Midface Including Le Fort Level Injuries

Le Fort fractures occur at uniform weak areas in the midface often due to blunt impact to the face. Sporting injuries are a common cause of facial trauma; however, use of protective equipment has reduced the number of sports-related injuries. All patients with traumatic injuries should be evaluated using Advanced Trauma Life Support protocol. Le Fort fractures can contribute to airway obstruction, and urgent intubation may be indicated. Surgery is indicated for most displaced Le Fort fractures to restore function and facial harmony. To facilitate reduction, the original occlusive relationship should be restored by placing the patient in MMF

31064 The Detroit Keloid Scale: A validated tool for rating keloids

Background: No keloid-specific outcome measures exist. Objective: To develop and validate the Detroit Keloid Scale (DKS), a standardized method of keloid assessment to better compare treatments. Methods: Forty-seven physicians were polled to develop the DKS. The scale was validated in 52 patients with keloids against the Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), and Dermatology Life Quality Index (DLQI) by 3 physicians. Results: The interrater reliability was “substantial” for observer component of the DKS and only “moderate” for the VSS and observer POSAS (ICC were 0.80, 0.60, and 0.47, respectively). Pearson’s correlation indicated a “moderate” association between the observer component of DKS with observer component of POSAS (ρ = 0.56, P \u3c.001) and a “substantial” relationship between the observer component of DKS and VSS (ρ = 0.63, P \u3c.001). Pearson’s correlation indicated a “moderate” association between the patient portion of DKS and patient portion of POSAS and the patient portion of the DKS and DLQI (0.61 and 0.60, respectively, P \u3c.05). The DKS total score consistently showed “substantial” relationship with POSAS total score (ρ = 0.65, P \u3c.001). Limitations: Single center study, no intrarater reliability analysis. Conclusions: The substantial interrater reliability of the DKS will allow for improved standardization in future keloid research

Large-scale variations in ozone and polar stratospheric clouds measured with airborne lidar during formation of the 1987 ozone hole over Antarctica

A joint field experiment between NASA and NOAA was conducted during August to September 1987 to obtain in situ and remote measurements of key gases and aerosols from aircraft platforms during the formation of the ozone (O3) hole over Antarctica. The ER-2 (advanced U-2) and DC-8 aircraft from the NASA Ames Research Center were used in this field experiment. The NASA Langley Research Center's airborne differential absorption lidar (DIAL) system was operated from the DC-8 to obtain profiles of O3 and polar stratospheric clouds in the lower stratosphere during long-range flights over Antarctica from August 28 to September 29, 1987. The airborne DIAL system was configured to transmit simultaneously four laser wavelengths (301, 311, 622, and 1064 nm) above the DC-8 for DIAL measurements of O3 profiles between 11 to 20 km ASL (geometric altitude above sea level) and multiple wavelength aerosol backscatter measurements between 11 to 24 km ASL. A total of 13 DC-8 flights were made over Antarctica with 2 flights reaching the South Pole. Polar stratospheric clouds (PSC's) were detected in multiple thin layers in the 11 to 21 km ASL altitude range with each layer having a typical thickness of less than 1 km. Two types of PSC's were found based on aerosol backscattering ratios: predominantly water ice clouds (type 2) and clouds with scattering characteristics consistent with binary solid nitric acid/water clouds (type 1). Large-scale cross sections of O3 distributions were obtained. The data provides additional information about a potentially important transport mechanism that may influence the O3 budget inside the vortex. There is also some evidence that strong low pressure systems in the troposphere are associated with regions of lower stratospheric O3. This paper discusses the spatial and temporal variations of O3 inside and outside the polar vortex region during the development of the O3 hole and relates these data to other measurements obtained during this field experiment

Heterogeneous processes: Laboratory, field, and modeling studies

The efficiencies of chemical families such as ClO(x) and NO(x) for altering the total abundance and distribution of stratospheric ozone are controlled by a partitioning between reactive (active) and nonreactive (reservoir) compounds within each family. Gas phase thermodynamics, photochemistry, and kinetics would dictate, for example, that only about 1 percent of the chlorine resident in the lower stratosphere would be in the form of active Cl or ClO, the remainder existing in the reservoir compounds HCl and ClONO2. The consistency of this picture was recently challenged by the recognition that important chemical transformations take place on polar regions: the Airborne Antarctic Ozone Experiment (AAOE) and the Airborne Arctic Stratospheric Expedition (AASA). Following the discovery of the Antarctic ozone hole, Solomon et al. suggested that the heterogeneous chemical reaction: ClONO2(g)+HCl(s) yields Cl2(g)+HNO3(s) could play a key role in converting chlorine from inactive forms into a species (Cl2) that would rapidly dissociate in sunlight to liberate atomic chlorine and initiate ozone depletion. The symbols (s) and (g) denote solid phase, or adsorbed onto a solid surface, and gas phase, respectively, and represent the approach by which such a reaction is modeled rather than the microscopic details of the reaction. The reaction was expected to be most important at altitudes where PSC's were most prevalent (10 to 25 km), thereby extending the altitude range over which chlorine compounds can efficiently destroy ozone from the 35 to 45 km region (where concentrations of active chlorine are usually highest) to lower altitudes where the ozone concentration is at its peak. This chapter will briefly review the current state of knowledge of heterogeneous processes in the stratosphere, emphasizing those results obtained since the World Meteorological Organization (WMO) conference. Sections are included on laboratory investigations of heterogeneous reactions, the characteristics and climatology of PSC's, stratospheric sulfate aerosols, and evidence of heterogeneous chemical processing

The LHC Sector Test

The proposal to inject beam into a sector of the partially completed LHC is presented. The test will provide an important milestone, force preparation of a number of key systems, and allow a number of critical measurements with beam. The motivation for the test is discussed, along with the proposed beam studies, the radiation issues and the potential impact on ongoing installation. The demands on the various accelerator systems implicated are presented along with the scheduling of the preparatory steps, the test itself and the recovery phase

The Efficacy of Vaginal Clindamycin for the Treatment of Abnormal Genital Tract Flora in Pregnancy

Objective: To assess the efficacy of 2% clindamycin vaginal cream (CVC) to treat bacterial vaginosis (BV) in pregnancy. Methods: A prospective, randomized, double-blind, placebo-controlled, tricenter study. Four hundred and four women with BV on Gram stain at their first antenatal clinic visit were randomized to receive a 3-day course of 2% CVC or placebo. The outcome was assessed using an intention to treat analysis at 3 weeks and 6 weeks post-treatment according to three different diagnostic methods based on five criteria (Gram stain and all four elements of clinical composite criteria: vaginal discharge, abnormal vaginal pH, clue cells, amine odor), three criteria (vaginal pH, clue cells, amine odor) or two criteria (clue cells and amine odor) to reflect stringency of diagnosis, historical precedence and government agency recommendations respectively. Results: Using five diagnostic criteria, 18% of CVC patients were cured and 70.8% either cured and/or improved compared to 1.6% and 12% of placebo patients respectively (p < 0.0001). Using three diagnostic criteria, 44.8% of CVC patients were cured and 77.3% were either cured and/or improved compared to 9.3% and 28.8% of placebo patients respectively (p < 0.0001). Using two diagnostic criteria, 75.0% of CVC patients were cured compared to 18.0% of placebo patients (p < 0.0001). Recurrence rates in those CVC patients successfully treated were approximately 6% at 6 weeks post baseline and 10% at 28 to 34 weeks gestation. Conclusions: A 3-day course of CVC appears to be well tolerated by the mother and statistically significantly more efficacious than placebo in the treatment of BV during the second trimester of pregnancy

Recent high pT measurements in STAR

After five years of data taking, the STAR experiment at the Relativistic Heavy Ion Collider (RHIC) at Brookhaven National Laboratory provides precise measurements of particle production at high transverse momentum in p-p, d-Au, and Au-Au collisions at sqrt(s) = 200 GeV. We review recent results on the flavor dependence of high pT particle suppression and hadron particle spectra at sqrt(s) = 62.4 GeV. New results on two-particle angular correlations for identified trigger particles and for low momentum associated charged hadrons in p-p and Au-Au as well as near-side $\Delta\eta$ correlations will be presented and discussed.Comment: 5th International Conference on Physics and Astrophysics of Quark Gluon Plasma, Calcutta. 8 pages, 10 figures, submitted to J. Phys. G: Nucl. Part. Phy

How do we create, and improve, the evidence base?

Providing best clinical care involves using the best available evidence of effectiveness to inform treatment decisions. Producing this evidence begins with trials and continues through synthesis of their findings towards evidence incorporation within comprehensible, usable guidelines, for clinicians and patients at the point of care. However, there is enormous wastage in this evidence production process, with less than 50% of the published biomedical literature considered sufficient in conduct and reporting to be fit for purpose. Over the last 30 years, independent collaborative initiatives have evolved to optimise the evidence to improve patient care. These collaborations each recommend how to improve research quality in a small way at many different stages of the evidence production and distillation process. When we consider these minimal improvements at each stage from an 'aggregation of marginal gains' perspective, the accumulation of small enhancements aggregates, thereby greatly improving the final product of 'best available evidence'. The myriad of tools to reduce research quality leakage and evidence loss should be routinely used by all those with responsibility for ensuring that research benefits patients, that is, those who pay for research (funders), produce it (researchers), take part in it (patients/participants) and use it (clinicians, policy makers and service commissioners)

Initial results from beam commissioning of the LHC beam dump system

Initial commissioning of the LHC beam dump system with beam took place in August and September 2008. The preparation, setting-up and the tests performed are described together with results of the extractions of beam into the dump lines. Analysis of the first detailed aperture measurements of the extraction channels and kicker performance derived from dilution sweep shapes are presented. The performance of the other equipment subsystems is summarised, in particular that of the dedicated dump system beam instrumentation