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This study aimed to evaluate the effect of neck dissection on survival and complication rates in patients with no clinical or radiological evidence of cervical nodal disease (N0) undergoing salvage laryngectomy.
A retrospective study was conducted of patients with squamous cell carcinoma of the larynx following primary radiotherapy that required salvage laryngectomy. Disease-free and overall survival rates were compared over three years using Kaplan–Meier analysis. Pharyngocutaneous fistula rate, hospitalisation length and the requirement for further surgical intervention were also compared across cohorts.
Twenty-three cases met the inclusion criteria (17 neck dissections, 6 undissected). No significant differences in survival outcomes were identified. One patient who underwent neck dissection for advanced, recurrent transglottic squamous cell carcinoma showed evidence of occult lymph node metastases. Fistula rates did not differ significantly between dissected and non-dissected groups; however, two patients required surgical repair of post-operative pharyngocutaneous fistula following neck dissection.
In this study, elective neck dissection did not appear to alter survival outcomes or complication rates during salvage laryngectomy. Given the small but significant risk of occult neck metastases, its true value remains unclear.
Introduction: 9-1-1 telecommunicators receive minimal education on agonal breathing, often resulting in unrecognized out-of-hospital cardiac arrest (OHCA). We successfully piloted an educational intervention that significantly improved telecommunicators’ OHCA recognition and bystander CPR rates in Ottawa. We sought to better understand the operations of Canadian 9-1-1 communications centers (CC) in preparation for a multi-centre study of this intervention. Methods: We conducted a National survey of all Canadian CCs. Survey domains included information on organizational structure, dispatch system used, education curriculum, and performance monitoring. It was peer-reviewed, translated in French, pilot-tested, and distributed electronically using a modified Dillman method. We designated respondents in each CC before distribution and used targeted follow-up and small incentives to increase response rate. Respondents also described functioning of neighboring CCs if known. Results: We received information from 51/51 provincial and 1/25 territorial CCs, representing 99.7% of the Canadian population. CCs largely utilize the Medical Dispatch Priority System (MPDS) platform (93%), many are Province/Ministry regulated (50%) and most require a High School diploma as minimum entry level education (78%). Telecommunicators receive initial in-class training (median 1.3 months, IQR 0.3-1.9; range 0.1-2.2), often followed by a preceptorship (84.4%) (median 1.0 months, IQR 0.7-1.7; range 0.4-6.0). Educational curriculum includes information on agonal breathing in 41% of CC, without audio examples in 34%. Among responding CCs, over 39,000 suspected OHCA 9-1-1 calls are received annually. Few CCs maintain local performance statistics on OHCA recognition (25%), bystander CPR rates (25%) or survival rates (50%). Most (97%) expressed interest in future research collaborations. Conclusion: Most Canadian telecommunicators receive no or minimal education in recognizing agonal breathing. Further training and improved OHCA monitoring may assist recognition and enhance outcomes.
The role of panendoscopy in the modern investigation of head and neck cancer is changing with the development of improved radiological techniques, in-office biopsy capabilities and the low rate of synchronous primary tumours. This study aimed to review the indications for panendoscopy in the investigation of newly diagnosed head and neck cancer.
A retrospective review was conducted of 186 patients with newly diagnosed head and neck cancer, between January 2014 and December 2015, at two tertiary centres.
Obtaining a tissue diagnosis was the most common indication for panendoscopy (65 per cent), followed by surgical planning including transoral robotic surgery suitability assessment (22.6 per cent), and the investigation of carcinoma of an unknown primary (11.3 per cent). Two synchronous primary tumours were identified, generating a yield of 1.1 per cent.
Panendoscopy remains integral in the assessment of transoral robotic surgery suitability. Refining indications for modern panendoscopy could reduce the need for this procedure in this cohort of patients.
A significant number of X-ray binaries are now known to exhibit long-term periodicities on timescales of ~10 - 100 days. Several physical mechanisms have been proposed that give rise to such periodicities, one of which is radiation-driven warping and precession of the accretion disk. Recent theoretical work predicts the stability to disk warping as a, function of the mass ratio, binary radius, viscosity and accretion efficiency. We investigate the stability of the superorbital periodicities in the neutron star X-ray binaries Cyg X-2, LMC X-4, SMC X-l and Her X-l, and thereby confront stability predictions with observation. We find that the period and nature of the superorbital variations in these sources is consistent with the predictions of warping theory.
This paper reviews some of the research that has been carried out at the University of Liverpool where the Flight Science and Technology Research Group has developed its Heliflight-R full-motion research simulator to create a simulation environment for the launch and recovery of maritime helicopters to ships. HELIFLIGHT-R has been used to conduct flight trials to produce simulated Ship-Helicopter Operating Limits (SHOLs). This virtual engineering approach has led to a much greater understanding of how the dynamic interface between the ship and the helicopter contributes to the pilot's workload and the aircraft's handling qualities and will inform the conduct of future real-world SHOL trials. The paper also describes how modelling and simulation has been applied to the design of a ship's superstructure to improve the aerodynamic flow field in which the helicopter has to operate. The superstructure aerodynamics also affects the placement of the ship's anemometers and the dispersion of the ship's hot exhaust gases, both of which affect the operational envelope of the helicopter, and both of which can be investigated through simulation.
Using new (Cycle 9) HST / WFPC2 data, we have studied a peculiar star forming region in the nearby Sc-type spiral NGC 6946. The region has a bubble-like shape and a diameter of about 600 pc. Near the centre is an extremely luminous young globular cluster with MV = −13.2 mag. The cluster has a compact core with a core radius of about 1.3 pc but is surrounded by an extended halo with a power-law luminosity profile similar to that observed for young LMC clusters. From Keck / HIRES high-dispersion spectroscopy we measure a velocity dispersion of 10 km s−1, leading to a dynamical mass estimate of about 1.7 × 106 solar masses. The dynamical mass estimate is comparable to the expectation from population synthesis modelling under the assumption of a Salpeter IMF extending down to 0.1 M⊙.
The incidence of oropharyngeal squamous cell carcinoma in the Western world is increasing, with the human papillomavirus epidemic implicated in this observed trend. The optimal treatment modality is yet undetermined regarding oncological outcomes.
This study comprised 98 patients with oropharyngeal squamous cell carcinoma, treated with either primary transoral surgery with adjuvant therapy or primary chemoradiotherapy with curative intent, between 2008 and 2012. Clinicopathological characteristics including tumour–node–metastasis stage, human papillomavirus status, treatment modality, recurrence and overall survival were collated.
Five per cent of primary surgical patients had locoregional recurrences compared with 25 per cent of primary chemoradiotherapy patients. A lower rate of locoregional recurrence was observed in the human papillomavirus positive group.
This paper reports higher rates of overall survival and local control for oropharyngeal squamous cell carcinoma treated with primary surgery compared with primary chemoradiotherapy. This reflects overall lower tumour stage and higher human papillomavirus status in this group.
To evaluate the prevalence of variations in the anatomical route of the spinal accessory nerve from the base of the skull to the point where it enters the trapezius muscle. A case report is used to demonstrate an example of a rare but clinically important anatomical variant of this nerve.
An independent review of the literature using Medline, PubMed and Q Read databases was performed using combinations of terms including ‘spinal accessory nerve’, ‘anatomy’, ‘surgical anatomy’, ‘anatomical variant’, ‘cranial nerve XI’ and ‘shoulder syndrome’.
Our report demonstrates marked variation in spinal accessory nerve anatomy. At the point of crossing over the internal jugular vein, the spinal accessory nerve passes most commonly laterally (anterior) to the internal jugular vein. The reported incidence of this lateral relationship varies from 67 to 96 per cent. The nerve can also pierce the internal jugular vein, as demonstrated in our case study, with incidence ranging from 0.48 to 3.3 per cent.
Anatomical variations of the spinal accessory nerve are not uncommon, and it is important for the surgeon to be aware of such variations when undertaking surgery in both the anterior and posterior triangles of the neck.
Spatial studies of the emission line regions in planetary nebulae (PN) can provide insight into the physical and chemical environments across the nebulae. In a collaborative effort by the coauthors, a K-band Fabry-Perot etalon has been coupled with an advanced 256 × 256 InSb focal plane array at the Wyoming Infrared Observatory 2.3m telescope. This system permits us to obtain spatially resolved, 0.24″/pixel, moderate spectral resolution (R ≈ 800), flux-density IR emission line images of astronomical sources. We obtained continuum-subtracted images of Br γ, HeI 2.06 μm, the 2-μm UIR features, and the 3.3 μm PAH dust feature in the PN NGC 6572, NGC 7027, and NGC 7662. One objective was to determine the spatial morphology of two unidentified emission lines, UIR1−2.199 μm, and UIR2−2.287 μm (Geballe et al. 1991). These UIR lines appear in the spectra of many PN (Hora et al. 1997) and in the Orion Nebula (Luhman & Rieke 1996). Geballe et al. suggested that the UIR lines are most likely forbidden transitions and showed that the parent ion ionization potential is ≈ 30–40 eV, while the ionization potential for the ions themselves is 40–60 eV. Here we directly compare the distribution of the UIR emitters to that of the gas (H+,He+) and dust (PAHs).
The study of on-body energy harvesting is most often focused on improving and optimizing the energy harvester. However, other factors play a critical factor in the energy harvesting integration techniques of the harvester to close-to body materials of the wearable device. In addition, one must recognize the wide array of human factors and ergonomic factors that lead a variation of the energy harvesting. In this work, key affecting variables at varying on-body locations are investigated for commercial thermoelectric generators (TEGs) integrated within a textile-based wearable platform. For this study, a headband and an armband is demonstrated with five TEGs connected in series in a flexible form factor via Pyralux®. These platforms enable comparison of the amount of energy harvested from the forehead versus the upper arm during various external conditions and movement profiles, e.g. running, walking, and stationary for periods of up to 60 minutes. During these tests, ambient temperature, ambient humidity, accelerometry, and instantaneous power are recorded live during the activity and correlated to the energy harvested. Human factors such as skin temperature and application pressure were also analyzed. Our analysis demonstrates that vigorous movement can generate over 100 μW of instantaneous power from the headband and up to 35 μW from the armband. During the stationary movement profile, the instantaneous power levels of both the headband and the armband decreased to a negligible value. Our studies show that for higher intensities of movement, air convection on the cool side of the TEG is the dominating variable whereas the temperature gradient has a significant effect when the subject is stationary. This work demonstrates key materials and design factors in on-body thermoelectric energy harvesting that allows for a strategic approach to improving the integration of the TEGs.
The present Report covers the period 1982-1984. As with previous Reports, it has not been possible to cover all publications or even every field of research. Some subsections of this Report, the Magellanic Clouds for example, report a body of work as extensive as that in some commissions.