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The mainstay of management of epistaxis refractory to first aid and cautery is intranasal packing. This review aimed to identify evidence surrounding nasal pack use.
A systematic review of the literature was performed using standardised methodology.
Twenty-seven eligible articles were identified relating to non-dissolvable packs and nine to dissolvable packs. Nasal packing appears to be more effective when applied by trained professionals. For non-dissolvable packs, the re-bleed rates for Rapid Rhino and Merocel were similar, but were higher with bismuth iodoform paraffin paste packing. Rapid Rhino packs were the most tolerated non-dissolvable packs. Evidence indicates that 96 per cent of re-bleeding occurs within the first 4 hours after nasal pack removal. Limited evidence suggests that dissolvable packs are effective and well tolerated by patients. There was a lack of evidence relating to: the duration of pack use, the economic effects of pack choice and the appropriate care setting for non-dissolvable packs.
Rapid Rhino packs are the best tolerated, with efficacy equivalent to nasal tampons. FloSeal is easy to use, causes less discomfort and may be superior to Merocel in anterior epistaxis cases. There is no strong evidence to support prophylactic antibiotic use.
In 1975, Hoessel, Elias, Wade and Huchra commenced a near infrared survey of 80 fields in the northern Milky Way with the Palomar 1.2 m Schmidt telescope, (Hoessel et al. 1979). This has now been issued as an atlas reproduced in the form of photographic paper prints. In 1977, the SRC 1.2 m Schmidt telescope at Siding Spring was authorized to commence a complementary survey of the southern Milky Way, consisting of the 151 ESO/SRC survey fields which have centres within 10° of the galactic plane and negative declinations (see Fig. 1). A further 12 fields have subsequently been added to the survey to permit coverage of the Large and Small Magellanic Clouds.
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 U.K. 1.2 metre Schmidt Telescope acquired its first full aperture objective prism in 1975. This was a very low dispersion prism (2400 Å/mm at 4300 Å) which has been found to be particularly useful in searching for faint QSO’s.
Most plates taken with the UK Schmidt Telescope are hypersensitized before use. The technique for the hyper-sensitization of IIIa-type emulsions has been described by Sim et al. (1976), and for the IV-N emulsion by Hartley and Tritton (1979). Photographic calibration is provided by two sensitometers, a seven-step linear array at the N-W corner and a 4 × 4 spot array in the S-E. During the calibration of this latter sensitometer (Dawe and Metcalfe 1981), which is a copy of a design by Schoening (1976), it became apparent that the sensitivity of the hypersensitized IIIa-emulsions in use was decreasing as a function of time in the plateholder.
It now appears almost certain that the precursor of SN 1987a was the brighter of the components of Sk-69 202, a blue supergiant, with a precursor mass of perhaps 12-16 solar masses. Prior to the explosion the precursor had a core mass of order six solar masses, and 0.1 to 0.2 solar masses of residual hydrogen envelope. The compact nature of this star can account for many of the odd features of the subsequent light curve and spectral evolution.
An analysis of the light curve and colour evolution shows four distinct epochs, which probably relate to the initial expansion of the fireball and the escape of shock-deposited thermal energy, the hydrogen-rich layers becoming optically thin, the exposure of the helium core, and the increasing transparency of the helium core.
The supernova appeared to be at its maximum on May 10, but is dimmer than a normal Type II because its light is apparently derived from recombinations and the radioactive decay of 56Ni to 56Co to 56Fe rather than by the thermal energy deposited by the passage of the shock.
To assess the distance between the bony groove created during subannular tubes placement and the chorda tympani, and examine the depth of the hypotympanum and retrotympanum.
Grooves drilled in cadaver temporal bones at two levels were imaged to measure: the distance between the chorda tympani nerve and the tympanic sulcus, and the depth of the hypotympanum and the retrotympanum relative to the annulus.
The chorda tympani was between 0 and 5 mm from the groove cut across the annulus. The hypotympanum average depth was 2 mm (0.44–6.40 mm) and the retrotympanum average depth was 1 mm (0–2.53 mm).
Grooves drilled across the tympanic sulcus should be placed at a point 20 per cent of the height of the tympanic membrane or lower; this will ensure least risk of injury to the chorda tympani nerve. The depth of the hypotympanum and retrotympanum dictates that the posteroinferior part of a subannular tube flange should be approximately 2 × 1 mm.
A statistical parallax algorithm (Clube and Dave, 1978a,b), using the technique of maximum likelihood, has been applied to a set of 103 ‘ab’ - RR Lyrae stars in the solar neighborhood (r 2<kpc), using observational data from the Royal Greenwich Observatory Bulletins. A second set of 130 ‘ab’ - RR Lyrae stars has been kindly supplied to us by Dr. A. Heck (Université de Liège) to permit a comparison between our analyses. The purpose of this investigation was:
(a) to investigate the variations of kinematical parameters and absolute luminosities of these stars as functions of Preston's index ΔS and of log (Period).
(b) to identify those RR Lyrae stars in the solar neighborhood which most closely resemble those in the galactic halo, those near the galactic center, and those in the Magellanic Clouds.
Traditional laboratory studies on dust-ice systems have proved how the nature of the dust surface significantly affects ice structure and reactivity. Although the surface composition effects have been widely studied recently, no attention has been paid to the dust sizes. We show how dust the grains size and topography, as well as their composition, affects their interaction with light and the morphology of water ice mantles on top of them.
Cricopharyngeal dysfunction following head and neck cancer treatment may lead to a significant reduction in oral intake. Carbon dioxide laser is an established procedure for the treatment of non-malignant cricopharyngeal disorders. We report our experience of laser cricopharyngeal myotomy with objective swallowing outcome measures, before and after treatment.
We identified 11 patients who had undergone carbon dioxide laser cricopharyngeal myotomy for dysphagia following radiotherapy, with or without chemotheraphy between January 2006 and July 2011. We analysed the swallowing outcomes following carbon dioxide laser cricopharyngeal myotomy by retrospective grading of pre- and post-procedure videofluoroscopic swallowing study of liquids, using the validated Modified Barium Swallow Impairment Profile.
The median Modified Barium Swallow Impairment Profile score was 13 pre-myotomy and 10 post-myotomy. This difference between scores was non-significant (p = 0.41). The median, cricopharyngeal-specific Modified Barium Swallow Impairment Profile variables (14 and 17) improved from 3 to 2, but were similarly non-significant (p = 0.16). We observed the improved Modified Barium Swallow Impairment Profile scores post-procedure in the majority of patients.
Endoscopic carbon dioxide laser cricopharyngeal myotomy remains a viable option in treatment-related cricopharyngeal dysfunction; its targeted role requires further prospective study. Objective analysis of the technique can be reported using the validated Modified Barium Swallow Impairment Profile.
The partial excavation under rescue conditions in 1961–63 of the ditches and
interior of an enclosure of the earlier neolithic period is described. The
enclosure, covering a total area of approximately 2.4 ha, was defined by
double concentric interrupted ditches, which were for the most part
naturally filled. There were many traces of activity within the interior,
presumed to be contemporary with the ditches, including pits, gullies, post-
and stake-holes, and varying concentrations of struck and burnt flint and
pottery. Human burials were found. There is a little Ebbsfleet pottery in
secondary contexts and there are later prehistoric, Roman and medieval
finds. It is probably not possible to ascribe a single or specific role to
the site, which may have been important as a place where several activities
were concentrated, including occupation, subsistence, exchange, enclosure or
defence, burial and ritual.
Case report data and a matched case-control study were used to investigate the epidemiological characteristics of hand, foot and mouth disease (HFMD) in children in Shenzhen, China between 2008 and 2011. Multivariate analyses were used to evaluate factors associated with severity of infection. Laboratory tests were performed to determine aetiological identification for samples from 163 severe and fatal cases as well as an outpatient-based HFMD sentinel surveillance system (n = 446). All identified EV71 belonged to sub-genotype C4a. No major changes in the CA16 and EV71 viruses were found until the end of 2011. Annual attack rates and the case-severity ratios (CSRs) rose from 0·82/1000 and 0·56/1000, respectively, in 2008 to 2·12/1000 and 6·13/1000 in 2011. The CSR was higher in migrants than in local residents. The adjusted odds ratio (OR) of having a severe attack for being a migrant was 2·45, having a fever >39°C (OR 5·77), visiting a private clinic (OR 2·65), longer time from symptom onset to diagnosis (OR 1·49), visiting a doctor (OR 1·51), early use of intramuscular pyrazolone (OR 3·36), early use of intravenous glucocorticoids (OR 2·28), or the combination of both (OR 3·75). The mortality and increasing case severity appears to be associated with socioeconomic factors including migration and is of worldwide concern.
The current status of the DRIFT (Directional Recoil Identification From Tracks)
experiment at Boulby Mine is presented, including the latest limits on the WIMP
spin-dependent cross-section from 1.5 kg days of running with a mixture of CS2
and CF4. Planned upgrades to DRIFT IId are detailed, along with ongoing work
towards DRIFT III, which aims to be the world’s first 10 m3-scale directional
Dark Matter detector.
Attitudes towards foreign policy have typically been explained by ideological and demographic factors. We approach this study from a different perspective and ex amine the extent to which foreign policy preferences correspond to genetic variation. Using data from the Minnesota Twin Family Study, we show that a moderate share of individual differences in the degree to which one's foreign policy preferences are hawkish or dovish can be attributed to genetic variation. We also show, based on a bivariate twin model, that foreign policy preferences share a common genetic source of variation with political ideology. This result presents the possibility that ideology may be the causal pathway through which genes affect foreign policy preferences.
The influence of five monoamine candidate genes on depressive symptom trajectories in adolescence and young adulthood were examined in the Add Health genetic sample. Results indicated that, for all respondents, carriers of the dopamine receptor D4 5-repeat allele were characterized by distinct depressive symptom trajectories across adolescence and early adulthood. Similarly, for males, individuals with the monoamine oxidase A 3.5-repeat allele exhibited unique depressive symptom trajectories. Specifically, the trajectories of those with the dopamine receptor D4 5-repeat allele were characterized by rising levels in the transition to adulthood, while their peers were experiencing a normative drop in depressive symptom frequency. Conversely, males with the monoamine oxidase A 3.5-repeat allele were shown to experience increased distress in late adolescence. An empirical method for examining a wide array of allelic combinations was employed, and false discovery rate methods were used to control the risk of false positives due to multiple testing. Special attention was given to thoroughly interrogate the robustness of the putative genetic effects. These results demonstrate the value of combining dynamic developmental perspectives with statistical genetic methods to optimize the search for genetic influences on psychopathology across the life course.
The great bustard Otis tarda became extinct in the UK during the 19th century due to a combination of factors, including hunting, egg collection and changes in agriculture. In 2003 a 10-year licence was granted to begin a trial to reintroduce the species back to the UK. Here we report on the first 5 years of the trial and assess the progress made towards establishing a founder population. From April 2004 to September 2009 a total of 102 great bustard chicks were imported from Russia and 86 released on Salisbury Plain. Monitoring showed that post-release survival was 18% in the first year following release, and that mortality of released bustards was mainly attributable to predation and collisions. Estimated adult survival was 74%, although the sample size was small. All known surviving great bustards are faithful to the surroundings of the release site, returning throughout the year. A lek has been established where males have been observed displaying to females. The first nesting attempt was in 2007, and in 2009 two females aged 3 and 4 years successfully nested, fledging one chick each. Models incorporating the new demographic estimates suggest that at the end of the 10-year trial period the project can expect to have 8–26 adults as a founder population.