Processing LHC data in the UK.

The Large Hadron Collider (LHC) is one of the greatest scientific endeavours to date. The construction of the collider itself and the experiments that collect data from it represent a huge investment, both financially and in terms of human effort, in our hope to understand the way the Universe works at a deeper level. Yet the volumes of data produced are so large that they cannot be analysed at any single computing centre. Instead, the experiments have all adopted distributed computing models based on the LHC Computing Grid. Without the correct functioning of this grid infrastructure the experiments would not be able to understand the data that they have collected. Within the UK, the Grid infrastructure needed by the experiments is provided by the GridPP project. We report on the operations, performance and contributions made to the experiments by the GridPP project during the years of 2010 and 2011--the first two significant years of the running of the LHC.

GridPP: the UK grid for particle physics.

The start-up of the Large Hadron Collider (LHC) at CERN, Geneva, presents a huge challenge in processing and analysing the vast amounts of scientific data that will be produced. The architecture of the worldwide grid that will handle 15 PB of particle physics data annually from this machine is based on a hierarchical tiered structure. We describe the development of the UK component (GridPP) of this grid from a prototype system to a full exploitation grid for real data analysis. This includes the physical infrastructure, the deployment of middleware, operational experience and the initial exploitation by the major LHC experiments.

Labial pit and ectopic salivary gland tissue.

We report the unusual case of a girl who presented with a lesion on her soft palate and subsequently was found to have a sinus in her labial sulcus. This case report discusses investigation and management of the patient. Further to this we discuss the postulated embryological development of both the parotid gland and labial pit.

A prospective, single-blind, randomized controlled trial of petroleum jelly/Vaseline for recurrent paediatric epistaxis.

The aim of the study was to determine if petroleum jelly was an effective treatment for paediatric epistaxis. A single-blind, prospective, randomized controlled trial was undertaken in an otolaryngology outpatient clinic of a paediatric hospital from March 2001 to March 2002. A total of 105 children referred with recurrent epistaxis were randomized into the study, 52 into the treatment arm and 53 into the control arm. Children in the treatment arm applied Vaseline twice a day bilaterally for 4 weeks and were monitored for any bleeds for the next 4 weeks. Children in the control arm were simply given an 8-week appointment and the number of bleeds were monitored for the 4 weeks prior to their appointment. The outcome measure was the proportion of children in each group without nosebleeds in the preceding 4 weeks. Both groups were equally distributed in age, duration of symptoms and duration of each bleed. Fourteen of 51 (27.5%) patients of the treatment arm and 18 of 53 (34%) of the control arm did not bleed in the 4 weeks before review (chi-square test, P = 0.472). It can be concluded that Vaseline alone confers no benefit over simple observation in recurrent childhood epistaxis.

The perceived risk of variant Creutzfeld-Jakob disease and the effect of additional delay in tonsillectomy: a questionnaire based parents perspective.

OBJECTIVES: In February 2001 the United Kingdom Department of Health in conjunction with the British Association of Otolaryngology, Head and Neck Surgeons decreed that all non-emergency tonsillectomies should be performed using disposable instruments because of the theoretical risk of transmission of variant Creutzfeld-Jakob disease (vCJD). There was an understandable delay in the provision of these instruments by the various manufacturers, leading to an increase in waiting time for surgery. It was decided to assess parental attitudes to the risk of vCJD, and assess the effect the additional delay had on their child. METHOD: A questionnaire was sent to the parents of all 249 children on the waiting list for tonsillectomy. RESULTS: Seventy percent replied, and of these, 37% felt there was a risk of reusing instruments, only 10% felt there was no risk, and the remaining 53% did not know if there was any risk. Nevertheless 41% of parents would have gone ahead using old instruments if allowed. All parents of the 73 children waiting greater than 6 months were questioned on the effect of the additional delay. Only 7% reported improvement in symptoms, and 68% felt the additional delay had badly affected their child's health and wellbeing. Ninety percent of parents felt their child's symptoms still warranted tonsillectomy. CONCLUSION: There is an awareness of risk of vCJD among parents whose children await tonsillectomy, although understandably the level of risk they feel is hard to quantify. The rate of symptom resolution whilst on the waiting list was very low.

Nasogastric tube misplacement into Eustachian tube.

Paediatric nasogastric tube placement can occasionally be difficult to perform. A unique case in a child is described where the tip of the nasogastric tube managed to travel via the Eustachian tube through the attic and into the mastoid cavity of the middle ear. To the best of the authors' knowledge, this has never been reported in the literature before.

Interaction of channel-blocking bispyridinium compounds with supported phospholipid layers.

The interaction of phospholipid monolayers of dioleoyl phosphatidylcholine (DOPC) on mercury electrodes with bispyridinium compounds is reported in this paper. The interaction is related to the modification of the capacitance-potential plot and in particular of two well defined phase transitions of the phospholipid monolayer. The order of the extent of interaction of the test compounds with the monolayer can be related to their structure and is: P65>Toxogonin>BPE>HS6>TMB4>HI6>BPT>P2S. The penetration of the compound into the monolayer depends on potential. At potentials more negative than the occurrence of the two phase transitions, the test compounds penetrate further and disrupt the monolayers. At more positive potentials this effect is reversed.

Patient eligibility for day case paediatric adenotonsillectomy.

There is a growing trend towards day case surgery and departments are constantly under pressure from Health Trusts to perform more day case procedures. Adenoidectomy and tonsillectomy are being performed as day case procedures in many centres and literature has suggested that it is safe to do so, provided the population characteristics are favourable. A prospective study of 100 consecutive patients presenting to our department for tonsillectomy or adenotonsillectomy was undertaken to assess the eligibility of our patient group for day surgery. Medical and social history was obtained as per recommended guidelines. Only 27% of our patients were eligible for day surgery and only 17% of parents preferred the option of day case adenotonsillectomy. There is a marked difference between our group and those previously reported in the literature. This regional variation has implications in the safe expansion of day surgical procedures.

Managing digital clinical photographs.

Digital cameras have been used for clinical photography in the Medical Illustration Department at Great Ormond Street Hospital NHS Trust for eight years. In that time methods have evolved to take advantage of both technological advances and experiences gained in operating a routine digital photographic service. The management of a large number of digital images requires assiduous attention to all stages of production. Current techniques are described for: controlling quality and exposure in the acquisition of images with a digital camera; temporary and permanent storage, backing up and archiving procedures; and cataloguing of clinical images. Planning for network delivery, the Electronic Patient Record and the management of images in teaching collections are discussed.

A prospective, single-blind, randomized controlled trial of antiseptic cream for recurrent epistaxis in childhood.

Epistaxis is common in children. Trials show antiseptic cream is as effective as cautery, but it is not known whether either is better than no treatment. We wished to know the efficacy of cream in children with recurrent epistaxis. The design was a single-blind, prospective, randomized controlled trial set in the Otolaryngology clinic in a children's hospital. The participants were 103 children referred by their general practitioner for recurrent epistaxis. Excluded were those with suspected tumours, bleeding disorders or allergies to constituents of the cream. Referral letters were randomized to treatment and no treatment groups. Treatment was antiseptic cream to the nose twice daily for 4 weeks, which was prescribed by the general practitioner before clinic attendance. All children were given an appointment for 8 weeks after randomization. The main outcome measures were the proportion of children in each group with no epistaxis in the 4 weeks preceding clinic review. Complete data were available for 88 (85%) of the children. Of the treatment group, 26/47 (55%) had no epistaxis in the 4 weeks before the clinic appointment. Of the controls, 12/41 (29%) had no epistaxis over the 4 weeks. This is a relative risk reduction of 47% for persistent bleeding (95% CI 9-69%) and an absolute risk reduction of 26% (95% CI 12-40%), giving a number needed to treat of 3.8 (95% CI 2.5-8.5). We conclude that antiseptic cream is an effective treatment for recurrent epistaxis in children.

The role of fibreoptic laryngoscopy in infants with stridor.

Stridor in infants may be potentially serious and would require further investigations in all cases. Laryngomalacia is the most common cause of congenital stridor. This is a self-limiting condition with a good prognosis but other causes of stridor should be excluded to enable the surgeon to plan further intervention if needed. Traditionally microlaryngoscopy and bronchoscopy under a general anaesthetic is performed to evaluate the airway. We have investigated the use of the flexible fibreoptic laryngoscope under local anaesthetics in infants with inspiratory stridor. The procedure was performed in the day surgery unit on a non-fasting, non-sedated child. A retrospective analysis of procedures performed between January 1998 and August 1999 was carried out. Of the 43 patients studied, laryngomalacia was diagnosed in 35, vocal cord palsies in six and two infants had a normal larynx. There were no complications during the procedure and only one child required further intervention. The results showed that the combination of fibreoptic laryngoscopy under local anaesthetic with follow-up is a safe, effective and cost effective method of assessing stridor in this group of patients.

Nursing in the nineties: managing the uncertainty.

OBJECTIVE: This study examined qualitative data on nurses' work lives from 53 hospitals that participated in the National Institutes of Health (NIH)-funded Outcomes Research in Nursing Administration Project (ORNA). BACKGROUND: The ORNA project examines the impact of nursing unit organizational structure on outcomes. The information reported in this article amplifies the quantitative data with qualitative data that enhances understanding of nurses' work lives. METHODS: Site coordinators at all participating hospitals were requested to send monthly journal entries for 6 months. Data were documented according to an agreed-on content outline that consisted of critical incidents and implications. Data were collected from 53 of the 65 study site coordinators (response rate 81.5%). Content analysis of all collected data was conducted by the research team. RESULTS: Study site coordinators in 53 hospitals characterize the acute care environment as turbulent and uncertain. Contributing factors include: 1) work load (fluctuating census, staff preparation, turnover); 2) loss of workplace identity (unit consolidation, hospital buy-outs, and system mergers); and 3) re-engineering (skill mix, new equipment/system changes, new documentation systems, rumored changes). CONCLUSIONS: This study adds to the growing body of literature that portrays environmental uncertainty from the narrative perspective. Although there is an ongoing need for the employment of fiscally accountable, quality enhancing organizational/management strategies, all initiatives are at risk unless personnel needs are attended to and seen as unique in each care setting. Some strategies are offered to meet this dual imperative.

The Outcomes Research in Nursing Administration Project: methodological issues in implementation.

This article describes the Outcomes Research in Nursing Administration (ORNA) project--a longitudinal, multisite study investigating the interrelationships of various hospital-level and nursing-unit-level characteristics, nursing unit organizational structure, and administrative and patient outcomes. A variety of methodological challenges were encountered in the actual conduct of the project in relation to the design, sampling plan, management of attrition, and data collection. The article describes these challenges and how they were successfully resolved.

Strategies to enhance internal validity in multi-center longitudinal research.

Lack of standardized data collection procedures in multi-center longitudinal research poses potential threats to the internal validity of the study. This article addresses several key issues in data collection that can affect the results of longitudinal research. The authors describe these issues in relation to the study currently in progress and cite specific strategies used during data collection to reduce or eliminate data collection inconsistencies. Use of these strategies is not limited to longitudinal, nonexperimental causal models. Outcomes managers and clinical nursing researchers may find some of the strategies useful to enhance the internal consistency of experimental and nonexperimental cross-sectional research.

Outcomes research. Clues to quality and organizational effectiveness?

Outcomes research has often been touted as the best response to concerns about quality in today's health care organizations. Yet, outcomes research is accompanied by its own set of problems. These problems must be addressed if outcomes research is, in fact, to guide assessments of quality and of organizational effectiveness. One question is how quality and organizational effectiveness should be defined. In addition, measurement issues are particularly problematic in outcomes research, as is the availability of appropriate data. This article discusses each of these areas, and concludes by presenting an integrated model to guide the assessment of outcomes, quality, and organizational effectiveness.

Nursing and alternative medicine. Legal and practice issues.

The burgeoning interest in alternative medicine in the past decade has created a demanding health care climate for professional nursing. Rising consumer consciousness and the cost of traditional Western medicine have together influenced an environment in which individuals and payers seek low-cost, high-value remedies. This article presents a definition of alternative medicine and an overview of related research initiatives. In addition, legal and practice considerations for professional nursing are discussed. The language of current nurse practice acts neither prohibits nor actively promotes alternative medicine practices. However, differences in the regulation of health care professionals, specifically physicians and nurses, create challenges for nurses as they respond to both consumer demand and the need for consumer protection, and work with physician colleagues in alternative medicine. Accompanying these challenges is the need to protect nurses' regulatory freedom and autonomy.

Surface plasmon resonance studies of immunoreactions utilizing disposable diffraction gratings.

The specificity of protein binding between immuno-gamma globulin (IgG) and anti-IgG has been investigated by means of surface plasmon resonance measurements, with a view to determining whether a perspex replica of a holographic diffraction grating can be used efficiently as the momentum-coupling device. The replicas are easy to fabricate, of low cost, and may be useful as disposable sensing heads in a biosensor. The majority of all published work concerning surface-plasmon-based biosensors has detailed the use of prisms as the momentum-coupling devices. Therefore, the relative advantages and disadvantages of both systems are discussed in this paper, including a sensitive optical technique which is beyond the scope of prism geometries.