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JAMA Otolaryngology–Head & Neck Surgery
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Associations of Prior Head Injury With Olfaction in Older Adults : Results From the Atherosclerosis Risk in Communities (ARIC) Study
1 Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia
2 Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
3 Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland
4 The MIND Center, School of Medicine, University of Mississippi Medical Center, Jackson
5 Department of Otolaryngology−Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
6 Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
7 Department of Epidemiology and Biostatistics, Michigan State University, East Lansing
8 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Otolaryngol Head Neck Surg. 2022;148(9):840-848. doi:10.1001/jamaoto.2022.1920
Loss of Smell Associated With Prior Head Injuries
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Question
What is the association of prior head injury, number of prior head injuries, and head injury severity with subjective and psychophysical (objective) olfactory function in older adults?
Findings
Participants with a history of prior head injury, particularly individuals with 2 or more prior head injuries and moderate, severe, or penetrating head injuries, were more likely to have objective anosmia compared with participants with no history of head injury.
Meaning
There should be consideration of objective olfactory assessment in patients with head injury; this is particularly important because poor olfaction has previously been associated with negative health outcomes.
Importance
Traumatic brain injury has been associated with short-term olfactory dysfunction, but the association of number of prior head injuries and head injury severity with both subjective and objective long-term olfactory function is less clear.
Objective
To investigate the associations of prior head injury, number of prior head injuries, and head injury severity with subjective and psychophysical (objective) olfactory function in older adults and to examine concordance between subjective and objective olfactory function among individuals with and without head injury.
Design, Setting, and Participants
This prospective cohort study included 5951 participants who attended Atherosclerosis Risk in Communities (ARIC) Study visit 5 (2011 through 2013). Data analysis was performed between November 2021 and May 2022.
Exposures
Head injury was defined by self-report and International Classification of Diseases codes.
Main Outcomes and Measures
Self-reported subjective olfactory dysfunction was assessed by the question, “Do you suffer from smell loss or a significantly decreased sense of smell?” Objective olfactory performance was assessed using the 12-item Sniffin’ Sticks odor identification test.
Results
Overall, the 5951 participants were a mean (SD) age of 75.6 (5.2) years, 3501 (58.8%) were female, 1356 (22.8%) were of Black race, and 1666 (28.0%) had a history of head injury. Participants with prior head injury were more likely than individuals without prior head injury to report subjective olfactory dysfunction (24% vs 20%; difference, 4%; 95% CI, 1% to 6%) and have objective anosmia (15% vs 13%; difference, 2%; 95% CI, 0.1% to 4%) but had lower concordance between subjective and objective assessment (72% vs 77%; difference, −5%; 95% CI, −8% to −3%). In logistic regression models adjusted for sociodemographics and medical comorbidities including cognitive status, participants with a history of prior head injury, particularly individuals with 2 or more prior head injuries and more severe head injuries, were more likely to self-report subjective olfactory dysfunction and were more likely to be found to have objective anosmia compared with participants with no history of head injury.
Conclusions and Relevance
Findings of this cohort study provide evidence supporting the association between head injury and olfactory dysfunction, particularly among individuals who experienced multiple prior head injuries and among individuals with more severe head injury. The findings also suggest that individuals with prior head injury were more likely to both under–self-report and over–self-report deficits compared with objective olfactory testing; therefore, it may be important to consider objective olfactory testing in this patient population.
Schneider ALC, Gottesman RF, Mosley TH, et al. Associations of Prior Head Injury With Olfaction in Older Adults : Results From the Atherosclerosis Risk in Communities (ARIC) Study . JAMA Otolaryngol Head Neck Surg. 2022;148(9):840–848. doi:10.1001/jamaoto.2022.1920
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y.me 4, 1957 H. A. BRACKMAN EAL EGG BREAKER Filed Dec. 30, 1955 INVENTORS W. l y-A/TraeA/Eys.
nited StatesA Patent EGG BREAKER Henry A. Brackman and Olive J. Brackman, Manitou Beach, Mich.
Application December 30, 1955, Serial No. 556,574
3 Claims. (Cl. 146-2) This invention relates to egg breaking devices, and more particularly has reference to a device of this nature adapted to first cut the shell of the egg in a manner to break the shell into approximately equal halves, and then separate said halves while providing at the same time an outlet for the contents of the shell.
Among important objects of the invention are the following:
First, to provide a particularly simple device of this type that can be manufactured at a relatively low cost;
Second, to facilitate the insertion of the egg in proper position to be broken and insure the retention of the egg in said position;
Third, to provide a device as stated thatcan be readily cleaned so as to be kept in a sanitary condition with minimum diiculty;
l Fourth, to provide an egg breaking device that will be l eiciently usable in breaking eggs of various sizes; and
Fifth, to form the device in such a manner as to particularly facilitate the cutting of the shell and the spreading of the shell portions to permit ow of the yoke and egg white therefrom.
Summarized briefly, the invention comprises a pair of opposed jaws having a spring hinge connection normally biasing the same to a closed position. The jaws include clamp elements adapted to grip the egg in position to be broken, and at the side of the jaws remote from the hinge connection, side by side knives are mounted. Thesev are tensioned to normally shift out of the egg-receiving space of the device, but may be urged into said space in the closed position of the jaws to cut 'the shell. When, following the separation of the shell into substantially equal halves the jaws are separated, the knives are disposed as abutments holding the shells in position against the clamp elements to permit ilow of the yoke and egg white therefrom. Y i
Other objects will appear from the following description the claims appended thereto, and from the annexed drawing, in which like reference characters designate lik parts throughout the several views, and wherein:
-1 Figure 1 is-a ,top plan view of our eggA breaking device with the jaws in closed position;
Figure 2 is a side elevational View;
Figure 3 is an end elevational View of the device as see from the right of Figure 2;
Figure 4 is a transverse sectional view on line 4 4 of Figure 2; and
Figure 5 is a top plan View showing the device in use with the jaws opened.
The egg breaker constituting the present invention includes a pair of opposed jaws 12, 14 of generally tubular formation, having openings formed in their inner and outer ends and having their top walls cut away to provide an entrance opening 15 for an egg E to be broken. The tubular body portions of the jaws include side walls 16, 18 extending along the front of the device, side walls 20, 22 extending along the back of the device, bottom Patented `lune 4, 1957 ICC walls 24, 26 and top walls 28, 30. 'I'he openings in the outer ends of the jaws have been designated at 32, 34 and in a commercial embodiment, these openings might be omitted, since the jaws could be closed at their outer ends without detracting from the efficiency of operation.
A spring hinge 36 connects the side walls 20, 22 at the abutting inner ends thereof, so that the jaws may swing between the closed and open positions thereof shown in Figures l and 5 respectively about an axis extending transversely of the device at one side thereof.
A pair of clamp elements is provided in the device, the
respective elements being connected to the body portionsl elements are shaped with upwardly diverging handles 38,
40 of inverted U-shape intermediate the ends of the said lengths, and said handles at the outer sides thereof merge into U-shaped, springable connecting portions 42, 44 rigidly connected to the top walls 28, 30 respectively.
At their inner sides, handles 38, 40 merge into elongated arcuate clamping portions 46, 43 respectively, these being lbowed oppositely so as to engage diametrically opposite portions of an inserted egg E.
It will be seen that this provides, when the jaws are closed, a centrally disposed egg-receiving space inwhich the egg may be swiftly inserted, to be held by the clamp elements in position to be cut by knives 50, 52.
The knives are formed from flat lengths of slightly springable material, said knives having at one end widened portions 50, 52 normally spaced outwardly from the adjacent sides of the respective body portions by reason of the inherent spring tension of U-shaped connecting members 54, 56 respectively anchored to the side walls 16, 18.
Along their inner side edges, the knives have inwardly directed blades 53, 60 and as shown in Figure 4, said blades intermediate their ends are formed with a series of teeth 62 of different heights. Thus, in a typical embodiment three teeth may be used in each series with the middle tooth being higher than the remaining teeth so as to penetrate the shell iirst and start the cut.
The springable mounting of the knives is such as to dispose the blades, normally, out of the egg-receiving space as shown in Figure 1. The blades, in this connection, are in side-by-side contacting relation in the closed position of the jaws (see Figure 1) so that they cooperate to make a single cut in the shell longitudinally of one side of the shell.
In use, one grasps the device with the opening 15 facing upwardly, and inserts the egg E through said opening.
The clamp elements spread against the inherent spring tension thereof to permit insertion or" the egg and then return to an egg gripping position'.
Thereafter, with the ngers of both hands disposed against the back walls 20, 22 of the jaws, one places the thumbs of the hands upon the depressible portions 50, 52 of the knives and shifts the knives inwardly against the springiness of the connecting portions 54, 56.
This cuts the shell of the egg longitudinally thereof, and as a next step one swings the jaws apart against the restraint of the spring hinge, with the blades still disposed in their inner or cutting positions by reason the continuing pressure of the thumbs thereagainst.
When the jaws are opened in this manner, the blades will be disposed as abutments bearing against the opposite halves of the egg, and as a result, on movement of the jaws apart the halves will be pulled away from one another, separating the same from one another com-
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