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There is growing concern over a future shortfall in provision of UK otolaryngology consultants. There is a declining rate of applications to otolaryngology specialty training in the UK.
This study aimed to systematically review the literature to establish what factors influence medical students’ and junior doctors’ decision to pursue a career in otolaryngology.
Medline, Embase and PubMed databases were searched in January 2019. Additional manual reference checks of identified literature were performed.
Eleven articles were included in the review. Common factors that positively influenced the decision to pursue a career in otolaryngology were exposure to the specialty, positive role models and a good work-life balance. Lack of exposure was a consistent deterrent from pursuing a career in otolaryngology.
This review reiterates the need for greater exposure to otolaryngology in the undergraduate curriculum. In addition, mentorship for students with an interest in otolaryngology should be a priority.
Since US President Donald J. Trump took office in January 2017, the future of the global economy has looked distinctly uncertain. This is not because a process of clear and purposeful change can be said to be underway. Instead, it is because of a pattern of piecemeal, inconsistent and contradictory fragments of policy, both domestic and international in orientation, in the arenas of trade, taxation, business relations, finance and banking, social and welfare provision, immigration, and environmental protection, whose cumulative significance remains unclear. The modest task of this essay is therefore to sketch the contours, patterns, inconsistencies and confusions presented by the Trump administration's approach to shaping the US economy and, by extension, the global economic order, and on that basis to offer an interpretation of its emerging implications for inequality both within the United States and across the world.
The optimal approach to unifocalisation in pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (pulmonary artery/ventricular septal defect/major aortopulmonary collaterals) remains controversial. Moreover, the impact of collateral vessel disease burden on surgical decision-making and late outcomes remains poorly defined. We investigated our centre’s experience in the surgical management of pulmonary artery/ventricular septal defect/major aortopulmonary collaterals.
Materials and methods
Between 1996 and 2015, 84 consecutive patients with pulmonary artery/ventricular septal defect/major aortopulmonary collaterals underwent unifocalisation. In all, 41 patients received single-stage unifocalisation (Group 1) and 43 patients underwent multi-stage repair (Group 2). Preoperative collateral vessel anatomy, branch pulmonary artery reinterventions, ventricular septal defect status, and late right ventricle/left ventricle pressure ratio were evaluated.
Median follow-up was 4.8 compared with 5.7 years for Groups 1 and 2, respectively, p = 0.65. Median number of major aortopulmonary collaterals/patient was 3, ranging from 1 to 8, in Group 1 compared with 4, ranging from 1 to 8, in Group 2, p = 0.09. Group 2 had a higher number of lobar/segmental stenoses within collateral vessels (p = 0.02). Group 1 had fewer catheter-based branch pulmonary artery reinterventions, with 5 (inter-quartile range from 1 to 7) per patient, compared with 9 (inter-quartile range from 4 to 14) in Group 2, p = 0.009. Among patients who achieved ventricular septal defect closure, median right ventricle/left ventricle pressure was 0.48 in Group 1 compared with 0.78 in Group 2, p = 0.03. Overall mortality was 6 (17%) in Group 1 compared with 9 (21%) in Group 2.
Single-stage unifocalisation is a promising repair strategy in select patients, achieving low rates of reintervention for branch pulmonary artery restenosis and excellent mid-term haemodynamic outcomes. However, specific anatomic substrates of pulmonary artery/ventricular septal defect/major aortopulmonary collaterals may be better suited to multi-stage repair. Preoperative evaluation of collateral vessel calibre and function may help inform more patient-specific surgical management.
Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is associated with high morbidity and mortality in the absence of clinical management, making identification of these cases crucial. We examined characteristics of HIV and viral hepatitis coinfections by using surveillance data from 15 US states and two cities. Each jurisdiction used an automated deterministic matching method to link surveillance data for persons with reported acute and chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, to persons reported with HIV infection. Of the 504 398 persons living with diagnosed HIV infection at the end of 2014, 2.0% were coinfected with HBV and 6.7% were coinfected with HCV. Of the 269 884 persons ever reported with HBV, 5.2% were reported with HIV. Of the 1 093 050 persons ever reported with HCV, 4.3% were reported with HIV. A greater proportion of persons coinfected with HIV and HBV were males and blacks/African Americans, compared with those with HIV monoinfection. Persons who inject drugs represented a greater proportion of those coinfected with HIV and HCV, compared with those with HIV monoinfection. Matching HIV and viral hepatitis surveillance data highlights epidemiological characteristics of persons coinfected and can be used to routinely monitor health status and guide state and national public health interventions.
Compulsory admission can be experienced as devaluing and stigmatising by people with mental illness. Emotional reactions to involuntary hospitalisation and stigma-related stress may affect recovery, but longitudinal data are lacking. We, therefore, examined the impact of stigma-related emotional reactions and stigma stress on recovery over a 2-year period.
Shame and self-contempt as emotional reactions to involuntary hospitalisation, stigma stress, self-stigma and empowerment, as well as recovery were assessed among 186 individuals with serious mental illness and a history of recent involuntary hospitalisation.
More shame, self-contempt and stigma stress at baseline were correlated with increased self-stigma and reduced empowerment after 1 year. More stigma stress at baseline was associated with poor recovery after 2 years. In a longitudinal path analysis more stigma stress at baseline predicted poorer recovery after 2 years, mediated by decreased empowerment after 1 year, controlling for age, gender, symptoms and recovery at baseline.
Stigma stress may have a lasting detrimental effect on recovery among people with mental illness and a history of involuntary hospitalisation. Anti-stigma interventions that reduce stigma stress and programs that enhance empowerment could improve recovery. Future research should test the effect of such interventions on recovery.
We present the first dedicated study into the phenomenon of ice sails. These are clean ice structures that protrude from the surface of a small number of debris-covered glaciers and can grow to heights of over 25 m. We draw together what is known about them from the academic/exploration literature and then analyse imagery. We show here that ice sails can develop by one of two mechanisms, both of which require clean ice to become surrounded by debris-covered ice, where the debris layer is shallow enough for the ice beneath it to melt faster than the clean ice. Once formed, ice sails can persist for decades, in an apparently steady state, before debris layer thickening eventually causes a reversal in the relative melt rates and the ice sails decay to merge back with the surrounding glacier surface. We support our image-based analysis with a surface energy-balance model and show that it compares well with available observations from Baltoro Glacier in the Karakoram. A sensitivity analysis of the model is performed and confirms the results from our empirical study that ice sails require a relatively high evaporative heat flux and/or a relatively low sensible heat flux in order to exist.
Dynamic ice-sheet models are used to assess the contribution of mass loss from the Greenland ice sheet to sea-level rise. Mass transfer from ice sheet to ocean is in a large part through outlet glaciers. Bed topography plays an important role in ice dynamics, since the acceleration from the slow-moving inland ice to an ice stream is in many cases caused by the existence of a subglacial trough or trough system. Problems are that most subglacial troughs are features of a scale not resolved in most ice-sheet models and that radar measurements of subglacial topography do not always reach the bottoms of narrow troughs. The trough-system algorithm introduced here employs mathematical morphology and algebraic topology to correctly represent subscale features in a topographic generalization, so the effects of troughs on ice flow are retained in ice-dynamic models. The algorithm is applied to derive a spatial elevation model of Greenland subglacial topography, integrating recently collected radar measurements (CReSIS data) of the Jakobshavn Isbræ, Helheim, Kangerdlussuaq and Petermann glacier regions. The resultant JakHelKanPet digital elevation model has been applied in dynamic ice-sheet modeling and sea-level-rise assessment.
In this paper we undertake a quantitative analysis of the dynamic process by which ice underneath a dry porous debris layer melts. We show that the incorporation of debris-layer airflow into a theoretical model of glacial melting can capture the empirically observed features of the so-called Østrem curve (a plot of the melt rate as a function of debris depth). Specifically, we show that the turning point in the Østrem curve can be caused by two distinct mechanisms: the increase in the proportion of ice that is debris-covered and/or a reduction in the evaporative heat flux as the debris layer thickens. This second effect causes an increased melt rate because the reduction in (latent) energy used for evaporation increases the amount of energy available for melting. Our model provides an explicit prediction for the melt rate and the temperature distribution within the debris layer, and provides insight into the relative importance of the two effects responsible for the maximum in the Østrem curve. We use the data of Nicholson and Benn (2006) to show that our model is consistent with existing empirical measurements.
The registration of gamma rays in a spark chamber has been simulated by Monte-Carlo-calculation technique. The spark chamber pictures of these gamma-ray events having a known energy and direction of incidence have been analysed for determinability of direction of incidence. The values obtained for angular resolution depending on energy are compared with values derived by other authors.
The ESRO satellite COS-B carries one single experiment aiming at the measurement of arrival direction and energy of celestial gamma rays with energies between 25 MeV and 10 GeV. The experiment is conventional in design and consists of a veto counter, a wire spark chamber, a telescope and an energy calorimeter.
The energy measurement is obtained by a CsI scintillation crystal of 4.7 radiation length thickness. The expected energy resolution at 100 MeV is 50% FWHM. The other detector elements are designed as to cause the least possible degradation of the energy measurement.
The possibilities for the detection of a small contribution of π -origin gamma rays in the presence of a power-law type background spectrum will be discussed.
The United States Naval Observatory (NAVOBSY) and the Naval Research Laboratory (NRL) are collaborating in a program to apply radio interferometric techniques to the determination of variations in Earth rotation, polar motion, and improved astronomical position reference systems. Investigations of VLBI and connected interferometer techniques and radio sources for astrometic application have been in progress for several years as part of the NRL radio astronomy program, and currently NRL and NAVOBSY are carrying out experimental programs to investigate VLBI time transfer techniques and UT determination using the connected element interferometer of the NRAO in Green Bank. Some previous results of observations using the Green Bank interferometer and proposed plans for operation as a dedicated system over a period of time to evaluate effectiveness for precise determination of Earth rotation parameters are discussed.
Shared decision making has been advocated as a means to improve patient-orientation and quality of health care. There is a lack of knowledge on clinical decision making and its relation to outcome in the routine treatment of people with severe mental illness. This study examined preferred and experienced clinical decision making from the perspectives of patients and staff, and how these affect treatment outcome.
“Clinical Decision Making and Outcome in Routine Care for People with Severe Mental Illness” (CEDAR; ISRCTN75841675) is a naturalistic prospective observational study with bimonthly assessments during a 12-month observation period. Between November 2009 and December 2010, adults with severe mental illness were consecutively recruited from caseloads of community mental health services at the six study sites (Ulm, Germany; London, UK; Naples, Italy; Debrecen, Hungary; Aalborg, Denmark; and Zurich, Switzerland). Clinical decision making was assessed using two instruments which both have parallel patient and staff versions: (a) The Clinical Decision Making Style Scale (CDMS) measured preferences for decision making at baseline; and (b) the Clinical Decision Making Involvement and Satisfaction Scale (CDIS) measured involvement and satisfaction with a specific decision at all time points. Primary outcome was patient-rated unmet needs measured with the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS). Mixed-effects multinomial regression was used to examine differences and course over time in involvement in and satisfaction with actual decision making. The effect of clinical decision making on the primary outcome was examined using hierarchical linear modelling controlling for covariates (study centre, patient age, duration of illness, and diagnosis). Analysis were also controlled for nesting of patients within staff.
Of 708 individuals approached, 588 adults with severe mental illness (52% female, mean age = 41.7) gave informed consent. Paired staff participants (N = 213) were 61.8% female and 46.0 years old on average. Shared decision making was preferred by patients (χ2 = 135.08; p < 0.001) and staff (χ2 = 368.17; p < 0.001). Decision making style of staff significantly affected unmet needs over time, with unmet needs decreasing more in patients whose clinicians preferred active to passive (−0.406 unmet needs per two months, p = 0.007) or shared (−0.303 unmet needs per two months, p = 0.015) decision making.
Decision making style of staff is a prime candidate for the development of targeted intervention. If proven effective in future trials, this would pave the ground for a shift from shared to active involvement of patients including changes to professional socialization through training in principles of active decision making.
Introduction: Effective interventions for smoking cessation are critically needed. Yoga has only begun to be evaluated for smoking cessation.
Aims: The primary aim was to assess participant satisfaction and perceived benefit of Hatha yoga. Secondary aims were to test evaluation tools, recruitment and retention techniques, and to generate preliminary effect size for a randomized trial.
Methods: This was a non-randomized, single-group, pilot study. Thirty-one participants entered the study and received group behavioural therapy followed by 30 minutes of Hatha yoga instruction. Participant satisfaction was assessed at the conclusion of eight sessions. Point prevalence smoking abstinence was assessed at the end of the intervention period.
Results: Participants were 36% male with an average age of 47 years (range 22–72) and a mean of 12.7 ± 5.6 cigarettes per day. Mean duration of smoking was 26.1 ± 15 years. Participant satisfaction was very high (88% very satisfied). Smoking abstinence at the end of the intervention was 29%.
Conclusions: Hatha yoga is acceptable and feasible to aid in smoking cessation. A regimen that includes breathing, postures, and meditation has been developed for testing in a randomized trial.
We investigate the structure, growth morphology and the related electro-optical properties of gallium nitride (GaN) films deposited on (0001) sapphire substrates by gas source molecular beam epitaxy (GSMBE) and use transmismission electron microscopy, atomic force microscopy and scanning tunneling microscopy, photoluminescence (PL) and cathodoluminescence (CL). We find two types of specimens: one type which shows a strong UV luminescence (band-to-band transition at 358nm/3.46eV) in CL and PL and only faint yellow luminescence (Gaussian shaped CL/PL peaks at around 528nm/2.35eV), specimen ‘B’, and another type, which shows a strong UV and a comparably strong yellow luminescence, specimen ‘Y’. These two types of specimens have a rough layer surface, specimen ‘Y’ even an islanded one with, facetted hexagonal islands with a width of 1-2μm at a height of 50nm. A correlation of spectrally resolved CL images to the observed defect structure shows: (i) the yellow luminescence is homogeneously distributed over the complete specimen for ‘B’ and ‘Y’ specimens. Our investigations strongly suggest the yellow luminescence to be related to screw dislocations with , which are found randomly distributed in ‘B’ and ‘Y’ specimens with a high density of 1.3·109cm−2; (ii) the strong UV luminescence in ‘Y’ specimens is located in the troughs between adjacent surface islands, where dislocations essentially in small angle grain boundaries of edge type, i.e. with or are located; (iii) in the case of the ‘B’ specimens these dislocations are randomly distributed and so is the luminescence.