Is diagnostic tonsillectomy indicated in all children with asymmetrically enlarged tonsils?

Objectives. The aims of the study were: (i) to determine the necessity for diagnostic tonsillectomy in children with asymmetrically enlarged tonsils; (ii) to determine the accuracy of clinical assessment of tonsillar asymmetry; and (iii) to determine how to manage children with clinical tonsillar asymmetry in a developing-world practice. Methods. A prospective study was carried out at Red Cross War Memorial Children's Hospital in Cape Town, over an 8-month period. All children undergoing tonsillectomy or adenotonsillectomy had a clinical assessment of tonsil symmetry done, and all tonsil and adenoid specimens were examined histologically. The maximum diameter and volume of the resected tonsils were measured. A comparison was done of true tonsil asymmetry in patients with asymmetrical tonsils and a subgroup of matched controls with symmetrical tonsils. Results. A total of 344 tonsils were analysed (172 patients). The 13 patients (7.6%) diagnosed as having clinically asymmetrically enlarged tonsils had no significant pathological diagnosis. In the patients with symmetrical tonsils there were 2 abnormal pathological findings (tuberculosis of the adenoids and T-cell lymphoma of the tonsils and adenoids). In the clinically asymmetrical tonsil group, true tonsillar asymmetry was 3 mm (maximum diameter), and 2.2 cm3 (volume), compared with 1.9 mm and 1.5 cm3 in the symmetrical tonsil group. When patients with clinical tonsillar asymmetry and symmetry were compared, the difference in maximum diameter (p = 0.62) and volume (p = 0.73) was not significantly different. Conclusions. Clinical tonsillar asymmetry is usually apparent rather than real. The incidence of significant pathology in children with asymptomatic, asymmetrical tonsils is low. Diagnostic tonsillectomy is indicated in children with asymmetrically enlarged tonsils associated with constitutional symptoms, cervical lymphadenopathy, rapid tonsil enlargement or significant tonsillar asymmetry

Is diagnostic tonsillectomy indicated in all children with asymmetrically enlarged tonsil?

Objectives. The aims of the study were: (i) to determine the necessity for diagnostic tonsillectomy in children with asymmetrically enlarged tonsils; (ii) to determine the accuracy of clinical assessment of tonsillar asymmetry; and (iii) to determine how to manage children with clinical tonsillar asymmetry in a developing-world practice. Methods. A prospective study was carried out at Red Cross War Memorial Children’s Hospital in Cape Town, over an 8-month period. All children undergoing tonsillectomy or adenotonsillectomy had a clinical assessment of tonsil symmetry done, and all tonsil and adenoid specimens were examined histologically. The maximum diameter and volume of the resected tonsils were measured. A comparison was done of true tonsil asymmetry in patients with asymmetrical tonsils and a subgroup of matched controls with symmetrical tonsils. Results. A total of 344 tonsils were analysed (172 patients). The 13 patients (7.6%) diagnosed as having clinically asymmetrically enlarged tonsils had no significant pathological diagnosis. In the patients with symmetrical tonsils there were abnormal pathological findings (tuberculosis of the adenoids and T-cell lymphoma of the tonsils and adenoids). In the clinically asymmetrical tonsil group, true tonsillar asymmetry was 3 mm (maximum diameter), and 2.2 cm3 (volume), compared with 1.9 mm and 1.5 cm3 in the symmetrical tonsil group. When patients with clinical tonsillar asymmetry and symmetry were compared, the difference in maximum diameter (p = 0.62) and volume (p = 0.73) was not significantly different. Conclusions. Clinical tonsillar asymmetry is usually apparent rather than real. The incidence of significant pathology in children with asymptomatic, asymmetrical tonsils is low. Diagnostic tonsillectomy is indicated in children with asymmetrically enlarged tonsils associated with constitutional symptoms, cervical lymphadenopathy, rapid tonsil enlargement or significant tonsillar asymmetry

The influence of barefoot and barefoot inspired footwear on the kinetics and kinematics of running in comparison to conventional running shoes.

Barefoot running has experienced a resurgence in footwear biomechanics literature, based on the supposition that it serves to reduce the occurrence of overuse injuries in comparison to conventional shoe models. This consensus has lead footwear manufacturers to develop shoes which aim to mimic the mechanics of barefoot locomotion. This study compared the impact kinetics and 3-D joint angular kinematics observed whilst running: barefoot, in conventional cushioned running shoes and in shoes designed to integrate the perceived benefits of barefoot locomotion. The aim of the current investigation was therefore to determine whether differences in impact kinetics exist between the footwear conditions and whether shoes which aim to simulate barefoot movement patterns can closely mimic the 3-D kinematics of barefoot running. Twelve participants ran at 4.0 m.s-1±5% in each footwear condition. Angular joint kinematics from the hip, knee and ankle in the sagittal, coronal and transverse planes were measured using an eight camera motion analysis system. In addition simultaneous tibial acceleration and ground reaction forces were obtained. Impact parameters and joint kinematics were subsequently compared using repeated measures ANOVAs. The kinematic analysis indicates that in comparison to the conventional and barefoot inspired shoes that running barefoot was associated significantly greater plantar-flexion at footstrike and range of motion to peak dorsiflexion. Furthermore, the kinetic analysis revealed that compared to the conventional footwear impact parameters were significantly greater in the barefoot condition. Therefore this study suggests that barefoot running is associated with impact kinetics linked to an increased risk of overuse injury, when compared to conventional shod running. Furthermore, the mechanics of the shoes which aim to simulate barefoot movement patterns do not appear to closely mimic the kinematics of barefoot locomotion

The Application of Ultrasonics in Non-Destructive Testing: A Review of Some of the Research at University College London

This paper presents a review of some of the research projects at University College London which use ultrasonic waves in non-destructive testing. The projects covered include a low-frequency scanning acoustic microscope, a new dark-field acoustic microscope, an update on finite difference model studies of wave propagation and scattering, developments in mode-conversion techniques for defect characterisation, a new high-resolution acoustic field sampling probe and a resume of the work on Zn0 transducers

An evaluation of the epidemiology of medication discrepancies and clinical significance of medicines reconciliation in children admitted to hospital.

To determine the incidence of unintended medication discrepancies in paediatric patients at the time of hospital admission; evaluate the process of medicines reconciliation; assess the benefit of medicines reconciliation in preventing clinical harm

Assigning stranded bottlenose dolphins to source stocks using stable isotope ratios following the Deepwater Horizon oil spill

The potential for stranded dolphins to serve as a tool for monitoring free-ranging populations would be enhanced if their stocks of origin were known. We used stable isotopes of carbon, nitrogen, and sulfur from skin to assign stranded bottlenose dolphins Tursiops truncatus to different habitats, as a proxy for stocks (demographically independent populations), following the Deepwater Horizon oil spill. Model results from biopsy samples collected from dolphins from known habitats (n = 205) resulted in an 80.5% probability of correct assignment. These results were applied to data from stranded dolphins (n = 217), resulting in predicted assignment probabilities of 0.473, 0.172, and 0.355 to Estuarine, Barrier Island (BI), and Coastal stocks, respectively. Differences were found west and east of the Mississippi River, with more Coastal dolphins stranding in western Louisiana and more Estuarine dolphins stranding in Mississippi. Within the Estuarine East Stock, 2 groups were identified, one predominantly associated with Mississippi and Alabama estuaries and another with western Florida. δ15N values were higher in stranded samples for both Estuarine and BI stocks, potentially indicating nutritional stress. High probabilities of correct assignment of the biopsy samples indicate predictable variation in stable isotopes and fidelity to habitat. The power of δ34S to discriminate habitats relative to salinity was essential. Stable isotopes may provide guidance regarding where additional testing is warranted to confirm demographic independence and aid in determining the source habitat of stranded dolphins, thus increasing the value of biological data collected from stranded individuals.Publisher PDFPeer reviewe

Minutes 1878

https://place.asburyseminary.edu/freemethodistminutesyearbooks/1016/thumbnail.jp

Characteristics of large Martian dust devils using Mars Odyssey Thermal Emission Imaging System visual and infrared images

A search for Martian dust devils has been carried out, using Mars Odyssey Thermal Emission Imaging System (THEMIS) visible-wavelength images. Simultaneous THEMIS thermal infrared wavelength images were then processed and analyzed to investigate the thermal properties of the dust devils observed; 3079 images were checked, concentrating on northern spring, summer, and autumn (LS from 0° to 270°, 20°S to 50°N). Mars Express High Resolution Stereo Camera, Mars Global Surveyor Mars Orbiter Camera, and other THEMIS visible images were used for comparison to potentially rule out any ambiguous geological features. Eight clear examples of dust devils have been found in five separate images, with a comparable number of unconfirmed possible devils. The rarity of dust devils observed is believed to result from a combination of the difficulty in identifying dust devils in medium resolution THEMIS data and the fact that the Mars Odyssey orbit flyover local time is later in the afternoon than would be optimum for dust devil searching. The temporal distribution of dust devil activity appears to be weighted more toward later afternoon, compared to Earth, but this may be a sampling effect due to size variation with time of sol, greater coverage later in the sol, or the small-number statistics. The thermal infrared images indicate that the lofted dust in the column is cooler than the surrounding surface and must be equilibrating with the atmosphere in the dust devil. This energy transfer is estimated to be about 10% of the heat flux energy that is available to drive the systems. The ground shadowed by the dust column also appears colder than the surroundings, because of reduced solar illumination. From the visible-wavelength images, the shadows of the dust columns were used to estimate the column opacity, which in turn gave estimates of the dust loadings, which ranged from 1.9 × 10?5 to 1.5 × 10?4 kg m?3, similar to lander-based observations. No thermal or visible trails are associated with the dust devils, indicating that the surface equilibrates quickly after the devil has passed and that track counting as a dust devil survey technique must underestimate dust devil populations and consequently dust loading calculations, confirming previous work

On the evaluation of global sea-salt aerosol models at coastal/orographic sites

Sea-salt aerosol global models are typically evaluated against concentration observations at coastal stations that are unaffected by local surf conditions and thus considered representative of open ocean conditions. Despite recent improvements in sea-salt source functions, studies still show significant model errors in specific regions. Using a multiscale model, we investigated the effect of high model resolution (0.1 degrees x 0.1 degrees vs. 1 degrees x 1.4 degrees) upon sea-salt patterns in four stations from the University of Miami Network: Baring Head, Chatam Island, and Invercargill in New Zealand, and Marion Island in the sub-antarctic Indian Ocean. Normalized biases improved from +63.7% to +3.3% and correlation increased from 0.52 to 0.84. The representation of sea/land interfaces, mesoscale circulations, and precipitation with the higher resolution model played a major role in the simulation of annual concentration trends. Our results recommend caution when comparing or constraining global models using surface concentration observations from coastal stations. (C) 2014 The Authors. Published by Elsevier Ltd.Postprint (published version