Smell and taste disorders in the UK: first experiences with a specialised smell and taste outpatient clinic

Olfactory dysfunction is common, affecting 1‐5% of those under the age of 60 1 and at least 20% of those aged more than 60 years. 2 In many UK centres, the approach to it is variable and routine olfactory testing is not performed, as noted by a recent survey of British ENT surgeons. 3 This is in contrast to Europe and the USA, where many specialist smell and taste centres already exist

Managing chronic rhinosinusitis in adults

Commentary by Carl Philpott, Clinical Senior Lecturer, Norwich Medical School and Honorary Consultant Ear, Nose and Throat Surgeon and Rhinologist, James Paget University Hospital: “The evidence presented by Rudmik et al. (2015) confirms the conclusions in the European Position Paper on Rhinosinusitis and Nasal Polyps (2012), but doesn’t add any new evidence or recommendations. This is not surprising because there have been no new RCTs in that time for chronic rhinosinusitis. Although open label and non-randomised series have been reported, any publications since 2012 have been themselves meta-analyses. As such, this systematic review supports the current recommendations to treat people who have chronic rhinosinusitis with topical steroids and nasal irrigation, and review treatment after 4 weeks. “Practice variation in the UK is high. Longitudinal data from the Clinical Practice Research Datalink (CPRD) show that 1% of UK adults receive treatment for chronic rhinosinusitis from their GP each year, averaging 4 GP visits (Gulliford et al. 2014). These people receive multiple medications, with 91% receiving an antibiotic prescription. The recent ENT-UK commissioning guideline (Royal College of Surgeons of England 2013) does not recommend routine antibiotic use for chronic rhinosinusitis in primary care, but GPs often prescribe repeated courses (Akkerman et al. 2005), which may cause resistance. “There is growing interest in the immune-modulating effects of macrolide antibiotics in chronic airway inflammatory disease. Low-dose, long-term macrolides are being prescribed in chronic rhinosinusitis for their effect on immune response and not primarily as antibacterial agents (Cervin and Wallwork 2007). Some evidence exists for longer term antibiotic use in secondary care, but this evidence is from 2 small conflicting RCTs (Wallwork et al. 2006 and Videler et al. 2011), resulting in a call for further larger trials (Piromchai et al. 2011). Recently some Clinical Commissioning Groups (CCGs) have insisted on a 3 month trial of macrolide antibiotics before people with chronic rhinosinusitis can be referred to secondary care (Soni-Jaiswal et al. 2015), despite the fact that no high-level evidence is available to support this approach. “Hospital Episode Statistics show that 1 in 3 people with chronic rhinosinusitis attending ear, nose and throat clinics in England are considered not to have responded adequately to current medical treatment and are considered for surgery. However, insufficient evidence is available to define the role of surgery, which has contributed to a 5-fold variation in UK intervention rates (Royal College of Surgeons of England 2013). Symptom duration before surgery varies from under 1 to over 10 years (Hopkins et al. 2015a, Hopkins et al. 2015b). If surgery is less effective than continued medical therapy, patients may be exposed to unnecessary risks and morbidity. If surgery is better, current variation reflects suboptimal patient care.

Beauty and Loss: Tolkien\u27s Eucatastrophe as a Mandate for the Church

In his writings, Tolkien affirms the presence of loss and longing, beauty and despair and analyzes the function they serve in both the secondary world of Middle-earth and the primary world. This thesis will explore his theories of the eucatastrophe and the dyscatastrophe, and his insistence that the joy and hope which are expressed by the eucatastrophe are dependent upon the dyscatastrophe—the presence of sorrow and despair. This thesis will also examine how Christians’ knowledge of Tolkien’s philosophy can better equip them to cope with the brokenness of a fallen world as well as provide motivation for developing and engaging a secular culture

PRODUCER RESPONSE TO CHANGES IN RETAIL FOOD MARKET

Marketing,

Arboreal twig-nesting ants form dominance hierarchies over nesting resources.

Interspecific dominance hierarchies have been widely reported across animal systems. High-ranking species are expected to monopolize more resources than low-ranking species via resource monopolization. In some ant species, dominance hierarchies have been used to explain species coexistence and community structure. However, it remains unclear whether or in what contexts dominance hierarchies occur in tropical ant communities. This study seeks to examine whether arboreal twig-nesting ants competing for nesting resources in a Mexican coffee agricultural ecosystem are arranged in a linear dominance hierarchy. We described the dominance relationships among 10 species of ants and measured the uncertainty and steepness of the inferred dominance hierarchy. We also assessed the orderliness of the hierarchy by considering species interactions at the network level. Based on the randomized Elo-rating method, we found that the twig-nesting ant species Myrmelachista mexicana ranked highest in the ranking, while Pseudomyrmex ejectus was ranked as the lowest in the hierarchy. Our results show that the hierarchy was intermediate in its steepness, suggesting that the probability of higher ranked species winning contests against lower ranked species was fairly high. Motif analysis and significant excess of triads further revealed that the species networks were largely transitive. This study highlights that some tropical arboreal ant communities organize into dominance hierarchies

Three-Body Capture of Irregular Satellites: Application to Jupiter

We investigate a new theory of the origin of the irregular satellites of the giant planets: capture of one member of a ~100-km binary asteroid after tidal disruption. The energy loss from disruption is sufficient for capture, but it cannot deliver the bodies directly to the observed orbits of the irregular satellites. Instead, the long-lived capture orbits subsequently evolve inward due to interactions with a tenuous circumplanetary gas disk. We focus on the capture by Jupiter, which, due to its large mass, provides the most stringent test of our model. We investigate the possible fates of disrupted bodies, the differences between prograde and retrograde captures, and the effects of Callisto on captured objects. We make an impulse approximation and discuss how it allows us to generalize capture results from equal-mass binaries to binaries with arbitrary mass ratios. We find that at Jupiter, binaries offer an increase of a factor of ~10 in the capture rate of 100-km objects as compared to single bodies, for objects separated by tens of radii that approach the planet on relatively low-energy trajectories. These bodies are at risk of collision with Callisto, but may be preserved by gas drag if their pericenters are raised quickly enough. We conclude that our mechanism is as capable of producing large irregular satellites as previous suggestions, and it avoids several problems faced by alternative models.Comment: 39 pages, 12 figures, 1 table, submitted to Icaru