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To determine if uterocervical angle (UCA), compared with cervical length (CL), is an independent predictor of spontaneous preterm birth (SPTB) in women with threatened preterm labour (TPTL). MLR found the independent predictors of SPTB<34wk to be CL<2.5cm(OR 7.37,95%CI2.42-22.43, p<0.0001) and history of SPTB(OR 4.12,95%CI1.39-13.06, p=0.016). Independent predictors of SPTB<37wk included CL<2.5cm(OR 11.43,95%CI4.80-27.23, p<0.0001), history of SPTB(OR 3.07 95%CI1.07-8.84, p=0.038) and history of LEEP(OR 2.97,95%CI1.02-8.69, p=0.047). [Extracted from the article]

Abstract Background Peripartum cardiomyopathy (PPCM) is an important cause of pregnancy-associated heart failure, which appears in previously healthy women towards the end of pregnancy or within five months following delivery. Although the ECG is widely used in clinical practice, its prognostic value has not been established in PPCM. Methods We analysed 12-lead ECGs of patients with PPCM, taken at index presentation and follow-up visits at 6 and 12 months. Poor outcome was determined by the composite endpoint of death, readmission, NYHA functional class III/IV or left ventricular ejection fraction (LVEF) of ≤35% at follow-up. Results This cohort of 66 patients had a median age of 28.59 (IQR 25.43–32.19). The median LVEF at presentation (33%, IQR 25–40) improved significantly at follow-up (LVEF 49%, IQR 38–55, P < 0.001 at 6 months; 52% IQR 38–57, P = 0.001 at 12 months). Poor outcome occurred in 27.91% at 6 months and 41.18% at 1 year. Whereas sinus tachycardia at baseline was an independent predictor of poor outcome at 12 months (OR 6.56, 95% CI 1.17–20.41, P = 0.030), sinus arrhythmia was associated with event free survival (log rank P = 0.013). T wave inversion was associated with an LVEF ≤35% at presentation (P = 0.038), but did not predict poor outcome. A prolonged QTc interval at presentation (found in almost half of the cohort) was an independent predictor of poor outcome at 6 months (OR 6.34, 95% CI 1.06–37.80, P = 0.043). Conclusion(s) A prolonged QTc and sinus tachycardia at baseline were independent predictors of poor outcome in PPCM at 6 months and 1 year respectively. Highlights • ECG abnormalities are frequently encountered in patients with PPCM. • The ECG has a predictive value in PPCM. • Sinus arrhythmia is associated with a good outcome in PCCM. • Sinus tachycardia predicts poor outcome in PPCM. • A prolonged QTc at baseline is an independent predictor of poor outcome in PPCM. [ABSTRACT FROM AUTHOR]

Objective: Total laryngectomy is considered the primary treatment modality for advanced laryngeal carcinoma. This study assessed the quality of life in patients after total laryngectomy, and ascertained whether quality of life is affected by socioeconomic status. Method: Forty-seven patients (20 state- and 27 private-sector) who underwent total laryngectomy between 1998 and 2014 responded to the University of Washington Quality of Life Questionnaire, the Voice-Related Quality of Life Questionnaire and the Brief Illness Perception Questionnaire. Results: Significant differences were found in socioeconomic status between state- and private-sector patients (p < 0.001). There was no significant difference in overall quality of life between groups (p = 0.210). State-sector patients scored significantly higher Voice-Related Quality of Life Questionnaire scores (p = 0.043). Perception of illness did not differ significantly between groups. Conclusion: Overall quality of life after total laryngectomy appears to be similar in patients from different socioeconomic backgrounds. However, patients from lower socioeconomic circumstances have better voice-related quality of life. The results illustrate the importance of including socioeconomic status when reporting voice outcomes in total laryngectomy patients. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Improving Communication for the Post-Operative Laryngectomee" in the November 21, 2005 issue.

Cellulose is degraded during the growth of the cultivated mushroom A. bisporus on composted straw. At the time of sporophore enlargement, a marked increase in extracellular endocellulase activity occurs. A high level of enzyme activity is maintained during subsequent cropping cycles. Some of the factors affecting growth and production of extracellular endocellulase activity by A. bisporus cultured in simple defined liquid media have been examined. Endocellulase production by the fungus closely paralleled mycelial growth in cultures containing microcrystalline cellulose. The enzyme was induced by various celluloses and cellobiose. In the presence of a cellulose inducer, glucose and cellobiose repressed enzyme production. Endocellulase activity in culture filtrates was inversely related to cellulose concentration in the culture. Although the activity of free enzyme was low, in high concentrations of cellulose more cellulose was degraded. Evidence was obtained for the existence of two forms of endocellulase activity. One form adsorbed strongly to cellulose and was predominant in cultures low in cellulose. In cultures with a high cellulose content, a nonadsorbable form of the enzyme was more abundant. It is suggested that the pattern of cellulase activities produced when A. bisporus is grown on different concentrations of cellulose is partly accounted for by its adsorption to the cellulose. [ABSTRACT FROM AUTHOR]

Background: HIV-infected individuals are at increased risk of tissue inflammation and accelerated vascular aging (‘inflamm-aging’). Abnormal diurnal blood pressure (BP) rhythms such as non-dipping may contribute to an increased risk of cardiovascular and cerebrovascular events in HIV infected individuals. However, little data exists on ambulatory blood pressure (ABP) and measures of vascular stiffness in the black African HIV infected population. Methods: This is a cross-sectional analysis of otherwise well, HIV infected outpatients on ART for >5 years. Study assessments included: 24hr ABP monitoring, pulse wave velocity (PWV) and central aortic systolic pressure (CASP) using a AtCor Medical Sphygmocor device, fasting lipogram, oral glucose tolerance test, high-sensitivity C-reactive protein (hsCRP) and anthropometric data. Patients completed a questionnaire of autonomic symptoms. CD4+ counts and viral loads were obtained from the National Laboratory results system. Results: Sixty seven black participants were included in the analysis of whom 91% (n = 61) were female with a mean age of 42.2 ± 8.6 years. The median duration on ART was 7.5 years (IQR = 6–10), 84% were virally supressed and the median CD4 count was 529.5cells/mm3 (IQR = 372.0–686.5). The majority (67%) were classified as overweight and 76% had an increased waist circumference, yet only 88% of participants were normotensive. A hsCRP level in the high cardiovascular risk category was found in 68% of participants. The prevalence of non-dipping BP was 65%. Interestingly, there was no association on multivariable analysis between dipping status and traditional risk factors for non-dipping BP, such as: obesity, autonomic dysfunction and older age. Conclusion: This relatively young cross-sectional sample of predominantly normotensive, but overweight black women on effective ART >5 years showed: a high prevalence of non-dipping BP, inflammation and vascular stiffness. Causality cannot be inferred but cardiovascular risk reduction should be emphasized in these patients. [ABSTRACT FROM AUTHOR]

Odour pollution is traditionally categorised as a public health issue, controlled via statutory legislation with the emphasis on control rather than prevention. As society demands a higher quality environment, odour pollution increases in importance as an amenity issue. Planning authorities can refuse planning permission on the grounds that the odour nuisance from the proposed development will be detrimental to the amenity of the area. Planning authorities are therefore in the unique position of being able to prevent odour pollution. Potential odour polluters are under increasing pressure to demonstrate to planning authorities that odour has been minimised as far as possible. The communication of technical odour control data and assessments, through mechanisms such as Environmental Impact Assessments (EIA), is becoming an important part of the decision making process. The lack of specific odour policy and guidance within the planning arena is highlighted. The reconstruction of Derby Sewage Treatment works (STW) is useda a case study to highlight how a technical assessment of odour emissions, using the WRc Sewage Treatment Odour Production (STOP) Model can be successfully used within the planning arena to achieve planningpermission with no additional conditions. [ABSTRACT FROM AUTHOR]

Al-Khiday, located on the bank of the White Nile in Sudan, offers an exceptionally preserved stratigraphic sequence, providing a unique opportunity to use organic residue analysis to investigate diet and subsistence during the Khartoum Mesolithic and the Early Neolithic, a period of nearly 3500 years (7000–4500 cal BC). While the vast and diverse Mesolithic fish assemblage indicates a strong reliance on products from aquatic habitats, floodplains, vegetated marshes, and open water, results from the lipid residue analysis suggest that the fish were not cooked in ceramic pots, but consumed in other ways. Rather, pots were more specialized in processing plants, including wild grasses, leafy plants, and sedges. These results, confirmed by experimental analysis, provide, for the first time, direct chemical evidence for plant exploitation in the Khartoum Mesolithic. Non-ruminant fauna (e.g., warthog) and low lipid-yielding reptiles (e.g., Adanson's mud turtle and Nile monitor lizard), found in significant numbers at al-Khiday, were likely also cooked in pots. There is little evidence for the processing of wild ruminants in the Mesolithic pots, suggesting either that ruminant species were not routinely hunted or that large wild fauna may have been cooked in different ways, possibly grilled over fires. These data suggest sophisticated economic strategies by sedentary people exploiting their ecological niche to the fullest. Pottery use changed considerably in the Early Neolithic, with ruminant products being more routinely processed in pots, and while the exploitation of domesticates cannot be confirmed by a small faunal assemblage, some dairying took place. The results provide valuable information on Early and Middle Holocene lifeways in central Sudan. [ABSTRACT FROM AUTHOR]

Introduction HIV-positive children are possibly more prone to developing cholesteatoma. Chronic inflammation of the middle ear cleft may be more common in patients with HIV and this may predispose HIV-positive children to developing cholesteatoma. There are no studies that describe the radiological morphology of the middle ear cleft in HIV-positive compared to HIV-negative children with cholesteatoma. Objectives Compare the radiological differences of the middle ear cleft in HIV-positive and HIV-negative children with cholesteatoma. Methods A retrospective, cross-sectional, observational analytical review of patients with cholesteatoma at our institute over a 6 year period. Results Forty patients were included in the study, 11 of whom had bilateral cholesteatoma and therefore 51 ears were eligible for our evaluation. HIV-positive patients had smaller (p=0.02) mastoid air cell systems (MACS). Forty percent of HIV-positive patients had sclerotic mastoids, whereas the rate was 3% in HIV-negative ears (p<0.02). Eighty-two percent of the HIV-positive patients had bilateral cholesteatoma compared to 7% of the control group (p<0.02). There was no difference between the 2 groups with regards to opacification of the middle ear cleft, bony erosion of middle ear structures, Eustachian tube obstruction or soft tissue occlusion of the post-nasal space. Conclusion HIV-positive paediatric patients with cholesteatoma are more likely to have smaller, sclerotic mastoids compared to HIV-negative patients. They are significantly more likely to have bilateral cholesteatoma. This may have implications in terms of surveillance of HIV-positive children, as well as, an approach to management, recurrence and follow-up. HIV infection should be flagged as a risk factor for developing cholesteatoma. [ABSTRACT FROM AUTHOR]

It has long been recognised that the Sahara Desert contains sediment, landform and palaeoecological evidence for phases of increased humidity during the Quaternary period. Many authors have also suggested that during some of these humid periods very large lakes, termed megalakes, developed in several basins within the Sahara. Recent work has questioned their existence. In particular it has been argued that the lack of well-developed and spatially extensive shorelines in these basins suggests that discrete groundwater and spring deposits have been misinterpreted as evidence for megalakes. In this paper we re-evaluate the evidence used to identify megalakes. Firstly, we apply a comprehensive remote sensing and GIS analyses to the megalake shorelines, their catchments and the wider Sahara. This not only supports the previously proposed existence of numerous megalakes, but also indicates a previously unrecognised megalake in the Niger Inland Delta region, here named Megalake Timbuktu. Secondly, we review the geomorphic and sedimentary evidence for the megalakes, highlighting the importance of the sedimentary record in identifying lake highstands, particularly through the example of the Chotts Megalake in southern Tunisia where we provide new sedimentary information on lake shorelines. This analysis demonstrates that in much of the Sahara the dynamic aeolian systems preclude the preservation of well-developed shorelines, but the distribution of fragmented geomorphic features and localised lake deposits provide robust evidence for Quaternary megalake formation. The paper concludes by highlighting that although extensive evidence for Saharan megalake formation exists, the current chronology of lake highstands indicates that the vast majority date to Marine Isotope Stage (MIS) 5 or earlier. Only megalakes Chad and Timbuktu, which derive much of their water from outside the desert, show evidence for Holocene (African Humid Period or AHP) shorelines. The AHP record of the other megalakes indicate the existence of much smaller water bodies than those that developed earlier in the Pleistocene indicating that it was significantly drier than these earlier humid phases. • Many studies have reported evidence for megalakes in the Sahara, yet recent work has questioned their existence. • A comprehensive remote sensing analyses of the entire Sahara supports the presence of most previously proposed megalakes, This analysis reveals a new megalake that we call Megalake Timbuktu. • A review of the evidence for megalakes highlights the importance of the sedimentary record in their identification. • The chronology of lake highstands indicates that the vast majority date to Marine Isotope Stage (MIS) 5 or earlier. [ABSTRACT FROM AUTHOR]

The radio occultation (RO) technique, which makes use of radio signals transmitted by the global positioning system (GPS) satellites, has emerged as a powerful and relatively inexpensive approach for sounding the global atmosphere with high precision, accuracy, and vertical resolution in all weather and over both land and ocean. On 15 April 2006, the joint Taiwan-U.S. Constellation Observing System for Meteorology, Ionosphere, and Climate (COSMIC)/ Formosa Satellite Mission 3 (COSMIC/FORMOSAT-3, hereafter COSMIC) mission, a constellation of six niicrosatellites, was launched into a 512-km orbit. After launch the satellites were gradually deployed to their final orbits at 800 km, a process that took about 17 months. During the early weeks of the deployment, the satellites were spaced closely, offering a unique opportunity to verify the high precision of RO measurements. As of September 2007, COSMIC is providing about 2000 RO soundings per day to support the research and operational communities. COSMIC RO data are of better quality than those from the previous missions and penetrate much farther down into the troposphere; 70%-90% of the soundings reach to within 1 km of the surface on a global basis. The data are having a positive impact on operational global weather forecast models. With the ability to penetrate deep into the lower troposphere using an advanced open-loop tracking technique, the COSMIC RO instruments can observe the structure of the tropical atmospheric boundary layer. The value of RO for climate monitoring and research is demonstrated by the precise and consistent observations between different instruments, platforms, and missions. COSMIC observations are capable of intercalibrating microwave measurements from the Advanced Microwave Sounding Unit (AMSU) on different satellites. Finally, unique and useful observations of the ionosphere are being obtained using the RO receiver and two other instruments on the COSMIC satellites, the tiny ionosphere photometer (TIP) and the tri band beacon. [ABSTRACT FROM AUTHOR]

BACKGROUND: Trimethoprim/sulfamethoxazole (TMP/SMX) is currently the first choice for empiric therapy of acute uncomplicated urinary tract infection (UTI) in women. In areas where resistance to TMP/SMX is known to be high, ciprofloxacin and other fluoroquinolones are recommended as first-line choices for the empiric therapy of UTI. OBJECTIVE: This study compared the efficacy and safety profile of once-daily extended-release ciprofloxacin 500 mg (referred to hereafter as ciprofloxacin QD) with those of conventional ciprofloxacin 250 mg BID, each administered orally for 3 days, in the treatment of uncomplicated UTI in women. METHODS: In this multicenter, prospective, randomized, double-blind, double-dummy, Phase III trial, adult women with clinical signs and symptoms of acute uncomplicated UTI, pyuria, and a positive pretherapy urine culture (>/=10(5) colony-forming units/mL) received ciprofloxacin QD or ciprofloxacin BID. Bacteriologic and clinical outcomes were assessed at the test-of-cure visit (4-11 days after completion of therapy) and the late follow-up visit (25-50 days after completion of therapy). RESULTS: The intent-to-treat population consisted of 891 patients (444 ciprofloxacin QD, 447 ciprofloxacin BID); 422 patients were evaluable for efficacy (199 ciprofloxacin QD, 223 ciprofloxacin BID). At the test-of-cure visit, bacteriologic eradication was achieved in 94.5% (188/199) of the ciprofloxacin QD group and 93.7% (209/223) of the ciprofloxacin BID group (95% CI, -3.5 to 5.1). Clinical cure was achieved in 95.5% (189/198) of the ciprofloxacin QD group and 92.7% (204/220) of the ciprofloxacin BID group (95% CI, -1.6 to 7.1). Bacteriologic and clinical outcomes at the late follow-up visit were consistent with the test-of-cure findings. The rate of eradication of Escherichia coli, the most prevalent organism, was >97% in each treatment group. Rates of drug-related adverse events were similar with the once- and twice-daily ciprofloxacin regimens (10% and 9%, respectively). CONCLUSION: Extended-release ciprofloxacin 500 mg given once daily for 3 days was as effective and well tolerated as conventional ciprofloxacin 250 mg given twice daily for 3 days in the treatment of acute uncomplicated UTI in women. [ABSTRACT FROM AUTHOR]