Achievement of Target Gain Larger than Unity in an Inertial Fusion Experiment

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

Heritable gene expression differences between lake and stream stickleback include both parallel and antiparallel components

The repeated phenotypic patterns that characterize populations undergoing parallel evolution provide support for a deterministic role of adaptation by natural selection. Determining the level of parallelism also at the genetic level is thus central to our understanding of how natural selection works. Many studies have looked for repeated genomic patterns in natural populations, but work on gene expression is less common. The studies that have examined gene expression have found some support for parallelism, but those studies almost always used samples collected from the wild that potentially confounds the effects of plasticity with heritable differences. Here we use two independent pairs of lake and stream threespine stickleback (Gasterosteus aculeatus) raised in common garden conditions to assess both parallel and antiparallel (that is, similar versus different directions of lake–stream expression divergence in the two watersheds) heritable gene expression differences as measured by total RNA sequencing. We find that more genes than expected by chance show either parallel (22 genes, 0.18% of expressed genes) or antiparallel (24 genes, 0.20% of expressed genes) lake–stream expression differences. These results correspond well with previous genomic studies in stickleback ecotype pairs that found similar levels of parallelism. We suggest that parallelism might be similarly constrained at the genomic and transcriptomic levels.

Assessing reproductive isolation using a contact zone between parapatric lake-stream stickleback ecotypes

Ecological speciation occurs when populations evolve reproductive isolation as a result of divergent natural selection. This isolation can be influenced by many potential reproductive barriers, including selection against hybrids, selection against migrants and assortative mating. How and when these barriers act and interact in nature is understood for relatively few empirical systems. We used a mark-recapture experiment in a contact zone between lake and stream three-spined sticklebacks (Gasterosteus aculeatus, Linnaeus) to evaluate the occurrence of hybrids (allowing inferences about mating isolation), the interannual survival of hybrids (allowing inferences about selection against hybrids) and the shift in lake-like vs. stream-like characteristics (allowing inferences about selection against migrants). Genetic and morphological data suggest the occurrence of hybrids and no selection against hybrids in general, a result contradictory to a number of other studies of sticklebacks. However, we did find selection against more lake-like individuals, suggesting a barrier to gene flow from the lake into the stream. Combined with previous work on this system, our results suggest that multiple (most weakly and often asymmetric) barriers must be combining to yield substantial restrictions on gene flow. This work provides evidence of a reproductive barrier in lake-stream sticklebacks and highlights the value of assessing multiple reproductive barriers in natural contexts.

Joint analysis of BICEP2/keck array and Planck Data

We report the results of a joint analysis of data from BICEP2/Keck Array and Planck. BICEP2 and Keck Array have observed the same approximately 400  deg^{2} patch of sky centered on RA 0 h, Dec. -57.5°. The combined maps reach a depth of 57 nK deg in Stokes Q and U in a band centered at 150 GHz. Planck has observed the full sky in polarization at seven frequencies from 30 to 353 GHz, but much less deeply in any given region (1.2  μK deg in Q and U at 143 GHz). We detect 150×353 cross-correlation in B modes at high significance. We fit the single- and cross-frequency power spectra at frequencies ≥150  GHz to a lensed-ΛCDM model that includes dust and a possible contribution from inflationary gravitational waves (as parametrized by the tensor-to-scalar ratio r), using a prior on the frequency spectral behavior of polarized dust emission from previous Planck analysis of other regions of the sky. We find strong evidence for dust and no statistically significant evidence for tensor modes. We probe various model variations and extensions, including adding a synchrotron component in combination with lower frequency data, and find that these make little difference to the r constraint. Finally, we present an alternative analysis which is similar to a map-based cleaning of the dust contribution, and show that this gives similar constraints. The final result is expressed as a likelihood curve for r, and yields an upper limit r_{0.05}<0.12 at 95% confidence. Marginalizing over dust and r, lensing B modes are detected at 7.0σ significance.

Pharmacogenomics related to growth disorders

Growth disorders resulting in short stature are caused by a wide range of underlying pathophysiological processes. To improve height many of these conditions are treated with recombinant human growth hormone (rhGH). However, substantial inter-individual variability in growth response both in the short and long-term is recognised. Over the last decade, disease-specific growth prediction models have been developed that the clinician can use to define a child's potential response to rhGH and to optimise starting and maintenance doses of rhGH. These models, however, are not able to predict all the variations in treatment response. There has, therefore, been recent interest in using genetic information to contribute to the evaluation of responses to rhGH, including high-throughput technologies for assessing DNA markers (genome) and mRNA transcripts (transcriptome) as pharmacogenomic tools. This review will focus on how these pharmacogenomic approaches are being applied to growth disorders.

Insights into the pathophysiology of catch-up compared with non-catch-up growth in children born small for gestational age: an integrated analysis of metabolic and transcriptomic data

Small for gestational age (SGA) children exhibiting catch-up (CU) growth have a greater risk of cardiometabolic diseases in later life compared with non-catch-up (NCU) SGA children. The aim of this study was to establish differences in metabolism and gene expression profiles between CU and NCU at age 4-9 years. CU children (n=22) had greater height, weight and body mass index standard deviation scores along with insulin-like growth factor-I (IGF-I) and fasting glucose levels but lower adiponectin values than NCU children (n=11; all P<0.05). Metabolic profiling demonstrated a fourfold decrease of urine myo-inositol in CU compared with NCU (P<0.05). There were 1558 genes differentially expressed in peripheral blood mononuclear cells between the groups (P<0.05). Integrated analysis of data identified myo-inositol related to gene clusters associated with an increase in insulin, growth factor and IGF-I signalling in CU children (P<0.05). Metabolic and transcriptomic profiles in CU SGA children showed changes that may relate to cardiometabolic risk.

Network analysis: a new approach to study endocrine disorders

Systems biology is the study of the interactions that occur between the components of individual cells - including genes, proteins, transcription factors, small molecules, and metabolites, and their relationships to complex physiological and pathological processes. The application of systems biology to medicine promises rapid advances in both our understanding of disease and the development of novel treatment options. Network biology has emerged as the primary tool for studying systems biology as it utilises the mathematical analysis of the relationships between connected objects in a biological system and allows the integration of varied 'omic' datasets (including genomics, metabolomics, proteomics, etc.). Analysis of network biology generates interactome models to infer and assess function; to understand mechanisms, and to prioritise candidates for further investigation. This review provides an overview of network methods used to support this research and an insight into current applications of network analysis applied to endocrinology. A wide spectrum of endocrine disorders are included ranging from congenital hyperinsulinism in infancy, through childhood developmental and growth disorders, to the development of metabolic diseases in early and late adulthood, such as obesity and obesity-related pathologies. In addition to providing a deeper understanding of diseases processes, network biology is also central to the development of personalised treatment strategies which will integrate pharmacogenomics with systems biology of the individual.

3-M syndrome: a growth disorder associated with IGF2 silencing

3-M syndrome is an autosomal recessive disorder characterised by pre- and post-natal growth restriction, facial dysmorphism, normal intelligence and radiological features (slender long bones and tall vertebral bodies). It is known to be caused by mutations in the genes encoding cullin 7, obscurin-like 1 and coiled-coil domain containing 8. The mechanisms through which mutations in these genes impair growth are unclear. The aim of this study was to identify novel pathways involved in the growth impairment in 3-M syndrome. RNA was extracted from fibroblast cell lines derived from four 3-M syndrome patients and three control subjects, hybridised to Affymetrix HU 133 plus 2.0 arrays with quantitative real-time PCR used to confirm changes found on microarray. IGF-II protein levels in conditioned cell culture media were measured by ELISA. Of the top 10 downregulated probesets, three represented IGF2 while H19 was identified as the 23rd most upregulated probeset. QRT-PCR confirmed upregulation of H19 (P<0.001) and downregulation of IGF2 (P<0.001). Levels of IGF-II secreted into conditioned cell culture medium were higher for control fibroblasts than those for 3-M fibroblasts (10.2±2.9 vs 0.6±0.9 ng/ml, P<0.01). 3-M syndrome is associated with a gene expression profile of reduced IGF2 expression and increased H19 expression similar to that found in Silver-Russell syndrome. Loss of autocrine IGF-II in the growth plate may be associated with the short stature seen in children with 3-M syndrome.

Detection of B-mode polarization in the cosmic microwave background with data from the South Pole Telescope

Gravitational lensing of the cosmic microwave background generates a curl pattern in the observed polarization. This "B-mode" signal provides a measure of the projected mass distribution over the entire observable Universe and also acts as a contaminant for the measurement of primordial gravity-wave signals. In this Letter we present the first detection of gravitational lensing B modes, using first-season data from the polarization-sensitive receiver on the South Pole Telescope (SPTpol). We construct a template for the lensing B-mode signal by combining E-mode polarization measured by SPTpol with estimates of the lensing potential from a Herschel-SPIRE map of the cosmic infrared background. We compare this template to the B modes measured directly by SPTpol, finding a nonzero correlation at 7.7σ significance. The correlation has an amplitude and scale dependence consistent with theoretical expectations, is robust with respect to analysis choices, and constitutes the first measurement of a powerful cosmological observable.

Mutations in CUL7, OBSL1 and CCDC8 in 3-M syndrome lead to disordered growth factor signalling

3-M syndrome is a primordial growth disorder caused by mutations in CUL7, OBSL1 or CCDC8. 3-M patients typically have a modest response to GH treatment, but the mechanism is unknown. Our aim was to screen 13 clinically identified 3-M families for mutations, define the status of the GH-IGF axis in 3-M children and using fibroblast cell lines assess signalling responses to GH or IGF1. Eleven CUL7, three OBSL1 and one CCDC8 mutations in nine, three and one families respectively were identified, those with CUL7 mutations being significantly shorter than those with OBSL1 or CCDC8 mutations. The majority of 3-M patients tested had normal peak serum GH and normal/low IGF1. While the generation of IGF binding proteins by 3-M cells was dysregulated, activation of STAT5b and MAPK in response to GH was normal in CUL7(-/-) cells but reduced in OBSL1(-/-) and CCDC8(-/-) cells compared with controls. Activation of AKT to IGF1 was reduced in CUL7(-/-) and OBSL1(-/-) cells at 5 min post-stimulation but normal in CCDC8(-/-) cells. The prevalence of 3-M mutations was 69% CUL7, 23% OBSL1 and 8% CCDC8. The GH-IGF axis evaluation could reflect a degree of GH resistance and/or IGF1 resistance. This is consistent with the signalling data in which the CUL7(-/-) cells showed impaired IGF1 signalling, CCDC8(-/-) cells showed impaired GH signalling and the OBSL1(-/-) cells showed impairment in both pathways. Dysregulation of the GH-IGF-IGF binding protein axis is a feature of 3-M syndrome.

Comparison of pork quality and sensory characteristics for antibiotic free yorkshire crossbreds raised in hoop houses

The objective of this study was to compare pork characteristics and to determine consumer acceptability of pork chops from antibiotic free Yorkshire crossbreds sired by Berkshire (BY), Large Black (LBY), Tamworth (TY) or Yorkshire (YY) boars and reared in hoop houses. The experiments were conducted at the North Carolina Agricultural and Technical State University (NCA&TSU) Farm in Greensboro, NC and the Cherry Research Station Center for Environmental Farming Systems (CEFS) Alternative Swine Unit in Goldsboro, NC (source of antibiotic free Yorkshire sows used at both places). Twenty-four sows were artificially inseminated at each location in each of three trials. Litters were weaned at 4 wks old, and reared within deep-bedded outdoor hoop houses. To compare pork characteristics, 104 randomly selected animals were harvested at a USDA-inspected abattoir at approximately 200 d of age. Variables measured included pH, color score, L*, a*, b*, marbling score, drip loss, hot carcass weight, backfat thickness (BF), loin muscle area (LMA), and slice shear force. Sensory panel tests were also conducted at two time periods. The data was analyzed with GLM in SAS 9.01 including location, trial, and sire breed as fixed effects. Backfat thickness, LMA, color score and a* were different among breeding groups (p<0.05). The LBY pigs had thicker backfat and smaller LMA than the other breed types. The TY and YY had less backfat than all other breed groups. Color score was lower for YY than BY and LBY but intermediate for TY. The a* was lower for TY than other breeds except LBY which was intermediate. For one sensory panel test, YY pork was more preferred overall as well as for juiciness and texture compared to BY and LBY (p<0.05), but no impact of breed type was noted for the other test, with values similar for BY, LBY, TY and YY pork. This information may help small farmers make decisions about breed types to use for outdoor production.

Measuring the sustainability of a community safety promotion network: working from the inside out

Mackay Whitsunday Safe Communities (MWSC) was developed using a capacity building model that consciously attempted to design sustainability into the network. Our aim was to quantify the flow of resources used by MWSC to implement and sustain its injury control activities. Resource exchange among network members was quantified and analysed using social network analysis. In 2004, MWSC accessed an estimated 6.5 full-time staff equivalents and $0.9 million. However, these resources were largely accessed externally. The linking relationships that connected MWSC to its external support network, more than half of which were maintained by six broker network facilitators, were the critical social asset used to access resources and sustain network productivity. The sustainability of this network and arguably similar safety promotion networks is vulnerable to the changing priorities of external sponsoring agents and highly dependent on its leaders who facilitated access to the resources it required to remain productive.

Treatment of whole blood (WB) and red blood cells (RBC) with S-303 inactivates pathogens and retains in vitro quality of stored RBC

A pathogen inactivation (PI) process has been developed using the frangible anchor linker effector (FRALE) compound S-303. A series of experiments were performed in whole blood (WB) to measure the level of viral and bacterial inactivation. The results showed that 0.2mM S-303 and 2mM glutathione (GSH) inactivated >6.5 logs of HIV, >5.7 logs of Bluetongue virus, >7.0 logs of Yersinia enterocolitica, 4.2 logs of Serratia marcescens, and 7.5 logs of Staphylococcus epidermidis. Recent development for S-303 is focused on optimization of the PI process for red blood cell concentrates (RBC). A series of studies in RBC showed that 0.2mM S-303 and 20mM GSH inactivated approximately 5 logs or greater of Y. enterocolitica, E. coli, S. marcescens, S. aureus, HIV, bovine viral diarrhoea virus, bluetongue virus and human adenovirus 5. In both applications of the S-303 process, in vitro parameters of RBC function and physiology were retained compared to conventional RBC. Results from these studies indicate that S-303 can be applicable for PI of RBC and WB.

The development of participatory health research among incarcerated women in a Canadian prison

This paper describes the development of a unique prison participatory research project, in which incarcerated women formed a research team, the research activities and the lessons learned. The participatory action research project was conducted in the main short sentence minimum/medium security women's prison located in a Western Canadian province. An ethnographic multi-method approach was used for data collection and analysis. Quantitative data was collected by surveys and analysed using descriptive statistics. Qualitative data was collected from orientation package entries, audio recordings, and written archives of research team discussions, forums and debriefings, and presentations. These data and ethnographic observations were transcribed and analysed using iterative and interpretative qualitative methods and NVivo 7 software. Up to 15 women worked each day as prison research team members; a total of 190 women participated at some time in the project between November 2005 and August 2007. Incarcerated women peer researchers developed the research processes including opportunities for them to develop leadership and technical skills. Through these processes, including data collection and analysis, nine health goals emerged. Lessons learned from the research processes were confirmed by the common themes that emerged from thematic analysis of the research activity data. Incarceration provides a unique opportunity for engagement of women as expert partners alongside academic researchers and primary care workers in participatory research processes to improve their health.

Constitutional delay of growth and puberty is not commonly associated with mutations in the acid labile subunit gene

OBJECTIVES

Constitutional delay of growth and puberty (CDGP) is a common clinical condition that may be inherited as an autosomal dominant, recessive or X-linked trait. However, single-gene defects underlying CDGP have not yet been identified. A small number of children (to date 10) with modest growth failure and in the majority delayed puberty, a phenotype similar to that of CDGP, have been reported to carry mutations in the IGF acid labile subunit (IGFALS) gene which encodes the ALS, a part of the ternary complex carrying IGF-I in the circulation. The aim of our study was to screen a well-characterised CDGP cohort exhibiting a range of growth retardation and pubertal delay for pathogenic sequence variants in IGFALS.

DESIGN AND METHODS

We used denaturing high performance liquid chromatography (dHPLC) to screen for IGFALS mutations in DNA samples from 90 children (80 males) with CDGP of predominantly White European origin. DNA fragments generating abnormal waveforms were directly sequenced.

RESULTS

No IGFALS mutation was identified in the coding sequences or exon-intron boundaries in our CDGP cohort. One abnormal waveform pattern in dHPLC in 15 children with CDGP was found to represent a recognised synonymous single-nucleotide polymorphism of the coding transcript in the second exon in residue 210 of IGFALS.

CONCLUSIONS

IGFALS sequence variants are unlikely to be a common association with pubertal delay in children with CDGP.

Broadband dielectric function of nonequilibrium warm dense gold

We report on the first single-state measurement of the broadband (450-800 nm) dielectric function of gold isochorically heated by a femtosecond laser pulse to energy densities of 10(6) - 10(7) J/kg. A Drude and an interband component are clearly seen in the imaginary part of the dielectric function. The Drude component increases with energy density while the interband component shows both enhancement and redshift. This is in strong disagreement with predictions of a recent calculation of dielectric function based on limited Brillouin zone sampling.

Ex vivo blood stimulation assay as a translational research tool in the development of the ticilimumab (CP-675,206)

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Background: Cytotoxic T Lymphocyte-associated Antigen 4 (CTLA4) is an activation-induced T lymphocyte negative costimulatory receptor which down-regulates cellular immune responses. CTLA4 blockade may break peripheral immunological tolerance, leading to an effective immune response to cancer. Tools for assessing the effects of such a blockade are limited, as CTLA4 is not constitutively expressed on circulating T cells, and because activated lymphocytes are difficult to access in vivo. Therefore, we have employed ex vivo blood stimulation assays to define pharmacodynamic properties of the anti-CTLA4 antibody, ticilimumab. Methods: Ex vivo blood stimulation assays employed staphylococcal enterotoxin A (SEA) to stimulate isolated peripheral blood mononuclear cells (PBMC) or whole blood. Stimulation was monitored by production of interleukin 2 (IL-2). This assay was used preclinically to predict in vivo responses in animal models and in samples from cancer patients, as a batch release assay for production runs of ticilimumab, and clinically as a pharmacodynamic measurement in clinical trials of ticilimumab. Results: Screening experiments using the SEA assay allowed us to identify the lead candidate mAb with optimal CTLA4 blockade activity, ticilimumab. Dose-dependent increases in IL-2 production were observed in PBMC and whole blood samples up to an in vitro concentration of 100 ug/mL of ticilimumab, with 10 ug/mL identified as the minimum predicted efficacious concentration (Ceff). This functional potency assay was adapted for qualification of production lots of ticilimumab. Whole blood taken from cynomolgus monkeys dosed with ticilimumab demonstrated significant enhancement of IL-2 production at the same magnitude observed in in vitro experiments. Additionally, longitudinal samples taken from healthy volunteers and cancer patients suggested that an enhancement of 2.8 fold would be indicative of a pharmacodynamic effect of ticilimumab. Conclusions: The SEA assay provides a functional assessment of ticilimumab activity and can be used to guide the clinical development of this agent. Our data suggest that T cell reactivity is enhanced in the presence of ticilimumab in vitro, in primate models and in humans.

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Localized versus regional hyperthermia: comparison of xenotransplants treated with a small animal ultrasound system and waterbath limb immersion

The response of xenotransplants were compared with waterbath immersion vs focal ultrasound (US) hyperthermia using tumour growth delay, immunhistochemistry and histopathology assays. Waterbath hyperthermia was performed by limb immersion. Precautions were taken to minimize total body heating by surrounding the mouse with plastic insulators. Thermometry was performed with clinical-grade, 20-gauge needle thermocouples and monitored with a Labthermics unit. Significant differences in cytotoxicity between ultrasound and waterbath treatment of tumors at 43 degrees C were observed as determined by TUNNEL assay. Conversely, contralateral (non-treated) tumours in animals treated with similar temperature demonstrated no significant differences between modalities. Western blot analysis revealed increased hsp70 induction at 43 degrees C in waterbath vs focal ultrasound hyperthermia. Comparison of tumour growth delay between tumours heated with waterbath vs ultrasound at 43 degrees C but not at 41 degrees C revealed significant differences. This is the first study comparing localized vs regional hyperthermia using the small animal ultrasound system (SAHUS) delivery system. Consistent ultrasound hyperthermia can be achieved throughout a xenotransplant. At equivalent temperature of 43 degrees C for 60?min, waterbath hyperthermia demonstrated greater local response vs ultrasound hyperthermia.

Comparison of 2 wound volume measurement methods

OBJECTIVE

To compare 2 wound volume measurement techniques, the Kundin device and stereophotogrammetry, on 2 wound shapes.

DESIGN

Using 2 wound measurement techniques, the interrater and intrarater reliability and the bias and standard error of measurement of an L-shaped and a pear-shaped plaster of paris wound model were assessed.

SETTING

A clinical laboratory of a school of nursing.

PARTICIPANTS

Twenty-four raters, all but 2 being registered nurses, measured each of the wounds using both techniques.

INTERVENTIONS

Each rater measured each wound twice using each method in a randomly assigned order defined on a card that was drawn from a box. Measurements were recorded on a researcher-designed data collection form, which included some demographic data related to each participant.

MAIN OUTCOME MEASURES

The study hypothesis was that there would be no significant difference in accuracy between the 2 wound volume measurement methods.

RESULTS

The least biased and most accurate technique was stereophotogrammetry, with the smallest standard of error of measurement. Interrater reliability of average ratings was identical for both methods at 0.98. For single ratings, stereophotogrammetry was slightly higher than the Kundin device. Intrarater reliability was higher on the pear-shaped wound for the Kundin device, which had lower interrater reliability, suggesting that nurses were consistent in the direction and size of personal error. Intrarater reliability for stereophotogrammetry was identical to that of the Kundin device for the L-shaped wound and lower for the pear-shaped wound.

CONCLUSIONS

Although both techniques have acceptable accuracy, stereophotogrammetry is more accurate and has more clinical applications.

The lived experience of having a pressure ulcer: a qualitative analysis

In this descriptive, qualitative, phenomenological study, the researchers explored the phenomena of the lived experience of having a pressure ulcer to determine the essential structure of the experience. The sample included 8 respondents: 4 individuals who currently had a pressure ulcer and 4 who previously had a pressure ulcer that had healed. Four respondents also had a spinal cord injury and 5 had surgical flap reconstruction. Respondents were asked to reflect and reply to the following statements: "Please describe your experience of having a pressure ulcer. Share all the thoughts, perceptions, and feelings you can recall until you have no more to say about this experience." From verbatim transcriptions of interviews, 7 themes evolved with related sub-themes. The themes that emerged were (1) perceived etiology of the pressure ulcer; (2) life impact and changes; (3) psychospiritual impact; (4) extreme painfulness associated with the pressure ulcer; (5) need for knowledge and understanding; (6) need for and effect of numerous, stressful treatments; and (7) the grieving process. In this paper, the essential nature of the experience of living with a pressure ulcer is presented. Pressure ulcers had a profound impact upon the subjects' lives, including physical, social, and financial status; change of body image; and/or loss of independence and control. Those with a Stage IV pressure ulcer and flap repair and/or those with a spinal cord injury experienced the grieving process in some form. Although the experience of having a pressure ulcer has similarities for each individual, each experiences it in a unique manner. Patients with a pressure ulcer with or without a spinal cord injury have significant needs in learning to cope and live with their condition.

Bactericidal and tumoricidal activities of synthetic peptides derived from granulysin

Granulysin, a 9-kDa protein localized to human CTL and NK cell granules, is cytolytic against tumor cells and microbes. Molecular modeling predicts that granulysin is composed of five alpha-helices separated by short loop regions. In this report, synthetic peptides corresponding to the linear granulysin sequence were characterized for lytic activity. Peptides corresponding to the central region of granulysin lyse bacteria, human cells, and synthetic liposomes, while peptides corresponding to the amino or carboxyl regions are not lytic. Peptides corresponding to either helix 2 or helix 3 lyse bacteria, while lysis of human cells and liposomes is dependent on the helix 3 sequence. Peptides in which positively charged arginine residues are substituted with neutral glutamine exhibit reduced lysis of all three targets. While reduction of recombinant 9-kDa granulysin increases lysis of Jurkat cells, reduction of cysteine-containing granulysin peptides decreases lysis of Jurkat cells. In contrast, lysis of bacteria by recombinant granulysin or by cysteine-containing granulysin peptides is unaffected by reducing conditions. Jurkat cells transfected with either CrmA or Bcl-2 are protected from lysis by recombinant granulysin or the peptides. Differential activity of granulysin peptides against tumor cells and bacteria may be exploited to develop specific antibiotics without toxicity for mammalian cells.

Consensual validation of clinical practice model practice guidelines

Clinical Practice Model (CPM) Practice Guidelines facilitate the delivery of consistent, high-quality patient care by clarifying nursing services and supporting the practice and documentation of each step of the nursing process. CPM Practice Guidelines are unique because they are part of an integrated interactive systems thinking framework to support professional practice; they are reviewed and improved routinely using multiple sources of data and are used by hundreds of nurses daily throughout the United States and Canada. Guidelines are developed using a rigorous standardized format and process. Consensual validation is an important part of establishing and maintaining the credibility of these Guidelines.

A modular software system for computer-aided surgery and its first application in oral implantology

Development of complex software applications in image guided therapy (IGT) is often complicated by the fact that providing basic functionality for image processing and user interaction from a graphical user interfaces (GUI) requires considerable manpower for software development. We present a programming environment that combines the high-level image processing library AVW, in-house developed patient-to-image registration procedures, and an interface to position measurement hardware. A specific application can be developed by using Tcl/Tk, a simple platform-independent scripting language, for GUI development. This environment was applied to developing VISIT, a navigation system for computer-aided implant dentistry. VISIT is presented as a result of this paper. Parts of the development environment were made accessible to the public. Future work includes the implementation of video input for connecting ultrasound or fluoroscopy units. We conclude that our approach is well suited to accelerate the development of exploratory new applications of IGT.

Effects of dehydration on phonation in excised canine larynges

The effects of exposure to dry air on phonation were measured in an ex vivo model of vocal fold vibration. Excised canine larynges were mounted on an apparatus and made to phonate at a constant subglottal pressure by means of unhumidified airflow. The phonation threshold pressure (PTP), glottal airflow, sound intensity of the acoustic output, and effects on vocal efficiency were also assessed. Student's t-test was performed on the results. In 17 larynges, the average PTP increased from 10.0 cm H2O to 15.0 cm H2O after exposure to dry airflow (p < .001). In addition, the average flow increased from 585 mL/s to 801 mL/s at a constant suprathreshold subglottal pressure (p < .001), and from 323 mL/s to 610 mL/s at the PTP (p < .001). The average acoustic output levels, measured during stable phonation segments, markedly decreased with exposure to the dry airflow, from 91.5 dB to 88.5 dB (p < .001). The average vocal efficiency decreased from 3.63 x 10(-4) to 7.00 x 10(-5) (p < .001). No such changes were seen in control larynges phonated with 100% humidified air used for driving the airflow. The results support previously reported modeling and experimental findings that dehydration of the vocal fold generally degrades laryngeal performance.

Epidemiology of human immunodeficiency virus-associated opportunistic infections in the United States in the era of highly active antiretroviral therapy

The incidence of nearly all AIDS-defining opportunistic infections (OIs) decreased significantly in the United States during 1992-1998; decreases in the most common OIs (Pneumocystis carinii pneumonia ¿PCP, esophageal candidiasis, and disseminated Mycobacterium avium complex ¿MAC disease) were more pronounced in 1996-1998, during which time highly active antiretroviral therapy (HAART) was introduced into medical care. Those OIs that continue to occur do so at low CD4+ T lymphocyte counts, and persons whose CD4+ counts have increased in response to HAART are at low risk for OIs, a circumstance that suggests a high degree of immune reconstitution associated with HAART. PCP, the most common serious OI, continues to occur primarily in persons not previously receiving medical care. The most profound effect on survival of patients with AIDS is conferred by HAART, but specific OI prevention measures (prophylaxis against PCP and MAC and vaccination against Streptococcus pneumoniae) are associated with a survival benefit, even when they coincide with the administration of HAART. Continued monitoring of incidence trends and detection of new syndromes associated with HAART are important priorities in the HAART era.

Aerodynamic measurements of patients with Parkinson's disease

Patients with Parkinson's disease commonly complain of voice dysfunction. Most of these complaints can be attributed to the known muscular control disorders that occur with Parkinson's disease. However, the manifestations of Parkinson's disease muscular dysfunction on parameters of phonation such as airflow, laryngeal resistance, and subglottal pressure necessary to sustain phonation have not been reported. The purpose of this study was to examine the aerodynamic characteristics of flow, laryngeal resistance, and phonation pressure threshold in a heterogeneous population of patients with Parkinson's disease who had varying voice complaints and to compare the data to similar studies for human subjects who have no voice complaints. The studies used a noninvasive method of detecting flow and acoustic signal from the lips, oral cavity and nose during phonation and used an external flow interruption technique to estimate subglottal pressure and phonation threshold pressure. About one third of the patients could not produce phonation at regular and loud intensities that were comfortable for normal subjects. The mean subglottal pressure (SGP) of patients with Parkinson disease who could produce 3 levels of intensity comparable to normal subjects was significantly higher than the mean SGPs for normal subjects for the same intensities of vocal production. The mean flow rates measured from patients with Parkinson's disease at the same 3 intensities of phonation was not significantly greater than in normal subjects. This indicated that the mean laryngeal resistance calculated for patients with Parkinson's disease was notably and significantly greater than mean laryngeal resistance calculated for normal subjects at the same intensity levels. The mean vocal efficiency (VE) for normal subjects was not significantly different than the mean VE for patients with Parkinson's disease, because greater pressure was used to generate similar flow and acoustic energy. These findings correlate with the perception of patients with Parkinson's disease that they are working harder to produce phonation. The observation of notably greater laryngeal resistance and phonation threshold pressure in patients with Parkinson's disease suggests that further studies of the glottic aperture in patients with Parkinson' disease may be useful for understanding how this common motor disorder disturbs phonation.

Split flexor pollicus longus tendon transfer for stabilization of the thumb interphalangeal joint: a cadaveric and clinical study

The split flexor pollicus longus (FPL) tendon transfer is a surgical technique using the radial half of the FPL tendon rerouted dorsally and inserted into the extensor pollicis longus tendon for correction of Froment's sign. A cadaveric model was designed to investigate the effects of the split FPL tendon transfer on pinch strength. Pinch strength was compared for extrinsic thumb flexion (1) without the split FPL and (2) with the split FPL, tensioned at 3 different positions (0 degrees flexion, 30 degrees flexion, and 60 degrees flexion). We report the clinical results of key pinch strength using split FPL tendon transfer as part of thumb reconstruction for 12 thumbs in 10 patients at an average follow-up time of 2 years. The cadaveric study showed no significant difference in pinch force between specimens with or without split FPL transfer or when comparing tensioning at 0 degrees versus 30 degrees versus 60 degrees. Froment's sign wa s reproduced in all cadavers with pinch activation without split FPL transfer and was eliminated in all specimens after the split FPL transfer. In the clinical portion of this study 12 transfers in 10 patients had an average follow-up pinch strength of 33.7 N (range, 18-80 N) and no evidence of Froment's sign. We conclude that the split FPL tendon transfer is an effective method for correction of Froment's sign due to intrinsic paralysis of the thumb.

Effect of dietary phosphorus on finishing steer performance, bone status, and carcass maturity

Yearling crossbred steers (n = 60; 386 kg) were individually fed in a completely randomized experimental design to determine their P requirement. Treatments were in a factorial arrangement with two levels of Ca (.35 or .70% of DM) and five concentrations of P (.14, .19, .24, .29, or .34% of DM). The finishing diet consisted of 34.5% dry-rolled corn, 22.5% brewers grits, 22.5% corn bran, 7.5% ground corncobs, 5% molasses, 3% fat, and 5% supplement. Supplemental P was provided as monosodium phosphate and Ca as limestone. Ash content was determined on the first phalanx bone from the lower front legs following slaughter, and rib bone breaking strength was determined with an Instron Universal Testing Machine. Carcass maturity and shear force were also evaluated on wholesale rib cuts. Because no interactions between Ca and P levels were detected, only main effects are presented. Daily gain, DMI, and feed efficiency were not affected by dietary P concentration or P intake. Bone ash (g or g/100 kg BW) and rib bone breaking strength were also unaffected by dietary P. Feeding .7% Ca decreased (P<.06) ADG and efficiency compared with feeding .35% Ca. Neither dietary Ca nor P had a significant effect on tenderness (shear force), skeletal maturity, or overall maturity. These results indicate that the P requirement for finishing yearlings is .14% of diet DM or less and that supplementing P above levels supplied by basal ingredients in many grain-based finishing diets is not necessary.

Clinical evaluation of an automated turning bed

PURPOSE

The purposes of this study were to assess client comfort and sleep quality, client physiologic response (skin and respiratory status), the effect on the need for caregiver assistance, and cost when using an automated turning bed.

DESIGN

Nonexperimental, evaluative study.

SAMPLE

Twenty-four adult home or long-term care resident subjects who had a degenerative disease, spinal cord injury, stroke, cerebral palsy, or back surgery.

METHODS

Each subject agreed to use the automated turning bed for four weeks. Researchers completed a demographic survey and skin assessment, and assessed each subject for pressure ulcer risk and for the need of assistance of a care giver for turning before and after the four weeks of using the turning bed. Subjects rated the turning bed in terms of comfort and sleep quality.

FINDINGS

Subjects rated the turning bed as more comfortable than their own bed and expressed satisfaction at the pain relief attained when on the turning bed. While using the turning bed, there was a significant improvement in sleep quality. No skin breakdown or deterioration in respiratory status occurred. Fewer subjects required the assistance of a caregiver for turning when on the turning bed.

CONCLUSION

This automated turning bed shows great promise in meeting a need for patients with limited mobility whether they are homebound or in a residential community.

IMPLICATIONS FOR NURSING RESEARCH

Future studies that further investigate use of the turning bed for postoperative back patients while still in the acute care setting are indicated. Replicative studies with a larger sample size are also indicated.

Phonation threshold pressure measurements during phonation by airflow interruption

OBJECTIVE/HYPOTHESIS

Most methods to measure phonation threshold pressure (PTP) are clinically impractical because they are invasive. This report concerns an airflow interruption system developed to allow noninvasive estimation of (PTP) at different levels of vocal intensity. An estimation of PTP was made for normal subjects with normal larynges and no voice complaints and for individuals who had dysphonia associated with vocal polyps to compare the estimated minimal pressure across the glottis that was required to sustain phonation in the two conditions.

STUDY DESIGN

This was a methodological study designed to measure an unanticipated PTP from a subject.

METHODS

Subjects sustained a constant tone and the airflow was directed into a section of pipe with an airtight mask over the mouth and nose. The airflow, intramask pressure, and intensity of the acoustic output were recorded. A PTP was predicted from a difference between an estimate of the subglottal pressure and the vocal tract pressure at the point that phonation ceased after interruption of airflow. Eleven control subjects and 13 patients with vocal fold polyps were studied. In each population there were eight men and five women. The individuals in the group with vocal fold polyps averaged 39 years of age, and the control subject group averaged 49 years of age. Normal subjects produced a steady vowel /a/ at 75, 80, and 85 dB. Patients with polyps were unable to sustain phonation at these levels but were able to produce phonation at 65, 70, and 75 dB. The validity of the system was tested using a laryngeal model and in a patient with a normal larynx and voice who had a tracheotomy (placed for sleep apnea syndrome) which allowed direct measurement of subglottal pressure.

RESULTS

The measured mean PTP levels (with standard deviation [SD]) for the control subjects were 2.38 (1.273), 2.67 (1.879), and 2.98 (2.23) cm H2O at 75, 80, and 85 dB, respectively. The measured mean PTP levels (with SD) for the patients with polyps were 4.79 (2.67), 5.85 (2.34), and 7.37 (3.26) cm H2O at 75, 80, and 85 dB, respectively. The differences in mean PTP between groups at 75, 80, and 85 dB were significant at P = .013, P = .017, and P = .010, respectively.

CONCLUSIONS

The estimations of PTP for patients with vocal fold polyps were significantly higher than for the control subjects at three phonation levels.

The effects of rehydration on phonation in excised canine larynges

Experiments using excised canine larynges were conducted to study the restoration of vocal efficiency in dehydrated larynges. Excised larynges were dehydrated with warm, dry air to the point that airflow through the approximated vocal folds would not entrain the folds to produce phonation. The dehydrated vocal folds were then bathed in a saline solution. The rehydrated larynges were then remounted on the bench apparatus that enabled phonation with a constant humidified airflow, and measurements were made of phonation threshold pressure, glottal airflow, and amplitude. Hydration resulted in significantly increased efficiency and decrease in phonation threshold pressure. The findings confirm clinical impressions that hydration is critical in the physiology of normal phonation.

Two-dimensional wound measurement: comparison of 4 techniques

Two- and three-dimensional wound measurement techniques are documented in the literature and used clinically, as well as in research. The purpose of this study was to compare 4 two-dimensional wound measurement techniques: linear length and width using a ruler, planimetry, computerized stereophotogrammetry (SPG) length and width, and computerized SPG area. Three plaster of Paris wound models were developed and baseline measurements of outer wound perimeters obtained via a Coordinate Measuring Machine. The convenience sample of raters included 66 upper-division baccalaureate nursing students, graduate nursing students, nursing staff, and wound care nurses. Each rater measured each wound twice in a randomly assigned order of methods written on a card drawn from an envelope. The least biased technique was the computer area, followed in order by the computer length and width, planimetry, and ruler length and width. The most accurate technique, given multiple raters, was determined by the standard error of measurement. The smallest standard error of measurement, thus the most accurate, was the computer area technique, followed in order by the ruler length and width, computer length and width, and planimetry. Interrater reliability of average ratings was high; only the SPG area measurements for single ratings were reliable enough for clinical or research purposes. Intrarater reliability was high for methods with low interrater reliability, suggesting that nurses are consistent in the direction of personal error.

Lymphatic drainage after lumbar surgery

STUDY DESIGN

A case report of lymphatic drainage after anterior retroperitoneal debridement and reconstruction for lumbar osteomyelitis.

OBJECTIVES

To report a case of protracted lymphatic drainage after anterior lumbar surgery, a complication that has not been reported previously.

SUMMARY OF BACKGROUND DATA

Lymphatic drainage after transthoracic surgery is a well-recognized complication. The possibility of lymphatic drainage after anterior lumbar surgery is less likely to be considered.

METHODS

The cause, clinical symptoms and appearance, treatment, and differential diagnosis are reviewed.

RESULTS

Lymphangiography is useful in diagnosis and should be performed early if the diagnosis is in doubt. Percutaneous drainage can facilitate early wound healing.

CONCLUSION

Lymphatic drainage should be considered in the differential diagnosis of postoperative wound drainage, particularly after surgical debridement for osteomyelitis.

Subtraction ictal SPECT co-registered to MRI improves clinical usefulness of SPECT in localizing the surgical seizure focus

Traditional side-by-side visual interpretation of ictal and interictal single-photon emission computed tomography (SPECT) scans can be difficult in identifying the surgical focus, particularly in patients with extratemporal or otherwise unlocalized intractable epilepsy. Computer-aided subtraction ictal SPECT co-registered to MRI (SISCOM) may improve the clinical usefulness of SPECT in localizing the surgical seizure focus. We studied 51 consecutive intractable partial epilepsy patients who had interictal and ictal scans. The SPECT studies were blindly reviewed and classified as either localizing to 1 of 16 sites in the brain or as nonlocalizing. SISCOM images were localizing in 45 of 51 (88.2%) compared with 20 of 51 (39.2%) for traditional side-by-side inspection of ictal and interictal SPECT images (p < 0.0001). Inter-rater agreement for two independent reviewers was better for SISCOM (84.3% versus 41.2%, kappa = 0.83 versus 0.26; p < 0.0001). Concordance of seizure localization with the more established tests was also higher for SISCOM. Late injection of the radiotracer (> 45 seconds), but not secondary generalization of the seizure, was associated with a falsely localizing or nonlocalizing SISCOM. Epilepsy surgery patients whose SISCOM localization was concordant with a falsely localizing or nonlocalizing SISCOM. Epilepsy surgery patients whose SISCOM localization was concordant with the surgical site were more likely to have excellent outcome than patients with nonconcordant or nonlocalizing findings (62.5% [10/16] versus 20% [2/10]; p < 0.05). On the other hand, seizure localization by the traditional method of SPECT inspection had no significant association with postsurgical outcome. We conclude that SISCOM improves the sensitivity and the specificity of SPECT in localizing the seizure focus for epilepsy surgery. Concordance between SISCOM localization and site of surgery is predictive of postsurgical improvement in seizure outcome.