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To summarise published research investigating maximal temperatures associated with endoscopes used in otology. Possible thermal issues surrounding the use of endoscopes in middle-ear surgery are discussed, and recommendations regarding the safest ways to use endoscopes in endoscopic ear surgery are made.
A non-systematic review of the relevant literature was conducted, with descriptive analysis and presentation of the results.
There are currently no reports of any temperature-related deleterious effects in patients having undergone endoscopic ear surgery. There is debate regarding heat issues in endoscopic ear surgery, with a limited body of work documenting potential negative impacts of middle-ear heat exposure from endoscopes. The diameter of endoscope, type of light source used, distance from endoscope tip and duration of exposure are highlighted potential factors for high temperatures in endoscopic ear surgery.
There is a trend towards endoscopes being used routinely in ear surgery. Simple practice points are recommended to minimise potential thermal risks.
Litigation in surgery is increasing and liabilities are becoming unsustainable. This study aimed to analyse trends in claims, and identify areas for potential risk reduction, improved patient safety and a reduction in the number, and cost, of future claims.
Ten years of retrospective data on claims in otorhinolaryngology (2003–2013) were obtained from the National Health Service Litigation Authority via a Freedom of Information request. Data were re-entered into a spreadsheet and coded for analysis.
A total of 1031 claims were identified; of these, 604 were successful and 427 were unsuccessful. Successful claims cost a total of £41 000 000 (mean, £68 000). The most common areas for successful claims were: failure or delay in diagnosis (137 cases), intra-operative problems (116 cases), failure or delay in treatment (66 cases), failure to warn – informed consent issue (54 cases), and inappropriate treatment (47 cases).
Over half of the claims in ENT relate to the five most common areas of liability. Recent policy changes by the National Health Service Litigation Authority, over the level of information divulged, limits our learning from claims.
The Atacama Large Millimeter/submillimeter Array (ALMA) was used to obtain measurements of spatially and spectrally resolved CH3OH emission from comet C/2012 K1 (PanSTARRS) on 28-29 June 2014. Detection of 12-14 emission lines of CH3OH on each day permitted the derivation of spatially-resolved rotational temperature profiles (averaged along the line of sight), for the innermost 5000 km of the coma. On each day, the CH3OH distribution was centrally peaked and approximately consistent with spherically symmetric, uniform outflow. The azimuthally-averaged CH3OH rotational temperature (Trot) as a function of sky-projected nucleocentric distance (ρ), fell by about 40 K between ρ= 0 and 2500 km on 28 June, whereas on 29 June, Trot fell by about 50 K between ρ =0 km and 1500 km. A remarkable (~50 K) rise in Trot at ρ = 1500-2500 km on 29 June was not present on 28 June. The observed variations in CH3OH rotational temperature are interpreted primarily as a result of variations in the coma kinetic temperature due to adiabatic cooling, and heating through Solar irradiation, but collisional and radiative non-LTE excitation processes also play a role.
The loading of bone-anchored hearing system sound processors usually occurs two to three months after surgical implant. This study examined a new bone-anchored hearing system coupling mechanism that permits loading at two weeks post-implantation without compromising osseointegration.
Twenty implants were implanted into 15 patients. The interval between operation and time of processor loading was recorded, along with the cause of any delay and any late complications.
Two patients were fitted with implants at seven and nine weeks. The delay was a result of administrative errors; the patients reported no skin problems. Of the remaining 17 implants, 8 processors were fitted at 2 weeks, 1 at 3 weeks, 4 at 4 weeks, 3 at 7 weeks and 1 at 8 weeks. For those nine implants fitted later than two weeks, the delay was because of incomplete skin healing.
The Oticon Medical Xpress system allowed processor loading at two weeks post-operatively, providing skin healing was adequate. Early loading occurred in approximately half of the patients. All patients were fitted within the two to three months traditionally allowed. Prolonged skin healing time was the main reason for the delayed fitting of sound processors.
Concern has been raised about the lack of population data for the Nile crocodile Crocodylus niloticus in the lower/middle Zambezi valley. This area is important for conservation as well as being a source of crocodile eggs and adults for the ranching industry. Two spotlight surveys, in 2006 and 2009, were used to estimate population size, structure and trends. A stage-structured matrix model was parameterized from existing literature and the expected predictions were compared to those observed. The survey data suggests a population increase since 2006. Crocodile density was greatest (3.1 km−1) in the areas of increased wildlife and habitat protection and lowest (1.4 km−1) in areas of increased human presence. The predicted population stage structure differed to that observed, suggestive of a population not at equilibrium. Data on offtakes of crocodile eggs and adults would be useful for examining why this is the case. Continued monitoring of the wild population is necessary, to evaluate the trend of an increasing crocodile population, and additional demographic data for modelling purposes would be desirable.
In 1990 we reported that milk bottles pecked by jackdaws and magpies were a probable source of human Campylobacter infection. During April to June 1990 an extended study of Campylobacter infections was carried out in the Gateshead area. Prior to the study a health education programme was undertaken in an attempt to reduce human infection. Fifty-nine cases of human infection were recorded and 52 were interviewed. Thirty were entered into a case control study which demonstrated a very strong association between consumption of pecked milk and human Campylobacter infection (X2 = 12·6, P < 0·0004). It was estimated that between 500 and 1000 jackdaws (Corvus monedula) were present in the area where milk bottles were pecked and 63 isolates of Campylobacter were made from the bill and cloaca. Target bottles were put out in the early mornings and Campylobacters were isolated from 12 of 123 pecked bottles. Typing of the Campylobacters revealed a wide distribution of strains amongst birds, pecked milk and human infections. The health education programme had only limited success.
Detailed investigations of strain generation and relaxation in Si films grown on thin Si0.78Ge0.22 virtual substrates using Raman spectroscopy are presented. Good virtual substrate relaxation (>90%) is achieved by incorporating C during the initial growth stage. The robustness of the strained layers to relaxation is studied following high temperature rapid thermal annealing typical of CMOS processing (800-1050 °C). The impact of strained layer thickness on thermal stability is also investigated. Strain in layers below the critical thickness did not relax following any thermal treatments. However for layers above the critical thickness the annealing temperature at which the onset of strain relaxation occurred appeared to decrease with increasing layer thickness. Strain in Si layers grown on thin and thick virtual substrates having identical Ge composition and epilayer thickness has been compared. Relaxation through the introduction of defects has been assessed through preferential defect etching in order to verify the trends observed. Raman signals have been analysed by calibrated deconvolution and curve-fitting of the spectra peaks. Raman spectroscopy has also been used to study epitaxial layer thickness and the impact of Ge out-diffusion during processing. Improved device performance and reduced self-heating effects are demonstrated in thin virtual substrate devices when fabricated using strained layers below the critical thickness. The results suggest that thin virtual substrates offer great promise for enhancing the performance of a wide range of strained Si devices.
New photometry of main-sequence debris discs has been carried out at 850 and 450/μm; the derived SEDs indicate that the dust can lie in either thin rings or radially-extended discs, as seen directly in the few nearby objects which are resolvable. All such objects are consistent with a long wavelength opacity index β of 1.0±0.2 - similar to T Tauri stars, but significantly lower than embedded objects.
A conspicuous feature of many naturally limited populations of long-lived vertebrates is their relative stability. Both in populations that are regulated by predation or culling and in food-limited populations, population size can persist at approximately the same level for decades or even centuries (Runyoro et al. 1995; Waser et al. 1995; Clutton-Brock et al. 1997a; Newton 1998). The persistent fluctuations shown by Soay sheep and by some other island populations of ungulates (Boyd 1981; Leader-Williams 1988; Boussès 1991) raise general questions about the causes and consequences of variation in the stability of populations (see section 1.2). How regular are they? How are they related to population density? What are their immediate causes? To what extent do fluctuations in food availability, parasite number or predator density contribute to them? And what are their effects on development and on the phenotypic quality of animals born at contrasting population densities? And how much do changes in phenotype contribute to changes in dynamics?
As yet, there are very few cases where we understand either the ecological causes or the demographic consequences of persistent fluctuations in the size of naturally regulated populations of mammals (Hanski 1987; Saether 1997). Since we are able to monitor the growth, movements, breeding success and survival of large samples of individuals as population density changes, the Soay sheep offer an opportunity to investigate the causes and consequences of changes in population size with unusual precision (see Chapter 1).
Most species-specific conservation efforts require estimates of population size to establish priorities and to
monitor management activities. Yet obtaining reliable estimates of animal populations is often difficult, especially
given time and funding limitations experienced by
many research programmes. Consequently, there is a
great need for practical methods to provide indices of
animal density. Ideally, accurate estimates of populations
would be obtained through mark-recapture data
collected from recognizable individuals over multiple
censuses that cover the entire population range. Such
data are rarely available, so conservation biologists have
no alternative but to resort to analyses of less perfect
data, ranging from permanent-point censuses from cameras
through to transect data on sightings and spoor
encounters. The importance of census and monitoring
data makes the development, and validation, of new
techniques a priority. Because we do not live in a perfect
world, there is a need to develop methods that can
give an estimate of population sizes. It would be naïve
to assume that these will give hugely accurate estimates
of population size, but these techniques can prove useful
in identifying areas that are likely to benefit from
The monitoring and management of species depends on reliable population estimates, and this can be both difficult and very costly for cryptic large vertebrates that live in forested habitats. Recently developed camera trapping techniques have already been shown to be an effective means of making mark-recapture estimates of individually identifiable animals (e.g. tigers). Camera traps also provide a new method for surveying animal abundance. Through computer simulations, and an analysis of the rates of camera trap capture from 19 studies of tigers across the species' range, we show that the number of camera days/tiger photograph correlates with independent estimates of tiger density. This statistic does not rely on individual identity and is particularly useful for estimating the population density of species that are not individually identifiable. Finally, we used the comparison between observed trapping rates and the computer simulations to estimate the minimum effort required to determine that tigers,
or other species, do not exist in an area, a measure that is critical for conservation planning.
A schistosome infection is initiated when the parasite penetrates the skin of a susceptible host. Relatively large quantities
of protein are released by transforming cercariae compared to later larval stages. This represents the first parasite material
to which the host's immune system is exposed, yet little is known about the proteins which are released during the first
few hours post-transformation. We have shown that antiserum raised against such molecules was capable of imparting
protection against a schistosome challenge infection upon passive transfer to naïve mice. By screening a cercarial cDNA
library with this serum, 38 positive clones were identified. Sequence analysis showed these to represent 8 different
molecules which included Schistosoma mansoni 21·7 kDa antigen, calcium-binding-protein and the vaccine candidate
glutathione S-transferase (Sm28GST). In addition, 5 clones were isolated, 1 of which had significant homology to many
cytochrome C proteins, another with leukocyte elastase inhibitors and 3 which represented novel molecules. Four clones
were expressed in a prokaryotic high-level expression vector, sera produced against each purified recombinant protein and
used subsequently to probe Western blots and parasite sections. The leukocyte elastase inhibitor homologue and 2
unknowns induced significant proliferation by lymph node cells recovered from mice vaccinated with irradiated cercariae.
More strikingly, the 2 novel proteins stimulated very high levels of interferon γ (IFNγ) secretion both by lymph node cells
and those recovered by broncho-alveolar lavage from the lungs of vaccinated mice. Such results will be discussed in the
context of vaccine development.
Lung-stage schistosomula are the target of protective immunity in mice vaccinated with attenuated cercariae of Schistosoma
mansoni. Therefore, proteins present at this developmental stage, and in particular those which are secreted, are a potential
source of novel vaccine candidates. However, little information is available about such molecules. Here we describe the
cDNA clones identified by screening expression libraries with serum raised against proteins released by lung-stage
schistosomula. In total, 11 different cDNA species were identified, 6 of which have been described previously in S.
mansoni; these included fructose 1,6-bisphosphate aldolase and Sm21.7 which together accounted for two-thirds of all
positive clones. Of the 5 newly described schistosome genes, 1 cDNA had a high degree of homology to the s5a subunit
of 26S proteasomes, most significant being with the human protein. The remaining 4 clones showed no significant
homologies to any genes sequenced previously. Fructose 1,6-bisphosphate aldolase, Sm21.7, the proteasome homologue
and 1 unknown clone (A26) have been expressed in a bacterial expression system and serum produced against each
recombinant protein. Immunolocalization showed fructose 1,6-bisphosphate aldolase, Sm21.7 and the proteasome homologue
to be most abundant in muscle cells whilst clone A26 was distributed throughout many tissues, but was most
abundant in the tegument. Analysis of the cellular immune responses of vaccinated mice showed 3 of the 4 expressed
clones to be highly immunogenic, inducing the secretion of large quantities of the Th1-type cytokine interferon gamma.
The presence of naturally portacaval shunts has been investigated
the vasculature of normal and Schistosoma mansoni-infected Rattus
Using the technique of injecting Polystyrene microspheres in the superior
mesenteric vein, we
demonstrated that the presence of adult schistosomes in the lungs of R.
was not due to an innate anomaly of the
rat vasculature but resulted from the formation of portacaval shunts during
In rats harbouring a bisexual
infection, microspheres were only detected in the lungs from week 7. The
development and increasing size of the shunts
were maximal between weeks 7 and 10 and coincident with the translocation
of adult worms from the portal tract to the
lungs. At weeks 20–25, only 1–2% of the microspheres were recovered
from the lungs, suggesting that the portacaval
anastomoses have regressed due to reduction in portal hypertension after
translocation. R. rattus with a male-only
schistosome infection harboured adult worms in the lungs, indicating that
development of shunts does not solely
depend upon egg deposition in the liver to generate hypertension. The relationships
between the presence of the
schistosomes in the lungs, the portacaval shunting and the resistance to
reinfection is discussed.
The integrity of the hepatic portal vasculature was examined, relative to the resistance to Schistosoma mansoni observed in 68°0 of 129/Ola mice. The passage of microspheres to the lungs, following their injection via the superior mesenteric vein, indicated the presence of shunts in the majority of both naive and infected mice. There was a negative association between shunting of microspheres to the lungs and paucity of liver worms at 28/35 days post-infection. Schistosomula accumulated in the livers of resistant mice at a slower rate than in susceptible animals, and after day 21 relocated to the lungs. Many lung schistosomula injected via the superior mesenteric passed immediately to the lungs; the shunts thus greatly reduce the probability of trapping in the liver. Some parasites migrated back from the lungs, successfully lodged in the liver and began to feed on blood. Latex infusion demonstrated the location of large intrahepatic connections between the portal and hepatic veins. We suggest that as these liver worms grow, migrating upstream into progressively larger vessels, they reach the connections, pass out of the hepatic portal system, and relocate to the lungs. The presence of the natural shunts thus accounts for the resistant status of the mice.
Newly transformed schistosomula and day 8 lung parasites, derived from optimally irradiated cercariae, were used to immunize groups of C57B1/6 mice via 4 different injection routes. Schistosomula administered intradermally induced high levels of protection, comparable with that achieved by percutaneous vaccination. Intermediate levels were elicited by delivery of parasites via intraperitoneal or intratracheal routes. In contrast, intravenous injection of schistosomula to the lungs resulted in little or no resistance. Attenuated day 8 schistosomula administered intradermally were at least as immunogenic as irradiated cercariae. The fate of radio-isotope labelled attenuated lung schistosomula, injected via the various routes, was examined by compressed organ autoradiography. After intradermal vaccination, a proportion of parasites migrated from the site of injection to the draining lymph node and lungs. Conversely, schistosomula administered via the other 3 routes persisted to varying degrees at the injection site, but little onward migration was observed. We suggest that successful vaccination requires that some attenuated parasites migrate to, and sequester in, lymph nodes draining the vaccination site; persistence at the site of administration alone is not an adequate stimulus.
The leucocyte responses in peripheral blood and pulmonary airways are described following vaccination of mice with radiation-attenuated parasites, and subsequent challenge with normal parasites. Percutaneous vaccination stimulated a large and sustained expansion of the circulating lymphocyte pool, more marked than after intradermal vaccination with lung schistosomula which induced comparable levels of resistance. Macrophages and lymphocytes infiltrated the pulmonary airways in response to vaccination by both routes, the lymphocytes being particularly abundant after intradermal vaccination. Exposure of mice to an equivalent number of normal cercariae induced an earlier lymphocytosis of short duration; far fewer macrophages and lymphocytes infiltrated the lungs than after vaccination. An intense but transient pulmonary eosinophilia peaked at 3 weeks after primary exposure to either normal or attenuated parasites. Percutaneous challenge of vaccinated mice elicited higher levels of circulating lymphocytes than challenge of unsensitized controls. However, whilst leucocyte numbers of all cell types were still elevated in the airways at challenge as a consequence of vaccination, no further cellular recruitment was observed coincident with parasite elimination. Our data are compatible with the hypothesis that the mechanism of immunity in once-vaccinated mice involves a T lymphocyte-macrophage interaction triggered by antigen release from lung schistosomula.
The fate of 75Se-labelled parasites and their released pre-synthesized macromolecules has been followed in three murine infection models. Parasite numbers in specific tissues were determined by autoradiography, and released material was estimated by gamma-counting of tissues, with adjustment for the presence of parasite-associated radiolabel. Marked differences were found between the three models. The pattern of migration of normal schistosomula was similar to that previously reported. In addition we have described the transit of parasites through the lymph nodes draining the infection site. Significant quantities of released material were detected in the skin, draining lymph nodes, bloodstream and liver. The circulating material was of parasite origin, macromolecular, and hence potentially antigenic. In comparison to the normal infection, radiation-attenuated parasites (inducing a high level of resistance to challenge) persisted in the skin, draining lymph nodes and lungs, releasing a proportionally greater amount of material in the nodes. In mice exposed to attenuated parasites and treated with the compound ROl1–3128 at 24 h (inducing a low level of resistance) there was an early death and rapid clearance of the parasites whilst still in the skin. This situation resulted in the highest levels of released material in the skin, bloodstream and liver, but negligible levels in the draining lymph nodes. We suggest that the persistence of radiation-attenuated parasites in the skin and draining lymph nodes, together with the prolonged release of antigen in the latter site, compared to the normal situation, are major factors in the induction of resistance.