Experimental testing of a prototype cantilevered liquid-nitrogen-cooled silicon mirror

This report presents testing of a prototype cantilevered liquid-nitrogen-cooled silicon mirror. This mirror was designed to be the first mirror for the new soft X-ray beamlines to be built as part of the Advanced Light Source Upgrade. Test activities focused on fracture, heat transfer, modal response and distortion, and indicated that the mirror functions as intended.

169 Clinical Outcomes of Radial Head Arthroplasty as Primary Treatment for Post-traumatic Mason Type 3 and 4 Fractures: A Long-term Follow-up

Aim

Radial head arthroplasty (RHA) is the favoured treatment for complex radial head fractures, enabling functional restoration of elbow kinematics. However, study of long-term outcomes associated with RHA is largely neglected. This study aimed to fill the gap in the literature by firstly, assessing functional outcomes, and secondly, determining complications and rates of revision and/or removal of prosthesis associated with RHA, at our district general hospital.

Method

We retrospectively reviewed a consecutive single-surgeon series of patients receiving RHA as primary treatment for radial head fractures graded either 3 or 4 according to the Mason-Johnston classification between 2004 and 2009. Function at final follow-up was assessed using Quick Disabilities of the Arm, Shoulder and Hand (q-DASH) score and Mayo Elbow Performance Score (MEPS).

Results

16 patients identified; 12 available for final follow-up. Mean follow-up time of 12.60 years (range: 10.67-16.08). Mean q-DASH score of 8.2 (range: 0-34.1). Mean MEPS of 85.83 (range: 50-100) with 11 (91.67%) reporting excellent/good results. All complications occurred within the first year post-operatively. Stiffness was the most common (50%) complication, but additional procedures improved objective range of movement in affected patients. Only one patient required implant revision throughout follow-up, which was due to prosthesis subluxation in the first month.

Conclusions

This study is amongst the first to examine clinical outcomes associated with RHA with an average follow-up >12 years. Our results emphasise good functional restoration and low implant failure rate. Regular follow-up particularly in the early post-operative period is essential in detecting and resolving complications.

Building global development strategies for cf therapeutics during a transitional cftr modulator era

As CFTR modulator therapy transforms the landscape of cystic fibrosis (CF) care, its lack of uniform access across the globe combined with the shift towards a new standard of care creates unique challenges for the development of future CF therapies. The advancement of a full and promising CF therapeutics pipeline remains a necessary priority to ensure maximal clinical benefits for all people with CF. It is through collaboration across the global CF community that we can optimize the evaluation and approval process of new therapies. To this end, we must identify areas for which harmonization is lacking and for which efficiencies can be gained to promote ethical, feasible, and credible study designs amidst the changing CF care landscape. This article summarizes the counsel from core advisors across multiple international regions and clinical trial networks, developed during a one-day workshop in October 2019. The goal of the workshop was to identify, in consideration of the highly transitional era of CFTR modulator availability, the drug development areas for which global alignment is currently uncertain, and paths forward that will enable advancement of CF therapeutic development.

Conflict, Stereotypes and Masculinity in Australian and New Zealand Surfing

Surf board riding and surf life saving, two distinctively Australian and New Zealand sports were described in terms of important background features in an article published in the previous issue. Attention was drawn to the 1960s as a period in which conflict occurred between members of the two groups. Tensions between the groups have remained since that time. The present article examines aspects of these tensions in detail showing they have served to crystallise some inherent philosophical contrasts between each type of surfing activity. Data are presented as part of an examination of the many contrasts and tensions between the two groups. Despite the contrasts, the subculture of each surfing group share a similar characteristic masculinity. This article discusses this similarity as well as some of the continuing differences between each sport pattern.

The Institutionalization of Sport Forms

The institutionalization of sport forms is normally seen as involving such pro ceses as (increasing) bureaucratization and formalization; leading to the characteriza tion of sport in terms such as "technical efficiency" and generally ''instrumental orientations" on the part of those involved. However there is nothing logically ine vitable in institutionalization processes leading sport progressively in these direc tions. Cases can be found — even in compleN industrial societies — in which value patten,s emphasizing non-competitivveness and rejecting high degrees of formaliza tion and organization are institutionalized.

This article discusses the institutionalization of sport in terms of two contrasting types of sport subculture; play-sport subcultures and athletic-sport subcultures. Certain conditions are identified which are conducive to the development of each of these "types" of sport.

Cultural Interpretation in Sport: The Outside World and Pictures Inside Heads

This paper aims to give an evaluation of cultural interpretations of sport. There are four parts to the paper, each concerned with a somewhat different aspect of that central task. Part One — overviews some problems in cultural conceptualization and discusses a number of metatheoretical issues involved in cultural analysis. Part Two — gives a brief overview of some of the sociology or sport literature making use of cultural frameworks. Part Three — draws on both previous parts in suggesting the subculture concept is useful in overcoming some of the deficiencies of cultural analysis and this leads to a discussion in the final part of the processes of negotiation which occur in sport settings and which generate, reconstitute or change oultural structures.

Prehospital oral chlorhexidine does not reduce the rate of ventilator-associated pneumonia among critically ill trauma patients: A prospective concurrent-control study

PURPOSE

The purpose of the study was to test the hypothesis that prehospital oral chlorhexidine administered to intubated trauma patients will decrease the Clinical Pulmonary Infection Score (CPIS) during the first 2 days of hospitalization.

MATERIALS AND METHODS

Prospective interventional concurrent-control study of all intubated adult trauma patients transported by air ambulance to a 711-bed Midwestern academic trauma center over a 1-year period. Patients transported by 2 university-based helicopters were treated with oral chlorhexidine after intubation, and the control group was patients transported by other air transport services.

RESULTS

Sixty-seven patients were enrolled, of which 23 received chlorhexidine (9 patients allocated to the intervention were not treated). The change in CPIS score was no different between the intervention and control groups by intention to treat (1.06- vs 1.40-point reduction, P = .520), and no difference was observed in tracheal colonization (29.0% vs 36.7%, P = .586). No differences were observed in the rate of clinical pneumonia (8.7% vs 8.6%, P = .987) or mortality (P = .196) in the per-protocol chlorhexidine group.

CONCLUSIONS

The prehospital administration of oral chlorhexidine does not reduce the CPIS score over the first 48 hours of admission for intubated trauma patients. Further study should explore other prehospital strategies of reducing complications of critical illness.

Duration of prehospital intubation is not a risk factor for development of early ventilator-associated pneumonia

PURPOSE

Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality among critically ill patients with trauma. Few VAP prevention strategies have been studied in the prehospital environment. The objectives of this study are to measure the association between duration of prehospital intubation and intubation location with subsequent incidence of early (within 5 days) VAP.

MATERIALS AND METHODS

Single-center retrospective cohort study of all intubated adult (age≥18 years) patients with trauma presenting to a 711-bed Midwestern Level I trauma center between January 2005 and December 2011 (n=860).

RESULTS

Thirty-five patients (6.4%) were diagnosed as having early VAP during the study period. Using multivariable logistic regression to adjust for age, injury severity score, and year (corresponding to VAP bundle implementation), the duration of intubation prior to hospital admission was not associated with subsequent diagnosis of VAP (adjusted odds ratio, 0.90 per hour; 95% confidence interval, 0.70-1.15). Location of intubation was similarly not associated with VAP.

CONCLUSIONS

Duration of prehospital intubation and intubation location were not different in patients with trauma who developed early VAP. Further prospective analyses should be conducted to better elucidate the effect of prehospital management on the development of traditionally in-hospital complications.

Guided self-help concreteness training as an intervention for major depression in primary care: a Phase II randomized controlled trial

BACKGROUND

The development of widely accessible, effective psychological interventions for depression is a priority. This randomized trial provides the first controlled data on an innovative cognitive bias modification (CBM) training guided self-help intervention for depression.

METHOD

One hundred and twenty-one consecutively recruited participants meeting criteria for current major depression were randomly allocated to treatment as usual (TAU) or to TAU plus concreteness training (CNT) guided self-help or to TAU plus relaxation training (RT) guided self-help. CNT involved repeated practice at mental exercises designed to switch patients from an unhelpful abstract thinking habit to a helpful concrete thinking habit, thereby targeting depressogenic cognitive processes (rumination, overgeneralization).

RESULTS

The addition of CNT to TAU significantly improved depressive symptoms at post-treatment [mean difference on the Hamilton Rating Scale for Depression (HAMD) 4.28, 95% confidence interval (CI) 1.29-7.26], 3- and 6-month follow-ups, and for rumination and overgeneralization post-treatment. There was no difference in the reduction of symptoms between CNT and RT (mean difference on the HAMD 1.98, 95% CI -1.14 to 5.11), although CNT significantly reduced rumination and overgeneralization relative to RT post-treatment, suggesting a specific benefit on these cognitive processes.

CONCLUSIONS

This study provides preliminary evidence that CNT guided self-help may be a useful addition to TAU in treating major depression in primary care, although the effect was not significantly different from an existing active treatment (RT) matched for structural and common factors. Because of its relative brevity and distinct format, it may have value as an additional innovative approach to increase the accessibility of treatment choices for depression.

Frequency of abdominal wall hernias: is classical teaching out of date?

Objectives

Abdominal wall hernias are common. Various authors all quote the following order (in decreasing frequency): inguinal, femoral, umbilical followed by rarer forms. But are these figures outdated? We investigated the epidemiology of hernia repair (retrospective review) over 30 years to determine whether the relative frequencies of hernias are evolving.

Design

All hernia repairs undertaken in consecutive adult patients were assessed. Data included: patient demographics; hernia type; and operation details. Data were analysed using Microsoft Excel 2007 and SPSS.

Setting

A single United Kingdom hospital trust during three periods: 1985–1988; 1995–1998; and 2005–2008.

Main outcome measures

Frequency data of different hernia types during three time periods, patient demographic data.

Results

Over the three time periods, 2389 patients underwent 2510 hernia repairs (i.e. including bilateral and multiple hernias in a single patient). Inguinal hernia repair was universally the commonest hernia repair, followed by umbilical, epigastric, para-umbilical, incisional and femoral, respectively. Whereas femoral hernia repair was the second commonest in the 1980s, it had become the fifth most common by 2005–2008. While the proportion of groin hernia repairs has decreased over time, the proportion of midline abdominal wall hernias has increased.

Conclusion

The current relative frequency of different hernia repair type is: inguinal; umbilical; epigastric; incisional; para-umbilical; femoral; and finally other types e.g. spigelian. This contrasts with hernia incidence figures quoted in common reference books.

Comparison of the MMSE and RUDAS cognitive screening tools in an elderly inpatient population in everyday clinical use

We compared test score and performance times of Folstein's Mini Mental State Examination (MMSE) and the Rowland Universal Dementia Assessment Scale (RUDAS). Forty-six patients were recruited. The mean score was 20.6 for the MMSE and 20.5 for the RUDAS. Linear regression analysis revealed an r value of 0.83 (P < 0.05). The mean performance time was 9.4 min for both the MMSE and the RUDAS. Patient satisfaction was similar for both tests. Surveyed clinicians preferred the MMSE because of greater familiarity. We concluded that the RUDAS correlates well with the MMSE and is no more time-consuming to perform. It has good clinical utility as a cognitive screening tool.

Buttock cellulitis as a presentation of psoas abscess: a clinical reminder

Cellulitis is a common condition that is frequently managed by the general physicians on an acute medical take. This case report describes buttock cellulitis as a presentation of an iliopsoas abscess and illustrates the importance of considering a deep abscess when there are atypical features, when the cellulitis is in an unusual location or when the patient fails to improve with standard anti-microbial therapy.

The population-based prevalence of achondroplasia and thanatophoric dysplasia in selected regions of the US

There have been no large population-based studies of the prevalence of achondroplasia and thanatophroic dysplasia in the United States. This study compared data from seven population-based birth defects monitoring programs in the United States. We also present data on the association between older paternal age and these birth defects, which has been described in earlier studies. The prevalence of achondroplasia ranged from 0.36 to 0.60 per 10,000 livebirths (1/27,780-1/16,670 livebirths). The prevalence of thanatophoric dysplasia ranged from 0.21 to 0.30 per 10,000 livebirths (1/33,330-1/47,620 livebirths). In Texas, fathers that were 25-29, 30-34, 35-39, and > or =40 years of age had significantly increased rates of de novo achondroplasia among their offspring compared with younger fathers. The adjusted prevalence odds ratios were 2.8 (95% CI; 1.2, 6.7), 2.8 (95% CI; 1.0, 7.6), 4.9 (95% CI; 1.7, 14.3), and 5.0 (95% CI; 1.5, 16.1), respectively. Using the same age categories, the crude prevalence odds ratios for de novo cases of thanatophoric dysplasia in Texas were 5.8 (95% CI; 1.7, 9.8), 3.9 (95% CI; 1.1, 6.7), 6.1 (95% CI; 1.6, 10.6), and 10.2 (95% CI; 2.6, 17.8), respectively. These data suggest that thanatophoric dysplasia is one-third to one-half as frequent as achondroplasia. The differences in the prevalence of these conditions across monitoring programs were consistent with random fluctuation. Birth defects monitoring programs may be a good source of ascertainment for population-based studies of achondroplasia and thanatophoric dysplasia, provided that diagnoses are confirmed by review of medical records.

Updated CCPS Investigation Guidelines book

Incident investigation standards and performance criteria continue to improve. In recognition, the Center for Chemical Process Safety (CCPS) undertook a major project to upgrade and update the Incident Investigation Guidelines originally published in 1992. These significantly expanded guidelines provide a practical resource for effective investigation of process-related incidents, and reflect changes in good practices and expectations of regulators. This paper highlights the content of the new guidelines with special emphasis on what is new and improved. Entirely new chapters address the topics of legal considerations, the near-miss event, and continuous improvement of the investigation system. The objective of the guidelines is to allow chemical process organizations to develop and implement an incident investigation management system that is effective in identifying underlying causes.

Motor systems

The field of motor control has broadened considerably over the past decade. Increasingly detailed information has accrued about the cellular and molecular processes involved in motor pattern generation and motor learning while, at the other extreme, the comparison of studies in humans and monkeys has begun to bridge the gap between cognitive and motor functions. The most striking feature of recent research has been the intense use of electrophysiological procedures in behaving monkeys and non-invasive imaging procedures in humans to elucidate details of sensory-motor transformations and the functional roles of different brain regions in the learning, planning and execution of movements.

Chimpanzee (Pan troglodytes) handedness: variability across multiple measures of hand use

This study examined intertask consistency in handedness across multiple measures of hand use in a sample of 187 chimpanzees (Pan troglodytes). Hand preferences for 2 to 6 measures were collected from the sample, and hand preference scores were derived on the basis of the individual hand preferences for each measure. Seven of 15 possible intratask correlations were significant, with some degree of clustering depending on the motor demands of the tasks. Two overall measures of handedness revealed population-level right-handedness in the chimpanzees, although the degree of bias was reduced for chimpanzees tested on more than 3 measures of hand use. The results are interpreted in the context of several recent studies that proposed theoretical models of handedness in nonhuman primates.

Surgical ICU underutilization does not significantly discourage discharge

An SICU must have sufficient capacity to handle peak weekly demand to prevent re-admission and/or poor quality of care. Excess capacity may, however, encourage unnecessary SICU utilization. The goal of this study was to assess the influence of availability of SICU beds on patient discharge and re-admission rates. The case series included 1,492 days, 36,816 patient days, 8,821 discharges, and 186 re-admissions within 3 days from a 24-bed multidisciplinary SICU at a tertiary care center. Census was defined to equal the total number of patients in the SICU each day. We found low census levels were not associated with significantly lower discharge rates. Decreasing the census from 19-24 to 13-18 patients per day decreased discharge rates from 31% to 30%. Odds ratio that a decrease in census by five from 24 decreased discharge rate equaled 1.01 (95% confidence interval 0.96 to 1.06). We conclude that when hospital managers choose an appropriate SICU capacity they need not be concerned that intermittent excess capacity will prompt physicians to significantly decrease their discharge rates.

A clinical intervention for children exposed to alcohol in utero

This study describes a statewide system of delivering special services to children affected by prenatal alcohol exposure and investigates the usefulness of this system as part of a statewide fetal alcohol syndrome surveillance system. The Alaska Department of Health and Social Services administered seven clinics in four of the five largest cities in Alaska during 1992-1995. Among the 74 children selected to be evaluated for fetal alcohol syndrome, 70 had one or more central nervous system abnormalities. Four children were assigned the diagnosis of fetal alcohol syndrome. Recommendations made to parents of the evaluated children included parent support group follow-up (38%), referral to a psychologist (35%), and further school testing and planning (27%). Clinics for alcohol-exposed children provide health officials an opportunity to deliver appropriate services to children exposed to alcohol in utero and to their families. Further studies are necessary to improve the delivery of services to birth mothers of alcohol-exposed children who attend the clinic. State-wide fetal alcohol syndrome surveillance can be accomplished by linking these clinics with other state data sources.

Waiting times: the search for equitable solutions. Case study: Mater Misericordiae Adult Public Hospital Continuum of Care Model

For the survival of any health care organisation, evidence-based practice is fundamental, particularly in today's economic climate. The Mater Misericordiae Adult Public Hospital in Brisbane is committed to providing a flexible health care system that is responsive and accountable to the needs of the customers. As part of the Mater's continuous quality improvement program, a Continuum of Care Service Delivery Model was developed. This model comprises many innovative clinical management systems which have evolved over recent years. Clinical pathways, care management, pre-admission clinics, variance management and evidence-based practice are core components of the model.

Ondansetron prevents postoperative nausea and vomiting in women outpatients

Three doses of intravenous (i.v.) ondansetron, 1 mg, 4 mg, and 8 mg, were compared to placebo for their antiemetic effect and safety. The drugs or placebo were administered in a double-blind manner, prophylactically to 589 women undergoing elective outpatient surgical procedures under nitrous oxide opioid-based general endotracheal anesthesia. In the postanesthesia care unit, the number of emetic episodes, periodic assessments of nausea severity using an 11-point scale (0 = no nausea; 10 = worst nausea), vital signs, and adverse events were collected by an independent observer for 2 h. Upon discharge, identical information, with the exception of vital signs, was collected from the patients' diary and via phone call. One pre- and two poststudy blood specimens for hematology and chemistries were evaluated. During the initial 2 h, patients receiving any dose of ondansetron had significantly better complete response rates (no emesis) than those receiving placebo. Over the 24-h study period, patients who received either 4 mg or 8 mg ondansetron continued to have significantly greater complete response rates. Adverse events were minor, and ondansetron-treated patients had profiles similar to those of the placebo. Heart rate, blood pressure, respiratory rate, and laboratory safety variables were not different among the groups. Ondansetron did not prolong awakening time. This study indicates that ondansetron is a safe and effective prophylactic antiemetic for women who have outpatient surgery under nitrous oxide opioid-based general anesthesia.

Torsional testing of Canal Master U hand instruments

Ten each of size 25, 30, 35, 40, and 45 Canal Master U hand instruments were tested for torsional failure and revolutions to failure. In addition, the point at which separation occurred was measured on the instrument shaft. An Instron 1125 machine was used for all torsion testing. The mean torque failure value for size 25 and 35 Canal Master U instruments exceeded the ADA specification No. 28 minimum values while sizes 30, 40, and 45 were below the ADA minimum average values. All Canal Master U averages for revolutions to failure exceeded the ADA minimums. Although size 25 was above the minimum average, due to a wide range of values, 5 of the 10 were below the ADA specification No. 28 values. The point of instrument separation was 0.325 to 1.575 mm behind the cutting head. Due to the structural design differences of endodontic files versus Canal Master U, it is suggested that an additional category of ADA specification be introduced for Canal Master endodontic instruments.

Validation of a self-administered questionnaire for assessing occupational and environmental exposures of pregnant women

The present investigation sought to determine whether a self-administered questionnaire could be used to obtain occupational information from pregnant women attending the obstetrical clinics at the University of California, San Francisco from July to November 1986. The authors compared the accuracy of responses of 57 women on the self-administered questionnaire with those obtained on a detailed clinical interview by an occupational health professional. The self-administered questionnaire and the clinical interview included information on the woman's job title, the type of company she worked for, the level of physical activity, her exposures on the job and at home, and her partner's occupation. The authors also examined whether the "validity" of the self-administered questionnaire could be improved on review by an industrial hygienist. The questionnaire took less than 20 minutes to complete, with over 90% of the women answering three-quarters of it. It was "substantially" accurate in obtaining information on number of hours worked during pregnancy, type of shift worked, and stress level in the workplace; exposure to radiation, video display terminals, fumes, gases, and cigarette smoke in the workplace; and exposure to pesticides, paint, and cigarette smoke at home. On those variables for which the responses on the self-administered questionnaire were less accurate, review by the industrial hygienist improved the level of accuracy considerably. These findings suggest that a self-administered questionnaire can be used to obtain valid information from pregnant women attending a prenatal clinic.

Toxic shock syndrome and the vaginal contraceptive sponge

Thirteen confirmed cases of toxic shock syndrome temporally related to use of the vaginal contraceptive sponge have been reported. The observed risk of toxic shock syndrome in sponge users may be elevated above estimated background rates, but this risk remains very low. Traumatic manipulation of the sponge, use during menstruation or the puerperium, and prolonged retention of the sponge may additionally increase toxic shock syndrome risk. As with all contraceptives, risks must be balanced against benefits.

Nucleotide sequence of the 5' noncoding region and part of the gag gene of mouse mammary tumor virus; identification of the 5' splicing site for subgenomic mRNAs

We have determined the sequence of the first 1371 nucleotides at the 5' end of the genome of mouse mammary tumor virus using molecularly cloned proviral DNA of the GR virus strain. The most likely initiation codon used for the gag gene of mouse mammary tumor virus is the first one, located 312 nucleotides from the 5' end of the viral RNA. The 5' splicing site for the subgenomic mRNA's is located approximately 288 nucleotides downstream from the 5' end of the viral RNA. From the DNA sequence the amino acid sequence of the N-terminal half of the gag precursor protein, including p10 and p21, was deduced (353 amino acids).

The pharmacist and adverse drug reaction reporting

During premarketing trials, the number of patients exposed to a drug and the length of exposure to a drug are both limited. After marketing, many thousands, frequently millions, of patients are exposed to the drug over considerably longer periods of time, and adverse drug reactions not previously recognized appear. Because of these factors, postmarketing surveillance is extremely important. Pharmacists can contribute to drug safety and improved patient care by understanding and actively participating in the Food and Drug Administration's Spontaneous Reporting Program.

The region of mouse mammary tumor virus DNA containing the long terminal repeat includes a long coding sequence and signals for hormonally regulated transcription

Starting from a biologically active recombinant DNA clone of exogenous unintegrated GR mouse mammary tumor virus, we have generated three subclones of PstI fragments of 1.45, 1.1, and 2.0 kb in the plasmid vector PBR322. The nucleotide sequence has been determined for the clone of 1.45 kb which includes almost the complete region of the long terminal repeat (LTR) plus an adjacent stretch of unique sequence DNA. A short region of the 2.0 kb clone, containing the beginning of the LTR, has also been sequenced. Starting with the A of an initiation codon outside the LTR, we detected an open reading frame of 960 nucleotides, potentially coding for a protein of 320 amino acids (36K). Two hundred nucleotides downstream from the termination codon, and approximately 25 nucleotides upstream from the presumptive initiation site of viral RNA synthesis, we found a promoter-like sequence. The sequence AGTAAA was detected approximately 15-20 nucleotides upstream from the 3' end of virion RNA and probably serves as a polyadenylation signal. The 1.45 kb PstI fragment has been transfected into Ltk- cells together with a plasmid containing the thymidine kinase gene of herpes simplex virus. The virus-specific RNA synthesis detected in a Tk+ cell clone was strongly stimulated by the addition of dexamethasone.