, Boston, USA, 0.07 kgf/cm2) placed on the lower part of the mouthpiece of the single reed instrument. Furthermore, each participant performed three times three different notes at different pitches: high, medium, and low. An intraoral device was manufactured in order to dissipate the existing pressures. Results The piezoresistive sensors applied to the mouthpiece of the five clarinetists presented values between 16 and 226 g of force. In the case of the five saxophonists, the values registered were between 5 and 320 g of force. Conclusions Piezoresistive sensors are a valid option to characterize that single reed instrumentalists apply substantial forces at the lower lip that can be equivalent to medium orthodontic forces. The implementation of the Lip Pressure Appliance can be a valid solution on the prevention of eventual lesions resulting from the embouchure forces.

Background/objective: Playing a wind instrument implies rhythmic jaw movements where the embouchure applies forces with different directions and intensities towards the orofacial structures. These features are relevant when comparing the differences between a clarinettist and a saxophone player embouchure, independently to the fact that both belong to the single-reed instrument group, making therefore necessary to update the actual classification. Methods: Lateral cephalograms were taken to single-reed, double-reed and brass instrumentalists with the purpose of analyzing the relationship of the mouthpiece and the orofacial structures. Results: The comparison of the different wind instruments showed substantial differences. Therefore the authors purpose a new classification of wind instruments: Class 1 single-reed mouthpiece, division 1– clarinet, division 2 –saxophone; Class 2 double-reed instruments, division 1– oboe, division 2– bassoon; Class 3 cup-shaped mouthpiece, division 1– trumpet and French horn, division 2- trombone and tuba; Class 4 aperture mouthpieces, division 1– flute, division 2 – transversal flute and piccolo. Conclusions: Elements such as dental arches, teeth and lips, assume vital importance at a new nomenclature and classification of woodwind instruments that were in the past mainly classified by the type of mouthpiece and not taking into consideration its relationship with their neighboring structures.

Abstract Background Current clinical practice during high-flow nasal therapy (HFNT) involves utilization of a nasal cannula to provide humidification, with a facemask placed over the cannula to deliver aerosol. Few studies have compared aerosol delivery across various delivery interfaces during HFNT. The objective of this study was to address this gap in the literature and evaluate aerosol delivery using two nebulizer types across different drug delivery interfaces, nasal cannula, facemask, and mouthpiece, during simulated adult HFNT. Methods A facemask or mouthpiece and/or a nasal cannula were positioned on an anatomically correct adult head model. The head model was connected to a breathing simulator via a collection filter. Both healthy breathing pattern and distressed breathing patterns were utilized. Aerosol dose was determined by quantifying the mass of drug captured on a filter positioned distal to the trachea. Results During simulated healthy breathing, a significantly greater aerosol dose was observed when the vibrating mesh nebulizer (VMN) was integrated with HFNT alone, supplying aerosol and humidified air simultaneously (2.88 ± 0.15%), as opposed to using with a facemask (0.33 ± 0.07%, 1.62 ± 0.46%, and 1.07 ± 0.25% at 0 L/min (LPM), 2LPM, and 6LPM, respectively) or mouthpiece (0.56 ± 0.13%, 2.16 ± 0.06%, and 1.82 ± 0.41% at 0LPM, 2LPM, and 6LPM). In addition, aerosol delivery was also significantly greater when the VMN was integrated into simulated HFNT (2.88 ± 0.15%), in comparison with using the jet nebulizer (JN) with a facemask (0.82 ± 0.16%) or a mouthpiece (0.86 ± 0.11%). During simulated distressed breathing, a significantly greater aerosol dose was observed when the VMN was integrated with HFNT, supplying aerosol and humidified air simultaneously (6.81 ± 0.45%), compared with using a facemask (0.86 ± 0.04%, 2.96 ± 0.26%, and 4.23 ± 0.93% at 0LPM, 2LPM, and 6LPM) or mouthpiece (0.73 ± 0.37%, 0.97 ± 0.20%, and 3.11 ± 0.53% at 0LPM, 2LPM, and 6LPM, respectively). Aerosol delivery was also greater when the VMN was integrated into HFNT (6.81 ± 0.45%), in comparison with using the JN with a facemask (5.72 ± 0.71%) or a mouthpiece (0.69 ± 0.53%). Furthermore, across all drug delivery interfaces, and in line with previous reports, aerosol delivery was greater during simulated distressed breathing, in comparison with simulated healthy adult breathing. Conclusions This article will be of considerable benefit in enhancing the understanding of aerosol delivery during HFNT, an increasingly adopted therapeutic intervention by healthcare professionals.

Background and Aim: Discomfort associated with the gag reflex during transoral endoscopy can be troublesome. To overcome this problem during esophagogastroduodenoscopy (EGD), we recently developed a novel mouthpiece. The aim of the present study was to compare acceptance and tolerability of transoral EGD with conventional and new mouthpieces in unsedated patients and analyze the effects of the new mouthpiece. Methods: This study consisted of two phases of cephalometric and EGD examinations to analyze the effects of the new mouthpiece. Cephalometry was carried out in six subjects to evaluate differences in the size of the pharynx (anteroposterior diameter of the oropharynx and longitudinal diameter of the oral cavity) when subjects held the conventional mouthpiece (MAJ674) or the new mouthpiece in their mouths. EGD was done in 10 subjects using the conventional or new mouthpiece to evaluate the number of times the gag reflex occurred, examinee discomfort, and endoscope operability during EGD using a visual analogue scale (VAS). Results: Anteroposterior diameter of the oropharynx and longitudinal diameter of the oral cavity were significantly larger with the new mouthpiece than with the conventional mouthpiece (oropharynx: P = 0.03; oral cavity: P = 0.03). With the new mouthpiece during EGD, subjects had significantly fewer instances of the gag reflex (P = 0.01); VAS score for discomfort was significantly lower (P < 0.01) and score for endoscope operability was significantly higher (P = 0.04). Conclusion: The new mouthpiece we developed reduced the gag reflex during EGD by extending the pharynx, thus decreasing examinee discomfort and increasing endoscopic operability. [ABSTRACT FROM AUTHOR]

Scuba diving is one of the most rapidly growing marine sports in Japan. Many divers continuously clench the mouthpiece for scuba diving (SD mouthpiece) during the dive, and experience unpleasant symptoms of fatigue of the temporomandibular joint or oro-facial muscles after the dive. The purpose of this study was to investigate the effect of customization of the labial flange and platform of the SD mouthpiece on oro-facial muscle activities during the dive by simulating the state of holding the SD mouthpiece under water. EMG activity of the anterior belly of temporal muscles, masseter muscles and orbicular oris muscles while holding the SD mouthpiece for 7 min was recorded and integrated value of muscle activity as a parameter of muscle activity with and without customization was compared in four male beginner divers (28±2 years). Muscle activity of temporal muscles increased when the labial flange was narrowed, that of masseter muscles decreased when the labial flange was widened or the platform was extended, and that of orbicular oris muscles increased when the labial flange was widened or the platform was shortened. These results suggested that customization of the SD mouthpiece may improve muscle activities while holding the mouthpiece for scuba diving. [ABSTRACT FROM AUTHOR]

There are variations in the values reported for aerosol drug delivery across in vitro experiments throughout the published literature, and often with the same devices or similar experimental setups. Factors contributing to this variability include, but are not limited to device type, equipment settings, drug type and quantification methods. This study assessed the impact of head model choice on aerosol drug delivery using six different adults and three different paediatric head models in combination with a facemask, mouthpiece, and high-flow nasal cannula. Under controlled test conditions, the quantity of drug collected varied depending on the choice of head model. Head models vary depending on a combination of structural design differences, facial features (size and structure), internal volume measurements and airway geometries and these variations result in the differences in aerosol delivery. Of the widely available head models used in this study, only three were seen to closely predict in vivo aerosol delivery performance in adults compared with published scintigraphy data. Further, this testing identified the limited utility of some head models under certain test conditions, for example, the range reported across head models was aerosol drug delivery of 2.62 ± 2.86% to 37.79 ± 1.55% when used with a facemask. For the first time, this study highlights the impact of head model choice on reported aerosol drug delivery within a laboratory setting and contributes to explaining the differences in values reported within the literature.

While many research efforts have focused on head impact exposure in professional soccer, there have been few studies characterizing exposure at the youth level. The aim of this study is to evaluate a new instrumentation approach and collect some of the first head impact exposure data for youth female soccer players. Athletes were instrumented with custom-fit mouthpieces that measure head impacts. Detailed video analysis was conducted to identify characteristics describing impact source (e.g., kick, header, throw). A total of 763 verified head impacts were collected over 23 practices and 8 games from 7 athletes. The median peak linear accelerations, rotational velocities, and rotational accelerations of all impacts were 9.4 g, 4.1 rad/s, and 689 rad/s2, respectively. Pairwise comparisons resulted in statistically significant differences in kinematics by impact source. Headers following a kicked ball had the highest accelerations and velocity when compared to headers from thrown or another header. [ABSTRACT FROM AUTHOR]

Background: It is essential to understand, characterize, and measure the embouchure mechanism of a wind instrumentalists, where the applied forces on the perioral tissues can usually promote discomfort or pain. Methods: The sample consisted of five clarinet players and five saxophone players. The embouchure force measurements at the lower lip area were assessed using a piezoresistive sensor (FlexiForceTM, Tekscan, Boston, USA, 0.07 kgf/cm2) placed on the lower part of the mouthpiece of the single reed instrument. Furthermore, each participant performed three times three different notes at different pitches: high, medium, and low. An intraoral device was manufactured in order to dissipate the existing pressures. Results: The piezoresistive sensors applied to the mouthpiece of the five clarinetists presented values between 16 and 226 g of force. In the case of the five saxophonists, the values registered were between 5 and 320 g of force. Conclusions: Piezoresistive sensors are a valid option to characterize that single reed instrumentalists apply substantial forces at the lower lip that can be equivalent to medium orthodontic forces. The implementation of the Lip Pressure Appliance can be a valid solution on the prevention of eventual lesions resulting from the embouchure forces. [ABSTRACT FROM AUTHOR]

The objective of this study was to develop a mouthpiece sensor with improved head kinematic measurement for use in non-helmeted and helmeted sports through laboratory validation and pilot field deployment in female youth soccer. For laboratory validation, data from the mouthpiece sensor was compared to standard sensors mounted in a headform at the center of gravity as the headform was struck with a swinging pendulum. Linear regression between peak kinematics measured from the mouthpiece and headform showed strong correlation, with r2 values of 0.95 (slope = 1.02) for linear acceleration, 1.00 (slope = 1.00) for angular velocity, and 0.97 (slope = 0.96) for angular acceleration. In field deployment, mouthpiece data were collected from four female youth soccer players and time-synchronized with film. Film-verified events (n = 915) were observed over 9 practices and 5 games, and 632 were matched to a corresponding mouthpiece event. This resulted in an overall sensitivity of 69.2% and a positive predictive value of 80.3%. This validation and pilot field deployment data demonstrates that the mouthpiece provides highly accurate measurement of on-field head impact data that can be used to further study the effects of impact exposure in both helmeted and non-helmeted sports. [ABSTRACT FROM AUTHOR]

Playing a wind instrument implies rhythmic jaw movements where the embouchure applies forces with different directions and intensities towards the orofacial structures. These features are relevant when comparing the differences between a clarinettist and a saxophone player embouchure, independently to the fact that both belong to the single-reed instrument group, making therefore necessary to update the actual classification. Lateral cephalograms were taken to single-reed, double-reed and brass instrumentalists with the purpose of analyzing the relationship of the mouthpiece and the orofacial structures. The comparison of the different wind instruments showed substantial differences. Therefore the authors purpose a new classification of wind instruments: Class 1 single-reed mouthpiece, division 1– clarinet, division 2 –saxophone; Class 2 double-reed instruments, division 1– oboe, division 2– bassoon; Class 3 cup-shaped mouthpiece, division 1– trumpet and French horn, division 2- trombone and tuba; Class 4 aperture mouthpieces, division 1– flute, division 2 – transversal flute and piccolo. Elements such as dental arches, teeth and lips, assume vital importance at a new nomenclature and classification of woodwind instruments that were in the past mainly classified by the type of mouthpiece and not taking into consideration its relationship with their neighboring structures. [ABSTRACT FROM AUTHOR]

Highlights • Modeling mouthpiece for radiotherapy using a 3D printer. • Revealed accurate modeling with a 3D printer. • Elucidating the process of creating appropriate STL 3D images. • Usefulness of dose distribution of MED610 mouthpieces. Abstract Purpose The purpose of our study was to evaluate the usefulness of a biocompatible class VI resin PolyJet photopolymer Objet MED610 (MED610)-made mouthpiece fabricated using a 3D printer as a fixation device for head and neck radiotherapy patients. Methods Five mouthpieces made of GC Exafine putty type (GCEP) were fabricated from five dry skull bones. After computed tomography reconstruction of the GCEP-made mouthpiece and its surface extraction, the MED610-made mouthpieces were replicated. The sizes of the GCEP and MED610 mouthpieces were measured with a vernier caliper in width, length, and height, respectively. The volumes of these mouthpieces were measured by Archimedes' principle using pure water. For dose evaluation, the GCEP and MED610 mouthpieces were placed in the same part of a water phantom, and a 4-MV X-ray beam was located at the left maxillary gingiva, buccal mucosa, and oral floor. The dose for the planning target volume (PTV) was evaluated. Results The differences in the mean size and volume between the GCEP and MED610 mouthpieces were 0.03 mm and 0.21 cm3, respectively. Compared with the conventional GCEP mouthpiece, the dose absorption in the MED610 mouthpiece was closer to that in only water. When the mouthpiece was within the PTV margin, the minimum coverage dose at 95% of the PTV increased by 2.4% in the maxillary gingiva and by 3.6% in the buccal mucosa. Conclusion A 3D printer can construct a mouthpiece accurately. The MED610 mouthpiece is suitable for use in dosimetry in head and neck radiotherapy. [ABSTRACT FROM AUTHOR]

This randomized trial aimed to compare the safety and efficacy of the GAGLESS mouthpiece for esophagogastroduodenoscopy (EGD) with that of the conventional mouthpiece. In all, 90 participants were divided into the GAGLESS mouthpiece and conventional mouthpiece groups. The primary endpoint was the severity of pain using the visual analog scale (VAS), and secondary endpoints were examination time, past history of endoscopy, success of the procedure, systolic (SBP) and diastolic (DBP) blood pressure, oxygen saturation, pulse rate before and after EGD, and adverse events. Endoscopy was completed in all cases, and no complications were observed. VAS, when passing the scope through the pharynx, was 2.5 ± 2.4 and 2.0 ± 1.9 cm (p = 0.24) in the conventional and GAGLESS groups, respectively, and that, throughout the examination, was 2.5 ± 2.4 and 1.7 ± 1.5 cm (p = 0.06), respectively. The difference in blood pressure between the GAGLESS and conventional groups was not significant for SBP (p = 0.08) and significant for DBP (p = 0.03). The post-EGD difference in DBP was significantly lower in the GAGLESS group than in the conventional group. The results indicate that GAGLESS mouthpieces had a lower VAS during endoscopy than the conventional mouthpieces, and the changes in blood pressure were smaller with the GAGLESS mouthpiece.

BACKGROUND: Impulse oscillometry is a method of airway assessment and diagnosis that provides data on lung mechanics. In the literature, studies have used different types of mouthpieces or did not describe the model used for the tests. We sought to compare the 3 most commonly described mouthpieces in terms of test results, comfort, and subject preference. METHODS: Thirty-nine healthy volunteers were evaluated with spirometry and impulse oscillometry, assessing the resistance at 5 Hz and 20 Hz (R5 and R20, respectively), reactance at 5 Hz (X5), reactance area, and resonant frequency. A filter heat exchanger with a circular mouthpiece (B1), a filter heat exchanger with an oval mouthpiece (B2), and a filter heat exchanger with a circular mouthpiece coupled with a free-flow piece (B3) were compared using an acceptability and tolerance scale, and subjects noted their preference. RESULTS: Statistical analysis showed differences between all the mouthpieces and the predicted values for R5, R20, and X5. The mouthpiece comparison showed differences in R5 between a filter heat exchanger with an oval mouthpiece (B2) and a circular mouthpiece coupled with a free-flow piece (B3) (P = .007); resonant frequency between a filter heat exchanger with a circular mouthpiece (B1) and a filter heat exchanger with an oval mouthpiece (B2) (P = .004) and between a filter heat exchanger with a circular mouthpiece (B1) and a circular mouthpiece coupled with a free-flow piece (B3) (P = .003); and reactance area between a filter heat exchanger with a circular mouthpiece (B1) and a circular mouthpiece coupled with a free-flow piece (B3) (P = .01). In the subjective evaluation, acceptability and tolerance differences were found in the ease of carrying out the evaluation, and no difference was found with regard to the degree of discomfort. Ten subjects preferred a filter heat exchanger with a circular mouthpiece (B1), 15 preferred a filter heat exchanger with an oval mouthpiece (B2), and 14 preferred a circular mouthpiece coupled with a free-flow piece (B3). CONCLUSIONS: A circular mouthpiece coupled with a free-flow piece (B3) appeared to be the most suitable mouthpiece for the impulse oscillometry tests. It assured smaller impedance values for the respiratory system, and subjects expressed the most confidence in using this mouthpiece. [ABSTRACT FROM AUTHOR]

Background/Objective: Basketball players commonly use mouthguards for protecting their mouths from collisions with other players. Besides, literature reports that specific types of mouthguards may become an ergogenic device that facilitates a powerful jaw clenching, and a subsequent concurrent activation potentiation through this remote voluntary contraction of the mandible muscles. Methods: A randomized within-subjects design was used to study the effects of this mechanism on muscular performance (vertical jump, agility, bench press power and leg press power) into two different conditions (mouthguard and no mouthguard) in high-standard basketball players (n = 13). A mean differences analysis and a responder analysis were conducted. Results: Significant improvements were found (p < 0.05) in all vertical jump protocols using the mouthguard when compared to the no mouthguard conditions. However, no significant differences were found between the two conditions in agility and power (except in one load of bench press). Nevertheless, p-values were closer to statistical significance when analyzing the total time for the agility T-Test than when the first split time was under consideration (p = 0.111 and p = 0.944, respectively). Conclusion: This study demonstrated that the use of custom-made, bite-aligning mouthguard had an ergogenic effect on jump outcomes and inconclusive results in agility T-Test in professional basketball players. From the results obtained in the present study, the use of this type of mouthguards seems to be more justified in power actions on the court than in the strength and conditioning sessions at the gym in well-trained players. [ABSTRACT FROM AUTHOR]

This paper outlines a defense of the project of seeking to interpret Plato’s political thought as a valid method of interpreting Plato. It does so in two stages: in the first part, by rebutting denials of the possibility of interpreting Plato’s thought at all; in the second part, by identifying one set of ideas arguably central to Plato’s political thought, namely, his profound rejection of political anarchy, understood in terms of the absence of the authority of officeholders and posited both as characteristic of democracy and as the origin of tyranny. This approach to anarchy and its relationship to tyranny is, I contend, a Platonic innovation (so far as we can judge from surviving texts), and must be understood against the background of Greek writings that straightforwardly opposed the two. I aim here to show, on the one hand, that denying tout court the project of seeking to interpret Plato’s political thought is an implausibly extreme position, and, on the other, that pursuing that project can bear valuable fruit.

This paper presents a clinical case study investigating the pattern of a saxophonist's embouchure as a possible origin of orofacial pain. The rehabilitation addressed the dental occlusion and a fracture in a metal ceramic bridge. To evaluate the undesirable loads on the upper teeth, two piezoresistive sensors were placed between the central incisors and the mouthpiece during the embouchure. A newly fixed metal ceramic prosthesis was placed from teeth 13 to 25, and two implants were placed in the premolar zone corresponding to teeth 14 and 15. After the oral rehabilitation, the embouchure force measurements showed that higher stability was promoted by the newly fixed metal-ceramic prosthesis. The musician executed a more symmetric loading of the central incisors (teeth 11 and 21). The functional demands of the saxophone player and consequent application of excessive pressure can significantly influence and modify the metal-ceramic position on the anterior zone teeth 21/22. The contribution of engineering (i.e., monitoring the applied forces on the musician's dental structures) was therefore crucial for the correct assessment and design of the treatment plan.

Purpose: Intraoperative transcranial motor-evoked potential monitoring causes contraction of the masseter muscles, which may cause injuries to the oral cavity and damage to the orotracheal tube. We developed a mouthpiece made from vinyl-silicone impression material to prevent these injuries. The purpose of this study was to examine its efficacy and safety. Methods: Twenty-two patients undergoing spinal surgery under transcranial motor-evoked potential monitoring were fitted with bespoke vinyl-silicone mouthpieces by dentists before surgery. On induction of general anesthesia and orotracheal intubation, the mouthpiece was attached to the upper and lower dental arches. A lateral cervical X-ray was taken at the end of surgery to examine the condition of the orotracheal tube. The incidence of endotracheal tube deformation was compared with an historic control group of 20 patients in whom a conventional gauze bite block had been previously used before induction of the mouthpiece. The oral cavity was examined by a dentist the day before surgery and 3 days postoperatively, and intraoral injuries were recorded. Results: No endotracheal tube deformation was found in 22 patients fitted with the new mouthpiece. The incidence of tube deformation (none of 22 patients, 0 %) was significantly lower than in those who had been fitted with the gauze bite block (9 of 20 patients, 45.0 %; p < 0.001). Application of the mouthpiece resulted in no tongue or tooth injuries. Conclusion: A novel mouthpiece reduced the incidence of damage to the endotracheal tube caused by intraoperative transcranial motor-evoked potential monitoring. [ABSTRACT FROM AUTHOR]

Although diver's mouth syndrome (DMS) has long been recognized by scuba divers, little attention has been paid to the influence of wearing a scuba diving mouthpiece on the stomatognathic system. In this review, DMS-related stomatognathic events (DMS-SE) while wearing a mouthpiece, the relationship between components of the mouthpiece and those events, and design considerations to reduce the risk of those events are discussed based on evidence from 32 articles concerning scuba diving mouthpieces. Forward movement of the mandible, loss of molar occlusal support, and continuous jaw clenching while wearing a mouthpiece are considered to be pathogenic for DMS-SE. Several experimental studies have suggested a relationship between incidence of those events and the design of mouthpiece components such as the connector, labial flange, platform, and occlusal rug, and the possibility of reducing risk of those events through design customization of these components. Improvement of the shape of commercially available mouthpieces and creation of custom-made mouthpieces may thus contribute to the prevention and treatment of DMS-SE and the provision of a comfortable diving environment. [ABSTRACT FROM AUTHOR]

Mouthpiece ventilation (MPV) allows patients with neuromuscular disease to receive daytime support from a portable ventilator, which they can disconnect at will, for example, for speaking, eating, swallowing, and coughing. However, MPV carries a risk of underventilation. Our purpose here was to evaluate the effectiveness of daytime MPV under real-life conditions. Eight wheelchair-bound patients who used MPV underwent daytime polygraphy at home with recordings of airflow, mouthpiece pressure, thoracic and abdominal movements, peripheral capillary oxygen saturation (SpO2), and transcutaneous partial pressure of carbon dioxide (PtcCO2). Times and durations of tasks and activities were recorded. The Apnea–Hypopnea Index (AHI) was computed. Patient–ventilator disconnections ≥3 minutes and episodes of hypoventilation defined as PtcCO2>45 mmHg were counted. Patient–ventilator asynchrony events were analyzed. The AHI was >5 hour−1 in two patients. Another patient experienced unexplained 3% drops in arterial oxygen saturations at a frequency of 70 hour−1. Patient–ventilator disconnections ≥3 minutes occurred in seven of eight patients and were consistently associated with decreases in SpO2 and ≥5-mmHg increases in PtcCO2; PtcCO2 rose above 45 mmHg in two patients during these disconnections. The most common type of patient–ventilator asynchrony was ineffective effort. This study confirms that MPV can be effective as long as the patient remains connected to the mouthpiece. However, transient arterial oxygen desaturation and hypercapnia due to disconnection from the ventilator may occur, without inducing unpleasant sensations in the patients. Therefore, an external warning system based on a minimal acceptable value of minute ventilation would probably be useful. [ABSTRACT FROM AUTHOR]

Transoral robotic surgery (TORS), performed with the da Vinci surgical system (da Vinci), has been classified as a surgical approach for benign and malignant lesions of the oral cavity and laryngopharynx. It provides several unique advantages, which include a three-dimensional magnified view, ability to see and work around curves or angles, and the availability of two or three robotic arms. At present, however, the da Vinci surgical system does not provide haptic feedback. The potential risks specific to the transoral use of the da Vinci include tooth injury, mucosal laceration, ocular injury, and mandibular fracture. To prevent such intra-operative tooth injuries, we created a mouthpiece made of polyethylene terephthalate glycol (PETG) individually shaped for the patient's teeth. We compared the safety and efficacy of the PETG mouthpiece with those of a conventional mouthpiece made of ethylene-vinyl acetate (EVA). To determine the difference in tooth injury resulting from the two types of mouthpiece, we constructed an experimental system to measure load and strain. We measured the dynamic load and the strain from the rod to the tooth using the PETG and EVA mouthpiece. The rod was pressed against the tooth model outfitted with two types of mouthpiece and the dynamic load was measured with a load cell and the strain with a strain gage. The maximum dynamic load was 1.29 ± 0.03 kgf for the PETG mouthpiece and 2.24 ± 0.05 kgf for the EVA mouthpiece. The load against the tooth was thus less for the EVA mouthpiece. The strain was −166.84 ± 3.94 and 48.24 ± 7.77 με, respectively, while the load direction was parallel to that of the tooth axis for the PETG mouthpiece and perpendicular to the tooth axis for the EVA mouthpiece. The PETG mouthpiece reduced the tooth load compared with the EVA mouthpiece and the load direction was in parallel to the tooth axis. The PETG mouthpiece thus enhances tooth safety for TORS. [ABSTRACT FROM AUTHOR]

Protective mouthpieces have been used in a variety of sports to decrease the risk of orofacial injury. There are limited data to suggest that mouthpiece use during exercise may also provide an ergogenic effect. The aim of the present study was to investigate the effects of 3 different mouthpiece designs--boil-and-bite (BB) mouthpiece, ethylene vinyl acetate (EVA) custom mandibular mouthpiece, and polypropylene (Poly) custom mandibular mouthpiece--on respiratory physiology parameters and compare them with results of a no-mouthpiece (NM) condition. Sixteen college-aged, recreationally fit subjects ran for 10 minutes in 4 separate trials; mouthpiece conditions were randomly assigned to each trial for all subjects. Respiratory and cardiorespiratory measures, including oxygen uptake, carbon dioxide exhalation, ventilation, heart rate, tidal volume, and respiratory rate (RR), were assessed throughout testing. A repeated-measures analysis of variance indicated that RR was significantly lower (P = 0.04) in the BB mouthpiece condition (27.92 breaths per minute [BPM]) than in the NM condition (30.63 BPM). In paired ttests between conditions, the RR demonstrated in the BB condition (27.92 BPM) was significantly lower (P= 0.04) than that of each other condition (NM, 30.63 BPM; EVA, 29.92 BPM; and Poly, 29.92 BPM). The outcomes of the present study demonstrate that the use of the BB mouthpiece decreased RR during exercise. The differences cited between conditions may be attributed to the design of the mouthpiece and its mandibular placement as well as the activity of the genioglossus muscle. However, future studies should assess these parameters to determine the plausibility of these theories. [ABSTRACT FROM AUTHOR]

Background: Different types of nebulizers and interfaces are used for the treatment of adults and children with pulmonary diseases. The purpose of this study was to determine the efficiency of a mesh nebulizer (MN) with a proprietary adapter and a jet nebulizer (JN) under different configurations in adult and pediatric models of spontaneous breathing. We hypothesize that delivery efficiency of JN and MN will differ depending on the interface used during aerosol therapy in simulated spontaneously breathing adult and pediatric models. While we expect that aerosol delivery with JN will be less efficient than MN, we also hypothesize that lung deposition obtained with the adult lung model will be more than that with the pediatric lung model in all conditions tested in this study. Methods: A lung model using a teaching manikin connected to a sinusoidal pump via a collecting filter at the level of the bronchi simulating a spontaneously breathing adult (Vt 500 mL, RR 15 bpm, I:E ratio 1:2) or pediatric patient (Vt 150 mL, RR 25 bpm, I:E ratio 1:2). Albuterol sulfate (2.5 mg/3 mL) was aerosolized with JN (Mistymax 10, Airlife) or MN (Aerogen Solo®, Aerogen) with the Adapter (Aerogen Solo® Adapter, Aerogen Ltd, Galway, Ireland) using mouthpiece, aerosol mask, and valved-mask in adults and the dragon mask, aerosol mask, and valved-mask in pediatrics ( n=3). The Adapter, specifically designed for MN, was attached to all the interfaces used in this study with supplemental oxygen of 2 lpm, and in addition, the MP was tested with no additional flow in the adult model. The JN was driven with 10 lpm based on the manufacturer's label. Drug was eluted from the filter and analyzed via spectrophotometry. Descriptive statistics, dependent t-test and one-way analysis of variance were used for data analysis. Significant level was set at 0.05. Results: In adults, delivery efficiency of JN with the valved mask was significantly greater than that with the aerosol mask ( p=0.01). Aerosol delivery of JN with the mouthpiece was not statistically significant from the valved mask ( p=0.123) and the aerosol mask ( p=0.193). Drug delivery with MN with mouthpiece (15.42±1.4%) and valved-mask (15.15±1.1%) was greater than the open aerosol mask (7.54±0.39%; p=0.0001) in the adult lung model. With no flow mouthpiece delivery increased>2 fold (34.9±3.1%; p=.0001) compared to use of 2 lpm of flow. Using the JN with the pediatric model deposition with valved-mask (5.3±0.8%), dragon mask (4.7±0.9%), and aerosol mask (4.1±0.3%) were similar ( p>0.05); while drug delivery with MN via valved-mask (11.1±0.7%) was greater than the dragon mask (6.44±0.3%; p=0.002) and aerosol mask (4.6±0.4%; p=0.002), and the dragon mask was more efficient than the open aerosol mask ( p=0.009) Conclusion: The type of nebulizer and interface used for aerosol therapy affects delivery efficiency in these simulated spontaneously breathing adult and pediatric models. Drug delivery was greatest with the valved-mouthpiece and mask with JN and MN, while the standard aerosol mask was least efficient in these simulated spontaneously breathing adult and pediatric lung models. Delivery efficiency of JN was less than MN in all conditions tested in this study except in the aerosol mask. Lung deposition obtained with the adult lung model was more than that with the pediatric lung model. [ABSTRACT FROM AUTHOR]

The article discusses research on how the cardiorespiratory responses of athletes to exercise and physical agility are influenced by over-the-counter vented mouthguard use. Topics explored include the protective benefits of mouthguard use in sports, the experimental physical agility sessions completed by study participants such as the 40-meter dash, vertical jump test, and shuttle run, and the monitoring and evaluation of heart rate and blood lactate of research subjects.