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Tonsillectomy is one of the most common otolaryngological procedures. Nonetheless, there is still no universally approved ‘gold standard’ technique.
To compare the safety and efficacy of argon plasma coagulation and coblation techniques in tonsillectomy.
A multi-institutional, retrospective cohort study was conducted, comprising 283 patients who underwent bilateral tonsillectomies performed by a single surgeon between 2014 and 2017. The outcome measures included: operative time, intra-operative blood loss, post-operative pain and post-operative haemorrhage.
In the argon plasma coagulation group, mean operative time and post-operative haemorrhage rate were significantly reduced, p = 0.0006 and p = 0.003 respectively. There was no statistically significant difference between the two groups in terms of post-operative pain and intra-operative blood loss.
The argon plasma coagulation technique is easy, safe and efficacious. Argon plasma coagulation tonsillectomy seems cost-effective compared to coblation tonsillectomy: the single-use disposable electrode tip and wand used in this study cost AUD$76.50 and AUD$380 respectively. Argon plasma coagulation appears to be a favourable alternative to current modalities such as coblation.
Type 2 diabetes (T2D) is a chronic disease that disproportionately affects Indigenous Australians. We have previously reported the localization of a novel T2D locus by linkage analysis to chromosome 2q24 in a large admixed Indigenous Australian pedigree (Busfield et al. (2002). American Journal of Human Genetics, 70, 349–357). Here we describe fine mapping of this region in this pedigree, with the identification of SNPs showing strong association with T2D: rs3845724 (diabetes p = 7 × 10−4), rs4668106 (diabetes p = 9 × 10−4) and rs529002 (plasma glucose p = 3 × 10−4). These associations were successfully replicated in an independent collection of Indigenous Australian T2D cases and controls. These SNPs all lie within the gene encoding ceramide synthase 6 (CERS6) and thus may regulate ceramide synthesis.
Previous work presented by the author at these conferences has been summarized by G.N. Ramachandran in “Treatise on Collagen I , 177-8”. Epitactic crystallization of amides and diols in the collagen lattice of formalinized rat tail tendon, with equatorial expansion of the collagen lattice, was used to visualize the core diameter of each coil in the triple spiral at 7A and the vertical repeat of the hydrogen-bonding unit at 5.2A. Expansion of the non - formalinized collagen lattice has been observed as high as 20.1A when 1, 4-trans-(bisamino-methyl) - cyclo-hexane was inserted between the hexagonal array of protein spirals in the collagen lattice, the length of the inserted molecule being 13A. With dimensions based on Fisher - Hirschfelder - Taylor atomic models, with maximum extension of the dihydroxy compounds, the a. parameter of the expanded collagen would be expected to increase from 16.5A in the case of glycol to 20.6A in the case of 1, 5 - pentanediol, but actually the parameter decreases from 18.3A in the case of glycol to 16.2A in the case of 1, 5 - pentanediol. The larger figure in the case of glycol is explained by its hydrogen bonded dimerization. 1,3 propanediol fits in to the collagen lattice as its extended form. In the case of the other compounds, the chains are folded and fit together with Vander Waals bonding, and produce progressively smaller parameters for the a axis in collagen. In this nonaqueous equilibrium the non - formalinized collagen core diameter averages 7.7A ±0.2 and the spacing of hydrogen bond contacts along the collagen fiber axis is 4.8 ±0.2A.
The normal hexagonal structure of collagen is rearranged to tetragonal by treatraent of rat-tail tendon with two molar tetra-methylammonium chloride. The tetragonal parameters are a = 19.9 and c = 29.6A. Quite regular packing is indicated by the clarity of the X-ray diffractogram. The diffractogram clarity is greatly improved with respect to the collagen treated only with saline solution, and is considerably improved with respect to collagen oriented by cross-linking with aliphatic diols.
Rat tail tendons were fixed in 4% formaldehyde at 250 g tension, soaked in nearly saturated solution of the amides involved, and dried while still under tension. X-ray diffraction patterns, taken with rotation around the collagen fiber axis, showed well-defined layer lines of the amide and usually substantial expansion of the collagen equatorial spacing.
The layer lines on collagen, in two cases on abnormal or polymorphic axes, are clustered around the number 4.86 ± 0.33 Å, or a figure twice this, implying the presence of a repeating hydro gen-bond accepting group such as the carbonyl group at this interval. The prominent collagen layer line at 9.4 Å is approximately double this interval.
By soaking formalinized rat-tail tendons in 2 M resorcinol, the tendon lattice is expanded equatorially from an interplanar spacing of 11.7 Å to 14.5 Å, indicating a diameter of 7.2 Å for the spiral core of collagen. Resorcinol distorts the lattice of nylon (6:6), converting the normal triclinic cell to an orthorhombic cell whose a and b axes are approximately four times those of the original nylon and whose c axis is reduced from 17.2 to 16.5 Å.
Soldier operational performance is determined by their fitness, nutritional status, quality of rest/recovery, and remaining injury/illness free. Understanding large fluctuations in nutritional status during operations is critical to safeguarding health and well-being. There are limited data world-wide describing the effect of extreme climate change on nutrient profiles. This study investigated the effect of hot-dry deployments on vitamin D status (assessed from 25-hydroxyvitamin D (25(OH)D) concentration) of young, male, military volunteers. Two data sets are presented (pilot study, n 37; main study, n 98), examining serum 25(OH)D concentrations before and during 6-month summer operational deployments to Afghanistan (March to October/November). Body mass, percentage of body fat, dietary intake and serum 25(OH)D concentrations were measured. In addition, parathyroid hormone (PTH), adjusted Ca and albumin concentrations were measured in the main study to better understand 25(OH)D fluctuations. Body mass and fat mass (FM) losses were greater for early (pre- to mid-) deployment compared with late (mid- to post-) deployment (P<0·05). Dietary intake was well-maintained despite high rates of energy expenditure. A pronounced increase in 25(OH)D was observed between pre- (March) and mid-deployment (June) (pilot study: 51 (sd 20) v. 212 (sd 85) nmol/l, P<0·05; main study: 55 (sd 22) v. 167 (sd 71) nmol/l, P<0·05) and remained elevated post-deployment (October/November). In contrast, PTH was highest pre-deployment, decreasing thereafter (main study: 4·45 (sd 2·20) v. 3·79 (sd 1·50) pmol/l, P<0·05). The typical seasonal cycling of vitamin D appeared exaggerated in this active male population undertaking an arduous summer deployment. Further research is warranted, where such large seasonal vitamin D fluctuations may be detrimental to bone health in the longer-term.
Herbicide resistance is ‘wicked’ in nature; therefore, results of the many educational efforts to encourage diversification of weed control practices in the United States have been mixed. It is clear that we do not sufficiently understand the totality of the grassroots obstacles, concerns, challenges, and specific solutions needed for varied crop production systems. Weed management issues and solutions vary with such variables as management styles, regions, cropping systems, and available or affordable technologies. Therefore, to help the weed science community better understand the needs and ideas of those directly dealing with herbicide resistance, seven half-day regional listening sessions were held across the United States between December 2016 and April 2017 with groups of diverse stakeholders on the issues and potential solutions for herbicide resistance management. The major goals of the sessions were to gain an understanding of stakeholders and their goals and concerns related to herbicide resistance management, to become familiar with regional differences, and to identify decision maker needs to address herbicide resistance. The messages shared by listening-session participants could be summarized by six themes: we need new herbicides; there is no need for more regulation; there is a need for more education, especially for others who were not present; diversity is hard; the agricultural economy makes it difficult to make changes; and we are aware of herbicide resistance but are managing it. The authors concluded that more work is needed to bring a community-wide, interdisciplinary approach to understanding the complexity of managing weeds within the context of the whole farm operation and for communicating the need to address herbicide resistance.
Seven half-day regional listening sessions were held between December 2016 and April 2017 with groups of diverse stakeholders on the issues and potential solutions for herbicide-resistance management. The objective of the listening sessions was to connect with stakeholders and hear their challenges and recommendations for addressing herbicide resistance. The coordinating team hired Strategic Conservation Solutions, LLC, to facilitate all the sessions. They and the coordinating team used in-person meetings, teleconferences, and email to communicate and coordinate the activities leading up to each regional listening session. The agenda was the same across all sessions and included small-group discussions followed by reporting to the full group for discussion. The planning process was the same across all the sessions, although the selection of venue, time of day, and stakeholder participants differed to accommodate the differences among regions. The listening-session format required a great deal of work and flexibility on the part of the coordinating team and regional coordinators. Overall, the participant evaluations from the sessions were positive, with participants expressing appreciation that they were asked for their thoughts on the subject of herbicide resistance. This paper details the methods and processes used to conduct these regional listening sessions and provides an assessment of the strengths and limitations of those processes.
Alcohol use is commonly initiated during adolescence, with earlier onset known to increase the risk for alcohol use disorder (AUD). Altered function in neural reward circuitry is thought to increase the risk for AUD. To test the hypothesis that adolescent alcohol misuse primes the brain for alcohol-related psychopathology in early adulthood, we examined whether adolescent alcohol consumption rates predicted reward responsivity in the ventral striatum (VS), and in turn, AUD symptoms in adulthood.
A total of 139 low income, racially diverse urban males reported on their alcohol use at ages 11, 12, 15, and 17; completed self-reports of personality, psychiatric interviews, and a functional magnetic resonance imaging (fMRI) scan at age 20; and completed a psychiatric interview at age 22. We measured adolescent alcohol use trajectories using latent growth curve modeling and measured neural responses to monetary reward using a VS region of interest. We tested indirect effects of adolescent alcohol use on AUD symptoms at age 22 via VS reward-related reactivity at age 20.
Greater acceleration in adolescent alcohol use predicted increased VS response during reward anticipation at age 20. VS reactivity to reward anticipation at age 20 predicted AUD symptoms at age 22, over and above concurrent symptoms. Accelerated adolescent alcohol use predicted AUD symptoms in early adulthood via greater VS reactivity to reward anticipation.
Prospective findings support a pathway through which adolescent alcohol use increases the risk for AUD in early adulthood by impacting reward-related neural functioning. These results highlight increased VS reward-related reactivity as a biomarker for AUD vulnerability.
We present the first results of simultaneous INTEGRAL and RXTE observations of the microquasar GRS 1915+105. We focus on the analysis of the unique highly variable observation and show that we might have observed a new class of variability. We then study the energetic depenelence of a low frequency QPO from our steady observations.
To assess if there is a difference in salt intake (24 h urine collection and dietary recall) and dietary sources of salt (Na) on weekdays and weekend days.
A cross-sectional study of adults who provided one 24 h urine collection and one telephone-administered 24 h dietary recall.
Community-dwelling adults living in the State of Victoria, Australia.
Adults (n 598) who participated in a health survey (53·5 % women; mean age 57·1 (95 % CI 56·2, 58·1) years).
Mean (95 % CI) salt intake (dietary recall) was 6·8 (6·6, 7·1) g/d and 24 h urinary salt excretion was 8·1 (7·8, 8·3) g/d. Mean dietary and 24 h urinary salt (age-adjusted) were 0·9 (0·1, 1·6) g/d (P=0·024) and 0·8 (0·3, 1·6) g/d (P=0·0017), respectively, higher at weekends compared with weekdays. There was an indication of a greater energy intake at weekends (+0·6 (0·02, 1·2) MJ/d, P=0·06), but no difference in Na density (weekday: 291 (279, 304) mg/MJ; weekend: 304 (281, 327) mg/MJ; P=0·360). Cereals/cereal products and dishes, meat, poultry, milk products and gravy/sauces accounted for 71 % of dietary Na.
Mean salt intake (24 h urine collection) was more than 60 % above the recommended level of 5 g salt/d and 8–14 % more salt was consumed at weekends than on weekdays. Substantial reductions in the Na content of staple foods, processed meat, sauces, mixed dishes (e.g. pasta), convenience and takeaway foods are required to achieve a significant consistent reduction in population salt intake throughout the week.
Evidence from the Piovego, the fraud magistracy of early modern Venice, offers a critical perspective on the documentary record of credit and the ways in which this was used in practice. Although it was formally illegal to charge interest on personal loans, a variety of legal fictions were employed to evade the ban. Such fictions significantly reduced the transparency and certainty of exchange, pushing personal loans into a world of semi-legality. This was a ‘baroque economy’, in which people were aware of the potential discrepancy between surface form and underlying substance, and private agreements might be contested on grounds of substantive fairness. The ‘hidden transcripts’ presented by litigants indicate that the formal record must be interpreted through a ‘thick description’ that considers its role as a resource in a broader process of negotiation. Far from being a ‘market’, characterized by price competition, choice, and transparency, the informal economy of credit was embedded in long-term power relationships. Rather than celebrating intermediaries such as brokers and notaries as facilitators of ‘market’ relations, we need to understand them as part of a hierarchical network of power and wealth, embedded in long-term relationships.
Accurate and reproducible patient positioning is a critical step in radiotherapy for breast cancer. This has seen the use of permanent skin markings becoming standard practice in many centres. Permanent skin markings may have a negative impact on long-term cosmetic outcome, which may in turn, have psychological implications in terms of body image. The aim of this study was to investigate the feasibility of using a semi-permanent tattooing device for the administration of skin marks for breast radiotherapy set-up.
Materials and methods
This was designed as a phase II double-blinded randomised-controlled study comparing our standard permanent tattoos with the Precision Plus Micropigmentation (PPMS) device method. Patients referred for radical breast radiotherapy were eligible for the study. Each study participant had three marks applied using a randomised combination of the standard permanent and PPMS methods and was blinded to the type of each mark. Follow up was at routine appointments until 24 months post radiotherapy. Participants and a blind assessor were invited to score the visibility of each tattoo at each follow-up using a Visual Analogue Scale. Tattoo scores at each time point and change in tattoo scores at 24 months were analysed by a general linear model using the patient as a fixed effect and the type of tattoo (standard or research) as covariate. A simple questionnaire was used to assess radiographer feedback on using the PPMS.
In total, 60 patients were recruited to the study, of which 55 were available for follow-up at 24 months. Semi-permanent tattoos were more visible at 24 months than the permanent tattoos. Semi-permanent tattoos demonstrated a greater degree of fade than the permanent tattoos at 24 months (final time point) post completion of radiotherapy. This was not statistically significant, although it was more apparent for the patient scores (p=0·071) than the blind assessor scores (p=0·27). No semi-permanent tattoos required re-marking before the end of radiotherapy and no adverse skin reactions were observed.
The PPMS presents a safe and feasible alternative to our permanent tattooing method. An extended period of follow-up is required to fully assess the extent of semi-permanent tattoo fade.
The spatio-temporal distribution of air temperature over mountain glaciers can demonstrate complex patterns, yet it is often represented simplistically using linear vertical temperature gradients (VTGs) extrapolated from off-glacier locations. We analyse a network of centreline and lateral air temperature observations at Tsanteleina Glacier, Italy, during summer 2015. On average, VTGs are steep (<−0.0065 °C m−1), but they are shallow under warm ambient conditions when the correlation between air temperature and elevation becomes weaker. Published along-flowline temperature distribution methods explain centreline observations well, including warming on the lower glacier tongue, but cannot estimate lateral temperature variability. Application of temperature distribution methods improves simulation of melt rates (RMSE) in an energy-balance model by up to 36% compared to the environmental lapse rate extrapolated from an off-glacier station. However, results suggest that model parameters are not easily transferable to glaciers with a small fetch without recalibration. Such methods have potential to improve estimates of temperature across a glacier, but their parameter transferability should be further linked to the glacier and atmospheric characteristics. Furthermore, ‘cold spots’, which can be >2°C cooler than expected for their elevation, whose occurrence is not predicted by the temperature distribution models, are identified at one-quarter of the measurement sites.
CCDs make the near-infrared spectral region out to about 1.1 μ observable. A good deal of information on the spectra of AGNs in this range has been published, which we are trying to systematize and extend at Lick. Our original lens-grism spectrograph camera is opaque over the region λ8600-λ10250, no doubt as a result of a coating on one of the elements of the Nikon lens, making this program impossible with it. However our newer “UV-Schmidt” camera is quite effective in this region. With it we have obtained well exposed spectra at moderate resolution (FWHM ≈ 7 Å) of NGC 4151 in three overlapping segments covering the region 7000–11000 Å. Also, for comparison we obtained similar spectra of NGC 1976, the Orion Nebula. The wavelengths and relative line fluxes were measured, and most of the lines were identified. The strongest three lines in both objects are, in order, [S III] λ9532, He I λ10830, and [S III] λ9069. The Orion Nebula spectrum is very helpful for identifying lines in NGC 4151, and for comparison with it. Among the lines identified in NGC 1976, many of them previously known, are [O II], [S II], [Ar III], [Fe II], [Ni II], [Ni III], [Cl II], [C I], in addition to O I λ8446, many H I Paschen lines and He I.
In a recent essay, Harker and coauthors stated that considering herbicide resistance as a wicked problem “without clear causes or solutions” ignores what weed scientists know about the biology and management of herbicide-resistant weeds. In this response, we argue that this misrepresents what is meant by “wicked” and that the wicked problem concept is valuable in understanding the multifaceted nature of herbicide resistance as a human-caused phenomenon.
Unusual speleothems, associated with hyperalkaline (pH > 12) groundwaters
have formed within a shallow, abandoned railway tunnel at Peak Dale,
Derbyshire, UK. The hyperalkaline groundwaters are produced by the leaching
of a thin layer (<2 m) of old lime-kiln waste on the soil-bedrock surface
above the tunnel by rainwater. This results in a different reaction and
chemical process to that more commonly associated with the formation of
calcium carbonate speleothems from Ca-HCO3-type groundwaters and
degassing of CO2. Stalagmites within the Peak Daletunnel have
grown rapidly (averaging 33 mm y–1), following the closure of the
tunnel 70 years ago. They have an unusual morphology comprising a central
sub-horizontally-laminated column of micro- to nano-crystalline calcium
carbonate encompassed by an outer sub-vertical assymetricripple-laminated
layer. The stalagmites are composed largely of secondary calcite forming
pseudomorphs (<1 mm) that we believe to be predominantly after the 'cold
climate' calcium carbonate polymorph, ikaite (calcium carbonate hexahydrate:
CaCO3·6H2O), withminor volumes of small (<5 μm)
pseudomorphs after vaterite. The tunnel has a near constant temperature of
8–9°C, which is slightly above the previously published crystallization
temperatures for ikaite (<6°C). Analysis of a stalagmite actively growing
at the time ofsampling, and preserved immediately within a dry nitrogen
cryogenic vessel, indicates that following crystallization of ikaite,
decomposition to calcite occurs rapidly, if not instantaneously. We believe
this is the first occurrence of this calcium carbonate polymorph observed