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This paper describes several aspects of the physical layer and over the air interface of Loon. Loon utilizes stratospheric balloon-based high-altitude platforms (HAPs) that use Long-Term Evolution (LTE) to connect people with standard User Equipment (UEs) to the Internet. In particular, topics covered include the Loon prototype eNodeB (eNB) antenna pattern, the observed channel, UE battery life, and coexistence with terrestrial networks using the same spectrum. While channel models from a HAP to the ground have been well studied in the past, the use of polarization diversity to establish Multi-Input Multi-Output (MIMO) communication to real UEs below 1 GHz has not. In addition, a theoretical analysis of terrestrial coexistence and an analysis of the estimated impact on UE battery life when communicating with HAPs are presented. Finally, results from several measurement campaigns and from experiments with polarization diversity are presented as a spot check of theory.

BACKGROUND: The efficacy and safety of combination therapy with eflornithine and sulindac, as compared with either drug alone, in delaying disease progression in patients with familial adenomatous polyposis are unknown. METHODS: We evaluated the efficacy and safety of the combination of eflornithine and sulindac, as compared with either drug alone, in adults with familial adenomatous polyposis. The patients were stratified on the basis of anatomical site with the highest polyp burden and surgical status; the strata were precolectomy (shortest projected time to disease progression), rectal or ileal pouch polyposis after colectomy (longest projected time), and duodenal polyposis (intermediate projected time). The patients were then randomly assigned in a 1:1:1 ratio to receive 750 mg of eflornithine, 150 mg of sulindac, or both once daily for up to 48 months. The primary end point, assessed in a time-to-event analysis, was disease progression, defined as a composite of major surgery, endoscopic excision of advanced adenomas, diagnosis of high-grade dysplasia in the rectum or pouch, or progression of duodenal disease. RESULTS: A total of 171 patients underwent randomization. Disease progression occurred in 18 of 56 patients (32%) in the eflornithine-sulindac group, 22 of 58 (38%) in the sulindac group, and 23 of 57 (40%) in the eflornithine group, with a hazard ratio of 0.71 (95% confidence interval [CI], 0.39 to 1.32) for eflornithine-sulindac as compared with sulindac (P = 0.29) and 0.66 (95% CI, 0.36 to 1.24) for eflornithine-sulindac as compared with eflornithine. Among 37 precolectomy patients, the corresponding values in the treatment groups were 2 of 12 patients (17%), 6 of 13 (46%), and 5 of 12 (42%) (hazard ratios, 0.30 [95% CI, 0.07 to 1.32] and 0.20 [95% CI, 0.03 to 1.32]); among 34 patients with rectal or ileal pouch polyposis, the values were 4 of 11 patients (36%), 2 of 11 (18%), and 5 of 12 (42%) (hazard ratios, 2.03 [95% CI, 0.43 to 9.62] and 0.84 [95% CI, 0.24 to 2.90]); and among 100 patients with duodenal polyposis, the values were 12 of 33 patients (36%), 14 of 34 (41%), and 13 of 33 (39%) (hazard ratios, 0.73 [95% CI, 0.34 to 1.52] and 0.76 [95% CI, 0.35 to 1.64]). Adverse and serious adverse events were similar across the treatment groups. CONCLUSIONS: In this trial involving patients with familial adenomatous polyposis, the incidence of disease progression was not significantly lower with the combination of eflornithine and sulindac than with either drug alone. (Funded by Cancer Prevention Pharmaceuticals; ClinicalTrials.gov number, NCT01483144; EudraCT number, 2012-000427-41.).

Background Molecular studies suggest inhibition of colorectal mucosal polyamines (PAs) may be a promising approach to prevent colorectal cancer (CRC). Inhibition of ornithine decarboxylase (ODC) using low-dose eflornithine (DFMO, CPP-1X), combined with maximal PA export using low-dose sulindac, results in greatly reduced levels of normal mucosal PAs. In a clinical trial, this combination (compared with placebo) reduced the 3-year incidence of subsequent high-risk adenomas by >90 %. Familial Adenomatous Polyposis (FAP) is characterized by marked up-regulation of ODC in normal intestinal epithelial and adenoma tissue, and therefore PA reduction might be a potential strategy to control progression of FAP-related intestinal polyposis. CPP FAP-310, a randomized, double-blind, Phase III trial was designed to examine the safety and efficacy of sulindac and DFMO (alone or in combination) for preventing a clinically relevant FAP-related progression event in individuals with FAP. Methods Eligible adults with FAP will be randomized to: CPP-1X 750 mg and sulindac 150 mg, CPP-1X placebo and sulindac 150 mg, or CPP-1X 750 mg and sulindac placebo once daily for 24 months. Patients will be stratified based on time-to-event prognosis into one of the three treatment arms: best (ie, longest time to first FAP-related event [rectal/pouch polyposis]), intermediate (duodenal polyposis) and worst (pre-colectomy). Stage-specific, “delayed time to” FAP-related events are the primary endpoints. Change in polyp burden (upper and/or lower intestine) is a key secondary endpoint. Discussion The trial is ongoing. As of February 1, 2016, 214 individuals have been screened; 138 eligible subjects have been randomized to three treatment groups at 15 North American sites and 6 European sites. By disease strata, 26, 80 and 32 patients are included for assessment of polyp burden in the rectum/pouch, duodenal polyposis and pre-colectomy groups, respectively. Median age is 40 years; 59 % are men. The most common reasons for screening failure include minimal polyp burden (n = 22), withdrawal of consent (n = 9) and extensive polyposis requiring immediate surgical intervention (n = 9). Enrollment is ongoing. Trial registration This trial is registered at ClinicalTrials.gov (NCT01483144; November 21, 2011) and the EU Clinical Trials Register(EudraCT 2012-000427-41; May 15, 2014). Electronic supplementary material The online version of this article (doi:10.1186/s12876-016-0494-4) contains supplementary material, which is available to authorized users.

By about 1650, the seventeenth century Puritan search for the New Jerusalem led many an English enthusiast to the conviction that the millennial Kingdom of Christ was at hand. This current in Puritan thought had been gaining force since Thomas Brightman wrote his exegesis on Revelation at the beginning of the century.l With the coming of the civil war, the trickle begun by Brightman (and taken up by a few others before 1642)2 soon developed into a major stream. John Archer, Robert Maton, Jeremiah Burroughes, and William Bridge, to name but some, penned works that increased interest and heightened expectation in the subject during the decade of the forties.3 The infection even caught John Milton who briefly seemed convinced that the great millennial age was imminent.4 As long as these ideas remained pretty much in the realm of imaginative theory with only the vaguest reference to contemporary realization, the views expressed by those authors lacked precision. There was a good deal of fuzziness with respect to the nature of Christ's coming and much uncertainty about the type of reign he would establish. Would Christ's coming be physical or spiritual? Would it require any active work on the part of the saints? Would his reign be political and external or would it be solely ethical and internal? On most of these questions the writers of the forties tended to hedge; Christ would provide the answers himself in due time. But as the tempo of events quickened during and after the second civil war, and as the pressure for a political and ecclesiastical reorganization of the nation heightened during the period of the Commonwealth, the advocates of Christ's earthly rule were forced to turn their attention to a more clear and forthright statement of their aims and ideas. One result of this pressure was that the vague and general millenarianism of the forties soon broke down into several discernible types. While one group of writers remained rather moderate and theoretical,5 two other groups began drifting toward radical though opposite extremes. These latter two were radical in their rejection of the prevailing conditions in England, yet they were to differ markedly in their prescriptions for the world to come. One of these radical groups, seeing in the doctrine of the Holy Spirit the whole or essence of Christ's truth, developed a concept of the Kingdom of Christ that "spiritualized" the external manifestations of the apocalyptic hope to the point where they virtually vanished. The other radical group, a group that later became identified with the Fifth Monarch Men, center

• Postrhinoplasty epistaxis occurred in two patients, both of whom were found to be ingesting megadoses of vitamin E. The rate of vitamin E consumption in a population of 100 uncomplicated nasal operations during this same period was 16%. A review of the medical literature on vitamin E found recent evidence demonstrating a marked decrease in platelet adhesiveness with megadose ingestion of vitamin E. It is concluded that this should be avoided in the perioperative period. (Arch Otolaryngol Head Neck Surg1988;114:748-750)

One of the most difficult problems encountered in rhinoplasty is lack of nasal tip projection. An innovative technique is described that utilizes the removal of a median horizontal strip of lower lateral cartilage to enhance projection, while maintaining a natural highlight and tip support without the use of grafts. The indications are limited to noses that have a widened dome requiring removal of a central strip, and tip rotation. Alternate techniques are discussed; cases and results are discussed.

The cemento-ossifying fibroma, a mesodermal type of non-odontogenic tumor, is rarely discussed in the otolaryngologic literature. It is a tumor that is seen more in blacks than in whites, appears largely in the elderly, is chiefly located in the mandibular molar or premolar area and is generally neither aggressive nor excessively destructive. The triggering mechanism for its derivation from aberrant periodontal membrane growth or development from endosteal fibrous tissue remains controversial. We report a case of cemento-ossifying fibroma in a 26-year-old Hispanic male which was located in the posterior portion of the maxilla which destroyed the maxillary bone, orbital floor, and the lateral wall of the nose. One year prior to discovery of the lesion the patient sustained severe facial trauma resulting in facial bone fractures. It may be speculated that the trauma sustained was the critical triggering factor allowing for unchecked growth and destruction associated with an otherwise non-aggressive tumor, which may have been present prior to the traumatic incident.

Fifty consecutive rhytidectomies were performed utilizing high frequency needle dissection on one side and standard sharp dissection on the other for all incisions and flap elevation. The efficacy of this technique in hemostasis, prevention of hematoma, and wound healing is compared to the conventional technique of rhytidectomy. The advantages and disadvantages of the modality are discussed.