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Total laryngectomy is often utilised to manage squamous cell carcinoma of the larynx or hypopharynx. This study reports on surgical trends and outcomes over a 10-year period.
A retrospective review of patients undergoing total laryngectomy for squamous cell carcinoma was performed (n = 173), dividing patients into primary and salvage total laryngectomy cohorts.
A shift towards organ-sparing management was observed. Primary total laryngectomy was performed for locoregionally advanced disease and utilised reconstruction less than salvage total laryngectomy. Overall, 11 per cent of patients developed pharyngocutaneous fistulae (primary: 6 per cent; salvage: 20 per cent) and 11 per cent neopharyngeal stenosis (primary: 9 per cent; salvage: 15 per cent). Pharyngocutaneous fistulae rates were higher in the reconstructed primary total laryngectomy group (24 per cent; 4 of 17), compared with primary closure (3 per cent; 3 of 90) (p = 0.02). Patients were significantly more likely to develop neopharyngeal stenosis following pharyngocutaneous fistulae in salvage total laryngectomy (p = 0.01) and reconstruction in primary total laryngectomy (p = 0.02). Pre-operative haemoglobin level and adjuvant treatment failed to predict pharyngocutaneous fistulae development.
Complications remain hard to predict and there are continuing causes of morbidity. Additionally, prior treatment continues to affect surgical outcomes.
Animal studies have suggested that exposure of the middle ear to topical local anaesthesia may be ototoxic. This study aimed to report sensorineural hearing outcomes and patients’ satisfaction in those who underwent myringotomy and ventilation tube insertion using topical local anaesthesia.
Twenty-nine patients (32 ears) were operated on. Pre- and post-operative audiology findings were compared. A Likert-type questionnaire on treatment satisfaction was completed at the end of the procedure.
Median patient age was 55 years (range, 27–88 years). Pre- and post-operative bone conduction pure tone averages were 26.76 dB and 25.26 dB respectively (mean reduction of −1.22 dB, 95 per cent confidence interval of −5.91 to 8.13 dB; p = 0.7538). One ear (3 per cent) had a reduction in pure tone average of 10 dB.
The results suggest that sensorineural hearing loss is not a complication of ear exposure to topical local anaesthesia during myringotomy and ventilation tube insertion. The procedure was well perceived.
Results are presented from our ongoing studies of Titan using ALMA during the period 2012-2015, including a confirmation of the previous detection of vinyl cyanide (C2H3CN), as well as the first spatial map for this species on Titan. Simultaneous mapping of HC3N, CH3CN and C2H5CN reveal characteristic abundance patterns for each species that provide insight into their individual photochemical lifetimes, and help inform our understanding of Titan’s unique, time-variable atmospheric chemistry and global circulation. A time-sequence of HC3N maps covering 38 months reveals a dramatic change in the distribution of this gas consistent with high-altitude photochemical production followed by advection towards the southern (winter) pole, combined with rapid loss in the north after Titan’s 2009 seasonal equinox. The 2015 C2H3CN and C2H5CN maps show abundance peaks in Titan’s southern hemisphere, similar to those observed for the short-lived HC3N molecule. The longer-lived CH3CN, on the other hand, remains more concentrated in the north.
Despite aggressive multimodal therapy, human glioblastoma (hGBM), a highly malignant grade IV astrocytic tumour, remains incurable and inevitably relapses. Recent data has implicated intratumoral heterogeneity as the driver of therapy resistance and tumour relapse in hGBM. Thus models that capture the evolving hGBM biology in response to chemoradiotherapy will allow for the identification of cellular pathways that govern GBM therapy failure. In this study, we have developed a novel model to profile the clonal evolution of treatment naïve brain tumour initiating cell (BTIC) enriched hGBMs through chemoradiotherapy using: stem cell assays, BTIC marker expression and transcriptome analysis, immunohistochemistry, and cellular DNA barcoding technology. We report that treatment of hGBM BTICs leads to increased self-renewal capacity and higher transcript expression of stem cell genes Bmi1 and Sox2. Based on global transcriptome analysis of the in vitro treated hGBM, we also identify a hyper-aggressive form of glioma. Using our therapy-adapted hGBM-mouse xenograft model, we discover that despite tumour regression and increased mouse survival post-therapy, tumour relapse remains inevitable. The treatment-refractory cells again have increased self-renewal capacity and higher expression of Bmi1 and Sox2. Furthermore, by combining cellular DNA barcoding technology, which barcodes hGBM at single cell resolution, with our novel in vitro and in vivo therapy models, we are able to determine whether a pre-existing or a therapy driven subpopulation(s) seeds hGBM tumour relapse. Profiling the dynamic nature of heterogeneous hGBM subpopulations through disease progression and treatment may lead to the identification of novel therapeutic targets for the treatment of recurrent hGBM.
The development of complex social organisation and trade networks during the first and second millennia AD in the Sahel region of West Africa has long been hampered by a paucity of reliable data. Investigations at Birnin Lafiya, a large settlement mound of this period on the eastern arc of the Niger River, help to fill this gap. The site can now be placed within its broader landscape, and discoveries of early mud architecture, circular structures, human burial remains, personal ornamentation and striking potsherd pavements can be contrasted with contemporary sites both within the inland Niger region and at Ife to the south.
Provision of non-pharmacological interventions is a common policy objective for people with dementia, and support groups are an increasingly common intervention. However, there have been few attempts to synthesize evidence on the effectiveness of support groups for people with dementia. This review investigated the outcomes of support groups for people with dementia, explored participant characteristics and reviewed group formats.
A systematic review was undertaken and a narrative synthesis of data from 29 papers (reporting on 26 groups and a survey of a range of groups) was conducted.
Support groups seem acceptable to people with dementia. Qualitative studies report subjective benefits for participants but there is limited evidence of positive outcomes based on quantitative data. Samples have tended to be homogenous and this may limit the generalizability of findings.
Although qualitative studies will remain important in this area, further mixed-methods randomized controlled trials (RCTs)or comparison group studies with longer follow-up periods are needed to strengthen the evidence base.
This paper examines long-term care insurance sales to assess whether state income tax subsidies are effective in encouraging the private purchase of long-term care insurance. Drawing from the most comprehensive available sales data on long-term care insurance policies, cross-state and over-time variation in sales data during the late 1990s and early 2000s are analysed. This analysis uses a panel model with fixed effects controls for potential endogeneity between state provision of tax subsidies and actual sales of long-term care insurance policies. Income, health and family support factors are significant determinants in the sale of long-term care insurance, but the tax incentives provided by many state governments do not induce any more sales of long-term care insurance than could be expected without such incentives. These costly subsidies have not been prudent uses of public dollars, and have not helped states cope with the challenge of long-term care costs.
Titan's atmosphere harbors a suite of hydrocarbons and nitrogen-bearing compounds formed from the dissociation of the two main species, nitrogen (N2)and methane (CH4). It also contains oxygen compounds, likely produced from an influx of water and/or oxygen. The mixing ratios of these photochemical species vary with altitude, latitude, and time as a consequence of various chemical sources and sinks and of the atmospheric transport that redistributes them both vertically and horizontally. It is important to characterize and monitor the distribution of these chemical species because they play an important role in the radiative budget and provide insight into the seasonally varying atmospheric circulation. They can also help us understand the complex chemistry at work in Titan's atmosphere, leading to the formation of thick haze layers, which in turn affect the heat balance and general circulation. This chapter reviews the neutral composition of Titan's atmosphere, from the troposphere up to the thermosphere (~ 1400 km), and its vertical, horizontal, and temporal variations. These topics are interwoven with the origin and evolution, the general circulation, the clouds and weather, and the atmospheric chemistry of Titan that are the subjects of Chapters 1, 4, 6, and 7.
5.1.1 Historical perspective
The first unquestionable evidence for an atmosphere on Titan was the discovery of several absorption bands of methane in near-infrared spectra of the satellite (Kuiper, 1944). But it was not until the 1970s that Titan became an object of intense study.
To assess the effectiveness of a brief face-to-face health promotion intervention which included a ‘pledge’ using brief negotiation techniques, compared with standard advice-giving techniques, delivered in a community setting.
A parallel group pre–post design using randomised matched groups. Lifestyle helpers delivered the intervention (one consultation per participant). Diet, physical activity and anthropometric measurements were collected at baseline, 6 months and 12 months. Qualitative data were also collected.
Adults living in low socio-economic areas.
Recruitment and engagement of lifestyle helpers was difficult, and initial expectations that local health authority staff working in the community and community champions would act as lifestyle helpers were not realised. As a consequence, recruitment of participants was lower than anticipated. One hundred and twenty-eight adults were recruited and the retention rate was 48 % at 12 months. Barriers to participation included poor health and competing commitments. No significant differences in change in diet or physical activity behaviours, or BMI, between the intervention and control groups were observed. The control group had a significantly greater decrease in waist circumference at 12 months compared with the intervention group.
This exploratory trial provides important insights in terms of recruiting lifestyle helpers for community-based health promotion interventions, specifically (i) the priorities and limitations in terms of time (regardless of their general enthusiasm) for staff employed by the local health authority, and (ii) the willingness of potential community champions to serve their local community in areas where community identity and ‘spirit’ are seen as lacking.
This study sought to investigate whether an individual difference in beliefs regarding the importance of controlling intrusive thoughts influenced the effect of suppressing negative autobiographical memories. In Phase I of the study, 165 undergraduate students completed the control-subscale of the Interpretations of Intrusions Inventory (III-31). Students with scores in the top (strong beliefs) and bottom (weak beliefs) 30% of the III-31 were selected to participate in Phase II. In Phase II an equal number of students with these ‘strong’ and ‘weak’ beliefs (N = 60) were randomised to either a thought suppression or control condition. As expected, instructions to suppress resulted in a rebound effect; however, contrary to predictions, differences in beliefs regarding the importance of controlling intrusive thoughts did not influence thought suppression ability. The implications of the findings for understanding the influence of metacognition on thought suppression are discussed.
Over an eight-year period, harvesting methods based on simple mechanical aids (blade and shear) were evaluated against hand harvesting on mature morphologically contrasting tea clones in Southern Tanzania. The effects of shear step height (5–32 mm) and the harvest interval (1.8–4.2 phyllochrons) were also examined. Except in the year following pruning, large annual yields (5.7–7.9 t dry tea ha−1) were obtained by hand harvesting at intervals of two phyllochrons. For clones K35 (large shoots) and T207 (small shoots), the mean harvested shoot weights were equivalent to three unfurled leaves and a terminal bud. The proportions of broken shoots (40–48 %) and coarse material (4–6 %) were both relatively high. Using a blade resulted in similar yields to hand harvesting from K35 but larger yields from T207 (+13 %). The yield increase from clone T207 was associated with the harvest of more shoots and heavier shoots, smaller increases in canopy height, and a higher proportion (7–9 %) of coarse material compared to hand harvesting. On bushes, which had been harvested by hand for two years following pruning, using flat shears (no step) supported on the tea canopy resulted, over a three year period, in yields 8–14 % less than those obtained by hand harvesting and, for clone K35, a reduction in the leaf area index to below 5. The development of a larger leaf area index is made possible by adding a step to the shear. However, since annual yields were reduced by 40–50 kg ha−1 per mm increase in step height, the step should be the minimum necessary to maintain long-term bush productivity. As mean shoot weights following shear harvesting were about 13 % below those obtained by hand harvesting, there is scope, when using shears, to extend the harvest interval from 2 to 2.5 phyllochrons.
Introduction: We tested the hypothesis that repeated autoclaving removes protein deposits from the classic laryngeal mask airway (LMA). Methods: Twenty previously used LMAs were hand washed, machine washed, dried, autoclaved and randomly allocated into four equal-sized groups for repeat autoclaving on 0 (control), 1, 2 and 3 occasions. After the final autoclave cycle, the LMAs were immersed in a protein-staining solution, rinsed, dried and a high-resolution digital image taken of the dorsal and ventral surfaces. The severity of staining was scored by two blinded observers. Results: All LMAs were stained. There was no reduction in staining with repeat autoclaving. Conclusions: Repeat autoclaving does not remove protein deposits from the LMA.
This paper attempts to unpack strengths-based practice in social welfare in order to reveal the location of social justice within such an approach. Firstly, this paper will briefly explore the origins of a strengths approach, including historical development of the approach, mentioning some specific practice theories. The paper will then investigate the concepts, using Jim Ife's (1998) model of a social justice perspective in community development to achieve this.
The two approaches will then be discussed in terms of how they should be used together to support not only positive casework, but effective social action, using the work of UnitingCare Burnside as examples.
Cadmium (Cd) accumulates in the human food chain and poses a risk of kidney dysfunction (Fanconi Syndrome) and bone disorders in humans. The margin of safety between typical Cd intakes by humans and levels associated with toxicity is smaller than for other metals. Consumption of just one sheep kidney could cause an average adult person to exceed their Provisional Maximum Tolerable Daily Intake. However, the rate of accumulation in sheep’s liver and kidney, the primary target organs for Cd accumulation, is unclear. This makes prediction of the effects of varying Cd intake by sheep on the Cd concentration in these organs difficult. We undertook a meta-analysis of independent feeding trials, which sought to integrate previous findings in order to review existing legislation on permitted levels of Cd in animal feeds and organs. Resulting predictions on Cd accumulation in sheep liver and kidneys are applicable to the broad set of exposure situations investigated in the individual studies.
For most of the Twentieth Century the angiosperm archetypal flower has been viewed as relatively large, multiparted, with spirally arranged fleshy appendages, and as being probably beetle pollinated as in some extant Magnoliales. However, the preponderance of fossil evidence indicates that flowers with such characters do not appear until the mid-Cretaceous, well after smaller simpler fossil flowers such as platanoids and chloranthoids. Winteraceous and Chloranthaceous pollen appears more or less simultaneously in the Lower Cretaceous, but rapidly mounting evidence for mosaicism in Cretaceous taxa makes it unwise to extrapolate floral structure on the basis of dispersed pollen. Mid-Late Cretaceous fossils illustrate an increasing proportion of simple flowered Rosidae in the angiosperm flora. We report new fossil evidence of charcoalified flowers and fruits representing at least 20–30 diverse angiosperm taxa from the Cenomanian and Turonian deposits of the Atlantic Coastal Plain. These fossil flowers include representatives with hypanthia and floral cups, sympetaly, syncarpy, inferior ovaries, campylotropous ovules, nectaries of various forms, specialized anther dehiscence, epipetalous stamens, and connate filament tubes. Major taxonomic groups (as defined by Cronquist) represented by these fossils include Dilleniidae, Magnoliidae, Rosidae, monocots, and possibly Caryophyllidae. Thus, the early Late Cretaceous angiosperm flora had greater floral diversity than has previously been documented. This array of floral structures includes features that are now associated with bees and other specialized insect pollinators, thus providing a new perspective on the evolution of insect pollination.