Chronic rhinosinusitis: Patient experiences of primary and secondary care - a qualitative study

Objectives: To explore the experience of CRS and its management from the perspective of patients with CRS. To our knowledge this is the first qualitative study exploring sinus disease. Design: Semi-structured qualitative interviews. Setting: ENT outpatient clinic. Participants: 21 adult patients with CRS: 11 male, 10 female. Patients suffered from a range of types of CRS (including polyps and fungal disease) and differing durations of symptoms (1.5- 47 years). Participants were purposively selected. Thematic analysis was used. Outcome measures: Patient experience of CRS and its management. Results: Patients had concerns regarding management of their symptoms by both healthcare professionals and themselves, including delays to referral and repeated medications. They reported reduced quality of life and high financial and psychosocial costs associated with living with CRS. Conclusions: Despite guidelines for CRS treatment, outcomes remain variable leading to dissatisfaction with treatment. Adherence to existing guidelines may result in fewer repeated consultations in primary care and earlier referrals to secondary care

Evolution of Second-Order Cosmological Perturbations and Non-Gaussianity

We present a second-order gauge-invariant formalism to study the evolution of curvature perturbations in a Friedmann-Robertson-Walker universe filled by multiple interacting fluids. We apply such a general formalism to describe the evolution of the second-order curvature perturbations in the standard one-single field inflation, in the curvaton and in the inhomogeneous reheating scenarios for the generation of the cosmological perturbations. Moreover, we provide the exact expression for the second-order temperature anisotropies on large scales, including second-order gravitational effects and extend the well-known formula for the Sachs-Wolfe effect at linear order. Our findings clarify what is the exact non-linearity parameter f_NL entering in the determination of higher-order statistics such as the bispectrum of Cosmic Microwave Background temperature anisotropies. Finally, we compute the level of non-Gaussianity in each scenario for the creation of cosmological perturbations.Comment: 14 pages, LaTeX file. Further comments adde

MHCII-mediated dialog between group 2 innate lymphoid cells and CD4+ T cells potentiates type 2 immunity and promotes parasitic helminth expulsion

Group 2 innate lymphoid cells (ILC2s) release interleukin-13 (IL-13) during protective immunity to helminth infection and detrimentally during allergy and asthma. Using two mouse models to deplete ILC2s in vivo, we demonstrate that T helper 2 (Th2) cell responses are impaired in the absence of ILC2s. We show that MHCII-expressing ILC2s interact with antigen-specific T cells to instigate a dialog in which IL-2 production from T cells promotes ILC2 proliferation and IL-13 production. Deletion of MHCII renders IL-13-expressing ILC2s incapable of efficiently inducing Nippostrongylus brasiliensis expulsion. Thus, during transition to adaptive T cell-mediated immunity, the ILC2 and T cell crosstalk contributes to their mutual maintenance, expansion and cytokine production. This interaction appears to augment dendritic-cell-induced T cell activation and identifies a previously unappreciated pathway in the regulation of type-2 immunity

The scale of VGI in map production: a perspective of European National Mapping Agencies

The perspective of European National Mapping Agencies (NMA) on the role of citizen sensing in map production was explored. The NMAs varied greatly in their engagement with the community generating volunteered geographic information (VGI) and in their future plans. From an assessment of NMA standard practices, it was evident that much VGI was acquired with a positional accuracy that, while less than that typically acquired by NMAs, actually exceeded the requirements of the nominal data capture scale used by most NMAs. Opportunities for VGI use in map revision and updating were evident, especially for agencies that use a continuous rather than cyclical updating policy. Some NMAs had also developed systems to engage with citizen sensors and examples are discussed. Only rarely was VGI used to collect data on features beyond the standard set used by the NMAs. The potential role of citizen sensing and so its current scale of use by NMAs is limited by a series of concerns, notably relating to issues of data quality, the nature and motivation of the contributors, legal issues, the sustainability of data source, and employment fears of NMA staff. Possible priorities for future research and development are identified to help ensure that the potential of VGI in mapping is realized

Modeling the diurnal variability of agricultural ammonia in Bakersfield, California, during the CalNex campaign

NH3&nbsp;retrievals from the NASA Tropospheric Emission Spectrometer (TES), as well as surface and aircraft observations of NH3(g) and submicron NH4(p), are used to evaluate modeled concentrations of NH3(g)&nbsp;and NH4(p)&nbsp;from the Community Multiscale Air Quality (CMAQ) model in the San Joaquin Valley (SJV) during the California Research at the Nexus of Air Quality and Climate Change (CalNex) campaign. We find that simulations of NH3&nbsp;driven with the California Air Resources Board (CARB) emission inventory are qualitatively and spatially consistent with TES satellite observations, with a correlation coefficient (r2) of 0.64. However, the surface observations at Bakersfield indicate a diurnal cycle in the model bias, with CMAQ overestimating surface NH3&nbsp;at night and underestimating it during the day. The surface, satellite, and aircraft observations all suggest that daytime NH3&nbsp;emissions in the CARB inventory are underestimated by at least a factor of 2, while the nighttime overestimate of NH3(g)&nbsp;is likely due to a combination of overestimated NH3&nbsp;emissions and underestimated deposition. Running CMAQ v5.0.2 with the bi-directional NH3&nbsp;scheme reduces NH3 concentrations at night and increases them during the day. This reduces the model bias when compared to the surface and satellite observations, but the increased concentrations aloft significantly increase the bias relative to the aircraft observations. We attempt to further reduce model bias by using the surface observations at Bakersfield to derive an empirical diurnal cycle of NH3 emissions in the SJV, in which nighttime and midday emissions differ by about a factor of 4.5. Running CMAQv5.0.2 with a bi-directional NH3&nbsp;scheme together with this emissions diurnal profile further reduces model bias relative to the surface observations. Comparison of these simulations with the vertical profile retrieved by TES shows little bias except for the lowest retrieved level, but the model bias relative to flight data aloft increases slightly. Our results indicate that both diurnally varying emissions and a bi-directional NH3&nbsp;scheme should be applied when modeling NH3(g)&nbsp;and NH4(p)&nbsp;in this region. The remaining model errors suggest that the bi-directional NH3&nbsp;scheme in CMAQ v5.0.2 needs further improvements to shift the peak NH3&nbsp;land&ndash;atmosphere flux to earlier in the day. We recommend that future work include updates to the current CARB NH3inventory to account for NH3&nbsp;from fertilizer application, livestock, and other farming practices separately; adding revised information on crop management practices specific to the SJV region to the bi-directional NH3&nbsp;scheme; and top-down studies focused on determining the diurnally varying biases in the canopy compensation point that determines the net land&ndash;atmosphere NH3&nbsp;fluxes.</p

Mediation in the Law Curriculum

Cited by Lord Neuberger in ‘Educating Future Mediators’ at the 4th Civil Mediation Council National Conference, May 201

Production of photons in a bouncing universe

Using a new non-singular solution,it is shown that the production of photons in dilaton electrodynamics in a cosmological setting is increased if the effect of matter creation on the geometry is taken into account. This increment may be related to the problem of the origin of magnetic fields in the universe.Comment: 7pages, 4 figure