Natural disaster alters the adaptive benefits of sociality in a primate.

Weather-related disasters can radically alter ecosystems. When disaster-driven ecological damage persists, the selective pressures exerted on individuals can change, eventually leading to phenotypic adjustments. For group-living animals, social relationships are believed to help individuals cope with environmental challenges and may be a critical mechanism enabling adaptation to ecosystems degraded by disasters. Yet, whether natural disasters alter selective pressures on patterns of social interactions and whether group-living animals can, as a result, adaptively change their social relationships remains untested. Here, we leveraged unique data collected on rhesus macaques from 5 years before to 5 years after a category 4 hurricane, leading to persistent deforestation which exacerbated monkeys' exposure to intense heat. In response, macaques increased tolerance for and decreased aggression toward other monkeys, facilitating access to scarce shade critical for thermoregulation. Social tolerance predicted individual survival for 5 years after the hurricane, but not before it, revealing a clear shift in the adaptive function of social relationships in this population. We demonstrate that an extreme climatic event altered selection on sociality and triggered substantial and persistent changes in the social structure of a primate species. Our findings unveil the function and adaptive flexibility of social relationships in degraded ecosystems and identify natural disasters as potential evolutionary drivers of sociality. One-Sentence Summary: Testard et al. show that a natural disaster altered selection on sociality in group-living primates triggering persistent changes in their social structure.

The 40Ar(d,p)41Ar cross section between 3-7 MeV.

To determine the safety of using argon as a deuteron beam stopping material, the  40Ar(d,p)41Ar cross section was measured at average deuteron energies of 3.6 MeV, 5.5 MeV, and 7.0 MeV using an activation method. A 16-MeV deuteron beam produced by Lawrence Berkeley National Laboratory's 88-Inch Cyclotron was degraded to each energy by nickel foils and the front wall of an aluminum gas chamber. The reduced-energy deuterons were used to activate a sample of natAr gas. After each irradiation, the gas chamber's  41Ar activation was measured with a high-purity germanium detector. The cross sections measured were larger than a previous measurement by ∼40%.

Primary versus trauma-induced Gorham-Stout disease.

Gorham-Stout disease - also known as "disappearing bone disease" is currently considered a single entity with varying clinical manifestations. We reviewed the existent literature from the earliest historic description(Jackson in 1838) and Gorham and Stout's original series of patients, multiple case reports and series since. After analyzing 212 reported cases, we identified 76 cases with details that recorded either a history of multifocal disease or an identifiable history of preceding trauma. From this review, we have defined two distinct Gorham-Stout entities - those characteristically associated with lymphangiomatosis [a form of GLA (generalized lymphangiomatosis) questionably distinguishable by bone biopsy and radiologic appearance] with multifocal distributed bone lesions, and those others, usually self-limited, first appearing after a traumatic event and always confined to a single bone or closely adjacent one. Multifocal disease is more likely to have chylothorax as a complication. These two Gorham-Stout entities differ in their demographic distribution, clinical history and manifestations, and they follow divergent clinical courses. The prognosis differs, and so should approaches to monitoring as well as acute and long-term treatment. Further research should seek to identify and define the differences in pathology and molecular mechanisms.

A new analgesia regimen after (adeno) tonsillectomy in children: a pilot study.

OBJECTIVE: The objective was to ascertain the efficacy of a new analgesic regimen introduced in children undergoing (adeno)tonsillectomy in view of the ban on codeine use in children <12 years by the European Medicines Agency (EMA) and UK Medicines and Healthcare Products Regulatory Agency (MHRA). DESIGN: Prospective pilot study at a paediatric tertiary referral centre. MATERIALS AND METHODS: A total of 176 children undergoing (adeno) tonsillectomy over a 5-month period (Sept 2013-Jan 2014) were included in the study. Data were prospectively collected on analgesia used peri-operatively and patients were discharged on regular paracetamol and ibuprofen for 7 days and three doses of oral morphine sulphate solution to be used on days 3, 4 and 5. Pain scores were recorded on days 1-10 post-operatively using the Wong Baker Faces Pain Rating scale. RESULTS: The pain scores were significantly better (P-value < 0.0001) in children who were compliant with morphine (n = 93) than those who were not (n = 32). We also found that children who were compliant with morphine were less likely to seek help out of hours (P-value < 0.001). CONCLUSIONS: Oral morphine sulphate solution provides a reasonable alternative to codeine, albeit one should bear in mind that parental concerns and adverse effects of the drug were seen in a minority of patients (n = 11) and anaesthetists were reluctant to prescribe the drug in cases of severe OSA or associated central apnoeas (n = 7).

'Group and save' for paediatric tonsillectomy: is it required routinely?

OBJECTIVES: The aims of this study were: (1) to establish current UK practice with respect to 'group and save' of serum for paediatric tonsillectomy; and (2) to determine the need to group and save serum prior to routine paediatric tonsillectomy. METHODS: Members of the British Association of Otorhinolaryngologists-Head and Neck Surgeons were surveyed by e-mail. A prospective study (November 1999 to August 2002) of all children undergoing tonsillectomy or adenotonsillectomy was undertaken. Outcome measures included reactionary and secondary post-tonsillectomy haemorrhage rates, blood transfusion requirements and 'return to theatre' rates. RESULTS: We surveyed 464 association members. The response rate was 52 per cent (n=242). Twenty-five respondents (10.3 per cent) indicated that they undertook group and save prior to tonsillectomy or adenotonsillectomy in children. Two hundred and seventeen (89.7 per cent) indicated that they did not. Of those who did group and save for children, 20 respondents (80 per cent) did so routinely. The remaining five respondents (20 per cent) did so only for children weighing less than 15 kg (n=4) or less than 10 kg (n=1). During the study period, 325 children underwent tonsillectomy or adenotonsillectomy. The reactionary haemorrhage rate was 0.6 per cent (n=2) and the secondary haemorrhage rate 5.5 per cent (n=18). The two cases of reactionary haemorrhage were returned to theatre immediately for control of haemostasis. All secondary haemorrhages were managed conservatively. No child required blood transfusion during the study period. CONCLUSION: Routine group and save of serum for children undergoing elective tonsillectomy or adenotonsillectomy seems unnecessary. We recommend that it be undertaken only in special circumstances.

Patient perceptions of the otolaryngology ward round in a teaching hospital.

OBJECTIVE: This survey assesses patients' perceptions of a daily otolaryngology ward round in a teaching hospital. METHODS: Initial, open-ended questionnaires generated themes from which a structured questionnaire was constructed. Patients' perceptions in a wide range of areas were examined by asking them to indicate on a Likert scale the extent to which they agreed or disagreed with a number of statements concerning various aspects of the ward round. RESULTS: One hundred patients were surveyed. The response rate was 79 per cent. The findings showed overall patient satisfaction with the ward round, particularly in the areas of information-giving regarding diagnosis, treatment and follow-up arrangements. The large size of the ward round appeared to be intimidating and induced anxiety for approximately one-third of patients. Patients wished the roles of staff present to be better defined and to be informed of the presence of medical students. One-third of patients perceived staff to use language that was difficult to understand. CONCLUSIONS: The survey identified some improvement opportunities and will assist our department with its on-going endeavours to improve the ward round experience for both patients and staff.

Post-tonsillectomy haemorrhage: a prospective, randomized, controlled clinical trial of cold dissection versus bipolar diathermy dissection.

OBJECTIVE: To determine whether bipolar dissection tonsillectomy is associated with a higher post-operative haemorrhage rate than cold dissection tonsillectomy. DESIGN: Prospective, randomized, controlled trial. SETTING: Otolaryngology department of a teaching hospital. PARTICIPANTS: Two hundred and forty-five patients undergoing elective tonsillectomy between July 2002 and November 2004. INTERVENTIONS: Patients were randomly assigned to either bipolar dissection or cold dissection (with bipolar haemostasis). MAIN OUTCOME MEASURES: Post-operative haemorrhage rates, management (conservative or surgical) and blood transfusion requirements were recorded. The grade of surgeon and history of quinsy were also recorded. RESULTS: One hundred and forty-one patients (58 per cent) were randomized to the bipolar dissection and 104 (42 per cent) to the cold dissection groups. Seventeen patients (12.1 per cent) in the bipolar dissection group and eight patients (7.7 per cent) in the cold dissection group suffered haemorrhage (p = 1.0; degrees of freedom (Df) 0.0; 95 per cent confidence intervals (CI) -0.1 to 0.0). The haemorrhage rates for procedures conducted by senior house officers, specialist registrars and consultants were 11.4 per cent, 10.3 per cent and 5.0 per cent, respectively. Two patients required surgical intervention, both from the bipolar dissection group. No patients required blood transfusion. A history of quinsy was not associated with an increased haemorrhage rate. CONCLUSION: The difference in haemorrhage rates between groups and surgeon grades did not reach statistical significance. Nonetheless the trend towards a greater incidence of haemorrhage in the bipolar group and in procedures conducted by more junior surgeons during the trial raised concerns. The results of the National Prospective Tonsillectomy Audit and our interim results have led us to abandon the trial and disallow the use of bipolar dissection in tonsillectomies performed by junior staff members.

The influence of weather on the frequency of secondary post-tonsillectomy haemorrhage.

The aim of this study was to determine whether certain weather variables influence the secondary post-tonsillectomy haemorrhage rate and to examine the influence of a change in these variables on secondary haemorrhage. This was a prospective study carried out in a tertiary referral institution. All patients undergoing bilateral tonsillectomy over a one-year period were included. Local weather data, including daily temperature (max/min), relative humidity and water vapour pressure, were acquired. All patients readmitted to our department with secondary post-tonsillectomy haemorrhage were recorded. Of 346 patients undergoing tonsillectomy, 32 developed secondary haemorrhage (9.2 per cent). A significant negative correlation was found between secondary haemorrhage rate and the average monthly temperature (max/min) and water vapour pressure (Pearson's correlation = -0.8) (p < or = 0.002). These results suggest that performing tonsillectomy in warmer weather when the water vapour pressure is higher may reduce the secondary haemorrhage rate.

Student-perceived benefit from otolaryngology theatre attendance.

The value of theatre attendance by undergraduates is uncertain. This study aimed to evaluate the perceived benefits of attending operating theatre sessions during undergraduate otolaryngology attachments. The study comprised a questionnaire survey carried out in a university medical school. Fourth-year medical students were asked to complete a questionnaire at the end of their two-week attachment in otolaryngology. Completed questionnaires were returned by 152 students. The three most common student expectations were to see and learn common ENT operations, to see the anatomy involved and to learn about the disease being operated upon. Sixty per cent of students reported that their expectations had been met. On a Likert scale from 1 (strongly disagree) to 7 (strongly agree), the importance of theatre attendance as part of the curriculum was rated to be 4.7 (95 per cent confidence interval (CI) = 3.7 to 4.2) and the satisfaction of educational needs in operating theatre teaching was rated to be 3.9 (95 per cent CI = 3.7 to 4.2). Students perceived attending otolaryngology theatre sessions to be beneficial. This information is important in the planning of the otolaryngology undergraduate curriculum.

Surgical management of head and neck malignancy.

More than 90% of head and neck tumours are squamous cell carcinomas. This review focuses on tumours arising from the mucosal surfaces of the upper aerodigestive tract. We discuss the aetiology, presentation and investigation of these tumours and give special attention to their management which may comprise surgical resection, chemoradiation or combined therapy. The surgical treatment of the clinically positive neck and the somewhat controversial topic of management of the N0 neck are also discussed.

Retropharyngeal space swelling secondary to minor blunt head and neck trauma.

Retropharyngeal space swelling is a rare occurrence following minor head and neck trauma. Upper airway obstruction is a potentially life-threatening sequela. The authors present a case of retropharyngeal space haematoma following minor blunt head and neck trauma. Management was conservative with gradual spontaneous resolution of the haematoma. The literature is reviewed and the management and treatment principles presented.

Staff attitudes to a daily otolaryngology ward round.

This survey investigates the attitudes of medical and nursing staff towards the daily otolaryngology ward rounds in a teaching hospital. Initial, open-ended questionnaires generated themes from which a structured questionnaire was constructed. Respondents indicated on a Likert scale the extent to which they agreed or disagreed with statements concerning their attitudes towards the ward round. Thirty-five members of staff were surveyed. The overall response rate was 74.3 per cent (n = 26). The majority of staff agreed that the ward round was a constructive use of their time and served to promote team spirit. It allowed for adequate communication between medical and nursing staff but there was uncertainty about the provision of adequate patient communication. The nursing staff agreed that the ward round provided a valuable learning experience. There was uncertainty about this among the medical staff. There was agreement in both groups that patients find the ward round to be reassuring. A significant majority of staff expressed concerns over maintenance of patient confidentiality. These findings could be used to inform changes in the departmental ward round structure. Specific attention should be directed to discussing sensitive issues in a more private setting and maximizing educational opportunities for junior medical staff.

Audit-derived guidelines for training in endoscopic sinonasal surgery (ESS)--protecting patients during the learning curve.

The objective of the present study is to propose guidelines to ensure safe practice in teaching centres while allowing endoscopic sinonasal surgery (ESS) training to proceed. A prospective complications audit of ESS procedures was undertaken over a 5-year period (January 1996-December 2000). The results have been used to form specific guidelines for safe and effective ESS training. A total of 500 patients underwent ESS during the 5-year period. The senior author was the main surgeon in 55% of cases with the trainee observing or assisting. A supervised trainee was the main surgeon in 45% of cases. The overall complication rate was 1.2% (n = 6) (i.e. 0.7% for the 815 procedures performed). These were all minor complications. We encountered no major complications in 500 patients over the 5-year period. This audit shows that training need not compromise patient safety provided it is phased and structured. We propose appropriate phases and suggest the minimum requirements for units involved in ESS training.

The admission of patients with peri-tonsillar abscess to a general ENT ward and its influence on secondary post-tonsillectomy haemorrhage.

Patients with peri-tonsillar abscess require hospitalization. The aim of this prospective study was to determine whether the admission of patients with peri-tonsillar abscess to the same ward as those undergoing tonsillectomy influences the incidence of secondary post-tonsillectomy haemorrhage. We included all adult patients undergoing in-patient tonsillectomy (n = 183) and all patients with proven peri-tonsillar abscess (n = 46) over a 1-year period. Both patient groups were nursed in the same general otolaryngology ward. The operation dates of those patients who developed secondary post-tonsillectomy haemorrhage were matched to the dates when patients with peri-tonsillar abscess were admitted. Out of the 71 patients who had tonsillectomy on days when patients with peri-tonsillar abscess were admitted, 10 developed secondary haemorrhage. Out of the 112 patients who had tonsillectomy on days when no one in the ward had peri-tonsillar abscess, 16 developed secondary haemorrhage. No difference was demonstrated (chi2 = 0.0014, P > 0.05). In this study, admission of patients with peri-tonsillar abscess to a general otolaryngology ward does not influence the incidence of secondary post-tonsillectomy haemorrhage in patients undergoing elective surgery.

Slip! Slop! Slap! and SunSmart, 1980-2000: Skin cancer control and 20 years of population-based campaigning.

The Anti-Cancer Council of Victoria has been running sun protection programs for more than 20 years: Slip! Slop! Slap! from 1980 to 1988 and SunSmart from 1988 to the present. The Victorian Health Promotion Foundation has provided funding for the SunSmart program for the past 13 years. These programs have played an important role in changing the whole society's approach to the sun and have resulted in marked reductions in sun exposure. This article describes the social, political, economic, and organizational context within which these programs developed. Then 10 areas are discussed that illustrate a critical aspect of the development and implementation of this successful systemwide health promotion program. These areas focus on key aspects of the context within which the program operates and on issues that derive from the experience of implementing program strategies. In summary, the success of the two programs is described as having been built on two key foundations: the vital integration of research and evaluation, on one hand, and a strong basis of consistency and continuity, on the other.

Binding of ferric enterobactin by the Escherichia coli periplasmic protein FepB.

The periplasmic protein FepB of Escherichia coli is a component of the ferric enterobactin transport system. We overexpressed and purified the binding protein 23-fold from periplasmic extracts by ammonium sulfate precipitation and chromatographic methods, with a yield of 20%, to a final specific activity of 15,500 pmol of ferric enterobactin bound/mg. Periplasmic fluid from cells overexpressing the binding protein adsorbed catecholate ferric siderophores with high affinity: in a gel filtration chromatography assay the K(d) of the ferric enterobactin-FepB binding reaction was approximately 135 nM. Intrinsic fluorescence measurements of binding by the purified protein, which were more accurate, showed higher affinity for both ferric enterobactin (K(d) = 30 nM) and ferric enantioenterobactin (K(d) = 15 nM), the left-handed stereoisomer of the natural E. coli siderophore. Purified FepB also adsorbed the apo-siderophore, enterobactin, with comparable affinity (K(d) = 60 nM) but did not bind ferric agrobactin. Polyclonal rabbit antisera and mouse monoclonal antibodies raised against nearly homogeneous preparations of FepB specifically recognized it in solid-phase immunoassays. These sera enabled the measurement of the FepB concentration in vivo when expressed from the chromosome (4,000 copies/cell) or from multicopy plasmids (>100,000 copies/cell). Overexpression of the binding protein did not enhance the overall affinity or rate of ferric enterobactin transport, supporting the conclusion that the rate-limiting step of ferric siderophore uptake through the cell envelope is passage through the outer membrane.