Flight, Wind Tunnel, and Numerical Experiments with a Slender Cone at Incidence

The three-dimensional leeward separation about a 5-deg semi-angle cone of 11 deg angle of incidence was Investigated in night, in the wind tunnel, and by numerical computations. The test conditions were Mach numbers of 0.6, 1.5, and 1.8 at Reynolds numbers between 7 and 10 million based on freestream conditions and a 76.2-cm (30-in.) length of surface. The surface pressure conditions measured included those of fluctuating and mean static, as well as recovery pressures generated by obstacle blocks to provide skin friction and separation-line locations. The mean static pressures from flight and wind tunnel were in reasonably good agreement. The computed results gave the same distributions, but were slightly more positive in magnitude. The experimentally measured primary and secondary separation line locations compared closely with computed results. There were substantial differences In level between the surface root-mean-square pressure fluctuations obtained in night and in the wind tunnel, due, It Is thought, to a relatively high acoustic disturbance level in the tunnel compared with the quiescent atmospheric conditions in night

Guidelines for the Management of Soft Tissue Sarcomas

These guidelines were drawn up following a consensus meeting of UK sarcoma specialists convened under the auspices of the British Sarcoma Group and are intended to provide a framework for the multidisciplinary care of patients with soft tissue sarcomas. The guidelines published by the European Society of Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN) were used as the basis for discussion and adapted according to UK clinical practice and local requirements. Note was also taken of the National Institute for Health and Clinical Excellence (NICE) improving outcomes guidance (IOG) for people with sarcoma and existing technology appraisals. The guidelines are not intended to challenge NICE guidance but discrepancies may exist where current guidance does not reflect an international standard of care owing to the ever-evolving nature of cancer treatment. It is acknowledged that these guidelines will require updating on a regular basis. An appendix lists the key recommendations which are summarised below. Any patient with a suspected soft tissue sarcoma should be referred to a diagnostic centre and managed by a specialist sarcoma multidisciplinary team. Surgical excision followed by post operative radiotherapy is the standard management of high grade limb sarcomas although occasionally amputation remains the only option. Pre-operative treatment with chemotherapy or radiotherapy should be considered for patients with borderline resectable tumours. Isolated limb perfusion may permit limb salvage in some cases where amputation is the only other option. Adjuvant chemotherapy is not routinely recommended but may be considered in certain specific situations. Regular follow up is recommended to assess local control and the development of metastatic disease. Single agent doxorubicin is the standard first line therapy for metastatic disease. Ifosfamide is an alternative if anthracyclines are contraindicated. Combination therapy may be considered in individual patients. Second line agents include ifosfamide, dacarbazine, trabectedin and the combination of gemcitabine + docetaxel. Surgical resection of local recurrence and pulmonary metastases should be considered in individual patients. There is specific guidance on the management of retroperitoneal and uterine sarcomas

Integrated building design, information and simulation modelling: the need for a new hierarchy

The need to reduce radically the energy used by buildings is leading to new design practices. Current design and simulation software are used in very different ways, with energy simulation generally employed to check energy code compliance after the design stages are mostly finished. This linear approach to working practices, the modelling methods used and poor interoperability inhibit iterative design practices. This paper outlines a case study to elicit early software requirements for combined simulation and design software. The barriers to this type of integrated software are discussed. Finally, a change to the hierarchy of existing interoperable languages is proposed

The Effects of Increased Provision of Thoracic Surgical Specialists on the Variation in Lung Cancer Resection Rate in England

Introduction:There is a wide variation in the lung cancer resection rate in England. We assessed the effect of the regional provision of thoracic surgery service on the variation in lung cancer resection rate.Methods:A retrospective observational study correlating National Lung Cancer Audit data with thoracic surgery workforce data was performed to review the lung cancer resection rate in England in 2008 and 2009.Results:In 2008, there was a sixfold variation in resection rate, with a higher resection rate in hospitals where surgeons were based (base hospitals) than in peripheral hospitals (20.0% versus 11.6%, p < 0.001). The resection rate was also higher in cancer networks, which were served by two or more specialist thoracic surgeons (14.6% versus 12.7%, p = 0.028), and where surgeons were present in more than two-thirds of the lung cancer multidisciplinary team meetings (14.4% versus 12.0%, p = 0.046). In 2009, the overall resection rate increased from 14.5% to 18.4%. Four units increased their number of specialist thoracic surgeons and had a significantly higher increase in resection rate than units without expansion (relative rise 66.3% versus 19.2%; p = 0.022).Conclusions:The large variation in the resection rate seems, in part, to be related to the local availability of specialist thoracic surgeons. The greatest improvement in the resection rate was in units with expansion of specialist thoracic surgeons. We suggest the expansion of specialist thoracic surgeons will improve the resection rate and thereby the overall survival of lung cancer in England. This has significant implications for the future of training in cardiothoracic surgery and organization of cancer services

Paget's Osteosarcoma — no Cure in Sight

Purpose Paget' s osteosarcoma has a fearful reputation with a quoted survival of at best 5% at 5 years.We therefore reviewed our experience of 26 patients treated over the last 25 years using modern staging and limb salvage techniques to see if there had been any improvement in survival

Survival of patients with small cell lung cancer undergoing lung resection in England, 1998–2009

Introduction: Chemotherapy or chemoradiotherapy is the recommended treatment for small cell lung cancer (SCLC), except in stage I disease where clinical guidelines state there may be a role for surgery based on favourable outcomes in case series. Evidence supporting adjuvant chemotherapy in resected SCLC is limited but this is widely offered. Methods: Data on 359 873 patients who were diagnosed with a first primary lung cancer in England between 1998 and 2009 were grouped according to histology (SCLC or non-SCLC (NSCLC)) and whether they underwent a surgical resection. We explored their survival using Kaplan-Meier analysis and Cox regression, adjusting for age, sex, comorbidity and socioeconomic status. Results: The survival of 465 patients with resected SCLC was lower than patients with resected NSCLC (5-year survival 31% and 45%, respectively), but much higher than patients of either group who were not resected (3%). The difference between resected SCLC and NSCLC diminished with time after surgery. Survival was superior for the subgroup of 198 'elective' SCLC cases where the diagnosis was most likely known before resection than for the subgroup of 267 'incidental' cases where the SCLC diagnosis was likely to have been made after resection. Conclusions: These data serve as a natural experiment testing the survival after surgical management of SCLC according to NSCLC principles. Patients with SCLC treated surgically for early stage disease may have survival outcomes that approach those of NSCLC, supporting the emerging clinical practice of offering surgical resection to selected patients with SCLC

Effect of ageing and exercise training on myokine expression responses to acute exercise

Age-related muscle loss is a major contributor to falls, fraility and mortality. It has been widely suggested that chronic, age-related inflammation contributes to the gradual loss of skeletal muscle mass that occurs with ageing. Indeed, ageing is associated with elevations in a number of circulating inflammatory proteins, many of which have detrimental effects on skeletal muscle growth and protein balance. Exercise training has been shown to reduce chronic inflammation and, therefore, may represent an appropriate means to reduce age-related inflammation and counteract sarcopenia. Yet few studies have evaluated the effect of aging on skeletal muscle expression of inflammatory proteins and the effect of acute and repeated exercise on these factors. The aim of the current study was to determine the effect of 12 weeks of resistance exercise training on the levels of myokines within skeletal muscle, both at rest and following an acute bout of exercise and to examine how these responses may vary in young and older subjects, thus evaluating the potential for exercise to reduce age-related muscle inflammation. Six healthy young (aged 18-25 years) and 8 healthy older men (aged 60-75 years) completed 12 weeks of resistance exercise training. Muscle biopsies were collected before and 2 h after an acute exercise bout at the beginning and the end of the 12 week training period. Muscle tissue was analyzed for the expression of key inflammatory (MCP-1, IL-8, IL-6 and TNF-α) and anti-inflammatory cytokines (IL-10, IL-13 and IL-4) via bead-based multiplex analysis. Acute exercise increased the expression of inflammatory myokines, while anti-inflammatory myokines remained unchanged. In contrast to the hypothesis for this study, neither age nor training had a significant effect on the expression of myokines within skeletal muscle either in the resting state or 2 hours following exercise. However, older individuals displayed an increased inflammatory response to exercise prior to training when compared to younger individuals. Twelve weeks of resistance exercise training appeared to normalize this difference. Given the variability in myokine levels between individuals and the small subject number in the current study, further research is required to confirm this findin

Predicting Mid-Life Capital Formation with Pre-School Delay of Gratification and Life-Course Measures of Self-Regulation

How well do pre-school delay of gratification and life-course measures of self-regulation predict mid-life capital formation? We surveyed 113 participants of the 1967–1973 Bing pre-school studies on delay of gratification when they were in their late 40’s. They reported 11 mid-life capital formation outcomes, including net worth, permanent income, absence of high-interest debt, forward-looking behaviors, and educational attainment. To address multiple hypothesis testing and our small sample, we pre-registered an analysis plan of well–powered tests. As predicted, a newly constructed and pre-registered measure derived from preschool delay of gratification does not predict the 11 capital formation variables (i.e., the sign-adjusted average correlation was 0.02). A pre-registered composite self-regulation index, combining preschool delay of gratification with survey measures of self-regulation collected at ages 17, 27, and 37, does predict 10 of the 11 capital formation variables in the expected direction, with an average correlation of 0.19. The inclusion of the preschool delay of gratification measure in this composite index does not affect the index\u27s predictive power. We tested several hypothesized reasons that preschool delay of gratification does not have predictive power for our mid-life capital formation variables

UK Guidelines for the Management of Bone Sarcomas

These guidelines have been developed in order to provide an overview and a set of broad-based key recommendations for the management of patients with bone sarcomas in the UK. They have taken into consideration the most up-to-date scientific literature along with the recent recommendations by the European Society of Medical Oncology. The principles of the NICE guidance on both “improving outcomes for patients with sarcomas” and “improving outcomes with children and young people with cancer” have been incorporated. As care evolves, it is acknowledged that these guidelines will need updating. The key recommendations are that bone pain or a palpable mass should always lead to further investigation and patients with clinicoradiological findings suggestive of a primary bone tumour should be sent to a reference centre. Patients should then have their care managed at such a specialist centre by a fully accredited multidisciplinary team

Ibuprofen ingestion does not affect markers of post-exercise muscle inflammation

PURPOSE: We investigated if oral ingestion of ibuprofen influenced leucocyte recruitment and infiltration following an acute bout of traditional resistance exercise Methods: Sixteen male subjects were divided into two groups that received the maximum over-the-counter dose of ibuprofen (1200mg d(-1)) or a similarly administered placebo following lower body resistance exercise. Muscle biopsies were taken from m.vastus lateralis and blood serum samples were obtained before and immediately after exercise, and at 3 and 24 h after exercise. Muscle cross-sections were stained with antibodies against neutrophils (CD66b and MPO) and macrophages (CD68). Muscle damage was assessed via creatine kinase and myoglobin in blood serum samples, and muscle soreness was rated on a ten-point pain scale. RESULTS: The resistance exercise protocol stimulated a significant increase in the number of CD66b(+) and MPO(+) cells when measured 3 h post exercise. Serum creatine kinase, myoglobin and subjective muscle soreness all increased post-exercise. Muscle leucocyte infiltration, creatine kinase, myoglobin and subjective muscle soreness were unaffected by ibuprofen treatment when compared to placebo. There was also no association between increases in inflammatory leucocytes and any other marker of cellular muscle damage. CONCLUSION: Ibuprofen administration had no effect on the accumulation of neutrophils, markers of muscle damage or muscle soreness during the first 24 h of post-exercise muscle recovery