Thoracotomy in a spontaneously breathing neonate undergoing tracheo-oesophageal fistula repair

No Abstrac

Osteoporosis therapy: an example of putting evidence-based medicine into clinical practice

A major aim of evidence-based medicine is to assist clinical decision-making by providing the most current and reliable medical information. Systematic reviews and meta-analyses are important tools in this process. Systematic reviews identify and compile relevant evidence, while meta-analyses summarize and quantify the results of such reviews. Results from meta-analyses are, at present, the main source of summary evidence for the efficacy of treatments for a specific condition. They are important tools for helping to choose among treatment options, although they cannot be used to directly compare the magnitude of the effect of various therapies. However, the methods used and the consequent clinical value of the results, may be poorly understood by clinicians, who may therefore not take full advantage of the evidence. Recently, a panel of experts in osteoporosis and evidence-based medicine applied rigorous, validated, scientific standards to produce a systematic review and meta-analysis of randomized controlled trials of anti-resorptive agents used to treat osteoporosis. They found that, although several agents reduced the risk of vertebral fracture, only two, alendronate and risedronate, demonstrated convincing evidence for both non-vertebral and vertebral fracture risk reductions. The clinical implication of these results is that there are important differences in anti-fracture efficacy among currently available agents. In the absence of evidence from head-to-head clinical trials and because of the systematic nature and methodological rigor of the analyses, these data provide important information for clinical decision-makin

TB81: Investigations on the Life History and Habits of Pityokteines sparsus (Coleoptera: Scolytidae)

The primary objectives of this study are (1) to investigate the life history of Pityokteines sparsus (LeConte) in the Oxbow area of northern Maine; (2) to study the seasonal and daily flight behavior of the insect; (3) to investigate the food energy relations of the species.https://digitalcommons.library.umaine.edu/aes_techbulletin/1110/thumbnail.jp

TB80: Scanning Electron Microscopy of Insects: Techniques for the Novice

The scanning electron microscope (SEM) has been used to detail the morphology of small insects; however, it is often difficult for the novice to obtain acceptable results without time-consuming and costly experimentation. This brief paper outlines some of the techniques and problems encountered in an examination of the balsam bark beetle Pityokteines sparsus (Le Conte ) and the hymenopterous parasitoid Brachymeria intermedia (Nees). The information presented herein is mainly for the benefit of individuals wishing to use the SEM but having little or no experience concerning the special problems associated with the photography of insect specimens, and may form a base from which reasonable results can be obtained after limited experimentation.https://digitalcommons.library.umaine.edu/aes_techbulletin/1109/thumbnail.jp

Empathic engineering: helping deliver dignity through design.

Dignity is a key value within healthcare. Technology is also recognized as being a fundamental part of healthcare delivery, but also a potential cause of dehumanization of the patient. Therefore, understanding how medical devices can be designed to help deliver dignity is important. This paper explores the role of empathy tools as a way of engendering empathy in engineers and designers to enable them to design for dignity. A framework is proposed that makes the link between empathy tools and outcomes of feelings of dignity. It represents a broad systems view that provides a structure for reviewing the evidence for the efficacy of empathy tools and also how dignity can be systematically understood for particular medical devices.This paper was authored through funding from the EPSRC-NIHR HTC Partnership Award: Promoting Real Independence through Design Expertise (ref: EP/M000273/1) and NIHR Collaboration for Leadership in Applied Health Research and Care East of England (CLAHRC EoE) at the Cambridge and Peterborough NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.This is the final version of the article. It first appeared from Taylor & Francis via http://dx.doi.org/10.3109/03091902.2015.108809

Does the Swedish Interactive Threshold Algorithm (SITA) accurately map visual field loss attributed to vigabatrin?

Purpose Vigabatrin (VGB) is an anti-epileptic medication which has been linked to peripheral constriction of the visual field. Documenting the natural history associated with continued VGB exposure is important when making decisions about the risk and benefits associated with the treatment. Due to its speed the Swedish Interactive Threshold Algorithm (SITA) has become the algorithm of choice when carrying out Full Threshold automated static perimetry. SITA uses prior distributions of normal and glaucomatous visual field behaviour to estimate threshold sensitivity. As the abnormal model is based on glaucomatous behaviour this algorithm has not been validated for VGB recipients. We aim to assess the clinical utility of the SITA algorithm for accurately mapping VGB attributed field loss. Methods The sample comprised one randomly selected eye of 16 patients diagnosed with epilepsy, exposed to VGB therapy. A clinical diagnosis of VGB attributed visual field loss was documented in 44% of the group. The mean age was 39.3 years ± 14.5 years and the mean deviation was -4.76 dB ±4.34 dB. Each patient was examined with the Full Threshold, SITA Standard and SITA Fast algorithm. Results SITA Standard was on average approximately twice as fast (7.6 minutes) and SITA Fast approximately 3 times as fast (4.7 minutes) as examinations completed using the Full Threshold algorithm (15.8 minutes). In the clinical environment, the visual field outcome with both SITA algorithms was equivalent to visual field examination using the Full Threshold algorithm in terms of visual inspection of the grey scale plots , defect area and defect severity. Conclusions Our research shows that both SITA algorithms are able to accurately map visual field loss attributed to VGB. As patients diagnosed with epilepsy are often vulnerable to fatigue, the time saving offered by SITA Fast means that this algorithm has a significant advantage for use with VGB recipients

Modelling deep convection and its impacts on the tropical tropopause layer

The UK Met Office's Unified Model is used at a climate resolution (N216, ~0.83°×~0.56°, ~60 km) to assess the impact of deep tropical convection on the structure of the tropical tropopause layer (TTL). We focus on the potential for rapid transport of short-lived ozone depleting species to the stratosphere by rapid convective uplift. The modelled horizontal structure of organised convection is shown to match closely with signatures found in the OLR satellite data. In the model, deep convective elevators rapidly lift air from 4–5 km up to 12–14 km. The influx of tropospheric air entering the TTL (11–12 km) is similar for all tropical regions with most convection stopping below ~14 km. The tropical tropopause is coldest and driest between November and February, coinciding with the greatest upwelling over the tropical warm pool. As this deep convection is co-located with bromine-rich biogenic coastal emissions, this period and location could potentially be the preferential gateway for stratospheric bromine

The effect of voluntary fasting and dehydration on flicker-induced retinal vascular dilation in a healthy individual: a case report

INTRODUCTION: Dynamic retinal vessel analysis represents a well-established method for the assessment of vascular reactivity during both normal conditions and after various provocations. We present a case where the subject showed abnormal retinal vessel reactivity after fasting voluntarily for 20 hours. CASE PRESENTATION: A healthy, 21-year-old man who fasted voluntarily for 20 hours exhibited abnormal retinal vascular reactivity (dilation and constriction) after flicker provocation as measured using the Dynamic Retinal Vessel Analyser (Imedos, Jena, Germany). CONCLUSION: The abnormal vascular reactivity induced by fasting was significant; abnormal levels of important nutrients due to fasting and dehydration could play a role through altering the concentration of vasoactive substances such as nitric oxide. This hypothesis needs further investigation