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The initial assessment of epistaxis patients commonly includes: first aid measures, observations, focused history taking, and clinical examinations and investigations. This systematic review aimed to identify evidence that informs how the initial assessment of these patients should be conducted.
A systematic review of the literature was performed using a standardised methodology and search strategy.
Seventeen articles were included. Factors identified were: co-morbidity, intrinsic patient factors, coagulation screening and ice pack use. Hypertension and anticoagulant use were demonstrated to adversely affect outcomes. Coagulation screening is useful in patients on anticoagulant medication. Four studies could not be accessed. Retrospective methodology and insufficient statistical analysis limit several studies.
Sustained ambulatory hypertension, anticoagulant therapy and posterior bleeding may be associated with recurrent epistaxis, and should be recorded. Oral ice pack use may decrease severity and can be considered as first aid. Coagulation studies are appropriate for patients with a history of anticoagulant use or bleeding diatheses.
Knowledge of ENT is important for many doctors, but undergraduate time is limited. This study aimed to identify what is thought about ENT knowledge amongst non-ENT doctors, and the key topics that the curriculum should focus on.
Doctors were interviewed about their views of ENT knowledge amongst non-ENT doctors, and asked to identify key topics. These topics were then used to devise a questionnaire, which was distributed to multiple stakeholders in order to identify the key topics.
ENT knowledge was generally thought to be poor amongst doctors, and it was recommended that undergraduate ENT topics be kept simple. The highest rated topics were: clinical examination; when to refer; acute otitis media; common emergencies; tonsillitis and quinsy; management of ENT problems by non-ENT doctors; stridor and stertor; otitis externa; and otitis media with effusion.
This study identified a number of key ENT topics, and will help to inform future development of ENT curricula.
Observations, photographs, and video footage of a 337 cm total length female smalltooth sand tiger shark, Odontaspis ferox made at a depth of 348 m on the northern slope of San Ambrosio Island in the Desventuradas Islands (26°19.456′S 79°52.281′W) on 25 February 2013 represent not just the first record of this species in Chilean waters, but the first in the entire south-eastern Pacific Ocean, marking a tremendous range extension of this species. We also summarize the few known occurrences of this species along the Pacific and Atlantic coasts of South America.
Stencil apertures of various interior angle, i.e. angle between two sides of a polygon, are analyzed for print performance. Aperture size and sidewall taper are also examined for their individual and combined effects on printing. The results show no effect of interior angle within the bounds of the experiment. Sidewall taper becomes relevant when aperture geometry is nearly square.
The complex [Ir(ppy)2(dpbpy)][PF6] (Hppy = 2-phenylpyridine, dpbpy = 6,6'-diphenyl-2,2'-bipyridine) has been prepared and evaluated as an electroluminescent component for light-emitting electrochemical cells (LECs). The complex exhibits two intramolecular face-to-face π-stacking interactions and long-lived LECs have been constructed; the device characteristics are not significantly improved in comparison to analogous LECs with 6-phenyl-2,2'-bipyridine with only one π-stacking interaction.
In 1988, there were two outbreaks of legionellosis in Bolton Health District. Altogether 37 cases of Legionnaires' disease and 23 cases of non-pneumonic legionellosis were identified. Twenty-five patients with Legionnaires' disease were associated with an engineering plant, 4 with Bolton town centre, and 8 with both the plant and town centre. Twenty-two people with non-pneumonic legionellosis were linked with the engineering plant and one with the plant and the town centre. A case-control study carried out among 37 employees with legionellosis and 109 control subjects at the plant showed that infection was associated with one of the 15 cooling towers on the site. Legionella pneumophila indistinguishable by serological and genetic typing methods was isolated from this cooling tower and from sputum samples from two patients. In the town centre, no one tower was linked with infection and L. pneumophila was not cultured from any of the nine towers identified. Control measures were implemented and to date there have been no further cases of legionellosis associated with Bolton Health District.
The ecosystem approach to fisheries recognises the interdependence between harvested species and other ecosystem components. It aims to account for the propagation of the effects of harvesting through the food-web. The formulation and evaluation of ecosystem-based management strategies requires reliable models of ecosystem dynamics to predict these effects. The krill-based system in the Southern Ocean was the focus of some of the earliest models exploring such effects. It is also a suitable example for the development of models to support the ecosystem approach to fisheries because it has a relatively simple food-web structure and progress has been made in developing models of the key species and interactions, some of which has been motivated by the need to develop ecosystem-based management. Antarctic krill, Euphausia superba, is the main target species for the fishery and the main prey of many top predators. It is therefore critical to capture the processes affecting the dynamics and distribution of krill in ecosystem dynamics models. These processes include environmental influences on recruitment and the spatially variable influence of advection. Models must also capture the interactions between krill and its consumers, which are mediated by the spatial structure of the environment. Various models have explored predator-prey population dynamics with simplistic representations of these interactions, while others have focused on specific details of the interactions. There is now a pressing need to develop plausible and practical models of ecosystem dynamics that link processes occurring at these different scales. Many studies have highlighted uncertainties in our understanding of the system, which indicates future priorities in terms of both data collection and developing methods to evaluate the effects of these uncertainties on model predictions. We propose a modelling approach that focuses on harvested species and their monitored consumers and that evaluates model uncertainty by using alternative structures and functional forms in a Monte Carlo framework.
This chapter examines how goals and reference points might be set for higher trophic levels – such as marine mammals, birds and fish. It briefly explores the general characteristics of objectives for higher trophic levels within the context of ecosystem-based management, noting that the emphasis for managing the effects of human activities on higher trophic levels is biased towards fisheries-based approaches rather than approaches that take into account the maintenance of ecosystem structure and function. Following this, the precautionary approach developed in the Commission for the Conservation of Antarctic Marine Living Resources (CCAMLR) for taking account of higher trophic levels in setting catch limits for target prey species is described. The last section considers indicators of the status of predators with respect to establishing target and limit/threshold reference points that can be used directly for making decisions. These indicators include univariate indices summarizing many multivariate parameters from predators, known as composite standardized indices, as well as an index of predator productivity directly related to lower trophic species affected by human activities.
Ecosystem-based management encapsulates notions of conservation and wise use of ecosystems (Mangel et al. 1996). Managers are now expected (a) to maintain ecosystem properties and, in some cases, (b) to restore ecosystems when they are judged to be impacted (caused to be altered), directly or indirectly, by human activities. With appropriate scientific support, they need to define how ecosystems might be judged to be impacted and to determine mechanisms for reducing or eliminating such impacts.
Few randomised controlled trials have been aimed specifically at substance use reduction among people with psychotic disorders.
To investigate whether a 10-session intervention consisting of motivational interviewing and cognitive-behavioural therapy (CBT) was more efficacious than routine treatment in reducing substance use and improving symptomatology and general functioning.
A community sample of people with a psychotic disorder and who reported hazardous alcohol, cannabis and/or amphetamine use during the preceding month was recruited. Participants were randomly allocated to motivational interviewing/CBT (n=65) or treatment as usual (n=65), and were assessed on multiple outcomes at baseline, 15 weeks, 6 months and 12 months.
There was a short-term improvement in depression and a similar trend with regard to cannabis use among participants who received the motivational interviewing/CBT intervention, together with effects on general functioning at 12 months. There was no differential benefit of the intervention on substance use at 12 months, except for a potentially clinically important effect on amphetamine use.
The motivational interviewing/CBT intervention was associated with modest improvements.
The concentrations of U, Th, and K in a charnockite-alkali granite intrusive complex from SW Sweden and associated, partly charnockitized country rocks are presented. The charnockitic components have constant low U and Th levels throughout the compositional range with a mean Th/U ratio of 1.2 to 1.5. The transition from charnockite to granite is marked by a sharp increase in Th and U concentrations with mean Th/U ratios increasing to 3.4 4.4. However, the K concentration increases relatively smoothly with increasing acidity through the compositional range studied. Late shearing of the alkali granite led to significant Th depletion with little change in the U and K concentrations. Charnockitization of the country rock granite gneisses is marked by depletion in Th and K while the U content is almost unchanged.
It is suggested that the behaviour of U and Th reflects the tendency for Th to associate with magma-dissolved water whilst U shows a greater affinity for coexisting free volatiles. In the absence of a significant free volatile phase during crystallization of this charnockite-granite suite, U was incorporated into primary mineral lattice sites whereas Th entered sites from which it could be liberated more easily.