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Study outcomes of re-irradiation after salvage total laryngectomy (TL) for patients with recurrent laryngeal cancer. Determine overall survival (OS) and progression-free survival (PFS). Determine the incidence of severe complications associated with re-irradiation with a focus on carotid blowout (CB). Patients previously irradiated, with recurrent or second primary cancer of the larynx status-post salvage TL who received a second course of radiation from 2000 to 2017 were identified. Toxicities were measured using the CTCAE 4.0. Major toxicities were defined as grade 3+. Survival data and Kaplan-Meier curves were computed in SAS 9.4. Twenty-six patients were included in the analysis. Seventeen had progression of disease and 16 died during the follow-up period. Nine patients had no evidence of disease (NED) at last follow-up. One-, two-, and five-year OS were 65.8%, 44.2%, and 23.2%. One-, two-, and five-year PFS were 48.4%, 24.7%, and 18.5%. The most common severe toxicities were fibrosis (61.5%), dysphagia (53.8%), and wound healing complication (23.1%). Four patients (15.4%) suffered carotid blowouts. Two blowouts were preceded by manipulation of the aerodigestive tract. Patients undergoing re-irradiation for recurrent laryngeal cancer have a poor prognosis with high risk of progression or recurrence. Re-irradiation may offer survival benefit at the expense of significant toxicities. The incidence of severe toxicity is high enough to warrant pretreatment counseling. Carotid blowout was seen in 15% of patients unrelated to cancer progression. Caution should be exercised in re-irradiated patients before instrumentation of the aerodigestive tract.

BACKGROUND: Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) are a well-known pathological entity. We have encountered several patients with MD of the ACL, found to have a anterior translation of tibia a exceeding 5 mm with an intact ACL. We studied this cohort and investigated the likely cause of this. METHODS: A retrospective search of our department's radiology system to identify all patients referred from the knee orthopaedic clinic for MR imaging over a span of 10 years. All patients had MD within the substance of the ACL and an intact ACL. We evaluated the degree of anterior translation of the tibia (ATT) in relation to the femur in mucoid degeneration of ACL. RESULTS: We identified 464 consecutive cases. The mean age was 52 years. There was a male predominance of 261 to 203 female. The average PTF measurement was 2.4 mm with a range of 0-20mm. Of the 464 cases, 3 397 patients had an insignificant ATT of < 5 mm. (0mm. 67. 67 67 patients had a ATT >5 mm. Of them, 32.8% had a ATT of 6 mm, 53.7% had a ATT range between 7 and 9 mm, with the remaining 13.4% above 9 mm in length. CONCLUSION: It is essential to look for other secondary signs of ACL tears and not only focus on ATT as well as correlate this with clinical findings.

This paper introduces the pan-Wales (UK) Home-Grown Homes (HGH) project (2018 to 2020) which focusses on three areas of improvement for delivering high performance, affordable and healthy homes. The HGH project is funded by Powys County Council, through the European Regional Development Fund’s Agricultural Stream. The HGH project is being delivered by Woodknowledge Wales in a consortium with Cardiff Metropolitan University (CMU), TRADA and Coed Cymru, with seven work packages. ‘More and Better Homes from Wood’ (work package (WP) WP3) focusses on the assessment of building performance for dwellings using timber, and is being delivered by a multi-disciplinary team at CMU through the Sustainable and Resilient Built Environment (SuRBe) group. This paper discusses the context and need for the HGH project as Wales launched its low carbon agenda in March 2019. The focus of this paper on introducing the building performance assessment (BPA) protocol to be implemented by SuRBe across several housing case studies in Wales, through the design, in-construction and occupancy phases, to address thermal and fire (TaF) performance issues, and impacts on occupants’ quality of life, comfort and safety. Preliminary results of in-construction testing on a live construction site are presented, with the challenges of conducting thermography tests whilst construction is in progress and weather conditions in spring in the UK (April 2019). This paper will be useful for academics, architects, building contractors, housing developers and professionals undertaking building performance assessment and evaluation on live construction sites.

Introduction The Universal Neonatal Hearing Screening programme was implemented in Ireland in 2014. Approximately 100 infants are identified with a permanent childhood hearing impairment (PCHI) each year, an incidence of 1.5/1,000. Best practice dictates that all children who are identified with PCHI should have access to prompt paediatric assessment to determine the need for aetiological investigations. The implementation of the UNHS programme did not include any increased resource for paediatrics thus raising concern regarding timely access to medical assessment. This survey aimed to assess the provision of aetiological assessment services nationally with a view to informing future service development. Methods All paediatricians involved in aetiological assessment were identified from the national audiology lead. A questionnaire was developed using the BAAP standards and was sent by post with email reminders. Results were collated on excel. Results 38 consultants were identified of whom 37 responded. 33 paediatricians reported that they assessed children with PCHI in clinic. Only 6/33 had received any specific training in the assessment of PCHI infants. This work was not included in any job plan and no additional posts had been developed. Only 1 paediatrician reported participating in a regional support network, but the vast majority (92.9%) surveyed expressed an interest in developing a regional network. 5/33 (15%) saw the infants in a dedicated hearing clinic. Waiting time for assessment was beyond the recommended timeframe in all cases, (range 2–52 weeks, average of 14.4 weeks). Only 8/29 (27%) assess by 6 weeks of age, the time limit for treatment of congenital CMV infection. Access to MRI is limited, only 12 (28.6%) reported having access to MRI within 12 weeks of age thus the majority of MRI require sedation. 77% routinely refer all children with PCHI to ophthalmology. Conclusion The above survey highlights significant deficits in the paediatric component of the UNHS. Identified gaps include; inadequate appropriately trained staff and lack of timely access to necessary investigations and tertiary services. A national multi-disciplinary working group has been developed to address the deficits and ensure an improvement in service provision.

Eastern hemlock (Tsuga canadensis Carriere) and the Carolina hemlock (Tsuga caroliniana Engelmann) are ecologically important tree species in eastern North America forests that are currently threatened by the hemlock woolly adelgid (HWA, Adelges tsugae Annand, Hemiptera: Adelgidae). HWA has spread rapidly from its original introduction site into new areas. Once present, HWA kills its hosts over a period of 4 to 10 years leading to a phenomenon that is known scientifically and colloquially as hemlock decline. To date, quarantine, chemical management, and biocontrol efforts have failed to curb the spread of the HWA. As such, forest management efforts are now being redirected towards developing an understanding of the effects of hemlock removal on vegetation dynamics, changes in forest composition, and changes in ecosystem function. In this study, we parameterize a spatially explicit landscape simulation model LANDIS II for a specific forested region of the southern Appalachians. Parameterization involves defining the life-history attributes of 37 tree species occupying 11 ecological zones and is based on knowledge of: current vegetation composition data, recent historic management and fire regimes, and life-history traits of each species. The parameterized model is used to explore a simple scenario of catastrophic hemlock mortality likely to occur as a result of HWA herbivory. Our results emphasize that hemlock is an important foundation species. When hemlock is removed from the system, forest composition changes considerably with a greater presence of shade intolerant pine and oak species. Additionally, hemlock removal leads to a period of transient, relatively unstable vegetation dynamics as the forest communities restructure.

Problem statement: Hepatic-only metastasis in colorectal cancer is not a rare clinical finding and can account for 30% of cases. However, only 10-25% of cases are suitable for hepatic resection as part of their treatment pathway. We sought to document our own findings by reviewing patients with hepatic-only disease. Approach: A retrospective analysis was designed to include all patients seen at our institution from 1st January 2000 until 30th June 2010 and information as derived from the patients’ records. Results: Forty-four (44) patients were found, with an average age of 60.8 years and a male preponderance. The majority of patients (approximately 57%) with hepatic-only metastases developed their disease following adjuvant therapy. Better overall survival was seen when a primary tumor had a low grade of histological differentiation and fewer than 3 hepatic lesions appreciated on conventional radiology. Better outcome was seen in patients who underwent hepatic resection. Conclusion: Patients with hepatic-only metastases are not uncommon within our institution. Hepatic resection afforded better outcome and compares favorably with published literature.

Forest landscape models simulate forest change through time using spatially referenced data across a broad spatial scale (i.e. landscape scale) generally larger than a single forest stand. Spatial interactions between forest stands are a key component of such models. These models can incorporate other spatio-temporal processes such as natural disturbances (e.g. wildfires, hurricanes, outbreaks of native and exotic invasive pests and diseases) and human influences (e.g. harvesting and commercial thinning, planting, fire suppression). The models are increasingly used as tools for studying forest management, ecological assessment, restoration planning, and climate change. In this paper, we define forest landscape models and discuss development, components, and types of the models. We also review commonly used methods and approaches of modeling forest landscapes, their application, and their strengths and weaknesses. New developments in computer sciences, geographic information systems (GIS), remote sensing technologies, decision-support systems, and geo-spatial statistics have provided opportunities for developing a new generation of forest landscape models that are increasingly valuable for ecological research, restoration planning and resource management.

The forests of southeastern North America are influenced by a variety of disturbances including fire and insect outbreaks. In this paper, we discuss the role of disturbances in structuring forest landscapes with particular emphasis placed on the reciprocal interaction between forest structure and outbreaks of the southern pine beetle (Dendroctonus frontalis Zimmermann). We highlight work in which we are currently involved to illustrate the importance and utility of using spatially explicit forest modeling as a tool for understanding forest–insect interactions and its potential role in determining management strategies.

The reciprocal interaction of landscape structure and ecological processes is a cornerstone of modern landscape ecology. We use a simulation model to show how landscape structure and herbivory interact to influence outbreaks of southern pine beetle (Dendroctonus frontalis Zimmermann) in a landscape representative of the southern Appalachian Mountains, USA. We use LANDIS and its biological disturbance agent module to simulate the effects of landscape composition (proportion of landscape in host area) and host aggregation on the size and severity of insect outbreaks and the persistence of the host species, Table Mountain Pine (Pinus pungens Lamb.). We find that landscape composition is less important in the modeled landscapes than host aggregation in structuring the severity of insect outbreaks. Also, simulated southern pine beetle outbreaks over time tend to decrease the aggregation of host species on the landscape by fragmenting large patches into smaller ones, thereby reducing the severity of future outbreaks. Persistence of Table Mountain pine decreases throughout all simulations regardless of landscape structure. The results of this study indicate that when considering alternative restoration strategies for insect-affected landscapes, it is necessary to consider the patterns of hosts on the landscape as well as the landscape composition.

The present study examines the relations between adolescent motherhood and children’s behavior, substance use, and internalizing problems in a sample of 1,368 children of 712 female twins from Australia. Adolescent motherhood remained significantly associated with all mental health problems, even when using a quasiexperimental design capable of controlling for genetic and environmental confounds. However, the relation between adolescent motherhood and offspring behavior problems and substance use was partially confounded by family background variables that influence both generations. The results are consistent with a causal relation between adolescent motherhood and offspring mental health problems, and they highlight the usefulness of behavior genetic designs when examining putative environmental risks for the development of psychopathology. The generalizability of these results to the United States, which has a higher adolescent birth rate, is discussed.

We used LANDIS, a model of forest disturbance and succession, to simulate successional dynamics of forests in the southern Appalachian Mountains. The simulated environments are based on the Great Smoky Mountains landscapes studied by Whittaker. We focused on the consequences of two contrasting disturbance regimes—fire exclusion versus frequent burning—for the Yellow pine (Pinus L., subgenus Diploxylon Koehne) and oak (Quercus L.) forests that occupy dry mountain slopes and ridgetops. These ecosystems are a conservation priority, and declines in their abundance have stimulated considerable interest in the use of fire for ecosystem restoration. Under fire exclusion, the abundance of Yellow pines is projected to decrease, even on the driest sites (ridgetops, south- and west-facing slopes). Hardwoods and White pine (P. strobus L.) replace the Yellow pines. In contrast, frequent burning promotes high levels of Table Mountain pine (P. pungens Lamb.) and Pitch pine (P. rigida Mill.) on the driest sites and reduces the abundance of less fire-tolerant species. Our simulations also imply that fire maintains open woodland conditions, rather than closed-canopy forest. For oaks, fire exclusion is beneficial on the driest sites because it permits oaks to replace the pines. On moister sites (north- and east-facing slopes), however, fire exclusion leads to a diverse mix of oaks and other species, whereas frequent burning favors Chestnut oak (Q. montana Willd.) and White oak (Q. alba L.) dominance. Our results suggest that reintroducing fire may help restore decadent pine and oak stands in the southern Appalachian Mountains.

Question: Can fire be used to maintain Yellow pine (Pinus subgenus Diploxylon) stands disturbed by periodic outbreaks of southern pine beetle? Location: Southern Appalachian Mountains, USA. Methods: We used LANDIS to model vegetation disturbance and succession on four grids representative of xeric landscapes in the southern Appalachians. Forest dynamics of each landscape were simulated under three disturbance scenarios: southern pine beetle, fire, and southern pine beetle and fire, as well as a no disturbance scenario. We compared trends in the abundance of pine and hardwood functional types as well as individual species. Results: Yellow pine abundance and open woodland conditions were best maintained by a combination of fire and southern pine beetle disturbance on both low elevation sites as well as mid-elevation ridges & peaks. On mid-elevation SE-W facing slopes, pine woodlands were best maintained by fire alone. Conclusions: Our simulations suggest that fire can help maintain open pine woodlands in stands affected by southern pine beetle outbreaks.

Field methods, a normalized difference vegetation index (NDVI) and a geographic information system (GIS) were used to analyze the recovery of wetland plant communities altered by historic agricultural disturbance. Rice fields abandoned at 3, 30, 75, and 132 yr prior to fieldwork were compared to an uncultivated control site for this study. Site physical characteristics and treatments were used to postulate mechanisms that facilitate changes in wetland plant communities. Abundance and dominance data for each species were recorded. Results show that disturbed communities did not return to the referenced control community composition. Areas disturbed by past agriculture are dominated by a mixture of Zizania aquatica, Zizaniopsis miliacea, and Juncus roemerianus. Dispersal trends of woody species in disturbed areas occurred methodically from riverside embankments to the island interiors. While woody patch distributions are greatest near riverside embankments, there is also evidence of an increase in woody patch distribution dispersing into island interiors.

Ecotones that are controlled by a single environmental gradient or a set of correlated environmental factors are hypothesized to show a sigmoid wave form in percentage cover as the ecotone is crossed. This study investigates the sigmoid wave hypothesis at the alpine treeline in Glacier National Park, Montana, USA. We find that approximately half of the sampled locations exhibit a sigmoid wave form in percentage cover across the ecotone. These results indicate that in some cases treeline is controlled by a single environmental gradient or a set of correlated environmental factors. However, in other cases, additional factors that are not correlated with the primary controlling gradient act to change the form of the transition. We investigated surficial geology as a possible controlling factor that would not be correlated with the primary climatic gradients found along transects across the alpine treeline. In at least some of the cases, surficial geology type was shown to be significantly associated with differences between sigmoidal and non-sigmoidal transitions. These results support previous evidence for sigmoid wave transitions at the boreal forest-tundra ecotone, but also show that the alpine treeline case is more complex. We argue that in cases where ecotones are used as sites for monitoring the effects of climate change on vegetation, care should be taken to utilize only sites that exhibit a sigmoidal transition so as to minimize the effects of non-climate-related controlling factors on the interpretations.

An adult female domestic shorthair cat was evaluated for chronic upper respiratory disease and vomiting. A diagnosis of idiopathic megaesophagus with intermittent gastroesophageal intussusception (GEI) was made based on radiographic and endoscopic examinations. The GEI was manually reduced by use of a stomach tube during the endoscopic procedure. An incisional gastropexy was performed to prevent recurrence. Gastroesophageal intussusception is a rare condition in cats. In dogs it is usually associated with rapid progression of clinical signs, culminating in death. In this cat, the condition was associated with chronic signs, probably due to the intermittent nature of the GEI.

The Edinburgh-Cape Blue Object Survey is a major survey to discover blue stellar objects brighter than B similar to 18 in the southern sky. It is planned to cover an area of sky of 10 000 deg(2) with \b\ > 30 degrees and delta < 0 degrees. The blue stellar objects are selected by automatic techniques from U and B pairs of UK Schmidt Telescope plates scanned with the COSMOS measuring machine. Follow-up photometry and spectroscopy are being obtained with the SAAO telescopes to classify objects brighter than B = 16.5. This paper describes the survey, the techniques used to extract the blue stellar objects, the photometric methods and accuracy, the spectroscopic classification, and the limits and completeness of the survey.

There are few studies examining the quality of life (QOL) of patients with haemorrhoidal disease. Transanal heamorrhoidal dearterialization (THD) is a treatment modality for heamorrhoidal disease in which a Doppler transducer is used to locate the supplying arteries that are subsequently ligated. The aim of this study was to assess symptoms and QOL changes following THD.This was a prospective evaluation of QOL and symptom changes following THD. Patient symptoms, demographics and QOL were recorded preoperatively and 1-month post-operatively following THD using the medical outcomes study short-form-36 (SF-36).Thirteen patients undergoing THD were evaluated. One month following THD symptoms of haemorrhoid protrusion, bleeding, anal pain, painful defaecation, constipation and tenesmus, had all significantly reduced (P0.05). Limitations in usual role activities because of physical health problems (53.8 +/- 10.5 Vs 90.4 +/-4.5, P = 0.004), vitality, energy and fatigue (45 +/- 6.9 Vs 73.5 +/- 5.0, P= 0.003), general mental health, psychologic distress and wellbeing (60.9 +/- 6.9 Vs 83.1 +/- 5.9, P= 0.023), limitations in social activities because of physical or emotional problems (58.7 +/- 8.8 Vs 84 +/- 5.9, P = 0.025), and physical pain (52.9 +/- 7.9 Vs 84.6 +/- 6.4, P= 0.005) scores had all improved 1-month following THD.THD significantly reduces symptoms of haemorrhoidal disease and improves specific aspects of QOL 1-month following surgery.

The capacity of a labyrinth spillway is a function of the total head, the effective crest length, and the crest coefficient. The crest coefficient depends on the total head, weir height, thickness, crest shape, apex configuration, and the angle of the side legs. Data and a procedure are presented for designing labyrinth weirs for angles between 6° and 35°, and for a range of heads. The design procedure allows the angle of the side legs and the number of cycles to be varied until the desired layout and capacity are achieved. The solution is presented in a spreadsheet format that automatically calculates the dimensions for the labyrinth. Even though the design procedure is quite accurate, it is recommended that the capacity and performance be verified with a model study. The model can evaluate factors not included in the design procedure, like aeration effects at low heads, unusual flow conditions in the approach channel, and flow conditions in the discharge channel.

The southern pine beetle (Dendroctonus frontalis Zimmermann) is the most destructive insect pest of pine (Pinus spp.) forests in the southern United States. Restoring and managing pine stands infested by southern pine beetle are critically important for forest health and sustainability in the region. The successful restoration of damaged pine forests requires the integration of information of beetle biology and behavior, pine ecology, and landscape restoration. Certain social, economic, and political issues also need to be considered concomitantly. The knowledge for effective restoration and management of southern pine forests has increased greatly in the past decade. In this chapter, we provide a synthesis of new and existing knowledge to address the goals, framework, implementation, social and political impacts on the restoration of the southern pine forests in the context of southern pine beetle. We also provide information on common restoration methods and cost estimates. More effective use and further development of such knowledge could substantially reduce the economic, ecological, and social impact of southern pine beetle within the southern United States and adjacent areas.

Understanding existing levels of genetic diversity of sheep breeds facilitates in situ and ex situ conservation activities. A comprehensive evaluation of US sheep breeds has not been previously performed; therefore, we evaluated the genetic diversity among and within 28 US sheep breeds. Both major and minor breeds were included in the analysis and consisted of 666 animals from 222 producers located in 38 states. The level of within-breed genetic diversity was variable and not dependent upon status of a breed as a major or minor breed. Bayesian cluster analysis indicated the breeds were grouped more by physiological differences (meat vs. wool production) rather than geographic origin. Results suggest several actionable items to improve in situ and ex situ conservation. The results clearly identify breeds in need of increased in situ and ex situ management (e.g., Hog Island and Karakul) and allow several suggestions for in situ management of flocks. Conversely, several of the breeds appear genetically similar and therefore require less emphasis on collecting germplasm samples for the gene bank. Commercially important breeds (e.g., Rambouillet and Suffolk) were found to have substantial variation, which should enable breeders to proceed, unencumbered by genetic diversity concerns, with selection strategies that maximize profit.

The lunar solar power system (LSP) is a system for collecting solar radiant power on the lunar surface, converting the power to microwaves, and transmitting multiple power beams directly (or indirectly using orbital reflectors) to Earth stations. The microwave transmission systems for LSP direct beams consist of phased arrays of randomly placed reflector antennas distributed over large diameter equivalent apertures near the lunar limbs, each aperture generating multiple radiating wave fronts of different frequencies converging toward equivalent focal points beyond the Earth surface receiver planes. Unlike most versions of the space solar power system (SPS), the radiation patterns are governed by radiative near field or Fresnel diffraction constraints and provide a more uniform intensity over most of the receiver ground area and more rapid attenuation beyond the beam collection zone than is possible with Fraunhofer diffraction limited power beams. Statistical theories for radiation patterns of random arrays and phase or amplitude errors of reflector antennas have been described. These are combined to predict mean and peak side lobe power levels. Central beam power distributions are calculated from transmitting wavefront curvature and amplitude distributions. Parametric values for single power beams and mature global power distribution systems are presented for beaming power to receivers on Earth.

The people of Earth will need more than 20,000 billion watts (GWe) of electric power by 2050 for a high level of prosperity. Power needs in the 22nd Century could exceed 100,000 GWe. The Lunar Power System (LPS) can provide solar electric power to Earth at less cost than conventional terrestrial systems and with far less environmental impact. A manned International Lunar Base (ILB) can accelerate development of LPS by: • • providing the initial transportation and habitation facilities that will greatly reduce up front costs and risks; • • demonstrating the emplacement over a 5–10 year period of a moderate scale LPS (1–100 GWe); • • enabling early exploration of alternative LPS designs, emplacement methods, maintenance, and in situ manufacturing of implementation equipment. LPS can support the establishment of an ILB by: • • substantially increasing the net wealth of the world and enabling general prosperity; • • providing wider support and greater funding of operations beyond Earth than for purely scientific research; • • accelerating the development of resources in cis-lunar space and on the moon. An international LPS program can foster world trust that lunar resources are being developed for the greatest good of mankind. The costs of SPS and LPS are compared. The organization of an international program for LPS is outlined.

Background A complete pathological response occurs in 10–30 per cent of patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiotherapy (CRT). The standard of care has been radical surgery with high morbidity risks and the challenges of stomata despite the favourable prognosis. This review assessed minimalist approaches (transanal excision or observation alone) to tumours with a response to CRT. Methods A systematic review was performed using PubMed and Embase databases. Keywords included: ‘rectal’, ‘cancer’, ‘transanal’, ‘conservative’, ‘complete pathological response’, ‘radiotherapy’ and ‘neoadjuvant’. Original articles from all relevant listings were sourced. These were hand searched for further articles of relevance. Main outcome measures assessed were rates of local recurrence and overall survival, and equivalence to radical surgery. Results Purely conservative ‘watch and wait’ strategies after CRT are still controversial. Originally used for elderly patients or those who refused surgery, the data support transanal excision of rectal tumours showing a good response to CRT. A complete pathological response in the T stage (ypT0) indicates < 5 per cent risk of nodal metastases. Conclusion Rectal tumours showing an excellent response to CRT may be suitable for local excision, with equivalent outcomes to radical surgery. This approach should be the subject of prospective clinical trials in specialist centres.

Chronic idiopathic constipation may be the result of an autonomic neuropathy. This hypothesis was tested in 23 constipated patients and 17 age matched controls, using the acetylcholine sweat spot test devised to test autonomic integrity in diabetes. Acetylcholine (0.01%) was injected in the dorsum of the foot painted with a mixture of starch and iodine. Active sweat glands appeared on the surface of the skin as small black dots which were photographed and counted, using a grid with 60 subareas. Two measurements were made: the number of dots per unit subarea (sweat spot test score) and the % number of abnormal subareas (with less than six spots). These two parameters were correlated. The median sweat spot test score was 9.53 in patients and 13.92 in controls (p = 0.0001), the receiver operating characteristic curve showing that a score of 12 delimited normal and abnormal subjects. Increasing age was correlated with a low score in patients, probably because of prolonged symptoms. Seventy per cent of patients and one control had a borderline or abnormal number of subareas. These results suggest that idiopathic constipation is associated with a degree of autonomic denervation. The sweat spot test is an easy, inexpensive method to test this hypothesis and deserves a place in the clinical assessment of slow transit constipated patients.

A simple technique for Kirschner-wire placement in small bones is to place the wire over the to-be-pinned bones, push the wire out through the skin, and run the wire back across the bones.

Keeping the endoscope warm until just before use eliminates the problem of fogging

The current trend towards integrating CMOS circuitry and photonic devices on silicon-on-insulator (SOI) wafers into monolithic optoelectronic circuits requires modification of the traditional rib waveguide to provide a planar surface. One possible modification involves creating a trench on either side of the rib and then filling this trench with a planarizing oxide. The resulting planar surface is much more compatible with the photolithographic systems required to print the small dimensions found in state-of-the-art CMOS. We report the fabrication of prototype trench-isolated waveguides, measurement of optical performance and comparison with simulation. 2.5 μm thick Si film was utilized with 0.5 μm deep trenches ranging from 1 to several microns in width. Rib widths ranged from 2 μm to 3 μm (the maximum value providing single mode propagation). Allowed modes were determined with FEMLAB, while beam propagation was studied using Optiwave BPM. Simulation indicated mode confinement would be lost for trench widths less than 1.5 μm. The narrowest trench width which could be fabricated was 2.0 μm, and qualitative optical testing shows good mode confinement to the central rib for a trench geometry greater than 3.0 μm.

Placing a loop of suture on an intramedullary nail locking screw keeps the screw firmly on the screwdriver. The screw can be retrieved should the need arise.

A simple technique is detailed for quickly clearing the tip of the arthroscope of particulate debris that may become lodged there while it is in place in the joint. Two or 3 taps with the back end of a Mayo scissors (or an instrument of equal weight) on the scope where it enters the joint should suffice. The taps must not be too firm, for fear of damaging the scope's fiberoptic cables.

Error-free transmission under all polarization conditions in /spl ges/10 Gbit/s ULH agile optical networks is achieved through dynamic control and through margining for low-probability events. Simulation and experimental results are presented that help to derive bounds on speed and magnitude of polarization-induced impairments.