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Malignant otitis externa is a potentially fatal infection of the skull base. With an ageing population and increasing prevalence of diabetes, the incidence of malignant otitis externa in the British population is rising. To date, there remain no accepted diagnostic criteria, few prognostic indicators and no consensus treatment pathways.
A prospective case series was conducted at a tertiary referral teaching hospital.
A cohort of susceptible individuals predominates (elderly, male, with immunosuppression and diabetes), with 25 per cent reporting a preceding incident. Otorrhoea, otalgia and canal granulation were the commonest presenting features, alongside positive pseudomonas cultures. No clear markers for predicating disease severity were isolated; however, a high initial haemoglobin A1c level demonstrated a significant moderately positive correlation with length of treatment.
A treatment pathway designed to provide a standardised approach to investigation and treatment is proposed, which aims to increase earlier diagnosis, streamline care and facilitate the development of best practice.
During the 2009 influenza pandemic, a rapid assessment of disease severity was a challenge as a significant proportion of cases did not seek medical care; care-seeking behaviour changed and the proportion asymptomatic was unknown. A random-digit-dialling telephone survey was undertaken during the 2011/12 winter season in England and Wales to address the feasibility of answering these questions. A proportional quota sampling strategy was employed based on gender, age group, geographical location, employment status and level of education. Households were recruited pre-season and re-contacted immediately following peak seasonal influenza activity. The pre-peak survey was undertaken in October 2011 with 1061 individuals recruited and the post-peak telephone survey in March 2012. Eight hundred and thirty-four of the 1061 (78.6%) participants were successfully re-contacted. Their demographic characteristics compared well to national census data. In total, 8.4% of participants self-reported an influenza-like illness (ILI) in the previous 2 weeks, with 3.2% conforming to the World Health Organization (WHO) ILI case definition. In total, 29.6% of the cases reported consulting their general practitioner. 54.1% of the 1061 participants agreed to be re-contacted about providing biological samples. A population-based cohort was successfully recruited and followed up. Longitudinal survey methodology provides a practical tool to assess disease severity during future pandemics.
The Pueblo population of Chaco Canyon during the Bonito Phase (AD 800–1130) employed agricultural strategies and water-management systems to enhance food cultivation in this unpredictable environment. Scepticism concerning the timing and effectiveness of this system, however, remains common. Using optically stimulated luminescence dating of sediments and LiDAR imaging, the authors located Bonito Phase canal features at the far west end of the canyon. Additional ED-XRF and strontium isotope (87Sr/86Sr) analyses confirm the diversion of waters from multiple sources during Chaco’s occupation. The extent of this water-management system raises new questions about social organisation and the role of ritual in facilitating responses to environmental unpredictability.
This paper highlights the importance of reporting air–bone gap closure in stapes surgery according to the American Academy of Otolaryngology – Head and Neck Surgery guidelines and reviews compliance in recent years.
A retrospective case series was conducted and the outcomes were reviewed. Closure of the air–bone gap was calculated in 204 adult patients using the aforementioned guidelines. Results were recalculated ignoring the Carhart phenomenon to determine any significant difference. Adherence to guidelines was also reported as a secondary outcome.
Ignoring the Carhart phenomenon resulted in 75 per cent over-reporting of successful air–bone gap closure (p < 0.001). Over-reporting occurred in 5.9 per cent of papers, and in 11.8 per cent it was difficult to determine how the results were reached.
Despite the existence of clear guidelines, stapes surgery outcomes are still being over-reported as successful. This can lead to incorrect information being provided to patients during the consent process and makes comparative studies difficult.
The Taipan galaxy survey (hereafter simply ‘Taipan’) is a multi-object spectroscopic survey starting in 2017 that will cover 2π steradians over the southern sky (δ ≲ 10°, |b| ≳ 10°), and obtain optical spectra for about two million galaxies out to z < 0.4. Taipan will use the newly refurbished 1.2-m UK Schmidt Telescope at Siding Spring Observatory with the new TAIPAN instrument, which includes an innovative ‘Starbugs’ positioning system capable of rapidly and simultaneously deploying up to 150 spectroscopic fibres (and up to 300 with a proposed upgrade) over the 6° diameter focal plane, and a purpose-built spectrograph operating in the range from 370 to 870 nm with resolving power R ≳ 2000. The main scientific goals of Taipan are (i) to measure the distance scale of the Universe (primarily governed by the local expansion rate, H0) to 1% precision, and the growth rate of structure to 5%; (ii) to make the most extensive map yet constructed of the total mass distribution and motions in the local Universe, using peculiar velocities based on improved Fundamental Plane distances, which will enable sensitive tests of gravitational physics; and (iii) to deliver a legacy sample of low-redshift galaxies as a unique laboratory for studying galaxy evolution as a function of dark matter halo and stellar mass and environment. The final survey, which will be completed within 5 yrs, will consist of a complete magnitude-limited sample (i ⩽ 17) of about 1.2 × 106 galaxies supplemented by an extension to higher redshifts and fainter magnitudes (i ⩽ 18.1) of a luminous red galaxy sample of about 0.8 × 106 galaxies. Observations and data processing will be carried out remotely and in a fully automated way, using a purpose-built automated ‘virtual observer’ software and an automated data reduction pipeline. The Taipan survey is deliberately designed to maximise its legacy value by complementing and enhancing current and planned surveys of the southern sky at wavelengths from the optical to the radio; it will become the primary redshift and optical spectroscopic reference catalogue for the local extragalactic Universe in the southern sky for the coming decade.
Due to their extremely small luminosity compared to the stars they orbit, planets outside our own Solar System are extraordinarily difficult to detect directly in optical light. Careful photometric monitoring of distant stars, however, can reveal the presence of exoplanets via the microlensing or eclipsing effects they induce. The international PLANET collaboration is performing such monitoring using a cadre of semi-dedicated telescopes around the world. Their results constrain the number of gas giants orbiting 1–7 AU from the most typical stars in the Galaxy. Upgrades in the program are opening regions of “exoplanet discovery space” – toward smaller masses and larger orbital radii – that are inaccessible to the Doppler velocity technique.
The dates listed were obtained using a stainless steel counter with an active volume of 1.3 L and a background of 16.3 cpm at an absolute filling pressure of 152 cm Hg. The present proportional counter in use is made of O.F.H.C. copper, and has an active volume of 1.25 L and a background of 5.2 cpm, at an absolute counter filling pressure of 152 cm Hg. CO2 is used as the counting gas and the counter is filled to a pressure of between 76 cm and 228 cm of Hg (depending on the sample size) at a temperature of 23 ± 0.3°C. The counter is shielded, starting from the top, by 5 cm of lead and 26 cm of iron, and is surrounded by an array of 22 Geiger tubes, and then finally by 2.5 cm of mercury. The thickness of the sides and base is greater than 10 cm of iron. As yet no neutron shielding is used and this probably accounts for the large fluctuations of background with barometric pressure (0.32 cpm per 1 cm Hg change in the pressure).
We consider the action of independent and identically distributed n × n circulants S1, S2, … on V = [v1, …, vn] whose columns are the positions of n points in ℝd. The positions of the n points after m transformations are the columns of W(m) = VS1 … Sm. We describe, in several ways, the shape of the configuration of the points W(m) as m →∞. When n = 3, 4 and d = 2, a special discussion in terms of Moebius transformations is given.
X-ray binaries (XBs) dominate the X-ray emission of normal galaxies. The new X-ray satellite XMM will study the XB population of M31 in detail. The resulting M31 sample will significantly advance our understanding of the evolutionary history of XBs, and ultimately allow us to probe the star formation history of stellar populations by X-ray observations.
The four-fold advantage over a conventional 4 m reflector which naive information theory confers on the 1.2 m UK Schmidt telescope (Dawe and Watson 1982, Watson 1983) is only approachable in practice under certain rather specific conditions. These relate principally to the surface distribution on the sky of the object classes of interest, and the type of detection employed. Clearly, for general survey work with sky-limited photographic detection, the information advantage is high, but it can be demonstrated (Dawe and Watson 1983) that the relatively new technique of multi-object fibre-optics spectroscopy (eg Hill et al. 1980, 1982, Gray 1983, Lund and Enard 1983) with linear detectors offers very high potential in certain regimes of operation. In particular, the UK Schmidt telescope (UKST) equipped with 400 fibre channels has four times the effective light grasp (= number of fibres utilized × aperture) of a 4 m reflector (with a 1 deg field and equipped with any number of fibres) for target objects with surface densities between approximately 1 and 10 per square degree (Dawe and Watson 1983). Objects ranging from galactic variable stars to quasars lie within these limits, but of especial interest are galaxies, whose apparent luminosity function in this range of surface densities runs from magnitudes 15 to 17 (MacGillivray, private communication). Large-scale, medium accuracy (60 km s−1) redshift surveys of galaxies within this magnitude range promise to be extremely fruitful (Davis 1982) and are easily within the reach of the UKST fibre-coupled to a CCD spectrograph (Watson and Dawe 1984).
The ZZ Ceti stars form a class of variable white dwarfs: the hydrogen dominated atmosphere ones, which do pulsate in an instability strip in the effective temperature range 13000K-11500K. We know 22 such ZZ Ceti white dwarfs. Their variations are caused by nonradial g-mode pulsations with periods are in the range 100-1000 seconds.
A subsample of the ZZ Ceti stars shows amplitude variations on time scales of the order of one month. These variations could be driven by nonlinear phenomena.
The variability of CD-24 7599 (V=11.48 mag) was discovered by JCC during observing run XCOV7 of the Whole Earth Telescope (WET, Nather et al. 1990) network in February, 1992. The star was observed as an additional target and 117 hours of high-quality temporal spectroscopic observations were obtained.
Our analysis of these data revealed the presence of 7 independent pulsation modes between 27.0 and 38.1 cycles per day (313 – 441 μHz) with semiamplitudes of 2.1 – 10.2 milli-modulation amplitudes (mma). We showed that peaks at linear combination frequencies detected in the power spectra were not due to eigenmodes excited to visible amplitude by resonant mode coupling.
Since the development of intratympanic aminoglycoside in the 1950s, otologists have been able to chemically ablate the vestibule. We present the results of using low-dose intratympanic gentamicin to treat Ménière's disease.
A retrospective review was performed of all patients who underwent low-dose intratympanic gentamicin therapy over seven years. Data on gender, age, number of procedures, pure tone audiometry and symptom control were analysed.
In all, 38 patients underwent low-dose intratympanic gentamicin therapy. These comprised 25 females and 13 males, with an average age of 58.4 years. Hearing was preserved in 87.5 per cent of patients, with no significant difference before and after treatment (p = 0.744). In all, 85.7 per cent of patients had complete or substantial symptom control (classes A and B, respectively).
Low-dose intratympanic gentamicin therapy was effective in controlling the symptoms of Ménière's disease patients, while preserving hearing.
Gamma-ray burst host galaxies are deficient in molecular gas, and show anomalous metal-poor regions close to GRB positions. Using recent Australia Telescope Compact Array (ATCA) Hi observations we show that they have substantial atomic gas reservoirs. This suggests that star formation in these galaxies may be fuelled by recent inflow of metal-poor atomic gas. While this process is debated, it can happen in low-metallicity gas near the onset of star formation because gas cooling (necessary for star formation) is faster than the Hi-to-H2 conversion.
This study investigated whether patients who remain symptomatic more than a year following idiopathic facial paralysis gain benefit from tailored facial physiotherapy.
A two-year retrospective review was conducted of all symptomatic patients. Data collected included: age, gender, duration of symptoms, Sunnybrook facial grading system scores pre-treatment and at last visit, and duration of treatment.
The study comprised 22 patients (with a mean age of 50.5 years (range, 22–75 years)) who had been symptomatic for more than a year following idiopathic facial paralysis. The mean duration of symptoms was 45 months (range, 12–240 months). The mean duration of follow up was 10.4 months (range, 2–36 months). Prior to treatment, the mean Sunnybrook facial grading system score was 59 (standard deviation = 3.5); this had increased to 83 (standard deviation = 2.7) at the last visit, with an average improvement in score of 23 (standard deviation = 2.9). This increase was significant (p < 0.001).
Tailored facial therapy can improve facial grading scores in patients who remain symptomatic for prolonged periods.
The aim of this paper was to propose a guideline for the management of intrinsic facial nerve tumours based on our practice and findings in the literature.
A retrospective review of intrinsic facial nerve tumours over the last 15 years was performed. Parameters measured included age, presenting symptoms, pre- and post-treatment hearing and House–Brackmann grading, tumour position, treatment and duration of follow up.
A total of 15 patients presented with intrinsic facial nerve tumours over the study period. The most common presenting complaint was facial symptoms (93.3 per cent), followed by hearing loss (46.7 per cent). Three patients with stable facial nerve function (House–Brackmann grades II–III) were treated conservatively. Twelve patients underwent surgery to treat progressive or recurrent symptoms. Facial function was maintained or improved in 60.0 per cent of patients and hearing was preserved in 66.7 per cent.
We propose that all stable tumours associated with good facial function of grade III or below should be treated conservatively. For symptomatic or progressive lesions, tailored surgery depending on the tumour site and hearing level should be offered to preserve native nerve function and facial musculature. For patients with prolonged paralysis, tumours can be monitored and other forms of facial reanimation and support offered.
Background: Clinical perfectionism is a risk and maintaining factor for anxiety disorders, depression and eating disorders. Aims: The aim was to examine the psychometric properties of the 12-item Clinical Perfectionism Questionnaire (CPQ). Method: The research involved two samples. Study 1 comprised a nonclinical sample (n = 206) recruited via the internet. Study 2 comprised individuals in treatment for an eating disorder (n = 129) and a community sample (n = 80). Results: Study 1 factor analysis results indicated a two-factor structure. The CPQ had strong correlations with measures of perfectionism and psychopathology, acceptable internal consistency, and discriminative and incremental validity. The results of Study 2 suggested the same two-factor structure, acceptable internal consistency, and construct validity, with the CPQ discriminating between the eating disorder and control groups. Readability was assessed as a US grade 4 reading level (student age range 9–10 years). Conclusions: The findings provide evidence for the reliability and validity of the CPQ in a clinical eating disorder and two separate community samples. Although further research is required the CPQ has promising evidence as a reliable and valid measure of clinical perfectionism.