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Generating large topologically protected surface currents using conventional III–V infrared materials such as InAsSb/InGaSbAs quantum wells (QWs) and superlattices (SLs) has been important. In such materials, topological states can be formed at the edge by hybridizing ordinary electronic band structures. However, achieving large surface currents out of these materials is still difficult due to low emission currents and high carrier defects. In this work, we present two hybridized topological structures: one for the 6.22 Å metamorphic QWs and the other for the 6.10 Å pseudomorphic SLs. Both structures are tailored for the same hybridization gap (Δ) of ∼60 meV and optimized for the minimum crystal defects. While the QW grown on metamorphic buffers generates a significant amount of mismatch-related crystal defects, the SL grown on lattice-matched buffers produces an excellent crystalline-quality. Quasiparticle interference mapping and calculations on a SL sample show good agreement of the band structure.

A 26-year-old woman presenting for an elective day case procedure under general anaesthesia had undiagnosed subglottic stenosis leading to a life threatening airway emergency requiring emergency front-of-neck airway. We outline the case and discuss key anaesthetic considerations in subglottic stenosis, including concerning features of a medical/anaesthetic history and the potential for rapid deterioration of a stenotic airway following manipulation. We also consider the effect of anaesthesia on the calibre of subglottic stenosis and the effects of positive pressure ventilation. Subglottic stenosis is a rare condition with congenital, acquired and idiopathic origins; however, iatrogenic trauma is the most common cause. We are aware of a small number of published case reports of previously undiagnosed subglottic stenosis in adults discovered after induction of anaesthesia; situational deterioration to 'cannot intubate, cannot oxygenate' scenarios appear even rarer.

Background:Pharyngoesophageal diverticula have many subtypes, with Zenker's diverticulum being the most common. First described in 1983, a Killian–Jamieson diverticulum is an outpouching in the anterolateral wall at the pharyngoesophageal junction. This is located inferiorly to the cricopharyngeus muscle, unlike Zenker's diverticula which occur superiorly. Killian–Jamieson diverticula are rare and are commonly misdiagnosed as Zenker's diverticula. Less than 30 reports of Killian–Jamieson diverticula have been described in the literature.Case report:A 69-year-old man presented with a 2-year symptomatic history, and was found to have simultaneous Zenker's diverticulum and Killian–Jamieson diverticulum. He was treated successfully with open surgical excision of both pouches.Conclusion:Zenker's diverticulum and Killian–Jamieson diverticulum are diagnosed using radiological studies and endoscopy. Their differentiation is important, as surgical management differs. This paper reviews the literature on Killian–Jamieson diverticula and the management options available.

Subcooled flow boiling heat transfer experiments were performed with water and ethylene glycol/water mixtures at five flow velocities and four fluid inlet temperatures. Both turbulent flow and laminar flow were tested in a special test facility with its experimental test section heated from the bottom surface only. Boiling curves and subcooled flow boiling heat transfer coefficients of the tested fluids were determined from the experimental measurements. Predictive correlations of the subcooled flow boiling heat transfer coefficients were developed based on the experimental data. Comparisons are presented of wall temperatures between the experimental measurements and the correlation predictions.

We compared lower limb coronal alignment measurements obtained pre- and post-operatively with long-leg radiographs and computer navigation in patients undergoing primary total knee replacement (TKR). A series of 185 patients had their pre- and post-implant radiological and computer-navigation system measurements of coronal alignment compared using the Bland-Altman method. The study included 81 men and 104 women with a mean age of 68.5 years (32 to 87) and a mean body mass index of 31.7 kg/m2(19 to 49). Pre-implant Bland–Altman limits of agreement were -9.4° to 8.6° with a repeatability coefficient of 9.0°. The Bland–Altman plot showed a tendency for the radiological measurement to indicate a higher level of pre-operative deformity than the corresponding navigation measurement. Post-implant limits of agreement were -5.0° to 5.4° with a repeatability coefficient of 5.2°. The tendency for valgus knees to have greater deformity on the radiograph was still seen, but was weaker for varus knees.The alignment seen or measured intra-operatively during TKR is not necessarily the same as the deformity seen on a standing long-leg radiograph either pre- or post-operatively. Further investigation into the effect of weight-bearing and surgical exposure of the joint on the mechanical femorotibial angle is required to enable the most appropriate intra-operative alignment to be selected.

Atmospheric-pressure glow plasmas in air or other gases are attractive for industrial plasma processing, but attempts to obtain large-volume plasmas are plagued with filamentation due to transverse plasma instability. A method to prevent transverse instability of DC glow discharges using a resistive barrier is presented. Experimental data on current-voltage characteristics, light intensity versus time, and quantitative striation measurements indicate that the plasma is a true DC glow discharge which shows some longitudinal instability, but is transversely stabilized by a barrier with resistivity in the 104-106 Ω-m range. A finite-element model of the discharge's electric field elucidates the mechanism of transverse stabilization.

The operation of double-barrier resonant tunneling diodes (RTDs) is investigated through self-consistent numerical solution of the Wigner transport equation. Prevalent boundary conditions are demonstrated to lead to unphysical boundary layers in electrostatically self-consistent calculations. New boundary conditions based on nonequilibrium statistics are proposed and validated. Unphysical solutions are also associated with the application of the popular Boltzmann collision operator in the limit of high electron density. An original formulation of the collision operator in the relaxation time approximation is proposed leading to proper asymptotic behavior in both limits of the relaxation time. Coupled solutions of the Wigner transport equation and the Poisson equation for an RTD structure reveal current to be a continuous but multivalued function of applied bias and tristability to be an intrinsic property of device operation.

A methodology for monitoring long-term beach face volume change with a combination of intermittent profiling and video imagery is developed. Intertidal beach morphology can be mapped from video with the use of movement of the waterline over a tidal cycle. Such maps provide detailed information on spatial and temporal evolution of the intertidal area, but no direct information on beach face volume changes as a whole. However, beach face volume might well be correlated with cross-shore changes to a contour located in the intertidal zone. This is significant because such a parameter can be calculated from maps of the intertidal morphology generated with video images. This idea was tested with a series of video images and surveys that were collected over a year and a half on an intermediate beach on the Coromandel Peninsula, New Zealand, over a wide range of conditions. The surveyed profiles show a strong (r2 = 0.95) relationship between the surveyed cross-shore location of the 2-m contour and the su...

Injury to the superficial digital flexor tendon (SDFT) is common in equids, with a high risk of re-injury associated with changes in tendon stiffness. In vivo measurement of limb stiffness has been shown to correlate with tendon stiffness after injury [1] but requires kinematic analysis which is impractical in a clinical setting. We have developed a simple system for measuring limb stiffness statically, which could be used as a tool for monitoring SDFT healing.To validate a goniometric measurement of limb stiffness.Cross sectional study.Initially, forelimb stiffness indices were determined at the walk for 6 equids using a validated kinematic analysis [1]. Limb stiffness indices were then calculated using portable floor scales to record ground reaction force (GRF), and an electrogoniometer to record metacarpophalangeal joint angle. Goniometric limb stiffness indices were subsequently measured in 11 horses ranging from 2 to 20 years of age, with no clinical evidence of SDFT injury. Strength and significance of correlation and agreement between the measurement methods was assessed and association between limb stiffness, limb (left vs. right), weight and age of horse and were calculated.There were strong positive correlations between GRF and joint angle (R(2) = 0.98) and between the static and kinematic methods (R = 0.78, P0.01). There was a positive correlation between limb stiffness and weight (R(2) = 0.85, P0.01), but no association with age or limb.This study validated the measurement of limb stiffness in a clinical setting. The positive correlation of limb stiffness and weight supports the theory of an optimised limb spring [2] for energy-efficient cursorial locomotion which may, in turn, provide a clinically-relevant measure of running efficiency and therefore the quality of tendon healing post injury. Ethical animal research: Owner consent was obtained.None. Competing interests: None declared.

The Senate Bill 3 process has produced flow recommendations for rivers and estuaries in Texas to maintain sound ecological environments. Ideally, the recommendations for each component of the flow regime are associated with specific, and quantitative, hypotheses of expected ecological responses. Having completed the first round of flow recommendation development, Texas is now in the process of conducting targeted research to test the efficacy of the flow recommendations. Higgins et al (2011) propose an evaluation framework that includes monitoring to access 1. Environmental Flow Implementation 2. Short‐Term Responses to Implementing Flow Prescription Components and to Support Adaptive Management 3. Long‐Term Ecosystem Status and Trends This paper presents a case study of the ongoing application of this framework to the implementation of flow regime recommendations at Lake O’ the Pines Reservoir on the Big Cypress Creek. ENVIRONMENTAL FLOWS PROJECT The Caddo Lake Institute (CLI) initiated the environmental flow project ("Project") to restore and protect healthy flows in the Caddo Lake watershed and larger Cypress Basin in 2004 as part of the Sustainable River Project (SRP) (a cooperative program between the U.S. Army Corps of Engineers (USACE) and the Nature Conservancy (TNC)). The initial goal was to seek changes to reservoir operations at Lake O’ the Pines (LOTP) to meet a recommended flow regime to restore and maintain the ecological health of Big Cypress Creek and Caddo Lake while also meeting the water needs of people. The Project has since expanded its scope to include recommendations for flow regimes to other major tributaries to Caddo Lake and within the Cypress Basin. The overall objective is assuring a sound ecological environment, which is defined as “A resilient, functioning ecosystem characterized by intact, natural processes, and a balanced, integrated, and adaptive community of organisms comparable to that of the natural habitat of a region.” (TIFP 2008)

Acute compartment syndrome has a multitude of aetiologies. Unfortunately, the diagnosis is often delayed, resulting in permanent functional loss. Although spontaneous muscle infarction is an uncommon, yet well-recognized complication of diabetes mellitus, subsequent development of compartment syndrome appears to be rare, with only five case reports identified in the literature. This condition has not been reported in the emergency medicine literature. We report a case of a diabetic gentleman who presented with lower limb pain significantly out of proportion to any obvious injury and had a subsequent diagnosis of acute compartment syndrome. Despite fasciotomies, he had a persistent foot drop. Nontraumatic acute compartment syndrome secondary to diabetic muscle infarction should be considered in any diabetic patient presenting with pain out of proportion to sustained injury.

Anterior cervical spine fusion and stabilization is a well-recognized procedure for a number of cervical spine disorders. Unfortunately, the complex anatomy of the cervical spine means that these procedures are not without complications. Pharyngo-oesophageal perforation is a rare but potentially life-threatening complication of cervical spine surgery and may present intra-operatively, in the immediate post-operative period or many years later. We present the case of a gentleman with ankylosing spondylitis who presented with a pharyngeal perforation and fistula five years after cervical spine surgery.

We describe a new patterning technique that employs microcontact printing to replace preformed labile self-assembled monolayers (SAMs) selectively; we call this "microdisplacement printing". We demonstrate that this technique results in ordered molecular regions of both the patterning ("displacing") molecule as well as the remnant labile film, here 1-adamantanethiolate. The existence of the 1-adamantanethiolate SAM before patterning hinders lateral surface diffusion of the patterning molecules, and therefore permits the use of molecules that are otherwise too mobile to pattern by other methods.

Objective: To audit sore throat management in adults, introduce proforma-based guidelines and to reaudit clinical practice.Setting: Adult emergency department of an inner city teaching hospital.Methods: A literature search was carried out to identify relevant guidelines. In stage one, patients presenting to the emergency department with sore throat were identified retrospectively from the emergency department attendance register. Proformas were completed retrospectively. In stage two, new guidelines were introduced and staff educated about the guidelines. In stage three, patients presenting with sore throat were identified at triage and proformas were completed at time of consultation.Outcome Measures: (1) appropriate clinical assessment of the likelihood of bacterial infection using the clinical scoring system, (2) appropriateness of antibiotic prescription, (3) recommendation of supportive treatments to patients.Results: Introduction of a clinical scoring system reduced the inappropriate prescribing of antibiotics from 44 per cent to 11 per cent. Correct antibiotic prescription rose from 60 per cent to 100 per cent. Although the variety of advice given about supportive treatment increased, the actual number of patients receiving documented supportive advice fell from 67.8 per cent in stage one to 58 per cent in stage three.Conclusion: The introduction of clinically based guidelines for the diagnosis and management of sore throat in adults can reduce inappropriate antibiotic prescribing.

Aims: To determine whether guidelines relating to the diagnosis and treatment of acute otitis media (AOM) in children are followed in a tertiary paediatric emergency department (ED).Methods: A literature search was undertaken to identify national and international guidelines relating to the diagnosis and management of AOM in children. The guidelines were assessed for their applicability to UK practice. A retrospective case note audit was undertaken. Children presenting to the ED with a discharge diagnosis of AOM over a two month period were identified from the ED computer discharge system. The notes were analysed for compliance with the identified guidelines.Results: 50 children were identified (age range three months to 11 years). Eighty-six per cent of children received antibiotics. Fifty-two per cent of children had documented signs of AOM. Twenty-five of these children received antibiotics (22 in accordance with guidelines, three not in accordance with guidelines, antibiotic not documented in one case). Thirty-nine per cent of children received antibiotics inappropriately. In all cases, the antibiotic dosage was below the dose recommended in all guidelines.Conclusion: There is poor compliance with national (and international) guidelines for the management of AOM in this ED. National guidelines must be introduced into the department by direct teaching at senior house officer and middle grade level, a re-audit must be carried out and regular reviews of the notes of patients diagnosed with AOM must be undertaken to ensure compliance with guidelines is maintained.

SUMMARY Anti-Saccharomyces cerevisiae antibodies (ASCAs) have been proposed as serological markers, which may differentiate Crohn's disease (CD) from ulcerative colitis (UC) and predict disease phenotype. Their importance in pathogenesis is unproven. We investigated the relationship between ASCAs, disease phenotype and NOD2/CARD15 genotype in CD and whether ASCAs were related to antibodies to other fungal proteins. Serum from 228 patients [143 CD, 75 UC, 10 with indeterminate colitis (IC)] and 78 healthy controls (HC) were assayed for ASCA. Antibodies (IgA, IgG) to other fungal proteins (Fusarium species ATC20334, Mycoprotein) were measured in the same samples using an in-house enzyme-linked immunosorbent assay (ELISA) assay. ASCAs were present in 57% of CD, 19% of UC, 30% of IC and 8% of HCs. ASCA-positive status was a predictor for CD with sensitivity of 57%, specificity of 87%, positive predictive value of 78% and negative predictive value of 68%. ASCA was associated with proximal (gastroduodenal and small bowel involvement) rather than purely colonic disease (P

The relative intensities of dielectronic satellite lines determined by radiative transition probabilities and autoionization rates are calculated for the transitions 2lnl' – 1snl'', 2lnl' – 1s2l (n = 4–5, l' = 0–3, l'' = 0–3, l = 0–1) in He-like ions and for the transitions 1s2lnl' – 1s2nl'', 1s2lnl' – 1s22l (n = 4–5, l' =0–3, l'' = 0–3, l = 0–1) in Li-like ions, for all Z = 5–54, using the perturbation theory method (Z-expansion). Relativistic effects are taken into account using the Breit–Pauli operators. The asymptotic dependence on n of the energy matrix is discussed for 2lnl' and 1s2lnl' autoionizing states. The intermediate coupling coefficients obtained after diagonalization of the energy matrices are also studied. It was observed that these coefficients change very sharply with n and Z due to a redistribution of the contributions of relativistic and correlation effects. As a result, all other atomic characteristics (radiative and nonradiative transition rates, branching ratios, and relative intensity factor) display nonmonotonic Z- and n-dependencies with maxima and minima. PACS Nos.: 32.80D, 31.20G, 31.30J, 31.50

In this paper, we study both experimentally and theoretically how the change of the p-doping profile, particularly the p-i junction placement, affects the output characteristics of 1.3-/spl mu/m InGaAsP-InP multiple-quantum-well (MQW) lasers. The relationship between the p-doping profile before and after regrowth is established, and the subsequent impact of changes in the p-i junction placement on the device output characteristics, is demonstrated. Device characteristics are simulated including carrier transport, capture of carriers into the quantum wells, the quantum mechanical calculation of the properties of the wells, and the solution for the optical mode and its population self-consistently as a function of diode bias. The simulations predict and the experiments confirm that an optimum p-i junction placement simultaneously maximizes external efficiency and minimizes threshold current. Tuning of the base epitaxial growth Zn profile allows one to fabricate MQW devices with a threshold current of approximately 80 A/cm/sup 2/ per well for devices with nine QW's at room temperature or lasers with a characteristic temperature T/sub 0/=70 K within the temperature range of 20/spl deg/C-80/spl deg/C.

Collagen fibril size is decreased in repair tissue following tendon injury compared to normal tendon matrix in horses. Mesenchymal stem cells have been suggested to promote regeneration of tendon matrix rather than fibrotic repair following injury, although this concept remains unproven.To explore the hypothesis that implantation of autologous mesenchymal stem cells derived from bone marrow into a surgically created central core defect in the superficial digital flexor tendon (SDFT) of horses would induce the formation of a matrix with greater ultrastructural similarities to tendon matrix than the fibrotic scar tissue formed in control defects.Tissue was collected 16 weeks after induction of injury and 12 weeks after treatment from normal and injured regions of control and treated limbs of 6 horses and examined using transmission electron microscopy. Collagen fibril diameters were measured manually with image analysis software and surface areas calculated. Three parameters assessed for normal and injured tissue were mass average diameter (MAD), collagen fibril index (CFI) and the area dependent diameter (ADD).Normal regions from both treated and control limbs displayed higher MAD and CFI values, as well as a characteristic bimodal distribution in fibril size. Injured regions from both treated and control limbs displayed significantly lower MAD and CFI values, as well as a unimodal distribution in fibril size. There were no significant differences between treated and control limbs for any of the parameters assessed.Intralesional injection of autologous bone marrow derived mesenchymal stem cells had no measurable effect on the fibril diameter of collagen in healing tissue in the SDFT of this experimental model 16 weeks after injury.Favouring matrix regeneration over fibrotic repair may not be the mechanism by which autologous mesenchymal stem cells assist healing of tendon injury.

Analyses of thermodynamic data gathered from airborne dropwindsondes during the Tropical Cyclone Structure (2008) experiment are presented for the disturbance that became Typhoon Nuri. Although previous work has suggested that Nuri formed within the protective recirculating "pouch" region of a westward-propagating wave-like disturbance and implicated rotating deep convective clouds in driving the inflow to spin up the tangential circulation of the system-scale flow, the nature of the thermodynamic environment that supported the genesis remains a topic of debate. During the genesis phase, vertical profiles of virtual potential temperature show little variability between soundings on a particular day and the system-average soundings likewise show a negligible change. There is a tendency also for the lower and middle troposphere to moisten. However, the data show that on the scale of the recirculating region of the disturbance, there was no noticeable reduction of virtual temperature in the lower troposphere, but a small warming (less than 1 K) in the upper troposphere. Vertical profiles of pseudo-equivalent potential temperature, θe, during the genesis show a modestly decreasing deficit of θe in the vertical between the surface and a height of minimum θe (between 3 and 4 km), from 17.5 K to 15.2 K. The findings reported here are consistent with that found for developing disturbances observed in the Pre-Depression Investigation of Cloud Systems in the Tropics (PREDICT) experiment in 2010. Some implications of the findings are discussed.

Platelet-rich plasma (PRP) is increasingly used for treatment of orthopaedic injuries. However, the effects of different stimuli on the release pattern of regenerative and proinflammatory factors from equine platelets are largely unknown and an optimal treatment protocol remains to be established.The aim of this study was to identify a stimulus that enhanced release of histopromotive factors (platelet-derived growth factor BB [PDGF] and transforming growth factor 1β[TGF]) without causing concurrent release of a proinflammatory mediator (CCL5).Washed platelets were prepared from 6 healthy ponies and release of growth factors and CCL5 measured using commercially available ELISAs for human proteins following incubation with or without thrombin, chitosan or equine recombinant tumour necrosis factor (erTNF) over 24 h and subsequently over 96 h. Additionally, noncoagulated samples were analysed.Regardless of whether a stimulus was present or what stimulus was used, PDGF and TGF release was maximal by 0.5-1 h when clot formation took place and very little release was observed after 24 h. Growth factor release was minimal in noncoagulated samples. In contrast, CCL5 release was not associated with coagulation and appeared to persist for much longer. High concentrations of erTNF caused significantly greater release of CCL5 at 6 h than any other stimulus tested.Growth factor release from equine platelets is dependent on coagulation but independent of the initiating stimulus, and is accompanied by more sustained release of proinflammatory mediators.Supernatants collected from coagulated platelets could be an alternative treatment to PRP.

An optical study of fully strained ultrathin ${\mathrm{LaNiO}}_{3}$ films is presented and compared with LDA + DMFT calculations. ${\mathrm{LaNiO}}_{3}$ films were grown by pulsed laser deposition on ${\mathrm{LaAlO}}_{3}$ and ${\mathrm{SrTiO}}_{3}$ substrates which provide compressive and tensile strain, respectively. Optical conductivity data show a Drude peak with a spectral weight that is significantly reduced compared to that obtained from LDA calculations. The extended Drude analysis reveals the presence of a pseudogap around 80 meV for the film on ${\mathrm{SrTiO}}_{3}$ and near 40 meV, at low temperature only, for the film on LAO. An unusual temperature dependence of the optical conductivity is observed, with the Drude plasma frequency increasing by up to 20$%$ at low temperature due to spectral weight transfer from bands lying 2--4 eV below the Fermi energy. Such a strong temperature dependence of the Drude spectral weight has previously been reported for correlated electron systems in which a phase transition is present. In ${\mathrm{LaNiO}}_{3}$, however, no phase transition is observed.

A previous study has identified exercise undertaken during training to be associated with racing performance in flat racehorses. However, no such studies have been conducted in National Hunt (NH) horses.To determine whether exercise undertaken during training is associated with racing performance in NH racehorses.Data were collected as part of a larger study investigating injury occurrence in NH racehorses. Race records and daily exercise data were obtained from NH racehorses at 14 training yards. Canter, gallop and race distances accumulated in the 30 days preceding a 'case race' were calculated. Associations between exercise-, horse- and race-level variables and the odds of winning, winning prize money, being pulled up and falling were identified using mixed effects logistic regression.Data from 4444 races run by 858 horses were included in analyses. Horses accumulating longer canter distances in the preceding 30 days were more likely to win or win prize money and less likely to be pulled-up. Horses accumulating longer race distances in a 30 day period were more likely to win, whilst those accumulating longer gallop distances in a 30 day period were more likely to win prize money. Horses that had jump-schooled in the preceding 30 days were more likely to fall during the race than those that had not. Trainer and horse were associated with racing performance after adjusting for exercise.Results from this study suggest that NH race performance may be improved through modification of exercise regimens. After controlling for the abilities of individual trainers and horses and conditions of the case race, horses accumulating longer exercise distances in the 30 days preceding a race were more likely to be successful. However, horses that had jump-schooled in the 30 days preceding a race were more likely to fall.

The optical properties of LaNiO3 thin films are investigated over a wide energy and temperature range. Thin films of varying thickness were grown by pulsed laser deposition on LaAlO3 and SrTiO3 substrates. The optical conductivity data of the films reveal a number of interband transitions above 1 eV, which are in good agreement with band structure calculations. No well defined Drude peak is observed; however, in stark contrast with local-density approximation theory predicting a finite density of states at the Fermi energy. This experimental finding of a vanishing Drude spectral weight, compared to a finite electron kinetic energy obtained from band structure calculations, highlights the importance of strong electronic correlations in LaNiO3.

The effects of mixed sheep and cattle grazing of stream margins, channelisation, and the benefits of riparian retirement were assessed through a survey of five streams in Southland, New Zealand. Morphological and vegetation data affecting erosion processes and aquatic habitat were compared among grazed, channelised, and retired reaches. There is no evidence that grazing streambanks in floodplain streams of northern Southland will lead to rapid and severe deterioration of channel form, except in small streams (< 2 m wide) under intensive grazing of wet streamside soils. Generally, the dominant erosion mechanism—the undercutting of banks—is largely unaffected by grazing stream margins. In contrast, channelisation has led to severe streambank and streambed erosion in two of the three streams examined. The major factor in this degradation appears to be straightening and deepening the channel so that underlying uncohesive shingle is exposed to high flows. Riparian retirement had variable effects depen...

We present experimental evidence that silver nanoparticles in the size range of 5-10 nm undergo a reversible structural transformation under hydrostatic pressures up to 10 GPa. We have used x-ray diffraction with a synchrotron light source to investigate pressure-dependent and size-dependent trends in the crystal structure of silver nanoparticles in a hydrostatic medium compressed in a diamond-anvil cell. Results suggest a reversible linear pressure-dependent rhombohedral distortion which has not been previously observed in bulk silver. We propose a mechanism for this transition that considers the bond-length distribution in idealized multiply twinned icosahedral particles. To further support this hypothesis, we also show that similar measurements of single-crystal platinum nanoparticles reveal no such distortions.

Meningococcal disease remains an important cause of mortality and morbidity in the paediatric population. Survivors of invasive meningococcal disease remain at risk from the long-term sequelae of microvascular disease. Chronic orthopaedic sequelae have been reported infrequently in the orthopaedic and radiology literature and there are no reports in the Emergency Medicine literature. We report the case of a 7-year-old boy who presented to the Emergency Department with a limp; having survived invasive meningococcal disease at the age of 14 months. His radiographs revealed some of the long-term sequelae of this severe disease. We review the literature around the long-term orthopaedic sequelae of meningococcal disease.

Objective:We report an adult case of cystic lymphangioma treated with OK-432 (Picibanil®).Method:A case report and review of the literature concerning the use of OK-432 to treat cystic lymphangioma is presented.Results:A 31-year-old woman developed a cystic lymphangioma four weeks post-partum. This was treated initially by aspiration, for diagnostic purposes. Investigation suggested that surgery would be challenging. A review of the literature demonstrated success with OK-432 in the treatment of this condition, although primarily in the paediatric population. This patient was successfully treated thus, and at the time of writing remained symptom free. A suggested management plan is outlined.Conclusion:Treatment with OK-432 is useful in the management of cystic lymphangiomas in adults and should be considered as first line treatment.

Objectives:To present a case of benign mediastinal thymic cyst, and to review the published information on these cysts, including their incidence, presentation, diagnosis and management.Methods:We report the case of a 55-year-old man who presented with a unilateral vocal fold palsy subsequently found to be due to the presence of a benign mediastinal thymic cyst. A literature search was undertaken to identify the incidence, key features and management of this rare condition.Results:Benign mediastinal thymic cysts are a rare cause of mediastinal masses. Usually diagnosed incidentally, their management is usually surgical. Vocal fold palsy in isolation has not previously been reported in association with mediastinal thymic cysts.Conclusion:This report describes what we believe to be the first published case of a completely reversible vocal fold palsy presenting in association with a rare benign mediastinal thymic cyst.

Surgical procedures in otolaryngology are often associated with the need for blood transfusions. Homologous blood transfusions carry risks and may be unacceptable to some patient groups. The Jehovah's Witness Society is known to many because of its stance on blood products. Refusal of potentially life-saving treatment creates ethical dilemmas for treating clinicians. Throughout the world, Jehovah's Witnesses have fought for the right to refuse blood products. This article examines the need for blood in otolaryngological procedures, surgical strategies to reduce blood loss, the beliefs of Jehovah's Witnesses regarding the acceptability of blood, and procedures and legal stances adopted when treating Jehovah's Witnesses.

Foreign body ingestion in children is a common presenting complaint to the emergency department. Although the majority of ingested foreign bodies pass through the gastrointestinal tract unaided, some children will require either non-surgical or surgical intervention. Retained oesophageal foreign bodies may cause a multitude of problems, including mucosal ulceration, inflammation or infection, and more seriously paraoesophageal or retropharyngeal abscess formation, mediastinitis, empyema, oesophageal perforation and aorta-oesophageal fistula formation. We present a case of a 12-month-old child in whom delayed diagnosis of glass ingestion resulted in the development of a retropharyngeal abscess, oesophageal perforation and mediastinitis. Such complications following foreign body ingestion in children are rare but potentially fatal. A high index of suspicion must be maintained in young children presenting with a possible history of foreign body ingestion as a delayed diagnosis may lead to significant morbidity and mortality. We review the literature surrounding paediatric retropharyngeal abscesses and mediastinitis.

APEC models for collisional ionization equilibrium are now available. These basic models have been benchmarked against astrophysical coronal spectra and show reasonable agreement; however, several atomic data issues need to be addressed. We plan to conduct an atomic data needs assessment and set priorities over the next year. New tools are under development to broaden the applicability of APEC models. We discuss the status of this development.

Background: Crohn's disease (CD) is characterized by heterogeneity of phenotype. The Vienna classification can be used to classify CD, and recent data illustrate that behavior evolves over the course of the disease. Clinical and biological influences on disease progression remain unclear. We examined the associations of CD disease progression at diagnosis and for up to 20 years of follow-up. Methods: Two hundred thirty-one well-characterized CD patients were studied. Demographic, clinical, and NOD2/CARD15 data were collected. Disease behavior according to the Vienna classification was assessed at diagnosis and for up to 20 years following diagnosis. Results: At diagnosis, 70% of patients had inflammatory disease, 9% stricturing, and 21% penetrating. Early age at diagnosis was associated with ileocolonic and upper GI disease (p = 0.015), and positive anti-Saccharomyces cerevisiae antibody (ASCA) was associated with ileal invovement (p = 0.008). Smoking was relatively protective against colonic, rather than ileal involvement at diagnosis (p < 0.02). At 20 years, 92% had progressed to a more severe disease type. Patients who progress to a more severe disease type require more frequent surgery (p < 0.00001). Multivariate analysis found disease progression to be associated with ileal disease location (p = 0.001) and positive ASCA (p = 0.003). Variant NOD2/CARD15 alleles were protective against rapid progression of disease phenotype (p = 0.04). The presence of perianal disease was independent of intestinal penetrating disease. Conclusions: The progression of disease type in CD is associated with the need for more frequent surgery. Rapid progression is associated with ileal disease and positive ASCA, and delayed progression is associated with variant NOD2/CARD15 alleles. Consideration should be given to a separate Vienna classification for perianal disease.

NOD2/caspase recruitment domain (CARD)15 variants are identified in up to 50% of Crohn's disease (CD) patients. Functional variants of toll-like receptor-4 (TLR4) and CD14 genes may also be relevant to disease pathophysiology. We aimed to assess the contribution of NOD2/CARD15, TLR4 and CD14 variants in Scottish and Irish CD patients. In all, 612 patients with well-characterised inflammatory bowel disease (252 Scottish CD, 247 Scottish UC, 113 Irish CD) and 304 controls were genotyped for variants of NOD2/CARD15 (1007fsinsC, G908R, R702W, P268S), TLR4 (A299G) and CD14 (T-159C). Genotype–phenotype analyses were performed. Variant 1007fsinsC (P=0.003) and G908R (P=0.008) but not R702W (P=0.269) alleles were more prevalent in Scottish CD (4.7, 1.8 and 7.1%, respectively) than Scottish control (2.3, 0.3 and 5.4%). CD allelic frequencies were lower than the series from Europe (P

A mitochondrial DNA (mtDNA) fragment containing the D-loop, phenylalanine tRNA, valine tRNA, and 12S and 16 rRNA genes was cloned and sequenced from 36 cows of 18 maternal lineages to identify the polymorphic sites within those regions and to detect the existence of heteroplasmic mtDNA in cows. Seventeen variable sites were observed within the D-loop and rRNA coding regions of bovine mtDNA within a 2.5-kb span. The hypervariable sites in the D-loop and rRNA coding regions were identified at nucleotide positions 169, 216, and 1594. Heteroplasmic mtDNA (variable mtDNA within a tissue) existed extensively in cows and was detected within the above regions in 11 of 36 cows sequenced. The insertion, deletion, and nucleotide transversion polymorphisms were found only in homopolymer regions. Heteroplasmy was observed frequently and seemingly is persistent in cattle. Though heteroplasmy was demonstrated, most lineages and mtDNA sites showed no heteroplasmy.

The cascade of microscopic processes relevant to semiconductor laser operation is outlined. An integrated laser simulator which encapsulates these processes is applied to illustrate the connection between an accurate model of the optical gain in the quantum wells and measured characteristics of representative 1.3 μm InGaAsP/InP lasers. These results highlight the impact of carrier transport effects on the observed optical gain and the modulation response of semiconductor lasers.

A survey of operational aerospace plasma facilities was performed. Plasma devices for aerospace facilities include multi-segment, Huels or vortex-stabilized, magnetically-stabilized, induction-coupled and magnetoplasmadynamic heaters. Performance comparisons and characterization issues for these heaters are discussed. Changes and trends in the further development of plasma facilities are discussed. These trends include extensive utilization of non-intrusive diagnostic techniques such as laser-induced fluorescence to characterize the arcjet flowstream. This characterization is expected to lead to plasma systems design modifications and optimizations. Some suggestions for optimizations are presented. Arc facility modernizations and upgrades are summarized. Additional survey information is presented for commercial or industrial plasma systems. Commercial plasma devices include the DC and ICP torches. Commercial plasma applications are discussed with emphasis given to environmental remediation projects. Plasma environmental processes include in-situ remediation and pyrolysis vitrification.

The word "change" is on everyone's lips this year. The desire for change in patient-care information applications is very strong, too, according to a recent Computers in Healthcare patient-care systems survey. Three nursing executives have studied the CIH survey results and give their view on why strategic planning for patient-care systems is so poor when the desire for these applications is so great.