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Background: Endoscopic endonasal trans-sphenoidal surgery (EETS) is a commonly used approach for the surgical treatment of primary pituitary adenomas. The role of this approach in patients with recurrent disease remains unclear. Here we review a high-volume institutional experience with repeat EETS for recurrent pituitary adenomas and compare outcomes against primary surgeries. Methods: A retrospective chart review of patients who underwent EETS at Toronto Western Hospital from 2008-2016 for pituitary adenomas was completed. Baseline patient characteristics and surgical outcomes were recorded for each surgery. Primary and repeat operations were compared for analysis using Fisher’s exact test and t-test where appropriate. Results: 347 primary and 48 repeat surgery patients were identified. The median follow-up was 3.6 years (range 0-10.6 years). Rates of GTR, optic decompression, endocrinopathy cure, and visual improvement in repeat EETS were 44%, 21%, 22%, and 21%, respectively. While these rates are lower when compared to primary surgeries (75% p<0.001, 58% p<0.001, 75% p=0.01, 37% and p=0.04), they demonstrate that desirable outcomes are still achievable after EETS for recurrent disease. Conclusions: These results from a quaternary-care centre suggest that repeat EETS is a viable option that is safe and effective at improving the visual and endocrine status in select patients with recurrent pituitary disease.
Introduction: Abdominal pain is one of the most frequent reasons for an emergency department (ED) visit. Most cases are functional and no therapy has proven effective. Our objective was to determine if hyoscine butylbromide (HBB) (BuscopanTM) is effective for children who present to the ED with functional abdominal pain. Methods: We conducted a randomized, blinded, superiority trial comparing HBB 10 mg plus acetaminophen placebo to oral acetaminophen 15 mg/kg (max 975 mg) plus HBB placebo using a double-dummy approach. We included children 8-17 years presenting to the ED at London Health Sciences Centre with colicky abdominal pain rated >40 mm on a 100 mm visual analog scale (VAS). The primary outcome was VAS pain score at 80 minutes post-administration. Secondary outcomes included adverse effects; caregiver satisfaction with pain management using a five-item Likert scale; recidivism and missed surgical diagnoses within 24-hours of discharge. Analysis was based on intention to treat. Results: We analyzed 225 participants (112 acetaminophen; 113 HBB). The mean (SD) age was 12.4 (3.0) years and 148/225 (65.8%) were females. Prior to enrollment, the median (IQR) duration of pain prior was 2 (4.5) hours and analgesia was provided to 101/225 (44.9%) of participants. The mean (SD) pre-intervention pain scores in the acetaminophen and HBB groups were 62.7 (15.9) mm and 60.3 (17.3) mm, respectively. At 80 minutes, the mean (SD) pain scores in the acetaminophen and HBB groups were 30.1 (28.8) mm and 29.4 (26.4) mm, respectively and there were no significant differences adjusting for pre-intervention scores (p = 0.96). The median (IQR) caregiver satisfaction was high in the acetaminophen [5 (2)] and HBB [5 (1)] groups (p = 0.79). The median (IQR) length of stay between acetaminophen [235 (101)] and HBB [234 (103)] was not significantly different (p = 0.53). The proportion of participants with a return visit for abdominal pain was 4/112 (3.5%) in the acetaminophen group and 6/113 (5.3%) in the HBB group. The most common adverse effect was nausea (9% in each group) and there were no significant differences in adverse effects between acetaminophen (26/112, 23.2%) and HBB (31/113, 27.4%) (p = 0.52). There were no missed surgical diagnoses. Conclusion: For children with presumed functional abdominal pain who present to the ED, both acetaminophen and HBB produce a clinically important (VAS < 30 mm) reduction in pain and should be routinely considered in this clinical setting.
Geophysical flows occur over a large range of scales, with Reynolds numbers and Richardson numbers varying over several orders of magnitude. For this study, jets of different densities were ejected vertically into a large ambient region, considering conditions relevant to some geophysical phenomena. Using particle image velocimetry, the velocity fields were measured for three different gases exhausting into air – specifically helium, air and argon. Measurements focused on both the jet core and the entrained ambient. Experiments considered relatively low Reynolds numbers from approximately 1500 to 10 000 with Richardson numbers near 0.001 in magnitude. These included a variety of flow responses, notably a nearly laminar jet, turbulent jets and a transitioning jet in between. Several features were studied, including the jet development, the local entrainment ratio, the turbulent Reynolds stresses and the eddy strength. Compared to a fully turbulent jet, the transitioning jet showed up to 50 % higher local entrainment and more significant turbulent fluctuations. For this condition, the eddies were non-axisymmetric and larger than the exit radius. For turbulent jets, the eddies were initially smaller and axisymmetric while growing with the shear layer. At lower turbulent Reynolds number, the turbulent stresses were more than 50 % higher than at higher turbulent Reynolds number. In either case, the low-density jet developed faster than a comparable non-buoyant jet. Quadrant analysis and proper orthogonal decomposition were also utilized for insight into the entrainment of the jet, as well as to assess the energy distribution with respect to the number of eigenmodes. Reynolds shear stresses were dominant in Q1 and Q3 and exhibited negligible contributions from the remaining two quadrants. Both analysis techniques showed that the development of stresses downstream was dependent on the Reynolds number while the spanwise location of the stresses depended on the Richardson number.
A large eddy simulation framework is used to explore the structure of the turbulent flow in a thermally stratified wind turbine array boundary layer. The flow field is driven by a constant geostrophic wind with time-varying surface boundary conditions obtained from a selected period of the CASES-99 field experiment. Proper orthogonal decomposition is used to extract coherent structures of the turbulent flow under the considered thermal stratification regimes. The flow structure is discussed in the context of three-dimensional representations of key modes, which demonstrate features ranging in size from the wind turbine wakes to the atmospheric boundary layer. Results demonstrate that structures related to the atmospheric boundary layer flow dominate over those introduced by the wind farm for the unstable and neutrally stratified regimes; large structures in atmospheric turbulence are beneficial for the wake recovery, and consequently the presence of the turbulent wind turbine wakes is diminished. Contrarily, the flow in the stably stratified case is fully dominated by the presence of the turbines and highly influenced by the Coriolis force. A comparative analysis of the test cases indicates that during the stable regime, higher-order modes contribute less to the overall character of the flow. Under neutral and unstable stratification, important turbulence dynamics are distributed over a larger range of basis functions. The influence of the wind turbines on the structure of the atmospheric boundary layer is mainly quantified via the turbulence kinetic energy of the first ten modes. Linking the new insights into structure of the wind turbine/atmospheric boundary layer and their interaction addressed here will benefit the formulation of new simplified models for commercial application.
Africa is experiencing a rapid increase in adult obesity and associated cardiometabolic diseases (CMDs). The H3Africa AWI-Gen Collaborative Centre was established to examine genomic and environmental factors that influence body composition, body fat distribution and CMD risk, with the aim to provide insights towards effective treatment and intervention strategies. It provides a research platform of over 10 500 participants, 40–60 years old, from Burkina Faso, Ghana, Kenya and South Africa. Following a process that involved community engagement, training of project staff and participant informed consent, participants were administered detailed questionnaires, anthropometric measurements were taken and biospecimens collected. This generated a wealth of demographic, health history, environmental, behavioural and biomarker data. The H3Africa SNP array will be used for genome-wide association studies. AWI-Gen is building capacity to perform large epidemiological, genomic and epigenomic studies across several African counties and strives to become a valuable resource for research collaborations in Africa.
The growing number of women with CHD presents unique challenges, including those related to pregnancy, which can lead to significant morbidity and mortality. We sought to evaluate the perception of paediatric cardiologists towards the reproductive health of women with CHD.
Paediatric cardiologists in the United States of America were invited to participate in a cross-sectional, anonymous survey. Information solicited included knowledge of contraceptive methods, experience caring for pregnant women with CHD, and referral patterns including the utilisation of high-risk obstetric and adult CHD specialists.
A total of 110 cardiologists responded – 90% with an academic affiliation and 70% with ⩾10 years’ clinical experience. Although 95% reported an understanding of available contraceptive options, 32% did not feel comfortable recommending birth control. Pregnant women with CHD were seen by 83% of responders, and 37% of the responders reported a low level of comfort in doing so. Among all respondents, 73% indicated that they would refer a pregnant CHD patient to a high-risk obstetrician and 60% to an adult CHD specialist – almost all respondents would not transfer care to a non-adult CHD cardiologist. Among paediatric cardiologists, 81% indicated that they would resume their patient’s care following delivery.
Our results illustrate a gap in what physicians feel should be done and the care that they feel comfortable providing pregnant women with CHD. As this population continues to grow, training adult CHD cardiologists with specific skills in reproductive health in women with CHD is the first step to closing the care gap that exists in the management of such patients.
To assess the temporal trend of reported occupational blood and body fluid exposures (BBFE) in French healthcare facilities.
Retrospective follow-up of reported BBFE in French healthcare facilities on a voluntary basis from 2003 to 2012 with a focus on those enrolled every year from 2008 to 2012 (stable cohort 2008–12).
Reported BBFE incidence rate per 100 beds decreased from 7.5% in 2003 to 6.3% in 2012 (minus 16%). Percutaneous injuries were the most frequent reported BBFE (84.0% in 2003 and 79.1% in 2012). Compliance with glove use (59.1% in 2003 to 67.0% in 2012) and sharps-disposal container accessibility (68.1% in 2003 to 73.4% in 2012) have both increased. A significant drop in preventable BBFE was observed (48.3% in 2003 to 30.9% in 2012). Finally, the use of safety-engineered devices increased from 2008 to 2012.
Of the 415,209 hospital beds in France, 26,158 BBFE could have occurred in France in 2012, compared with 35,364 BBFE in 2003. Healthcare personnel safety has been sharply improved during the past 10 years in France.
Infect. Control Hosp. Epidemiol. 2015;36(8):963–968
Dengue is regarded as the most important arboviral disease. Although sporadic cases have been reported, serotypes responsible for outbreaks have not been identified from central India over the last 20 years. We investigated two outbreaks of febrile illness, in August and November 2012, from Korea district (Chhattisgarh) and Narsinghpur district (Madhya Pradesh), respectively. Fever and entomological surveys were conducted in the affected regions. Molecular and serological tests were conducted on collected serum samples. Dengue-specific amplicons were sequenced and phylogenetic analyses were performed. In Korea and Narsinghpur districts 37·3% and 59% of cases were positive, respectively, for dengue infection, with adults being the worst affected. RT–PCR confirmed dengue virus serotype 1 genotype III as the aetiology. Ninety-six percent of infections were primary. This is the first time that dengue virus 1 outbreaks have been documented from central India. Introduction of the virus into the population and a conducive mosquitogenic environment favouring increased vector density caused the outbreak. Timely diagnosis and strengthening vector control measures are essential to avoid future outbreaks.
Simulation of yield response to water plays an increasingly important role in optimization of crop water productivity (WP) especially in prevalent drought in Africa. The present study is focused on a representative crop: bambara groundnut (Vigna subterranea), an ancient grain legume grown, cooked, processed and traded mainly by subsistence women farmers in sub-Saharan Africa. Over four years (2002, 2006–2008), glasshouse experiments were conducted at the Tropical Crops Research Unit, University of Nottingham, UK under controlled environments with different landraces, temperatures (23 ± 5 °C, 28 ± 5 °C, 33 ± 5 °C) and soil moisture regimes (irrigated, early drought, late drought). Parallel to this, field experiments were conducted in Swaziland (2002/2003) and Botswana (2007/2008). Crop measurements of canopy cover (CC), biomass (B) and pod yield (Y) of selected experiments from glasshouse (2006 and 2007) and field (Botswana) were used to calibrate the FAO AquaCrop model. Subsequently, the model was validated against independent data sets from glasshouse (2002 and 2008) and field (Swaziland) for different landraces. AquaCrop simulations for CC, B and Y of different bambara groundnut landraces are in good agreement with observed data with R2 (CC-0.88; B-0.78; Y-0.72), but with significant underestimation for some landraces.
Plasmonic nanoresonators can localize light beyond diffraction limit and can provide large field enhancements and thus can be used in sensing and spectroscopy applications. Here, we numerically show that efficient excitation of plasmonic resonances of nanoparticles is possible when they are integrated with Silicon Nitride waveguides in an integrated hybrid photonic-plasmonic platform.
Nanophase (n-) ZrO2 was produced in its pure and partially stabilized form by the gas-phase condensation method. The material was examined by x-ray diffraction and Raman scattering to obtain information on the structural evolution of the material during sintering. Two types of Y2O3 doped ZrO2 nanophase materials were made one by co-deposition of n-Y2O3 and n-ZrO2 in a consecutive manner and the second by mechanically mixing n-Y2O3 and n-ZrO2. We have determined that the co-deposition process is the most effect means of doping the n-ZrO2.
We have characterized the surface morphology and luminescence properties of GaN/AlN/ SiC layers of various thicknesses using secondary electron imaging (SEI), panchromatic room temperature cathodoluminescence (CL), atomic force microscopy (AFM), optical Nomarski microscopy, and room and low temperature photoluminescence (PL). The nominally undoped GaN layers were grown by MOCVD on 0.1 m thick AlN buffer layers on commercial 6H-SiC(0001) substrates. The GaN layer thicknesses are 0.5, 1.0, 1.6, and 2.6 m. A second 1.0 m thick layer was grown by identical procedures on a 6H-SiC substrate that was first etched in H2 to remove scratches and damage due to mechanical polishing. Biaxial compressive lattice mismatch stress is present in all layers and decreases with increasing layer thickness, while PL linewidths decrease. The 1 m layer on the H-etched substrate is as relaxed as the 2.6 m layer on a non H-etched substrate, however. Pronounced surface structures, apparently corresponding to columnar subgrain boundaries, are observed on the samples on non H-etched SiC. Their typical sizes increase from about 3 to 10 m with increasing layer thickness. They are absent in the H-etched sample. These structures are generally nonradiative in CL images, although mottled contrast is also observed inside them. Similar layers doped with 3×1018 cm−3 Si do not show these features, suggesting a different microstructure.
The electron-hole pair production energy (∼ 4.43 eV) in cadmium telluride semiconductor based detector would allow, in principle, to achieve spectroscopic performance close to germanium. In fact the material impurities, crystal lattice defects and low charge mobility, mainly for holes, can severely degrade the spectroscopic properties through charge trapping/detrapping and recombination phenomena, limiting the usable distance between the electrodes. The charge collection efficiency depends, following the Hecht relation, on the distance between the charge production location and the collecting cathode; we have studied the dependence of some CdTe spectroscopic parameters (energy resolution, photo-peak gain and efficiency) from this distance. A set of experimental tests were performed using a well collimated photon beam. The beam spot, obtained from a 57Co radioactive source through a thick (20 mm) tungsten collimator having a 0.2×2 mm window, was positioned between the two electrodes of a CdTe crystal of size 3×5×2 mm3, with the electrodes deposited on the 3×5 mm2 sides.
The detector was irradiated on the face having the area of 2×3 mm2, in the arrangement with the collecting field orthogonal to the incoming radiation (PTF configuration), and the largest side of the spot parallel to the electrode plane. Using a micro-positioning system a fine scanning of the interelectrodic region was performed.
In order to evaluate the detector behavior in a wider energy range, further tests using energies between 14 keV to 662 keV have been performed.
The results of these measurements are presented and discussed in order to emphasize a method to improve CdTe detector spectroscopic capabilities and to understand the detection behavior
The present paper establishes some required elements from both Quantum calculations and Kinetic Monte Carlo Modeling to perform full atomic scale simulations of Zirconia and Hafnia Atomic Layer Deposition (ALD) on Silicon technology process. In this view, we present quantum cluster calculations that investigate reaction pathways being part of the chemical reactions taking place at the different stages of the ALD growth. In particular, we detail ongoing research effort on the hydrolysis of adsorbed HfCl3 and ZrCl3 on ultra-thin SiO2. At very low water dose, the hydrolysis appears to be un-favourable. The complete reaction pathways with their associated activation barrier are detailed. We then show that actual available mechanisms emanating from quantum calculations are not sufficient to give a coherent picture of the layer structuring through a Kinetic Monte Carlo technique with the hope of giving new directions for further quantum studies.
This study calculated the comparability of two throat symptom assessment scales devised to evaluate either laryngopharyngeal reflux or globus.
United Kingdom hospital out-patient departments.
A total of 334 subjects, with and without throat symptoms, completed the Reflux Symptom Index and/or the Glasgow and Edinburgh Throat Scale. The following were calculated for the resultant data: Cronbach's α coefficient, principal component analysis, Kaiser normalisation, varimax and oblimin rotation, and eigenvalues.
Analysis of data from the Reflux Symptom Index and the Glasgow and Edinburgh Throat Scale revealed clearly similar symptom domains regarding (1) coughing and blockage, and (2) globus or postnasal drip or throat-clearing, as did combined analysis of their amalgamated items. Both instruments had good overall internal consistency (α = 0.75 and 0.81, respectively). The ‘heartburn or reflux’ item in the Reflux Symptom Index mapped poorly to each underlying factor.
The most commonly used laryngopharyngeal reflux and globus assessment questionnaires appear to detect very similar symptom clusters. The management of throat disorders may previously have been over-reliant on the presenting pattern of throat symptoms. Our findings indicate a need to revisit the traditional clinical classification of throat symptoms.
The NASA Star and Exoplanet Database (NStED) is a general purpose stellar archive with the aim of providing support for NASA's planet finding and characterization goals, stellar astrophysics, and the planning of NASA and other space missions. There are two principal components of NStED: a database of (currently) 140,000 nearby stars and exoplanet-hosting stars, and an archive dedicated to high-precision photometric surveys for transiting exoplanets. We present a summary of the latter component: the NStED Exoplanet Transit Survey Service (NStED-ETSS), along with its content, functionality, tools, and user interface. NStED-ETSS currently serves data from the TrES Survey of the Kepler Field as well as dedicated photometric surveys of four stellar clusters. NStED-ETSS aims to serve both the surveys and the broader astronomical community by archiving these data and making them available in a homogeneous format. Examples of usability of ETSS include investigation of any time-variable phenomena in data sets not studied by the original survey team, application of different techniques or algorithms for planet transit detections, combination of data from different surveys for given objects, statistical studies, etc. NStED-ETSS can be accessed at http://nsted.ipac.caltech.edu.