Follow-up after treatment for head and neck cancer: United Kingdom National Multidisciplinary Guidelines

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. In the absence of high-level evidence base for follow-up practices, the duration and frequency are often at the discretion of local centres. By reviewing the existing literature and collating experience from varying practices across the UK, this paper provides recommendations on the work up and management of lateral skull base cancer based on the existing evidence base for this rare condition

Adequately assessing dehydration: A holy grail of paediatric emergency medicine

We read the work by Pringle at al. [1] with interest. One of the holy grails of Paediatric Emergency Medicine has been the rapid and reliable identification of the child with serious dehydration, and the converse, the ability to know when to safely discharge a child with a history of gastroenteritis. Recently there has been an external validation of a previously derived clinical dehydration scale by Bailey et al. [2]. It is encouraging to see this type of study as too often scoring systems are created without further testing. However we wondered about the generalisability of this result to routine Pediatric Emergency Care. Specifically we noted that in that study participating nurses undertook an additional training programme prior to study commencement. Is the score still valid if used by Pediatric Emergency Care staff who have not had this additional training? Our previous work has shown that experience and training in assessment may be vital in correctly assigning dehydration categories in children [3]. We found significant variability between junior doctors' assessments of dehydration compared to their seniors. We concluded previous studies on dehydration scoring systems may have benefited from well-trained staff and the introduction of these systems to naive health care professionals may not replicate initial results. The Pringle et al. study, while containing only a small number of subjects, challenges this conclusion again as it appears the care setting may influence the utility of the tool. The holy grail has yet to be found

Substrate Integrated Bragg Waveguide: an Octave-bandwidth Single-mode Functional Transmission-Line for Millimeter-Wave and Terahertz Applications

We demonstrate an air-core single-mode hollow waveguide that uses Bragg reflector structures in place of the vertical metal walls of the standard rectangular waveguide or via holes of the so-called substrate integrated waveguide. The high-order modes in the waveguide are substantially suppressed by a modal-filtering effect, making the waveguide operate in the fundamental mode over more than one octave. Numerical simulations show that the propagation loss of the proposed waveguide can be lower than that of classic hollow metallic rectangular waveguides at terahertz frequencies, benefiting from a significant reduction in Ohmic loss. To facilitate fabrication and characterization, a proof-of-concept 20 to 45 GHz waveguide is demonstrated, which verifies the properties and advantages of the proposed waveguide. A zero group-velocity dispersion point is observed at near the middle of the operating band. This work offers a step towards a novel hybrid transmission-line medium that can be used in a variety of functional components for broadband millimeter-wave and terahertz applications.Comment: 11 pages, 9 figures, journal articl

Decentralization Policy and Citizen Participation in Government: The Case of Liberia

Political decentralization has been advanced in the 21st century as a prescription for enabling citizens\u27 participation in politics and increasing good governance. However, empirical investigations have offered limited knowledge about decentralization efforts in Liberia. This study explored if decentralization could serve as a catalyst for citizens\u27 participation and good governance in Liberia. The polarity of participation and representation - one of the pairs in the polarities of democracy model developed by Benet - was used to establish the theoretical foundation for this study. The study employed a case study research design. Data were collected through semi-structured interviews with 20 participants recruited through snowball sampling and subjected to a thematic content procedure for analysis. The main theme indicated that decentralization was perceived as Liberia\u27s best policy option to repair 171 years of political, social, and economic challenges. Establishment of service centers at the county level to manage social development funds and the passage of the local government act were acknowledged as achievements of the decentralization policy in Liberia. On the other hand, the country\u27s long history of centralized governance, corruption, inequality, constitution violations, and misused of public resources were identified as major obstacles to successful implementation of decentralization policy measures. The social change implication of the study involves identifying a potential avenue for the government and citizens of Liberia to build a stronger relationship through reform which will ultimately enhance citizens\u27 ability to be involved in governmental decision making at both national and local levels

The wave equation on singular space-times

We prove local unique solvability of the wave equation for a large class of weakly singular, locally bounded space-time metrics in a suitable space of generalised functions.Comment: Latex, 19 pages, 1 figure. Discussion of class of metrics covered by our results and some examples added. Conclusion more detailed. Version to appear in Communications in Mathematical Physic

Fast growth of magnetic fields in galaxy clusters: a self-accelerating dynamo

We propose a model of magnetic-field growth in galaxy clusters whereby the field is amplified by a factor of about 10^8 over a cosmologically short time of ~10^8 yr. Our model is based on the idea that the viscosity of the intracluster medium during the field-amplification epoch is determined not by particle collisions but by plasma microinstabilities: these give rise to small-scale fluctuations, which scatter particles, increasing their effective collision rate and, therefore, the effective Reynolds number. This gives rise to a bootstrap effect as the growth of the field triggers the instabilities which increase the Reynolds number which, in turn, accelerates the growth of the field. The growth is explosive and the result is that the observed field strength is reached over a fraction of the cluster lifetime independent of the exact strength of the seed field (which only needs to be above ~10^{-15} G to trigger the explosive growth).Comment: latex (AN style), 5 pages, 2 figure

Joint inversion estimate of regional glacial isostatic adjustment in Antarctica considering a lateral varying Earth structure (ESA STSE Project REGINA)

A major uncertainty in determining the mass balance of the Antarctic ice sheet from measurements of satellite gravimetry, and to a lesser extent satellite altimetry, is the poorly known correction for the ongoing deformation of the solid Earth caused by glacial isostatic adjustment (GIA). Although much progress has been made in consistently modelling the ice-sheet evolution throughout the last glacial cycle, as well as the induced bedrock deformation caused by these load changes, forward models of GIA remain ambiguous due to the lack of observational constraints on the ice sheet's past extent and thickness and mantle rheology beneath the continent. As an alternative to forward modelling GIA, we estimate GIA from multiple space-geodetic observations: GRACE, Envisat/ICESat and GPS. Making use of the different sensitivities of the respective satellite observations to current and past surface mass (ice mass) change and solid Earth processes, we estimate GIA based on viscoelastic response functions to disc load forcing. We calculate and distribute the viscoelastic response functions according to estimates of the variability of lithosphere thickness and mantle viscosity in Antarctica. We compare our GIA estimate with published GIA corrections and evaluate its impact in determining the ice mass balance in Antarctica from GRACE and satellite altimetry. Particular focus is applied to the Amundsen Sea Sector in West Antarctica, where uplift rates of several cm/yr have been measured by GPS. We show that most of this uplift is caused by the rapid viscoelastic response to recent ice-load changes, enabled by the presence of a low-viscosity upper mantle in West Antarctica. This paper presents the second and final contribution summarizing the work carried out within a European Space Agency funded study, REGINA, (www.regina-science.eu)

Single cell analysis shows decreasing FoxP3 and TGFβ1 coexpressing CD4+CD25+ regulatory T cells during autoimmune diabetes

Natural CD4+CD25+ regulatory T (CD4+CD25+ T reg) cells play a key role in the immunoregulation of autoimmunity. However, little is known about the interactions between CD4+CD25+ T reg cells and autoreactive T cells. This is due, in part, to the difficulty of using cell surface markers to identify CD4+CD25+ T reg cells accurately. Using a novel real-time PCR assay, mRNA copy number of FoxP3, TGFβ1, and interleukin (IL)-10 was measured in single cells to characterize and quantify CD4+CD25+ T reg cells in the nonobese diabetic (NOD) mouse, a murine model for type 1 diabetes (T1D). The suppressor function of CD4+CD25+CD62Lhi T cells, mediated by TGFβ, declined in an age-dependent manner. This loss of function coincided with a temporal decrease in the percentage of FoxP3 and TGFβ1 coexpressing T cells within pancreatic lymph node and islet infiltrating CD4+CD25+CD62Lhi T cells, and was detected in female NOD mice but not in NOD male mice, or NOR or C57BL/6 female mice. These results demonstrate that the majority of FoxP3-positive CD4+CD25+ T reg cells in NOD mice express TGFβ1 but not IL-10, and that a defect in the maintenance and/or expansion of this pool of immunoregulatory effectors is associated with the progression of T1D

An additional deep-water mass in Drake Passage as revealed by 3He data

We present 3He data froma repeat section across Drake Passage, fromthree sections off the South American continent in the Pacific, at 28?S, 35?S, and 43?S, and fromthree sections in the Atlantic, eastward of the Malvinas, close to 35?W, and near the Greenwich Meridian. In Drake Passage, a distinct high-3He signal is observed that is centered just above the boundary of the Lower and the Upper Circumpolar Deep Water (LCDW, UCDW), and is concentrated towards the northern continental slope. 3He concentrations in the Antarctic Circumpolar Current (ACC) upstream of Drake Passage (World Ocean Circulation Experiment section P19 at 88?W) are markedly lower than those found in Drake Passage, and a regional source of primordial helium in the path of the ACC that might cause the high-3He feature can be ruled out. We explain the feature by addition of high-3He waters present at the 43?S Pacific section. This supports a previous, similar interpretation of a low-salinity anomaly in Drake Passage (Naveira Garabato et al., Deep- Sea Research I 49 (2002) 681), that is strongly related to the high-3He feature. Employing multiparameter water mass analysis (including 3He as a parameter), we find that deep waters as met at the 43?S Pacific section, flowing south along the South American continental slope, contribute substantially to the ACC waters in Drake Passage (fractions exceed 50% locally). Lesser, but laterally more extended contributions are found east of the Malvinas, and still smaller ones are present at 35?W and at the Greenwich Meridian. Using velocity measurements from one of the two Drake Passage sections, we estimate the volume transport of these waters to be 7.071.2 Sv, but the average transport may be somewhat lower as the other realization had a less pronounced signal. The enhanced 3He signature in Drake Passage is essentially confined north of the Polar Front. Further downstreamthe signature crosses this front, to the extent that at 35?W the contributions south and north of it are of similar magnitude. At the same time, the 3He levels north of the front are reduced due to a substantial admixture of low-3He North Atlantic Deep Water, such that 3He becomes highest south of the front. The flow of Southeast Pacific deep slope waters entering the ACC constitutes the predominant exit pathway of the primordial helium released in the deep Pacific, and represents a considerable fraction of the deep water return flow fromthe Pacific into the ACC. Therefore and also because the density range of the added deep slope waters is intermediate between those of UCDW and LCDW, they must be considered a distinct water mass. r 2003 Elsevier Ltd. All rights reserved

Movement patterns and activity levels are shaped by the neonatal environment in Antarctic fur seal pups

This research was funded by the German Research Foundation (DFG) as part of the SFB TRR 212 (NC3)—Project Numbers 316099922, 396774617, and 396782756. It was also supported by core funding from the Natural Environment Research Council to the British Antarctic Survey’s Ecosystems Program.Tracking studies of juveniles are rare compared to those of adults, and consequently little is known about the influence of intrinsic and extrinsic factors on activity during this critical life stage. We used hourly GPS data, collected from 66 Antarctic fur seal pups from birth until moulting, to investigate the explanatory power of multiple individual-based and environmental variables on activity levels. Pups were sampled from two nearby breeding colonies of contrasting density during two subsequent years, and a two-state hidden Markov model was used to identify modalities in their movement behaviour, specifically 'active' and 'inactive' states. We found that movement was typified by central place exploration, with active movement away from and subsequent return to a location of inactivity. The probability of such directed exploration was unaffected by several factors known to influence marine mammal movement including sex, body condition, and temperature. Compared to pups born at the high-density colony, pups at low-density were more active, increased their activity with age, and transitioned earlier into the tussock grass, which offers protection from predators and extreme weather. Our study illustrates the importance of extrinsic factors, such as colony of birth, to early-life activity patterns and highlights the adaptive potential of movement.Publisher PDFPeer reviewe