Follow-up after treatment for head and neck cancer: United Kingdom National Multidisciplinary Guidelines

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. In the absence of high-level evidence base for follow-up practices, the duration and frequency are often at the discretion of local centres. By reviewing the existing literature and collating experience from varying practices across the UK, this paper provides recommendations on the work up and management of lateral skull base cancer based on the existing evidence base for this rare condition

Correlating Pedestrian Flows and Search Engine Queries

An important challenge for ubiquitous computing is the development of techniques that can characterize a location vis-a-vis the richness and diversity of urban settings. In this paper we report our work on correlating urban pedestrian flows with Google search queries. Using longitudinal data we show pedestrian flows at particular locations can be correlated with the frequency of Google search terms that are semantically relevant to those locations. Our approach can identify relevant content, media, and advertisements for particular locations.Comment: 4 pages, 1 figure, 1 tabl

Post-combustion Capture on Natural Gas Combined Cycle Plants: A Technical and Economical Evaluation of Retrofit, New Build, and the Application of Exhaust Gas Recycle

AbstractIf legislation proposing a reduction in CO2 production from fossil-fired power plants is enacted, it is conceivable that natural gas combined cycle (NGCC) plants may be required to implement carbon capture. Therefore, as the power industry plans their future generation portfolios, there is growing interest in the feasibility and costs associated with installing large-scale carbon capture to NGCC plants. The Electric Power Research Institute (EPRI) has recently completed an assessment on the technical feasibility, performance, and cost of applying current carbon dioxide (CO2) post-combustion capture (PCC) technologies at a typical commercial-scale NGCC power station. The study also considered the potential of exhaust gas recycle (EGR) as a novel technology for improving future NGCC capture economics

A metabolic view of the diversity-stability relationship

Abstract A theoretical analysis of the ''portfolio effect'' expressed in metabolic terms indicates that the coefficient of variation of total biomass in the ecosystem is influenced by three factors: metabolic diversity, total population size and organism biomass (body mass). The contribution of these factors to ecosystem stability depends on the power scaling of population size to its temporal variance: the Tilman's z. In natural populations, 1ozo2 both from a theoretical and an empirical background, and so a higher metabolic diversity, a larger population size and a bigger body mass are expected to increase ecosystem stability. The maximization of any of these factors will enhance ecosystem stability both at ecological (successional) and evolutionary timescales, which could explain a number of trends observed in ecosystems and in the history of life.

High energy trauma with complex fracture of the right tibial plateau, compartment syndrome and infection in a professional freestyler motorcyclist

High-energy tibial plateau fractures are complex lesions that may be associated with extensive soft tissue damages and severe complications, such as compartment syndrome and neurological injuries. This case report interests a professional motocross freestyler with complex tibial plateau fracture associated with compartment syndrome and partial common peroneal nerve impairment which complicated with a dehiscence of the surgical wound and infection after plate and screws fixation. One year later, despite the complexity of the fracture, the gravity of the soft tissue lesions and subsequent complications, the patient healed. This satisfactory result depended on the correct management in terms of type of treatment and timing.(www.actabiomedica.it)

Return to work after subacromial decompression, diagnostic arthroscopy, or exercise therapy for shoulder impingement : a randomised, placebo-surgery controlled FIMPACT clinical trial with five-year follow-up

Background: Arthroscopic subacromial decompression is one of the most commonly performed shoulder surgeries in the world. It is performed to treat patients with suspected shoulder impingement syndrome, i.e., subacromial pain syndrome. Only few studies have specifically assessed return-to-work rates after subacromial decompression surgery. All existing evidence comes from open, unblinded study designs and this lack of blinding introduces the potential for bias. We assessed return to work and its predictors in patients with shoulder impingement syndrome in a secondary analysis of a placebo-surgery controlled trial. Methods: One hundred eighty-four patients in a randomised trial had undergone arthroscopic subacromial decompression (n = 57), diagnostic arthroscopy, a placebo surgical intervention, (n = 59), or exercise therapy (n = 68). We assessed return to work, defined as having returned to work for at least two follow-up visits by the primary 24-month time point, work status at 24 and 60 months, and trajectories of return to work per follow-up time point. Patients and outcome assessors were blinded to the assignment regarding the arthroscopic subacromial decompression vs. diagnostic arthroscopy comparison. We assessed the treatment effect on the full analysis set as the difference between the groups in return-to-work rates and work status at 24 months and at 60 months using Chi-square test and the predictors of return to work with logistic regression analysis. Results: There was no difference in the trajectories of return to work between the study groups. By 24 months, 50 of 57 patients (88%) had returned to work in the arthroscopic subacromial decompression group, while the respective figures were 52 of 59 (88%) in the diagnostic arthroscopy group and 61 of 68 (90%) in the exercise therapy group. No clinically relevant predictors of return to work were found. The proportion of patients at work was 80% (147/184) at 24 months and 73% (124/184) at 60 months, with no difference between the treatment groups (p-values 0.842 and 0.943, respectively). Conclusions: Arthroscopic subacromial decompression provided no benefit over diagnostic arthroscopy or exercise therapy on return to work in patients with shoulder impingement syndrome. We did not find clinically relevant predictors of return to work either.Peer reviewe

Responsiveness of different pain measures and recall periods in people undergoing surgery after a period of splinting for basal thumb joint osteoarthritis

Background Basal thumb joint osteoarthritis (OA) is a common painful condition of the hand often treated surgically if non-operative care does not provide sufficient pain relief. Many instruments are available to measure pain for this condition including single item and multidimensional measures. To inform our choice of instrument for the purpose of evaluating the value of surgery for people with thumb OA, the aim of this study was to compare the longitudinal validity and signal to noise ratio of a single item numeric rating scale (NRS) for pain and the Patient-rated Wrist and Hand Evaluation (PRWHE) pain subscale, and to assess if recall period affects longitudinal validity of the NRS pain and reported pain levels. Methods We invited 52 patients referred for surgical treatment of basal thumb joint OA to participate in this study. All wore a splint for six weeks followed by surgery. Pain during the past day, week, and month and the PRWHE were collected at baseline, operation day, and 3, 6, 9 and 12 months after surgery. Responsiveness was assessed with two methods: 1) using participant-reported global improvement and PRWHE function subscale as external anchors (longitudinal validity) and 2) comparing Standardized Response Means (SRM). Results The Spearman's rho between PRWHE pain and participant-reported global improvement was better (0.71) compared with NRS past day (0.55), past week (0.62), or past month (0.59). Similar findings were found with PRWHE function as anchor (Pearson's r for PRWHE pain 0.78; NRS past day 0.68; past week 0.73; past month 0.69). The SRM of PRWHE pain subscale (2.8) and NRS past week (2.9) outperformed pain past day (2.3) and month (2.4). Mean pain was 0.3 points (on a 0 to 10 scale) worse during past week when compared with past day and 0.3 worse during past month than during past week. Conclusions All studied pain measures captured the change in pain over time. For clinical trials, we recommend PRWHE pain subscale or NRS past week due to their better signal noise ratio.Peer reviewe

Sexuality and behaviour of adolescents in relationship to sexually transmitted diseases in Libreville: a cross-sectional study

Background: The World Health Organization (WHO) defines a sexually transmitted infection (STI) as an infection that is transmitted during unprotected sexual intercourse. Indeed, the highest rates of STIs are usually found among young people aged 15 to 24. In Gabon, adolescents' knowledge of sexuality and STIs remains insufficient and early sexual intercourse is the most important factor favouring them. Improving adolescents' knowledge of sexuality education could influence their behaviour.Methods: A cross-sectional study was conducted among 1256 adolescents in schools in Libreville. Their socio-demographic characteristics, knowledge about STIs, the description of their sexuality and their behaviour towards STIs were obtained through ratings and frequencies. Authos calculated the overall average of adolescents on their knowledge of STIs. Odds ration were used to establish the link between the different variables.Results: Adolescents reported knowledge of STIs (1163/1256). AIDS was the most frequently cited STI by 94.50% of adolescents. Sexual intercourse was the main route of STI transmission and was cited by 687 adolescents who estimated that they knew at least one mode of STI transmission. Almost all female and male adolescents had poor knowledge of STIs, with 98.2% and 98.8% respectively. 84.96% of those with a sexual partner had ever had sex. More than half of sexually active adolescents had multiple partners.Conclusions: Adolescents have a poor overall knowledge of STIs. Sexual risk behaviour remains very high, regardless of gender. To contain the scourge, awareness campaigns using all the means of communication at our disposal and especially the media

Three week versus six week immobilisation for stable Weber B type ankle fractures : randomised, multicentre, non-inferiority clinical trial

OBJECTIVE To determine whether treatment of isolated stable Weber B type ankle fractures with a cast or a simple orthotic device for three weeks produces non-inferior outcomes compared with conventional immobilisation in a cast for six weeks. DESIGN Randomised, pragmatic, non-inferiority, clinical trial with blinded outcome assessment. SETTING Two major trauma centres in Finland, 22 December 2012 to 6 June 2016. PARTICIPANTS 247 skeletally mature patients aged 16 years or older with an isolated Weber B type fibula fracture and congruent ankle mortise in static ankle radiographs. INTERVENTIONS Participants were randomly allocated to conventional six week cast immobilisation (n=84) or three week treatment either in a cast (n=83) or in a simple orthosis (n=80). MAIN OUTCOME MEASURES The primary, non-inferiority, intention-to-treat outcome was the Olerud-Molander Ankle Score at 12 months (OMAS; range 0-100; higher scores indicate better outcomes and fewer symptoms). The predefined non-inferiority margin for the primary outcome was -8.8 points. Secondary outcomes were ankle function, pain, quality of life, ankle motion, and radiographic outcome. Follow-up assessments were performed at 6, 12, and 52 weeks. RESULTS 212 of 247 randomised participants (86%) completed the study. At 52 weeks, the mean OMAS was 87.6 (SD 18.3) in the six week cast group, 91.7 (SD 12.9) in the three week cast group, and 89.8 (SD 18.4) in the three week orthosis group. The between group difference at 52 weeks for the three week cast versus six week cast was 3.6 points (95% confidence interval -1.9 to 9.1, P=0.20), and for the three week orthosis versus six week cast was 1.7 points (-4.0 to 7.3, P=0.56). In both comparisons, the confidence intervals did not include the predefined inferiority margin of -8.8 points. The only statistically significant between group differences observed in the secondary outcomes and harms in the two primary comparisons were slight improvement in ankle plantar flexion and incidence of deep vein thrombosis, both in the three week orthosis group versus six week cast group. CONCLUSION Immobilisation for three weeks with a cast or orthosis was non-inferior to conventional cast immobilisation for six weeks in the treatment of an isolated stable Weber B type fracture.Peer reviewe