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A variety of paediatric tracheostomy tubes are available. This article reviews the tubes in current use at Great Ormond Street Hospital for Children and Evelina London Children's Hospital.
Methods
This paper outlines our current preferences, and the particular indications for different tracheostomy tubes, speaking valves and other attachments.
Results
Our preferred types of tubes have undergone significant design changes. This paper also reports further experience with certain tubes that may be useful in particular circumstances. An updated sizing chart is included for reference purposes.
Conclusion
The choice of a paediatric tracheostomy tube remains largely determined by individual clinical requirements. Although we still favour a small range of tubes for use in the majority of our patients, there are circumstances in which other varieties are indicated.
The International Mineralogical Association's approved amphibole nomenclature has been revised in order to simplify it, make it more consistent with divisions generally at 50%, define prefixes and modifiers more precisely and include new amphibole species discovered and named since 1978, when the previous scheme was approved. The same reference axes form the basis of the new scheme and most names are little changed but compound species names like tremolitic hornblende (now magnesiohornblende) are abolished and also crossite (now glaucophane or ferroglaucophane or magnesioriebeckite or riebeckite), tirodite (now manganocummingtonite) and dannemorite (now manganogrunerite). The 50% rule has been broken only to retain tremolite and actinolite as in the 1978 scheme so the sodic calcic amphibole range has therefore been expanded. Alkali amphiboles are now sodic amphiboles. The use of hyphens is defined. New amphibole names approved since 1978 include nyböite, leakeite, kornite, ungarettiite, sadanagaite and cannilloite. All abandoned names are listed. The formulae and source of the amphibole end member names are listed and procedures outlined to calculate Fe3+ and Fe2+ when not determined by analysis.
Surface velocity and deformation, radar sounding, and aerial photography data are used to describe the flow of Ross Ice Shelf around Crary Ice Rise. A continuous band of crevasses around the ice rise now allows the complete boundary to be mapped for the first time. The dynamics of three distinctly different areas of ice flow are studied. Just up-stream of the ice rise, there is a region of ice rumples dominated by intense longitudinal compression (0.01 a−1) and lateral tension. On the south-west side of the ice rise, intense shear (0.03 a−1) dominates, with the boundary layer of affected ice-shelf motion extending over 20 km from the ice-rise edge into the ice shelf. North-west of the ice rise, a crevasse-free block of ice, 40 km × 7 km, appears to have separated from the main ice rise and is now moving with the ice shelf. We refer to such moving blocks of ice as rafts. The separation of this raft is calculated to have occurred 20 ± 10 years ago. Other possible rafts are identified, including one on the south-west side of the ice rise which appears to be in the process of separating. Mechanisms for the formation of rafts are discussed.
Field studies were conducted in Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, and Tennessee during 2010 and 2011 to determine the effect of glufosinate application rate on LibertyLink and WideStrike cotton. Glufosinate was applied in a single application (three-leaf cotton) or sequential application (three-leaf followed by eight-leaf cotton) at 0.6, 1.2, 1.8, and 2.4 kg ai ha−1. Glufosinate application rate did not affect visual injury or growth parameters measured in LibertyLink cotton. No differences in LibertyLink cotton yield were observed because of glufosinate application rate; however, LibertyLink cotton treated with glufosinate yielded slightly more cotton than the nontreated check. Visual estimates of injury to WideStrike cotton increased with each increase in glufosinate application rate. However, the injury was transient, and by 28 d after the eight-leaf application, no differences in injury were observed. WideStrike cotton growth was adversely affected during the growing season following glufosinate application at rates of 1.2 kg ha−1 and greater; however, cotton height and total nodes were unaffected by glufosinate application rate at the end of the season. WideStrike cotton maturity was delayed, and yields were reduced following glufosinate application at rates of 1.2 kg ha−1 and above. Fiber quality of LibertyLink and WideStrike cotton was unaffected by glufosinate application rate. These data indicate that glufosinate may be applied to WideStrike cotton at rates of 0.6 kg ha−1 without inhibiting cotton growth, development, or yield. Given the lack of injury or yield reduction following glufosinate application to LibertyLink cotton, these cultivars possess robust resistance to glufosinate. Growers are urged to be cautious when increasing glufosinate application rates to increase control of glyphosate-resistant Palmer amaranth in WideStrike cotton. However, glufosinate application rates may be increased to maximum labeled rates when making applications to LibertyLink cotton without fear of reducing cotton growth, development, or yield.
Notoedric mange, caused by obligately parasitic sarcoptiform Notoedres mites, is associated with potentially fatal dermatitis with secondary systemic disease in small mammals, felids and procyonids among others, as well as an occasional zoonosis. We describe clinical spectra in non-chiropteran hosts, review risk factors and summarize ecological and epidemiological studies. The genus is disproportionately represented on rodents. Disease in felids and procyonids ranges from very mild to death. Knowledge of the geographical distribution of the mites is highly inadequate, with focal hot spots known for Notoedres cati in domestic cats and bobcats. Predisposing genetic and immunological factors are not known, except that co-infection with other parasites and anticoagulant rodenticide toxicoses may contribute to severe disease. Treatment of individual animals is typically successful with macrocytic lactones such as selamectin, but herd or wildlife population treatment has not been undertaken. Transmission requires close contact and typically is within a host species. Notoedric mange can kill half all individuals in a population and regulate host population below non-diseased density for decades, consistent with frequency-dependent transmission or spillover from other hosts. Epidemics are increasingly identified in various hosts, suggesting global change in suitable environmental conditions or increased reporting bias.
In the emergency department, portable point-of-care testing (POCT) coagulation devices may facilitate stroke patient care by providing rapid International Normalized Ratio (INR) measurement. The objective of this study was to evaluate the reliability, validity, and impact on clinical decision-making of a POCT device for INR testing in the setting of acute ischemic stroke (AIS).
Methods:
A total of 150 patients (50 healthy volunteers, 51 anticoagulated patients, 49 AIS patients) were assessed in a tertiary care facility. The INR’s were measured using the Roche Coaguchek S and the standard laboratory technique.
Results:
The interclass correlation coefficient and 95% confidence interval between overall POCT device and standard laboratory value INRs was high (0.932 (0.69 - 0.78). In the AIS group alone, the correlation coefficient and 95% CI was also high 0.937 (0.59 - 0.74) and diagnostic accuracy of the POCT device was 94%.
Conclusions:
When used by a trained health professional in the emergency department to assess INR in acute ischemic stroke patients, the CoaguChek S is reliable and provides rapid results. However, as concordance with laboratory INR values decreases with higher INR values, it is recommended that with CoaguChek S INRs in the > 1.5 range, a standard laboratory measurement be used to confirm the results.
Cyathostomins are the most prevalent equine intestinal parasites and resistance has been reported in these nematodes against all 3 licensed anthelmintic classes. Strategies need to be developed that are less dependent upon drugs and more reliant on management-based control. To develop these we need to understand natural transmission patterns better. Here, we analysed longitudinal fecal egg count (FEC) data from 5 pony populations used for conservation purposes. We tested how egg excretion varied amongst populations and individuals, and how this was affected by age and climate. There was evidence for consistency in FECs over time at the individual level; this was generally weak and accounted for <10% of the total variance. Animals <5 years old had higher FECs and there was profound seasonal variation in FECs, with highest levels recorded in spring/summer. Effects of monthly temperature and rainfall explained most, but not all, of the observed seasonal variation and associations between climate measures and FECs were stronger in younger versus adult animals. One population was occasionally treated with anthelmintics and analysis of this population suggested that treatment substantially altered the seasonal dynamics. This paper highlights the variability in strongyle egg excretion amongst individuals and the factors involved in this variation.
Macaca fascicularis is an excellent species to examine adaptation to a particularly wide array of habitats and environmental variables, especially where human impact is a core component of the landscape. Within the long-tailed macaque species (Macaca fascicularis) there are at least ten subspecies, dramatic variation in facial hair patterns, and body size varies from 2.5–7.0 kg for females and 4.7–14 kg for males (Gumert, Chapter 1; Fooden, 1995; Napier and Napier, 1967; Rowe, 1996). Despite their well-documented occurrence and utilization of primary tropical rainforest (up to 2,000m elevation), the long-tailed macaques appear to prefer riverine habitats, coastal forests, swamp or mixed forests and secondary forest habitats (Crockett and Wilson, 1980). The ability to thrive in a variety of environmental types probably played a role in this group's evolutionary success throughout Southeast Asia especially during the last 5–8,000 years of human-induced (agricultural) environmental change.
The island of Bali is approximately 5632 km2 and has a rich history of volcanic activity and thus some of the most fertile soils in the world. There are approximately 247 rivers all cascading down slopes from the central volcanic range. During both the wet and dry seasons moisture accumulates above the volcanoes in the center of the islands providing a nearly year-round supply for the rivers that course rapidly down towards the sea, creating deep ravines and ready access to water for the south central portion of the island.
Concentrations of air-borne bacteria and particles have been measured in turbulently ventilated operating theatres in full flow, half flow and zero flow conditions. Increased air-borne challenge produced by human activity and by mechanical cleaning procedures is demonstrated: die-away of this contamination is shown to be related to the ventilation rate. Ventilation can be reduced or turned off at night and during weekends, and cleaning can also be carried out, without increased risk of infection if full flow is restored one hour prior to preparation for surgery. Areas surrounding the theatres should remain at positive pressure with regard to the general hospital environment during low or no flow periods. The implementation of such energy-saving policies will substantially reduce theatre running costs without introducing infection hazards.
Adult European flat oysters, Ostrea edulis L., receiving a food supplement of the unicellular alga Tetraselmis suecica (Kylin) Butch, during laboratory conditioning for spawning produced more broods of larvae than oysters receiving only the natural phytoplankton in the seawater supply. Many of the broods from adults receiving this extra food were liberated sooner, and these larvae grew at an enhanced rate and provided greater spat yields than the broods from the control stock. The viability of larvae, which was significantly correlated with their lipid, and in particular neutral lipid, proportion at the time of liberation, declined as the length of the stock-conditioning period prior to female spawnings increased. This may be related to the decline in the dry meat weight and the condition factor of the adult oysters during the experiments irrespective of the feeding regime. The extra algal ration provided a check to the decline in dry meat weight of the food-supplemented adults.
Appetite and growth were studied in primary schoolboys (6–10 years) infected with Ascaris lumbricoides (86%) and Trichuris trichiura (100%) who received a single dose of pyrantel pamoate (which has little or no effect on Trichuris trichiura ) or a placebo. Boys were examined, allocated at random by descending Ascaris egg count to pyrantel (PR, n = 36) or placebo (PL, n = 36) groups, treated, and re-examined 3 and 7 weeks later. The 2 groups did not differ significantly before treatment in helminth infections, appetite, or growth. Three and 7 weeks after treatment, the PR group exhibited significantly greater increases than did the PL group in weight (0·2 kg and 0·4 kg more, respectively) and percentage weight-for-age (0·6% and 1·7% points more, respectively). Appetite increased significantly in the PR group at 3 and 7 weeks (P < 0·0005 and P < 0·01, respectively) but not in the PL group. The prevalence and intensity of A. lumbricoides infection were greatly reduced in the PR group at 3 and 7 weeks (both P < 0·0001) but not in the PL group. We conclude that treatment with pyrantel pamoate may improve appetite and growth in schoolchildren in areas where A. lumbricoides infections and poor growth are highly prevalent.
The prevalence of Taenia saginata (Cestoda) among 146 predominantly Pokot tribesmen in western Kenya was studied in an attempt to assess the reliability of detecting infections by faecal examinations. Firstly, a single faecal sample was microscopically examined after being processed by a standard ether sedimentation technique. Secondly, all subjects were treated with niclosamide and a purgative and the tapeworms were recovered. In this way the efficiency of diagnosing infections by faecal examinations was estimated. T. saginata eggs were found in the faeces of 68% of the men who were eventually found to be infected. Information was collected by interview from all subjects about whether they were or ever had been infected with tapeworms and about the form of treatment previously sought or taken. Eleven out of 25 men were apparently unaware of their tapeworm infections while no evidence of infection was found among 10 of the 24 reportedly infected men. A change in the pattern of treatment for tapeworms was reported which may have resulted in a recent decline in the prevalence of infection.
The Lower Permian of the Haushi basin, Interior Oman (Al Khlata Formation to Saiwan Formation/lower Gharif member) records climate change from glaciation, through marine sedimentation in the Haushi sea, to subtropical desert. To investigate the palaeoclimatic evolution of the Haushi Sea we used O, C, and Sr isotopes from 31 brachiopod shells of eight species collected bed by bed within the type-section of the Saiwan Formation. We assessed diagenesis by scanning electron microscopy of ultrastructure, cathodoluminescence, and geochemistry, and rejected fifteen shells not meeting specific preservation criteria. Spiriferids and spiriferinids show better preservation of the fibrous secondary layer than do orthotetids and productids and are therefore more suitable for isotopic analysis. δ18O of −3·7 to −3·1℅ from brachiopods at the base of the Saiwan Formation are probably related to glacial meltwater. Above this, an increase in δ18O may indicate ice accumulation elsewhere in Gondwana or more probably that the Haushi sea was an evaporating embayment of the Neotethys Ocean. δ13C varies little and is within the range of published data: its trend towards heavier values is consistent with increasing aridity and oligotrophy. Saiwan Sr isotope signatures are less radiogenic than those of the Sakmarian LOWESS seawater curve, which is based on extrapolation between few data points. In the scenario of evaporation in a restricted Haushi basin, the variation in Sr isotope composition may reflect a fluvial component.
The prenatal diet can program an individual's cardiovascular system towards later higher resting blood pressure and kidney dysfunction, but the extent to which these programmed responses are directly determined by the timing of maternal nutritional manipulation is unknown. In the present study we examined whether maternal nutrient restriction targeted over the period of maximal placental growth, i.e. days 28–80 of gestation, resulted in altered blood pressure or kidney development in the juvenile offspring. This was undertaken in 6-month-old sheep born to mothers fed control (100–150 % of the recommended metabolisable energy (ME) intake for that stage of gestation) or nutrient-restricted (NR; 50 % ME; n 6) diets between days 28 and 80 of gestation. Controls were additionally grouped according to normal (>3, n 7) or low body condition score (LBCS; <2, n 6), thereby enabling us to examine the effect of maternal body composition on later cardiovascular function. From day 80 to term (approximately 147 d) all sheep were fed to 100 % ME. Offspring were weaned at 12 weeks and pasture-reared until 6 months of age when cardiovascular function was determined. Both LBCS and NR sheep tended to have lower resting systolic (control, 85 (SE 2); LBCS, 77 (SE 3); NR, 77 (SE 3) mmHg) and diastolic blood pressure relative to controls. Total nephron count was markedly lower in both LBCS and NR relative to controls (LBCS, 59 (SE 6); NR, 56 (SE 12) %). Our data suggest that maternal body composition around conception is as important as the level of nutrient intake during early pregnancy in programming later cardiovascular health.
Myxomycetes (plasmodial slime moulds) are best known from temperate and boreal forests, where they are commonly found in association with decaying coarse woody debris and leaf litter on the forest floor (Martin & Alexopoulos 1969). There have been only a few reports of myxomycetes from either the continent of Antarctica or the subantarctic islands. In what apparently represents the first record of a myxomycete from the south polar region, Horak (1966) described a new species, Diderma antarcticolum Horak, from material collected on the Antarctic Peninsula (64°53′S, 62°53′W). Later, Ing & Smith (1980,1983) reported Didymium dubium Rost., Lamproderma arcyrioides (Sommerf.) Rost., Stemonitopsis (Comatricha) subcaespitosa (Peck) Nann.- Brem. and Diderma niveum (Rost.) Macbr. from South Georgia (54–55°S, 36–38°W). They also indicated that the latter species was known from Signy Island, South Orkney Islands (60°43′S, 45°36′W) and the Antarctic Peninsula (65°16′S, 64°08′W) as well as South Georgia.
We examined the effect of time after birth and β3-adrenergic agonist (Zeneca D7114) administration on uncoupling protein-1 (UCP1) abundance and thermoregulation in the lamb. Forty twin lambs, all born normally at term, were maintained at a cold ambient temperature of between 3 and 8 °C. At 0.5, 1.75, 5.25, 11.25 and 23.25 h after birth eight sets of twins were fed 20 ml of formula milk ± 10 mg kg-1 of β3-adrenergic agonist, and 45 min after feeding brown adipose tissue (BAT) was sampled. Colonic temperature was measured and BAT analysed for UCP1 abundance, GDP-binding to mitochondrial protein (i.e. thermogenic activity) and catecholamine content. Colonic temperature declined between 1.25 and 6 h from 40.2 °C to 39.2 °C and then increased to 39.8 °C at 12 h, but increased after feeding at all ages. UCP1 abundance increased from 1.25 h after birth, to peak at 2 h after birth in controls, compared with 6 h after birth in β3-adrenergic agonist-treated lambs. The level of GDP-binding to mitochondrial protein did not change significantly with age but was increased by β3-adrenergic agonist treatment. The noradrenaline (norepinephrine) content of BAT increased between 1.25 and 12 h after birth, irrespective of β3-adrenergic agonist administration. The total weight of perirenal BAT plus its lipid, protein and mitochondrial protein content declined over the first 6 h of life. UCP1 development continues over the first 24 h of neonatal life, and can be manipulated by β3-adrenergic agonist administration. This may represent one method of improving thermoregulation in newborn lambs. Experimental Physiology (2001) 86.1, 65-70.