The Ornaments of the Arma Veirana Early Mesolithic Infant Burial

Personal ornaments are widely viewed as indicators of social identity and personhood. Ornaments are ubiquitous from the Late Pleistocene to the Holocene, but they are most often found as isolated objects within archaeological assemblages without direct evidence on how they were displayed. This article presents a detailed record of the ornaments found in direct association with an Early Mesolithic buried female infant discovered in 2017 at the site of Arma Veirana (Liguria, Italy). It uses microscopic, 3D, and positional analyses of the ornaments as well as a preliminary perforation experiment to document how they were perforated, used, and what led to their deposit as part of the infant's grave goods. This study provides important information on the use of beads in the Early Mesolithic, in general, as well as the relationship between beads and young subadults, in particular. The results of the study suggest that the beads were worn by members of the infant's community for a considerable period before they were sewn onto a sling, possibly used to keep the infant close to the parents while allowing their mobility, as seen in some modern forager groups. The baby was then likely buried in this sling to avoid reusing the beads that had failed to protect her or simply to create a lasting connection between the deceased infant and her community.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10816-022-09573-7.

Intrinsic Dimensionality as a Metric for the Impact of Mission Design Parameters

High-resolution space-based spectral imaging of the Earth's surface delivers critical information for monitoring changes in the Earth system as well as resource management and utilization. Orbiting spectrometers are built according to multiple design parameters, including ground sampling distance (GSD), spectral resolution, temporal resolution, and signal-to-noise ratio. Different applications drive divergent instrument designs, so optimization for wide-reaching missions is complex. The Surface Biology and Geology component of NASA's Earth System Observatory addresses science questions and meets applications needs across diverse fields, including terrestrial and aquatic ecosystems, natural disasters, and the cryosphere. The algorithms required to generate the geophysical variables from the observed spectral imagery each have their own inherent dependencies and sensitivities, and weighting these objectively is challenging. Here, we introduce intrinsic dimensionality (ID), a measure of information content, as an applications-agnostic, data-driven metric to quantify performance sensitivity to various design parameters. ID is computed through the analysis of the eigenvalues of the image covariance matrix, and can be thought of as the number of significant principal components. This metric is extremely powerful for quantifying the information content in high-dimensional data, such as spectrally resolved radiances and their changes over space and time. We find that the ID decreases for coarser GSD, decreased spectral resolution and range, less frequent acquisitions, and lower signal-to-noise levels. This decrease in information content has implications for all derived products. ID is simple to compute, providing a single quantitative standard to evaluate combinations of design parameters, irrespective of higher-level algorithms, products, applications, or disciplines.

Pointing in a different direction: a case of bilateral absence of extensor indicis

Understanding anatomical variations, as well as, normal anatomy of the muscles and tendons of the hand is vital for successful clinical evaluation and surgery. A number of extensor muscle and tendon variations have been reported in the literature including duplication, triplication, and absence. We report a rare anatomical variation that includes bilateral absence of the extensor indicis (EI) muscles and bilateral duplication of the extensor digitorum (ED) tendon to the second digit in the forearm of an 83-year-old male cadaver during routine upper limbs dissection. In the present case, only three muscles were present in the deep compartment: extensor pollicis longus (EPL), extensor pollicis brevis (EPB), and abductor pollicis longus (APL) with bilateral absence of EI. The reported prevalence of bilateral absence of EI muscle and tendon ranges from 0.5 to 3.5% [1, 26]. The prevalence of an additional index tendon arising bilaterally from the ED muscle belly is 3.2 % of the population [1]. Extension of the index finger is governed by the actions of EI and ED. However, the four tendons of ED are linked to each other by juncturae tendinum (JT), restricting independent extension of the digits in certain postures, e.g. when the hand is fisted. With fisted hand, EI controls extension of the index finger. Clinically, EI tendons are used for tendon reconstruction procedures to restore function to the hand and thumb after trauma or tendon rupture. This report highlights the importance of anticipating anatomical variations and conducting pre-operative evaluations to confirm the presence of EI when planning tendon transfer procedures.

Evaluation of internet derived patient information for Acute Pancreatitis

INTRODUCTION

Possibly In the UK there are currently over 26,000 patients admitted to hospital for acute pancreatitis per annum and the incidence is rising. 55% of patients consult the internet for information regarding their medical condition. As the number of people using the internet has increased 57% since 2006, it is increasingly important for medical professionals to direct patients to accurate online sources of information. This paper aims to evaluate the quality of information available online for acute pancreatitis.

METHODS

The term 'acute pancreatitis' was searched using http://www.google.com, http://www.bing.com, and http://www.yahoo.com. The top 10 results of each of these websites were assessed using the University of Michigan consumer health website evaluation checklist.

RESULTS

Of the 30 websites found, 4 were excluded from the evaluation. Within the 26 evaluated websites there was high variability in website quality. However, the authors would have used 18 of the websites again for the purpose of finding out information on acute pancreatitis. 15 websites had a named author of which 11 displayed their credentials. 8 of the websites had been updated within the last year. 10 websites displayed a bias or conflict of interest. Generally, the layout and design of websites was good, however 7 of the websites contained distracting graphics and 9 of the websites had no search facility.

DISCUSSION

Doctors should give patients the information they want and need. With a high percentage of patients using the internet, medical professionals should recommend good quality websites to their patients. Engaging in this process could improve the consenting process as patients would be better informed. Good quality websites allows patients to explore conditions by themselves, with a re-consultation facilitating further discussion. Failure to engage in internet-based information risks patients making misinformed decisions due to bias and conflict of interest.

High-throughput synchrotron X-ray diffraction for combinatorial phase mapping

Discovery of new materials drives the deployment of new technologies. Complex technological requirements demand precisely tailored material functionalities, and materials scientists are driven to search for these new materials in compositionally complex and often non-equilibrium spaces containing three, four or more elements. The phase behavior of these high-order composition spaces is mostly unknown and unexplored. High-throughput methods can offer strategies for efficiently searching complex and multi-dimensional material genomes for these much needed new materials and can also suggest a processing pathway for synthesizing them. However, high-throughput structural characterization is still relatively under-developed for rapid material discovery. Here, a synchrotron X-ray diffraction and fluorescence experiment for rapid measurement of both X-ray powder patterns and compositions for an array of samples in a material library is presented. The experiment is capable of measuring more than 5000 samples per day, as demonstrated by the acquisition of high-quality powder patterns in a bismuth-vanadium-iron oxide composition library. A detailed discussion of the scattering geometry and its ability to be tailored for different material systems is provided, with specific attention given to the characterization of fiber textured thin films. The described prototype facility is capable of meeting the structural characterization needs for the first generation of high-throughput material genomic searches.

L-Glutamic acid as a mediator of sexual morphogenesis in Volvox capensis

In Volvox capensis the development of sexual individuals is in response to low concentrations (68 nM) of L-glutamic acid rather than to such species-specific glycoproteins as have been isolated in Volvox carteri or are believed to exist in a number of other species. V. capensis grows equally as well in light and in darkness in a medium supplemented with sodium acetate; however, L-glutamic acid is active as an inducer of the sexual form only in populations grown in the light. The site of action of L-glutamic acid and its biochemical role in the sexual response are unknown. Attempts to induce the sexual response by using the other L-amino acids, various analogs of glutamic acid, compounds of similar structure (e.g., gamma-aminobutyric acid), and intermediates of biochemical pathways known to involve L-glutamic acid (e.g., alpha-ketoglutarate or pyroglutamic acid) have been unsuccessful. L-Glutamic acid is produced by V. capensis as a natural product of the digestion of the glycoproteinaceous parental matrix at the time young spheroids escape. As a population increases, so does the level of L-glutamic acid produced at each succeeding generation until the threshold of sensitivity is reached and the induction of sexual forms is effected. This serves as a mechanism for ensuring the production of sexual spheroids and their zygotes, the only phase in the life cycle resistant to drying. Thus, Volvox is especially adapted to an existence in ephemeral pools of water resulting from seasonal rains.

Structure and orientational texture of self-organizing lipid bilayers

The structure of single supported dipalmitoyl-phosphatidylcholine bilayers prepared by vesicle fusion or Langmuir-Blodgett-Schaeffer (LBS) deposition techniques was characterized by x-ray reflectivity and grazing incidence diffraction in bulk water. LBS bilayers display symmetric leaflets similar to monolayer structures, while vesicle fusion yields more inhomogeneous bilayers. Diffraction establishes that lipids are always coupled across the bilayer even when leaflets are deposited independently and suggests the existence of orientational texture.

Ontogenetic scaling of foot musculoskeletal anatomy in elephants

This study quantifies the shape change in elephant manus and pes anatomy with increasing body mass, using computed tomographic scanning. Most manus and pes bones, and manus tendons, maintain their shape, or become more gracile, through ontogeny. Contrary to this, tendons of the pes become significantly more robust, suggesting functional adaptation to increasingly high loads. Ankle tendon cross-sectional area (CSA) scales the highest in the long digital extensor, proportional to body mass(1.08+/-0.21), significantly greater than the highest-scaling wrist tendon (extensor carpi ulnaris, body mass(0.69+/-0.09)). These patterns of shape change relate to the marked anatomical differences between the pillar-like manus and tripod-like pes, consistent with differences in fore- and hindlimb locomotor function. The cartilaginous predigits (prepollux and prehallux) of the manus and pes also become relatively more robust through ontogeny, and their pattern of shape change does not resemble that seen in any of the 10 metacarpals and metatarsals. Their CSAs scale above isometry proportional to body mass(0.73+/-0.09) and body mass(0.82+/-0.07) respectively. We infer a supportive function for these structures, preventing collapse of the foot pad during locomotion.

Probing the local order of single phospholipid membranes using grazing incidence x-ray diffraction

We report the first grazing incidence x-ray diffraction measurements of a single phospholipid bilayer at the solid-liquid interface. Our grazing incidence x-ray diffraction and reflectivity measurements reveal that the lateral ordering in a supported DPPE (1, 2-Dipalmitoyl-sn-Glycero-3-Phosphoethanolamine) bilayer is significantly less than that of an equivalent monolayer at the air-liquid interface. Our findings also indicate that the leaflets of the bilayer are uncoupled in contrast to the scattering from free standing phosphatidylcholine bilayers. The methodology presented can be readily implemented to study more complicated biomembranes and their interaction with proteins.

Selection of a Microbiological Corrosion System for Studying Effects on Structural Aluminum Alloys

Two laboratory methods, a metal-strip test and a tank test, were evaluated as microbiological corrosion systems for producing corroded test specimens on a structural aluminum alloy. The results show that corrosion of the test alloy occurred best in the metal-strip test in a deionized water-fuel medium inoculated with a mixture of microorganisms under aerated conditions. The metal-strip test was more successful for producing large numbers of corroded test specimens and proved more economical than the tank-type test, since less structural material is needed to obtain a specimen with sufficient corrosion areas, and since the corrosion can more easily be restricted by maskants to certain areas for specific test purposes.

Characterization of biological thin films at the solid-liquid interface by x-ray reflectivity

We demonstrate that 18 keV x-rays can be used to study organic thin films at the solid-liquid interface by x-ray reflectivity. We establish that this is a powerful technique for investigating biological systems in a previously inaccessible manner. Our measurements enabled the density distribution of single phospholipid bilayer membranes in bulk water to be measured with unprecedented precision. Previously, characterization of biomimetic structures normal to a "buried" interface was a domain of neutron reflectivity.

Neutron and X-ray scattering studies of cholera toxin interactions with lipid monolayers at the air–liquid interface

Using neutron/X-ray reflectivity and X-ray grazing incidence diffraction (GID), we have characterized the structure of mixed DPPE:GM(1) lipid monolayers before and during the binding of cholera toxin (CTAB(5)) or its B subunit (CTB(5)). Structural parameters such as the density and thickness of the lipid layer, extension of the GM(1) oligosaccharide headgroup, and orientation and position of the protein upon binding are reported. Both CTAB(5) and CTB(5) were measured to have approximately 50% coverage when bound to the lipid monolayer. X-ray GID experiments show that both the lipid monolayer and the cholera toxin layer are crystalline. The effects of X-ray beam damage have been assessed and the monolayer/toxin structure does not change with time after protein binding has saturated.

Cholera toxin assault on lipid monolayers containing ganglioside GM1

Many bacterial toxins bind to and gain entrance to target cells through specific interactions with membrane components. Using neutron reflectivity, we have characterized the structure of mixed DPPE:GM(1) lipid monolayers before and during the binding of cholera toxin (CTAB(5)) or its B-subunit (CTB(5)). Structural parameters such as the density and thickness of the lipid layer, extension of the GM(1) oligosaccharide headgroup, and orientation and position of the protein upon binding are reported. The density of the lipid layer was found to decrease slightly upon protein binding. However, the A-subunit of the whole toxin is clearly located below the B-pentameric ring, away from the monolayer, and does not penetrate into the lipid layer before enzymatic cleavage. Using Monte Carlo simulations, the observed monolayer expansion was found to be consistent with geometrical constraints imposed on DPPE by multivalent binding of GM(1) by the toxin. Our findings suggest that the mechanism of membrane translocation by the protein may be aided by alterations in lipid packing.

Mycobacterium bovis (bovine TB) exposure as a recreational risk for hunters: results of a Michigan Hunter Survey, 2001

SETTING

Tuberculosis caused by Mycobacterium bovis (bovine TB) is endemic in the white-tailed deer population of north-eastern Michigan. Hunters may be exposed to M. bovis via cutaneous inoculation while field dressing deer or by ingestion of undercooked venison. Michigan hunters have received inconsistent messages about their risk of acquiring tuberculosis from recreational exposure to deer. The most common health advice offered has been to wear gloves while field dressing deer and to cook venison products thoroughly.

OBJECTIVE

Data were collected to quantify these self-protective activities and to characterize hunters practicing these activities.

DESIGN

In 2001, we surveyed 1833 hunters who had successfully harvested deer in or near Michigan's bovine TB endemic area in 2000.

RESULTS

The survey response rate was 78%. Most hunters (89%) reported field dressing deer, 43% of whom wore gloves. Most hunters (95%) reported eating venison, 55% of whom reported their venison was always cooked thoroughly. Several hunter characteristics, including older age, female sex, higher awareness level, and area of residence, were significantly associated with the practice of these self-protective activities.

CONCLUSION

The survey results suggest that hunters should receive consistent advice encouraging glove use while field dressing deer and the thorough cooking of venison products before consumption.

Conformation of the O-specific polysaccharide of Shigella dysenteriae type 1: molecular modeling shows a helical structure with efficient exposure of the antigenic determinant alpha-L-Rhap-(1-->2)-alpha-D-Galp

The O-specific polysaccharide of Shigella dysenteriae type 1, which has the repeating tetrasaccharide unit -->3)-alpha-L-Rhap-(1-->3)-alpha-L-Rhap-(1-->2)-alpha-D-Galp-(1-->3)-alpha-D-GlcNAcp-(1--> (A-B-C-D), is a major virulence factor, and it is believed that antibodies against this polysaccharide confer protection to the host. The conformational properties of fragments of this O-antigen were explored using systematic search with a modified HSEA method (GLYCAN) and with molecular mechanics MM3(96). The results show that the alpha-D-Gal-(1-->3)-alpha-D-GlcNAc linkage adopts two favored conformations, phi/psi approximately equal to -40 degrees /-30 degrees (I) and approximately 15 degrees /30 degrees (II), whereas the other glycosidic linkages only have a single favored phi/psi conformational range. MM3 indicates that the trisaccharide B-C-D and tetrasaccharides containing the B-C-D moiety exist as two different conformers, distinguished by the conformations I and II of the C-D linkage. For the pentasaccharide A-B-C-D-A' and longer fragments, the calculations show preference for the C-D conformation II. These results can explain previously reported nuclear magnetic resonance data. The pentasaccharide in its favored conformation II is sharply bent, with the galactose residue exposed at the vertex. This hairpin conformation of the pentasaccharide was successfully docked with the binding site of a monoclonal IgM antibody (E3707 E9) that had been homology modeled from known crystal structures. For fragments made of repetitive tetrasaccharide units, the hairpin conformation leads to a left-handed helical structure with the galactose residues protruding radially at the helix surface. This arrangement results in a pronounced exposure of the galactose and also the adjacent rhamnose in each repeating unit, which is consistent with the known role of the as alpha-L-Rhap-(1-->2)-alpha-D-Galp moiety as a major antigenic epitope of this O-specific polysaccharide.

Methods of tissue extraction in advanced laparoscopy

Advances in laparoscopic surgery have revolved not only around new methods of tissue excision and repair, but also around specimen extraction. At the center of these recent advances is the need to be cost-effective and safe. Two particularly important advances in laparoscopic tissue extraction are use of electronic power morcellators, to cut up and remove large masses, and specimen bags to remove the extracted tissue safely. Although morcellators offer tremendous time savings, and can actually reduce the risk of hernia formation because fascia need not be torn or stretched, the use of power morcellators is not without concern. The sharp rotating blade can damage normal organs. Furthermore, one must watch closely so that morcellated specimens are not inadvertently misplaced. Specimen bags are also important, both in malignant and in benign conditions. Ultimately, the problem is spillage of tissue, whether it be cancer cells or products of conception. Although some specimen bags are equipped with self-opening devices, the largest bags must be opened manually.

Endothelin ET(A) and ET(B) receptors in postnatal intestine

We aimed to characterize endothelin (ET) receptors in the swine intestinal vasculature and to determine ischemia-reperfusion (I/R) effects on these receptors. Saturation and competitive binding assays were performed on mesenteric artery protein membranes from 1- and 40-day-old animals, both control and those subjected to 1 h of partial ischemia followed by 6 h of reperfusion in vivo. Scatchard analysis of saturation binding with (125)I-labeled ET-1 in membranes from endothelium-denuded (E(-)) vessels revealed that the maximum number of binding sites was greater in younger animals. Competitive (125)I-ET-1 binding was significant for a one-site model with ET-1, ET-3, and sarafotoxin S6c (S6c) in membranes from endothelium-intact (E(+)) and E(-) vessels in both age groups. The maximum number of ET-1 binding sites was significantly greater in younger animals. In the presence of the ET(A) receptor antagonist BQ-123, competitive (125)I-ET-1 binding was significant for a one-site model with ET-1 and S6c in membranes from E(+) vessels in both age groups. The maximum number of ET-1 binding sites was significantly greater in younger animals. After I/R, the maximum number of ET-1 binding sites was unchanged. In the presence of BQ-123, specific binding by ET-1 and S6c was eliminated in both age groups after I/R. These results suggest that both ET receptor populations are expressed to a greater degree in younger animals and I/R significantly affects the ET(B) receptor.

Relationship between flow rate and NO production in postnatal mesenteric arteries

We studied mesenteric arterial arcades from 3- and 35-day-old swine to determine the relationship between perfusate flow rate and release of nitric oxide (NO) into mesenteric effluent. Mesenteric arterial arcades were perfused under controlled-flow conditions with a peristaltic pump using warm oxygenated Krebs buffer. Basal rates of NO production were 43.6 +/- 4.2 vs. 12.1 +/- 2.5 nmol/min in 3- vs. 35-day-old mesentery during perfusion at in vivo flow rates (9 vs. 20 ml/min, respectively). Rate of NO production was directly related to flow rate over a wide range of flows (5-40 ml/min) in 3- but not 35-day-old mesentery. Both age groups demonstrated a brisk, albeit brief, increase in NO production in response to infusion of NO-dependent vasodilator substance P (10(-8) M/min). Tyrosine kinase inhibitor herbimycin A and L-arginine analog L-NMMA significantly attenuated flow-induced increase in NO production, and phosphatase inhibitor phenylarsine oxide increased magnitude of flow-induced increase in NO production in 3-day-olds. Removal of extracellular Ca(2+) and depletion of intracellular Ca(2+) stores (Ca(2+)-free Krebs with EGTA plus thapsigargin) had no effect on NO production in either group. Thus, basal rate of NO production is greater in mesenteric arterial arcades from 3- than from 35-day old swine, a direct relationship between flow rate and NO production rate is present in mesentery from 3- but not 35-day-olds, and phosphorylation events are necessary for this interaction to occur.

The Rotational Spectra, Isotopically Independent Parameters, and Interatomic Potentials for the X(1)(2)Pi(3/2) and X(2)(2)Pi(1/2) States of BrO

Observations of the rotational spectrum of BrO have been extended to include vibrational levels up to v = 8 in the X(1)(2)Pi(3/2) and v = 7 in the X(2)(2)Pi(1/2) states. The rotational spectra of isotopically enriched Br(18)O, X(1), v = 0, 1 and X(2), v = 0 have been observed as well. The spectra of all four isotopic species have been fit to a Hamiltonian in which the parameters have fixed isotopic ratios. An extensive set of isotopically independent parameters has been determined. Interatomic potentials have been derived for both the X(1) and X(2) states. The hyperfine constants and their vibrational dependencies have been determined more precisely and several of them have been determined for the first time. These are interpreted in terms of the electronic structure of the molecule. The isotope relations among the constants have provided a means of decorrelating the electron spin-rotation constant gamma from the fine-structure centrifugal distortion constant, A(D), and have allowed the first determination of an effective value for gamma. Copyright 2001 Academic Press.

Cyclic strain induces proliferation of cultured embryonic heart cells

Embryonic heart cells undergo cyclic strain as the developing heart circulates blood to the embryo. Cyclic strain may have an important regulatory role in formation of the adult structure. This study examines the feasibility of a computerized cell-stretching device for applying strain to embryonic cardiocytes to allow measurement of the cellular response. A primary coculture of myocytes and a secondary culture of nonmyocytes from stage-31 (7 d) embryonic chick hearts were grown on collagen-coated membranes that were subsequently strained at 2 Hz to 20% maximal radial strain. After 24 h, total cell number increased by 37+/-6% in myocyte cocultures and by 26+/-6% in nonmyocyte cultures over unstrained controls. Lactate dehydrogenase and apoptosis assays showed no significant differences in cell viabilities between strained and unstrained cells. After 2 h strain, bromodeoxyuridine incorporation was 38+/-1.2% versus 19+/-0.2% (P < 0.01) in strained versus unstrained myocyte cocultures, and 35+/-2.1% versus 16+/-0.2% (P = 0.01) in nonmyocyte cultures. MF20 antibody labeling and periodic acid-Schiff (PAS) staining estimated the number of myocytes in strained wells as 50-67% larger than in control wells. Tyrosine phosphorylation may play a role in the cellular response to strain, as Western blot analysis showed an increase in tyrosine phosphorylation of two proteins with approximate molecular weights of 63 and 150 kDa within 2 min of strain. The results of this study indicate that embryonic chick cardiocytes can be cultured in an active mechanical environment without significant detachment and damage and that increased proliferation may be a primary response to strain.

Endothelin-mediated vasoconstriction in postischemic newborn intestine

We previously suggested that the profound, sustained vasoconstriction noted in 3-day-old swine intestine after a moderate episode of ischemia-reperfusion (I/R) reflects the unmasking of underlying constrictor tone consequent to a loss of endothelium-derived nitric oxide (NO). In this study, we sought to determine whether endothelin-1 (ET-1) was the unmasked constrictor and whether selective loss of endothelial ET(B) receptors, which mediate NO-based vasodilation, participated in the hemodynamic consequences of I/R in newborn intestine. Studies were performed in innervated, autoperfused intestinal loops in 3- and 35-day-old swine. Selective blockade of ET(A) receptors with BQ-610 had no effect on hemodynamics under control conditions; however, when administered before and during I/R, BQ-610 significantly attenuated the post-I/R vasoconstriction and reduction in arteriovenous O(2) difference in the younger group. In 3-day-old intestine, reduction of intestinal O(2) uptake to a level similar to that noted after I/R by lowering tissue temperature had no effect on the response to BQ-610 or ET-1, indicating that the change in response to BQ-610 noted after I/R was not simply consequent to the reduction in tissue O(2) demand. In studies in mesenteric artery rings suspended in myographs, we observed a leftward shift in the dose-response curve for ET-1 after selective blockade of ET(B) receptors with BQ-788 in 3- but not 35-day-old swine. Rings exposed to I/R in vivo behaved in a manner similar to control rings treated with BQ-788 or endothelium-denuded non-I/R rings.

Determination of the sensitivity of a rapid Escherichia coli O157:H7 assay for testing 375-gram composite samples

Both 25-g single-size ground beef samples and 375-g composite ground beef samples were tested by a method combining an immunomagnetic separation (IMS) technique with a sandwich enzyme-linked immunosorbent assay (ELISA) system (IMS-ELISA). The results demonstrated that IMS-ELISA could detect the target, Escherichia coli O157:H7, at the level of 10(-1) CFU/g of sample in either the 25- or 375-g sample size.

Myomectomy. Comparison of open and laparoscopic techniques

It appears that both laparoscopic and laparotomy approaches to myomectomy are viable surgical procedures. Both surgeries can be performed with minimal risk. Pregnancy rates after either procedure are high. The advantage of laparotomy over laparoscopy is that it is technically easier. On the other hand, laparoscopy enables quicker and easier recovery. Moreover, the risk of adhesion formation is reduced. If the surgeon can rise to the technical challenge, a laparoscopic approach to myomectomy should be the intended surgery.

Trabeculated embryonic myocardium shows rapid stress relaxation and non-quasi-linear viscoelastic behavior

Passive viscoelastic behavior is important in embryonic cardiovascular function, influencing the rate and magnitude of contraction and relaxation. We hypothesized that if viscoelastic behavior is influenced by interstitial fluid flow, then the stage-21 (312d) and stage-24 (4d) chick myocardium with large intertrabecular spaces will exhibit much different viscoelastic behavior than stage-16 (212d) and stage-18 (3d) compact myocardium and a non-quasi-linear response. Excised left ventricular sections were tested with ramp-and-hold stress relaxation tests at axial stretch ratios of 1.05:1.1:1.2:1.3. The measured stress relaxation was much more rapid than previously observed in the compact, non-trabeculated myocardium. The reduced relaxation curves depended significantly on the stretch level. A continuous-spectrum quasi-linear relaxation function described their shape well but the model-fit parameters also depended on the stretch level. Sinusoidal stretching of ventricular sections at rates from 0.2 to 25Hz showed that the steepening of stress-strain curves with increasing strain rate was half as much as predicted by a quasi-linear model. Hysteresis ranged from 25-35%, varied little with loading rate from 0.2 to 8Hz, and was twice that predicted from a quasi-linear model. Doubling the viscosity of the perfusate in stress-relaxation tests produced increased stiffness and decreased relaxation rate. These results demonstrate that the passive viscoelastic behavior of the trabeculated embryonic myocardium is markedly different from that of younger, compact myocardium and is not quasi-linear.

Extracorporeal membrane oxygenation for infant postcardiotomy support: significance of shunt management

BACKGROUND

After repair of complex congenital heart defects in infants and children, postcardiotomy cardiac failure requiring temporary circulatory support can occur. This is usually accomplished with the use of extracorporeal membrane oxygenation (ECMO). ECMO management of patients with single-ventricle physiology and aorto-pulmonary shunts can be particularly challenging. We retrospectively reviewed our experience with postcardiotomy support with particular attention to those children with single-ventricle palliation.

METHODS

Thirty-five consecutive children (age 1 to 820 days, median 19 days) out of 1,020 patients (3.4%) required mechanical support (ECMO) after repair of congenital cardiac lesions from February 1994 to April 1999. Twenty-five patients underwent two ventricle repairs and 10 patients had single-ventricle palliation. Various parameters analyzed included strategies of shunt management, presence of presupport cardiac arrest, and timing of support initiation.

RESULTS

Overall hospital survival for these 35 patients was 61%. There were four additional late deaths. Hospital survival was the same for those patients in whom support was initiated for failure to wean from cardiopulmonary bypass in the operating room versus those patients in whom support was initiated after successful separation from cardiopulmonary bypass (6 of 10 vs 15 of 25 or 60% survival). In those patients with shunt-dependent pulmonary circulation, survival was significantly improved in those patients in which the aorto-pulmonary shunt was left open (4 of 5 with open shunt vs 0 of 4 with occluded shunt (p = 0.048).

CONCLUSIONS

The ability to readily implement postcardiotomy support is vital to the management of children with complex congenital cardiac disease. Overall survival can be quite satisfactory if support is employed in a rational and expedient manner. In patients with single-ventricle physiology and aorto-pulmonary shunts, leaving the shunt open during the period of support can result in markedly improved outcomes.

Prevalence and correlates of preventive care among adults with diabetes in Kansas

OBJECTIVE

To assess the prevalence and correlates of recommended preventive care among adults with diabetes in Kansas.

RESEARCH DESIGN AND METHODS

A cross-sectional telephone survey was conducted among a sample of adults (> or = 18 years of age) with self-reported diabetes. Recommended preventive care was defined based on four criteria: number of health-care provider (HCP) visits per year (> or = 4 for insulin users and > or = 2 for nonusers), number of foot examinations per year (> or = 4 for insulin users and > or = 2 for nonusers), an annual dilated eye examination, and a blood pressure measurement in the past 6 months.

RESULTS

The mean age of the 640 respondents was 61 years, 58% were women, and 86% were white. In the preceding year, 62% of respondents reported the appropriate number of visits to a HCP 27% the appropriate number of foot examinations, 65% an annual dilated eye examination, and 89% a blood pressure measurement in the preceding 6 months. Only 17% (95% CI 14-20) met all four criteria for recommended care. The adjusted odds of receiving recommended care were higher for males than for females (odds ratio [OR] 1.6; 95% CI 1.1-2.5), higher for people whose HCP scheduled follow-up appointments than for those who self-initiated follow-up (OR 2.7; 95% CI 1.6-4.8), and higher for former smokers than for current smokers (OR 3.1; 95% CI 1.6-6.9).

CONCLUSIONS

Preventive care for people with diabetes is not being delivered in compliance with current guidelines, especially for women and current smokers. Scheduling follow-up visits for patients, targeting certain high-risk populations, and developing protocols to improve foot care may be effective in improving care.

Rational design of organophosphorus hydrolase for altered substrate specificities

Organophosphorus hydrolase (OPH) is a bacterial enzyme that hydrolyzes a broad variety of OP neurotoxins, including chemical warfare agents and many widely used pesticides. OPH has extremely high hydrolytic efficiency with different phosphotriester and phophothiolester pesticides (k(cat) = 50-15,000 s(-1)) as well as phosphorofluorates such as DFP and the chemical warfare agents sarin and soman (k(cat) = 50-11,000 s(-1)). In contrast, the enzyme has much lower catalytic capabilities for phosphonothioate neurotoxins such as acephate or the chemical warfare agent VX [O-ethyl S-(2-diisopropyl aminoethyl) methylphosphonothioate] (k(cat) = 0.3-20 s(-1)). Different metal-associated forms of the enzyme have demonstrated varying hydrolytic capabilities for each of the OP neurotoxins, and the activity of OPH (Co2+) is consistently higher than that of OPH (Zn2+) by five- to 20-fold. Protein engineering strategies have exploited these metal-induced catalytic differences, and other slight modifications to the opd gene have resulted in significant enhancement of the rates of detoxification of the thioate pesticides and chemical warfare agents. In order to develop practical applications of OPH, other experiments have focused on improvement of enzyme production, localization, stability, and shelf-life, as well as efficient catalysis of substrates of interest.

Stages of change theory and the nicotine-dependent client: direction for decision making in nursing practice

Clinical practice is the basic purpose of nursing. Nursing's evolving professional development calls for the application of theory to direct decision making in nursing practice. Therefore, in an attempt to bridge what has been described as the "theory-practice gap," the author demonstrates how Prochaska and DiClemente's stages of change theory is relevant to nursing practice. According to Prochaska and DiClemente, behavioral change, such as smoking cessation, involves a process of five identified stages: precontemplation, contemplation, preparation, action, and maintenance. The author discusses each stage of change and the framework it provides for decision making in nursing practice. The concept of relapse is described and highlighted as a valuable learning experience. Finally, using the criteria set by Chinn and Kramer, systematic evaluation of the stages of change theory pinpoints strengths and discusses integration of the theory into nursing practice.