Introduction: Hemorrhage is the primary cause of death in 39% of trauma patients. In prehospital trauma management, there is debate over pursuing a ‘scoop-and-run’ approach versus early intravenous (IV) fluid therapy. We evaluated the literature regarding the effect of prehospital IV fluid therapy on mortality in adult trauma patients. Methods: A librarian-assisted search was conducted in PubMed, Medline and Embase. The population was adults with blunt and/or penetrating trauma. The intervention was total prehospital IV fluid volume 0-500 mL, and the control was prehospital fluid volume >500 mL. The outcome of interest was in-hospital mortality. Randomized controlled trials (RCTs), cohort and case-matched studies were included. Two reviewers used the Cochrane Risk of Bias (RoB) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tools to evaluate biases, and kappa was calculated for inter-rater agreement. A summary relative risk (RR) of in-hospital mortality was calculated and heterogeneity (I2) analysis performed using RevMan 5 software. Results: Four RCT's and eleven observational studies were identified, with n = 15,448 patients. Two RCTs and four observational studies were excluded due to non-English language, and the location or volume of IV fluid administered, leaving eight studies with n = 4,568 patients. Inter-rater agreement was high with the ROBINS-I (unweighted κ=0.8841) and RoB tool (unweighted κ=0.8276). Two studies found decreased mortality, one found increased mortality, and five found no significant relationship to mortality with 0-500 mL prehospital IV fluid. The summary relative risk of mortality with 0-500 mL IV fluid compared to >500 mL IV fluid was not significant (RR = 0.98 [0.87, 1.11]). The heterogeneity for all studies was high (I2 = 84%), but was low (I2 = 0%) with removal of two studies. Conclusion: The majority of studies did not find a relationship between the volume of prehospital IV fluids and in-hospital mortality. Study heterogeneity was low except for two studies: this may be explained by mortality only being recorded at emergency department discharge in one study, and the high rate of penetrating gunshot and stabbing wounds in the other. There is a paucity of high-quality RCTs on the topic, and many studies are at significant risk of bias. Further research is needed to delineate the best approach to IV fluid therapy in adult trauma patients.

Early maturation, indexed by pubertal development (PD), has been associated with earlier initiation and greater frequency of adolescent substance use, but this relationship may be biased by confounding factors and effects that change across development. Using a population-based Finnish twin sample (N = 3,632 individuals), we conducted twin modeling and multilevel structural equation modeling of the relationship between PD and substance use at ages 12–22. Shared environmental factors contributed to early PD and heavier substance use for females. Biological father absence was associated with early PD for boys but not girls, and did not account for the relationship between PD and substance use. The association between early PD and heavier substance use was partially due to between-family confounds, although early PD appeared to qualitatively alter long-term trajectories for some substances (nicotine), but not others (alcohol). Mediation by peer and parental factors did not explain this relationship within families. However, higher peer substance use and lower parental monitoring were themselves associated with heavier substance use, strengthening the existing evidence for these factors as targets for prevention/intervention efforts. Early maturation was not supported as a robust determinant of alcohol use trajectories in adolescence and young adulthood, but may require longer term follow-up. Subtle effects of early PD on nicotine and illicit drug use trajectories throughout adolescence and adulthood merit further investigation.

Differences by ethnic group in STI diagnosis rates have long been recognized in England. We investigated whether these may be explained by ethnic disparities in socioeconomic deprivation (SED). Data on all diagnoses made in sexual health clinics in England in 2013 were obtained from the mandatory STI surveillance system. Poisson regression was used to calculate incidence rate ratios (IRRs) of STIs, by ethnicity, with and without adjustment for index of multiple deprivation (IMD) a measure of area-level deprivation. Unadjusted IRRs (95% confidence intervals) were highest for gonorrhoea [8·18 (7·77–8·61) and 5·76 (5·28–6·29)] and genital herpes [4·24 (3·99–4·51) and 3·58 (3·23–3·98)] for people of black Caribbean and non-Caribbean/non-African black ethnicity and IRRs were highest for syphilis [8·76 (7·97–9·63)] and genital warts [2·23 (2·17–2·29)] for people of non-British/non-Irish white ethnicity compared to white British ethnicity. After adjustment for IMD, IRRs for gonorrhoea [5·76 (5·47–6·07)] and genital herpes [3·73 (3·50–3·97)] declined but remained highest for black Caribbeans and IRRs for syphilis [7·35 (6·68–8·09)] and genital warts [2·10 (2·04–2·16)] declined but remained highest for non-British/non-Irish white compared to white British. In England, ethnic disparities in STI diagnosis rates are partially explained by SED, but behavioural and contextual factors likely contribute. Clinic and community-based interventions should involve social peer networks to ensure they are targeted and culturally sensitive.

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.

During 1990 we surveyed the southern sky using a multi-beam receiver at frequencies of 4850 and 843 MHz. The half-power beamwidths were 4 and 25 arcmin respectively. The finished surveys cover the declination range between +10 and −90 degrees declination, essentially complete in right ascension, an area of 7.30 steradians. Preliminary analysis of the 4850 MHz data indicates that we will achieve a five sigma flux density limit of about 30 mJy. We estimate that we will find between 80 000 and 90 000 new sources above this limit. This is a revised version of the paper presented at the Regional Meeting by the first four authors; the surveys now have been completed.

A study has been carried out to investigate whether the action of triclabendazole (TCBZ) against Fasciola hepatica is altered by inhibition of P-glycoprotein (Pgp)-linked drug efflux pumps. The Sligo TCBZ-resistant fluke isolate was used for these experiments and the Pgp inhibitor selected was R(+)-verapamil [R(+)-VPL]. In the first experiment, flukes were initially incubated for 2 h in R(+)-VPL (100 μ m), then incubated in R(+)-VPL+triclabendazole sulphoxide (TCBZ.SO) (50 μg mL−1, or 133·1 μ m) until flukes ceased movement (at 9 h post-treatment). In a second experiment, flukes were incubated in TCBZ.SO alone and removed from the incubation medium following cessation of motility (after 15 h). In the third experiment, flukes were incubated for 24 h in R(+)-VPL on its own. Changes to the testis tubules and vitelline follicles following drug treatment and following Pgp inhibition were assessed by means of light microscope histology and transmission electron microscopy. Incubation of the Sligo isolate in either R(+)-VPL or TCBZ.SO on their own had a limited impact on the morphology of the two tissues. Greater disruption was observed when the drugs were combined, in terms of the block in development of the spermatogenic and vitelline cells and the apoptotic breakdown of the remaining cells. Sperm formation was severely affected and abnormal. Large spaces appeared in the vitelline follicles and synthesis of shell protein was disrupted. The results of this study support the concept of altered drug efflux in TCBZ-resistant flukes and indicate that drug transporters may play a role in the development of drug resistance.

A study was carried out to investigate whether the action of triclabendazole sulphoxide (TCBZ.SO) against the liver fluke, Fasciola hepatica is altered by inhibition of P-glycoprotein (Pgp)-linked drug efflux pumps. The Oberon TCBZ-resistant and Cullompton TCBZ-susceptible fluke isolates were used for this in vitro study and the Pgp inhibitor selected was R(+)-verapamil [R(+)-VPL]. For experiments with the Oberon isolate, flukes were incubated for 24 h with either R(+)-VPL (1×10−4m) on its own, TCBZ.SO (15 μg mL−1) alone, a combination of R(+)-VPL (1×10−4m) plus TCBZ.SO (15 μg mL−1), TCBZ.SO (50 μg mL−1) on its own, or a combination of TCBZ.SO (50 μg mL−1) plus R(+)-VPL (1×10−4m). They were also incubated in TCBZ.SO (50 μg mL−1) alone or in combination with R(+)-VPL (1×10−4m) until they became inactive; and in TCBZ.SO (50 μg mL−1) alone for a time to match that of the combination inactivity time. Flukes from the Cullompton isolate were treated with either TCBZ.SO (50 μg mL−1) alone or in combination with R(+)-VPL (1×10−4m) until they became inactive, or with TCBZ.SO (50 μg mL−1) alone time-matched to the combination inactivity time. Morphological changes resulting from drug treatment and following Pgp inhibition were assessed by means of scanning electron microscopy. Incubation in R(+)-VPL alone had a minimal effect on either isolate. TCBZ.SO treatment had a relatively greater impact on the TCBZ-susceptible Cullompton isolate. When R(+)-VPL was combined with TCBZ.SO in the incubation medium, however, the surface disruption to both isolates was more severe than that seen after TCBZ.SO treatment alone; also, the time taken to reach inactivity was shorter. More significantly, though, the potentiation of drug activity was greater in the Oberon isolate; also, it was more distinct at the higher concentration of TCBZ.SO. So, the Oberon isolate appears to be particularly sensitive to efflux pump inhibition. The results of this study suggest that enhanced drug efflux in the Oberon isolate may be involved in the mechanism of resistance to TCBZ.

The effects of silanising using the coupling agent γ-glycidoxpropyltrimethoxysilane on microstructural stability and magnetic properties of Sm-Co powder particles have been investigated. The silanisation provides structural stability by improving the oxidation resistance at 400oC for 10 hours. The untreated particles undergo microchemical changes by redistribution of alloying elements which mainly accumulate in parallel black and grey streaks in the interior of the particles. The silanised particles after heat treatment show coercivity of 836 Oe and the untreated particles show a much lower coercivity of 376 Oe. The difference in magnetic properties of uncoated particles is caused by diffusion of oxygen and microstructural instability.

In this work infrared thermography was used as a diagnostic tool for the performance assessment of a photovoltaic array integrated on the southern façade of NTUA's Chemical Engineering Building. This grid-connected 50 kWp solar photovoltaic array, installed under an EC Thermie Project (SE-142-97-GR-ES), operates in a standard and hybrid PV-Thermal configuration, meant to save conventional energy. The thermographic system used for the analysis covers the 8-12 ìm of wavelength region. The thermal images obtained showed that there are temperature differences on the PV panels, which may be attributed to PV material defects, manufacturing faults, external abuse, or PV malfunction.

An overview is given of the development of advanced nanoporous carbons as storage ma-terials for natural gas (methane) and molecular hydrogen in on-board fuel tanks for next-generation clean automobiles. The carbons are produced in a multi-step process from corncob, have surface areas of up to 3500 m2/g, porosities of up to 0.8, and reversibly store, by physisorp-tion, record amounts of methane and hydrogen. Current best gravimetric and volumetric storage capacities are: 250 g CH4/kg carbon and 130 g CH4/liter carbon (199 V/V) at 35 bar and 293 K; and 80 g H2/kg carbon and 47 g H2/liter carbon at 47 bar and 77 K. This is the first time the DOE methane storage target of 180 V/V at 35 bar and ambient temperature has been reached and exceeded. The hydrogen values compare favorably with the 2010 DOE gravimetric and volu-metric targets for hydrogen. A prototype adsorbed natural gas (ANG) tank, loaded with carbon monoliths produced accordingly and currently undergoing a road test in Kansas City, is de-scribed. A preliminary analysis of the surface and pore structure is given that may shed light on the mechanisms leading to the extraordinary storage capacities of these materials. The analysis includes pore-size distributions from nitrogen adsorption isotherms; spatial organization of pores across the entire solid from small-angle x-ray scattering (SAXS); pore entrances from scanning electron microscopy (SEM) and transmission electron microscopy (TEM); H2 binding energies from temperature-programmed desorption (TPD); and analysis of surface defects from Raman spectra. For future materials, expected to have higher H2 binding energies via appropriate sur-face functionalization, preliminary projections of H2 storage capacities based on molecular dy-namics simulations of adsorption of H2 on graphite, are reported.

Background: Seeking to identify where litigious claims against otolaryngologists are targeted (i.e. areas of highest risk) within the NHS and private sector would have positive implications in risk management and limiting the amount of litigation against otolaryngologists.

Method: The National Health Service Litigation Authority (NHSLA) and Medical Defence Union (MDU) were contacted and anonymous data obtained on claims within ENT.

Results: 887 claims were notified – 457 NHSLA and 430 MDU. The commonest claim in both groups was failure or delay in diagnosis (12 per cent NHSLA, 23 per cent MDU). The other commonest claims were all related to complications (nerve damage 10 per cent, deafness 8 per cent and dental damage 5 per cent). Dissatisfaction with results was 8 per cent total and, within the private sector, was almost exclusively in rhinology.

Conclusions: This study once again emphasizes the need for thorough clinical assessment, record keeping and good communication with patients. Recognising these areas of highest risk may limit future claims.

This article presents a combined approach to the nasopharynx, which has not been previously described. The technique is applicable to cases of recurrent nasopharyngeal carcinoma which exhibit lateral extension. We describe the technique and report a case in which it was used. A review is presented of all other techniques currently described. The authors would not advocate the use of a combined approach to the nasopharynx in all cases, but there certainly appears to be a place for this technique.

The anisotropy in room temperature plastic deformation has been investigated in single α(HCP)/β(BCC) colonies of a commercial α/β titanium alloy (Ti-6Al-2Sn-4Zr-2Mo-0.1Si) oriented for activation of individual basal slip systems. Detailed transmission electron microscopy (TEM) studies of the slip transmission mechanisms through the α/β interfaces have been performed to elucidate the role of these interfaces in determining yield and strain hardening behavior. Significant anisotropy in the yield strengths and hardening rates for the 3 unique basal slip systems is measured, and is attributed to the different slip transmission mechanisms active due to the near-Burgers orientation relationship existing between α- and β-phases. These results are should be transferable to other alloy systems exhibiting this orientation relationship.

A soft elastohydrodynamic lubrication model is formulated for deformable roll coating involving two contra-rotating rolls, one rigid and the other covered with a compliant layer. Included is a finite-strip model (FSM) for the deformation of the layer and a lubrication model with suitable boundary conditions for the motion of the fluid. The scope of the analysis is restricted to Newtonian fluids, linear elasticity/viscoelasticity and equal roll speeds, with application to the industrially relevant highly loaded or ‘negative gap’ regime. Predictions are presented for coated film thickness, inter-roll thickness, meniscus location, pressure and layer deformation as the control parameters – load (gap), elasticity, layer thickness and capillary number, $\hbox{\it Ca}$ – are varied. There are four main results:

1. Hookean spring models are shown to be unable to model effectively the deformation of a compliant layer when Poisson's ratio $\nu\rightarrow 0.5$. In particular, they fail to predict the swelling of the layer at the edge of the contact region which increases as $\nu\rightarrow 0.5$; they also fail to locate accurately the position of the meniscus, $X_M$, and to identify the presence, close to the meniscus, of a ‘nib’ (constriction in gap thickness) and associated magnification of the sub-ambient pressure loop.
2. Scaling arguments suggest that layer thickness and elasticity may have similar effects on the field variables. It is shown that for positive gaps this is true, whereas for negative gaps they have similar effects on the pressure profile and flow rate yet quite different effects on layer swelling (deformation at the edge of the contact region) and different effects on $X_M$.
3. For negative gaps and $\hbox{\it Ca}\,{\sim}\,O(1)$, the effect of varying either viscosity or speed and hence $\hbox{\it Ca}$ is to significantly alter both the coating thickness and $X_M$. This is contrary to the case of fixed-gap rigid roll coating.
4. Comparison between theoretical predictions and experimental data shows quantitive agreement in the case of $X_M$ and qualitive agreement for flow rate. It is shown that this difference in the latter case may be due to viscoelastic effects in the compliant layer.

We present the results from our first observing runs with the South Pole Imaging Fabry-Perot Inteferometer (SPIFI). SPIFI is a direct detection imaging spectrometer for use in the submillimeter - the first of its kind. SPIFI employs a 5 × 5 element array of bolometers as its focal plane, and uses two Fabry-Perot in series as its resolution achieving devices. To date, SPIFI has had 5 observing runs on the 15 meter James Clerk Maxwell Telescope (JCMT), three of which were entirely weathered out. During the two good runs, we obtained fully sampled maps in the 370 μm [CI] fine structure line and 372 μm CO(7→6) rotational line of the Galactic Center and the nuclei of several infrared bright galaxies. We present the results, and preliminary analysis of the data obtained for several of these sources below. To date, we have only used SPIFI in the 350 μm telluric window, but SPIFI can also access the 450 and 600 μm windows available to the JCMT, and the far-IR 200 μm window available to the NSF's 1.7 m AST/RO telescope at the South Pole. SPIFI is fully described in [1,2,9].

Two-dimensional flow is considered in a fluid bead located in the gap between a pair of contra-rotating cylinders and bounded by two curved menisci. The stability of such bead flows with two inlet films, and hence no contact line, are analysed as the roll speed ratio S is increased. One of the inlet films can be regarded as an ‘input flux’ whilst the other is a ‘returning film’ whose thickness is specified as a fraction ζ of the outlet film on that roll. The flow is modelled via lubrication theory and for Ca [Lt ] 1, where Ca represents the capillary number, boundary conditions are formally developed that account for S ≠ 1 and the non-constant gap. It is shown that there is a qualitative difference in the results between the single and double inlet film models unless small correction terms to the pressure drops at the interfaces are taken into account. Futhermore, it is shown that the inclusion of these small terms produces an O(1) effect on the prediction of the critical value of S at which bead break occurs. When the limits of the returning film fraction are examined it is found that as ζ → 0 results are in good agreement with those for the single inlet film. Further it is shown for a fixed input flux that as ζ → 1 a transition from bead break to upstream flooding of the nip can occur and multiple two-dimensionally stable solutions exist. For a varying input flux and fixed and ‘sufficiently large’ values of ζ there is a critical input flux &λmacr;(ζ) such that as S is increased from zero:

(i) bead break occurs for λ < &λmacr;;

(ii) upstream flooding occurs for λ > &λmacr;;

(iii) when λ = &λmacr; the flow becomes neutrally stable at a specific value of S beyond which there exist two steady solutions (two-dimensionally stable) leading to bead break and upstream flooding, respectively.