Leiomyosarcoma of the Inferior Turbinate

We report a case of leiomyosarcoma of the inferior nasal turbinate. The patient, a 68-year-old Caucasian male, presented with 4–6 weeks of epistaxis that was resistant to nasal packing and septal cautery. Upon inspection in the operating room, a small mass was excised from the inferior turbinate. High-power H&E-stained microscopy demonstrated bundles of malignant smooth muscle cells, and immunohistochemical stains were strongly positive for desmin, smooth muscle actin and vimentin, while negative for pankeratin EA1/EA3 and CaM 5.2, suggesting leiomyosarcoma as the diagnosis. Clear margins were obtained at a second surgery. At the time of this writing it is 8 months since his last surgery and he has remained symptom free

Physiological and performance effects of carbohydrate gels consumed prior to the extra-time period of prolonged simulated soccer match-play

Objectives: The physiological and performance effects of carbohydrate-electrolyte gels consumed before the 30 min extra-time period of prolonged soccer-specific exercise were investigated. Design: Randomised, double-blind, crossover. Methods: Eight English Premier League academy soccer players performed 120 min of soccer-specific exercise on two occasions while consuming fluid-electrolyte beverages before exercise, at half-time and 90 min. Carbohydrate-electrolyte (0.7 ± 0.1 g·kg-1 BM) or energy-free placebo gels were consumed ~5 min before extra-time. Blood samples were taken before exercise, at half-time and every 15 min during exercise. Physical (15-m and 30-m sprint speed, 30-m sprint maintenance and countermovement jump height) and technical (soccer dribbling) performance was assessed throughout each trial. Results: Carbohydrate-electrolyte gels improved dribbling precision (+29 ± 20%) and raised blood glucose concentrations by 0.7 ± 0.8 mmol·l-1 during extra-time (both p 3% during half-time (all p < 0.05). Conclusions: Carbohydrate-electrolyte gel ingestion raised blood glucose concentrations and improved dribbling performance during the extra-time period of simulated soccer match-play. Supplementation did not attenuate reductions in physical performance and hydration status that occurred during extra-time

Thirty Years of Land-cover Change in Bolivia

Land-cover change in eastern lowland Bolivia was documented using Landsat images from five epochs for all landscapes situated below the montane tree line at approximately 3000 m, including humid forest, inundated forest, seasonally dry forest, and cloud forest, as well as scrublands and grasslands. Deforestation in eastern Bolivia in 2004 covered 45 411 km2, representing;9% of the original forest cover, with an additional conversion of 9042 km2 of scrub and savanna habitats representing 17 % of total historical land-cover change. Annual rates of land-cover change increased from;400 km2 y1 in the 1960s to;2900 km2 y1 in the last epoch spanning 2001 to 2004. This study provides Bolivia with a spatially explicit information resource to monitor future land-cover change, a prerequisite for proposed mechanisms to compensate countries for reducing carbon emissions as a result of deforestation. A comparison of the most recent epoch with previous periods shows that policies enacted in the late 1990s to promote forest conservation had no observable impact on reducing deforestation and that deforestation actually increased in some protected areas. The rate of land-cover change continues to increase linearly nationwide, but is growing faster in the Santa Cruz department because of the expansion of mecha-nized agriculture and cattle farms

The Effects of 120 Minutes of Simulated Match Play on Indices of Acid-Base Balance in Professional Academy Soccer Players

This study investigated changes in indices of acid-base balance during 120 minutes of simulated soccer match-play that included a 30 min extra-time (ET) period. Eight English Premier League academy soccer players participated in a simulated soccer match that required varying intensities of intermittent exercise including 15 m sprints and soccer dribbling throughout. Blood samples were obtained prior to (i.e., baseline, pre-exercise) and throughout exercise (i.e., 15, 30, 45, 60, 75, 90, 105, 120 min), and at half-time. Sprint speeds over 15 m reduced in ET compared to the first (-0.39 ± 0.37 m∙s-1, -7 ± 6%, p = 0.021) but not the second half (-0.18 ± 0.25 m∙s-1, -3 ± 4%, p = 0.086). At 105 min, blood lactate concentrations reduced compared to the opening 30 min (-0.9 to -1.2 mmol·l-1, p 0.05). Although the perturbations in acid-base balance during ET were statistically significant, the decreases in blood pH, lactate, base excess, and bicarbonate concentrations may not represent metabolic acidosis or impairments in buffering capacity that are likely to explain reduced physical performance. Further research is warranted to investigate mechanisms of fatigue during ET and to develop interventions that attenuate decrements in performance

Cost-effectiveness of monitoring glaucoma patients in shared care: an economic evaluation alongside a randomized controlled trial

Background. Population aging increases the number of glaucoma patients which leads to higher workloads of glaucoma specialists. If stable glaucoma patients were monitored by optometrists and ophthalmic technicians in a glaucoma follow-up unit (GFU) rather than by glaucoma specialists, the specialists' workload and waiting lists might be reduced. We compared costs and quality of care at the GFU with those of usual care by glaucoma specialists in the Rotterdam Eye Hospital (REH) in a 30-month randomized clinical trial. Because quality of care turned out to be similar, we focus here on the costs. Methods. Stable glaucoma patients were randomized between the GFU and the glaucoma specialist group. Costs per patient year were calculated from four perspectives: those of patients, the Rotterdam Eye Hospital (REH), Dutch healthcare system, and society. The outcome measures were: compliance to the protocol; patient satisfaction; stability according to the practitioner; mean difference in IOP; results of the examinations; and number of treatment changes. Results. Baseline characteristics (such as age, intraocular pressure and target pressure) were comparable between the GFU group (n = 410) and the glaucoma specialist group (n = 405). Despite a higher number of visits per year, mean hospital costs per patient year were lower in the GFU group (€139 vs. €161). Patients' time and travel costs were similar. Healthcare costs were significantly lower for the GFU group (€230 vs. €251), as were societal costs (€310 vs. €339) (p < 0.01). Bootstrap-, sensitivity- and scenario-analyses showed that the costs were robust when varying hospital policy and the duration of visits and tests. Conclusion. We conclude that this GFU is cost-effective and deserves to be considered for implementation in other hospitals

The Emission and Distribution of Dust of the Torus of NGC 1068

We present observations of NGC 1068 covering the 19.7–53.0 μm wavelength range using FORCAST and HAWC+ on board SOFIA. Using these observations, high-angular-resolution infrared (IR) and submillimeter observations, we find an observational turnover of the torus emission in the 30–40 μm wavelength range with a characteristic temperature of 70–100 K. This component is clearly different from the diffuse extended emission in the narrow line and star formation regions at 10–100 μm within the central 700 pc. We compute 2.2–432 μm 2D images using the best inferred CLUMPY torus model based on several nuclear spectral energy distribution (SED) coverages. We find that when 1–20 μm SED is used, the inferred result gives a small torus size (<4 pc radius) and a steep radial dust distribution. The computed torus using the 1–432 μm SED provides comparable torus sizes, 5.1^(+0.4)_(-0.4) pc radius, and morphology to the recently resolved 432 μm Atacama Large Millimeter Array observations. This result indicates that the 1–20 μm wavelength range is not able to probe the full extent of the torus. The characterization of the turnover emission of the torus using the 30–60 μm wavelength range is sensitive to the detection of cold dust in the torus. The morphology of the dust emission in our 2D image at 432 μm is spatially coincident with the cloud distribution, while the morphology of the emission in the 1–20 μm wavelength range shows an elongated morphology perpendicular to the cloud distribution. We find that our 2D CLUMPY torus image at 12 μm can produce comparable results to those observed using IR interferometry

Why a successful task substitution in glaucoma care could not be transferred from a hospital setting to a primary care setting: A qualitative study

Background: Healthcare systems are challenged by a demand that exceeds available resources. One policy to meet this challenge is task substitution-transferring tasks to other professions and settings. Our study aimed to explore stakeholders' perceived feasibility of transferring hospital-based monitoring of stable glaucoma patients to primary care optometrists.Methods: A case study was undertaken in the Rotterdam Eye Hospital (REH) using semi-structured interviews and document reviews. They were inductively analysed using three implementation related theoretical perspectives: sociological theories on professionalism, management theories, and applied political analysis.Results: Currently it is not feasible to use primary care optometrists as substitutes for optometrists and ophthalmic technicians working in a hospital-based gl