Acute otitis media

A 3-year-old girl is brought to your office by her mother because she has a fever and complains that her ear hurts. She has no significant medical history. The child is not pleased to be in the physician's office and has been crying. Her mother explains that she developed a cold about 3 days ago with sniffles. Her temperature is 37.8 degreesC (100 degreesF), and the rest of the physical examination is completed with some difficulty. The only abnormalities are slight redness of the throat. a nose full of thick green mucus, and injected tympanic membranes. You wonder what findings other than red tympanic membranes should lead you to diagnose otitis media and also consider the recent controversy about whether to treat acute otitis media (AOM) with antibiotics.

Should watchful waiting be used more often for acute otitis media?

RECENT ANXIETY about the treatment of acute otitis media has been precipitated by a resistance to antibiotics by the common pathogens that can cause this infection.1, 2 The medical profession is facing an increasingly impotent option in the form of antibiotics, prompting physicians around the world to consider alternatives. In this issue of the ARCHIVES, Pichichero and Poole3 have undertaken a comprehensive study involving pediatricians and otorhinologists. The objectives were to assess their recognition of the physical findings of acute otitis media and their ability to perform myringotomy. The principal issue is the safety of performing myringotomy in children with acute otitis media. Because this is an office procedure in which a general anesthetic is not administered, the child is strapped to a papoose board and held down. Myringotomy is not without potential serious complications. The superior part of the middle ear cavity contains the ossicles and the chorda tympani branch . . . [Full Text of this Article]

Case fatality after an acute cardiac event: the effect of smoking and alcohol consumption

The objective of this study was to use a population-based register of acute cardiac events to investigate the association between survival after an acute event and history of smoking and alcohol consumption. The population was all residents of the Lower Hunter Region of Australia aged 25 to 69 years who suffered myocardial infarction or sudden cardiac death between 1986 and 1994. Among 10,170 events, 2504 resulted in death within 28 days. After adjusting for sex, age and medical history, current smokers had a similar risk of dying after an acute cardiac event to never-smokers [odds ratio (OR)=1.10, 95% confidence interval (CI) 0.94-1.29]. People who consumed more than 8 alcoholic drinks per day on more than 2 days per week (OR=1.93, 95% CI 1.39-2.69) and former moderate to heavy drinkers (OR=4.59, 95% CI 3.65-5.76) were more likely to die than people who were nondrinkers. The results of this large community study, suggesting no effect of smoking on case fatality and an increased risk of death after an acute cardiac event for heavy drinkers and former moderate to heavy drinkers, highlight the importance of a population view of case fatality. These results can also shed some light on reasons for the paradoxical results from clinical trials. (C) 2001 Elsevier Science Inc. All rights reserved.

Ocular media transmission of coral reef fish - can coral reef fish see ultraviolet light?

Many coral reef fish are beautifully coloured and the reflectance spectra of their colour patterns may include UVa wavelengths (315-400 nm) that are largely invisible to the human eye (Losey, G. S., Cronin, T. W., Goldsmith, T. H., David, H., Marshall, N. J., & McFarland, W.N, (1999). The uv visual world of fishes: a review. Journal of Fish Biology, 54, 921-943; Marshall, N. J. & Oberwinkler, J. (1999). The colourful world of the mantis shrimp. Nature, 401, 873-874). Before the possible functional significance of UV patterns can be investigated, it is of course essential to establish whether coral reef fishes can see ultraviolet light. As a means of tackling this question, in this study the transmittance of the ocular media of 211 coral reef fish species was measured. It was found that the ocular media of 50.2% of the examined species strongly absorb light of wavelengths below 400 nm, which makes the perception of UV in these fish very unlikely. The remaining 49.8% of the species studied possess ocular media that do transmit UV light, making the perception of UV possible. (C) 2001 Elsevier Science Ltd. All rights reserved.

Media stress intensity analysis for vertical stirred mills

Experimental work has been carried out to investigate the effect of major operating variables on milling efficiency of calcium carbonate in laboratory and pilot size Tower and Sala Agitated (SAM) mills. The results suggest that the stirrer speed, media size and slurry density affect the specific energy consumption required to achieve the given product size. Media stress intensity analysis developed for high-speed horizontal mills was modified to include the effect of gravitational force in the vertical stirred mills such as the Tower and SAM units. The results suggest that this approach can be successfully applied for both mill types. For a given specific energy input, an optimum stress intensity range existed, for which the finest product was achieved. Finer product and therefore higher milling efficiency was obtained with SAM in the range of operating conditions tested. (C) 2001 Elsevier Science Ltd. All rights reserved.

Characterization of micro-mesoporous carbon media

A simple method to characterize the micro and mesoporous carbon media is discussed. In this method, the overall adsorption quantity is the sum of capacities of all pores (slit shape is assumed), in each of which the process of adsorption occurs in two sequential steps: the multi-layering followed by pore filling steps. The critical factor in these two steps is the enhancement of the pressure of occluded 'free' molecules in the pore as well as the enhancement of the adsorption layer thickness. Both of these enhancements are due to the overlapping of the potential fields contributed by the two opposite walls. The classical BET and modified Kelvin equations are assumed to be applicable for the two steps mentioned above, with the allowance for the enhanced pore pressure, the enhanced adsorption energy and the enhanced BET constant,all of which vary with pore width. The method is then applied to data of many carbon samples of different sources to derive their respective pore size distributions, which are compared with those obtained from DFT analysis. Similar pore size distributions (PSDs) are observed although our method gives sharper distribution. Furthermore, we use our theory to analyze adsorption data of nitrogen at 77 K and that of benzene at 303 K (ambient temperature). The PSDs derived from these two different probe molecules are similar, with some small differences that could be attributed to the molecular properties, such as the collision diameter. Permeation characteristics of sub-critical fluids are also discussed in this paper. (C) 2001 Elsevier Science B.V. All rights reserved.

Surface diffusion of adsorbed molecules in porous media: Monolayer, multilayer, and capillary condensation regimes

This review provides an overview of surface diffusion and capillary condensate flow in porous media. Emphasis has been placed on the distinction between purely surface diffusion, multilayer surface diffusion, and, capillary condensate flow.

The semantic interference effect in the picture-word paradigm: An event-related fMRI study employing overt responses

We used event-related functional magnetic resonance imaging (fMRI) to investigate neural responses associated with the semantic interference (SI) effect in the picture-word task. Independent stage models of word production assume that the locus of the SI effect is at the conceptual processing level (Levelt et al. [1999]: Behav Brain Sci 22:1-75), whereas interactive models postulate that it occurs at phonological retrieval (Starreveld and La Heij [1996]: J Exp Psychol Learn Mem Cogn 22:896-918). In both types of model resolution of the SI effect occurs as a result of competitive, spreading activation without the involvement of inhibitory links. These assumptions were tested by randomly presenting participants with trials from semantically-related and lexical control distractor conditions and acquiring image volumes coincident with the estimated peak hemodynamic response for each trial. Overt vocalization of picture names occurred in the absence of scanner noise, allowing reaction time (RT) data to be collected. Analysis of the RT data confirmed the SI effect. Regions showing differential hemodynamic responses during the SI effect included the left mid section of the middle temporal gyrus, left posterior superior temporal gyrus, left anterior cingulate cortex, and bilateral orbitomedial prefrontal cortex. Additional responses were observed in the frontal eye fields, left inferior parietal lobule, and right anterior temporal and occipital cortex. The results are interpreted as indirectly supporting interactive models that allow spreading activation between both conceptual processing and phonological retrieval levels of word production. In addition, the data confirm that selective attention/response suppression has a role in resolving the SI effect similar to the way in which Stroop interference is resolved. We conclude that neuroimaging studies can provide information about the neuroanatomical organization of the lexical system that may prove useful for constraining theoretical models of word production. (C) 2001 Wiley-Liss, Inc.