The evidence on the effectiveness of management for malignant pleural effusion: a systematic review.

The aim of this study was to review systematically the available evidence on pleurodesis for malignant effusion, focusing on the choice of the agents, route of delivery and other strategies to improve outcomes. Four electronic databases (MEDLINE, EMBASE, Web of Science and Cochrane Controlled Trials Register) were searched, reference lists checked and letters requesting details of unpublished trials and data sent to authors of previous trials. Studies of malignant pleural effusion in humans were selected with no language restrictions applied. Criteria for randomised clinical trial (RCT) eligibility were random allocation of patients and non-concurrent use of another experimental medication or device. Methodological quality evaluation of the trials was based on randomisation, blinding, allocation concealment and intention to treat analysis. A random effect model was used to combine the relative risk estimates of the treatment effects whenever pooling for an overall effect was considered appropriate. Forty-six RCTs with a total of 2053 patients with malignant pleural effusions were reviewed for effectiveness of pleurodesis. Talc tended to be associated with fewer recurrences when compared to bleomycin (RR, 0.64; 95% CI, 0.34-1.20) and, with more uncertainty, to tetracycline (RR, 0.50; 95% CI, 0.06-4.42). Tetracycline (or doxycycline) was not superior to bleomycin (RR, 0.92; 95% CI, 0.61-1.38). When compared with bedside talc slurry, thoracoscopic talc insufflation was associated with a reduction in recurrence (RR, 0.21; 95% CI, 0.05-0.93). Strategies such as rolling the patient after instillation of the sclerosing agent, protracted drainage of the effusion and use of larger chest tubes were not found to have any substantial advantages. Talc appears to be effective and should be the agent of choice for pleurodesis. Thoracoscopic talc insufflation is associated with fewer recurrences of effusions compared with bedside talc slurry, but this is based on two small studies. Where thoracoscopy is unavailable bedside talc pleurodesis has a high success rate and is the next best option

Origin and significance of 'dispersed facies' basal ice: Svínafellsjökull, Iceland

Dispersed facies basal ice - massive (i.e. structureless) ice with dispersed debris aggregates - is present at the margins of many glaciers and, as a product of internal glacial processes, has the potential to provide important information about the mechanisms of glacier flow and the nature of the subglacial environment. The origin of dispersed facies is poorly understood, with several hypotheses having been advanced for its formation, and there is disagreement as to whether it is largely a sedimentary or a tectonic feature. We test these established hypotheses at the temperate glacier Svfnafellsjokull, Iceland, and find that none fully account for dispersed facies characteristics at this location. Instead, dispersed facies physical, sedimentological and stable-isotope (5180, 8D) characteristics favour a predominantly tectonic origin that we suggest comprises the regelation and straininduced metamorphism of debris-rich basal ice that has been entrained into an englacial position by tectonic processes operating at the base of an icefall. Further thickening of the resultant dispersed facies may also occur tectonically as a result of ice flow against the reverse bed slope of a terminal overdeepening. Lack of efficient subglacial drainage in the region of the overdeepening may limit basal melting and thus favour basal ice preservation, including the preservation of dispersed facies. Despite the relatively low sediment content of dispersed facies (~1.6% by volume), its thickness (up to 25 m) and ubiquity at Svfnafellsjokull results in a significant contribution to annual sediment discharge (1635-3270 m3 a"1) that is ~6.5 times that contributed by debris-rich stratified facies basal ice

A numerical investigation on the vortex formation and flow separation of the oscillatory flow in jet pumps

A two-dimensional computational fluid dynamics model is used to predict the oscillatory flow through a tapered cylindrical tube section (jet pump) placed in a larger outer tube. Due to the shape of the jet pump, there will exist an asymmetry in the hydrodynamic end effects which will cause a time-averaged pressure drop to occur that can be used to cancel Gedeon streaming in a closed-loop thermoacoustic device. The performance of two jet pump geometries with different taper angles is investigated. A specific time-domain impedance boundary condition is implemented in order to simulate traveling acoustic wave conditions. It is shown that by scaling the acoustic displacement amplitude to the jet pump dimensions, similar minor losses are observed independent of the jet pump geometry. Four different flow regimes are distinguished and the observed flow phenomena are related to the jet pump performance. The simulated jet pump performance is compared to an existing quasi-steady approximation which is shown to only be valid for small displacement amplitudes compared to the jet pump length.Comment: The following article has been accepted by the Journal of the Acoustical Society of America. After it is published, it will be found at: http://scitation.aip.org/JAS

Jet pumps for thermoacoustic applications: design guidelines based on a numerical parameter study

The oscillatory flow through tapered cylindrical tube sections (jet pumps) is characterized by a numerical parameter study. The shape of a jet pump results in asymmetric hydrodynamic end effects which cause a time-averaged pressure drop to occur under oscillatory flow conditions. Hence, jet pumps are used as streaming suppressors in closed-loop thermoacoustic devices. A two-dimensional axisymmetric computational fluid dynamics model is used to calculate the performance of a large number of conical jet pump geometries in terms of time-averaged pressure drop and acoustic power dissipation. The investigated geometrical parameters include the jet pump length, taper angle, waist diameter and waist curvature. In correspondence with previous work, four flow regimes are observed which characterize the jet pump performance and dimensionless parameters are introduced to scale the performance of the various jet pump geometries. The simulation results are compared to an existing quasi-steady theory and it is shown that this theory is only applicable in a small operation region. Based on the scaling parameters, an optimum operation region is defined and design guidelines are proposed which can be directly used for future jet pump design.Comment: The following article has been accepted by the Journal of the Acoustical Society of America. After it is published, it will be found at http://scitation.aip.org/JAS

Setting targets leads to greater long-term weight losses and ‘unrealistic’ targets increase the effect in a large community-based commercial weight management group

Background. Setting personal targets is an important behavioural component in weight management programmes. Normal practice is to encourage ‘realistic’ weight loss but the under-pinning evidence base for this is limited and controversial. This study investigates the effect of number and size of weight loss targets on long-term weight loss in a large community sample of adults. Methods. Weight change, attendance and target weight data for all new UK members, joining January to March 2012 was extracted from a commercial slimming organisation’s electronic database. Results. Of the 35 380 members who had weight data available at 12 months after joining, 69.1% (n=24 447)had a starting BMI≥30kg/m2. Their mean weight loss was 12.9±7.8% and for both sexes, weight loss at 12 months was greater for those who set targets (p25% was 7.6±4.0 kg/m2. A higher percentage of obese members did not set targets (p<0.001) compared to those with a BMI below 30kg/m2. Conclusions. Much of the variance in achieved weight loss in this population was explained by the number of targets set and the size of the first target. Whilst obese people were less likely to set targets, doing so increased the likelihood of achieving clinically significant weight loss and for some ‘unrealistic’ targets improved results

Two Massive, Low-Luminosity Cores Toward Infrared Dark Clouds

This article presents high-resolution interferometric mosaics in the 850 micron waveband of two massive, quiescent infrared dark clouds. The two clouds were chosen based on their likelihood to represent environments preceding the formation of massive stars. The brightest compact sources detected in each cloud have masses of approximately 110 and 60 solar masses with radii < 0.1 pc, implying mean volume densities of approximately 1 million particles per cubic centimeter and mean column densities of about 1 gram per square centimeter. Supplementary data show these cores to be cold and inactive. Low upper limits to their bolometric luminosities and temperatures place them at a very early stage of evolution while current models of massive star formation suggest they have the potential to form massive stars.Comment: 6 pages, 5 figures. Accepted for publication by the Astrophysical Journa

Pattern Selection in a Phase Field Model for Directional Solidification

A symmetric phase field model is used to study wavelength selection in two dimensions. We study the problem in a finite system using a two-pronged approach. First we construct an action and, minimizing this, we obtain the most probable configuration of the system, which we identify with the selected stationary state. The minimization is constrained by the stationary solutions of stochastic evolution equations and is done numerically. Secondly, additional support for this selected state is obtained from straightforward simulations of the dynamics from a variety of initial states.Comment: 7 pages, 6 figures, to appear in Physica