Coexistence of Surface Ferromagnetism and a Gapless Topological State in MnBi_{2}Te_{4}

Surface magnetism and its correlation with the electronic structure are critical to understanding the topological surface state in the intrinsic magnetic topological insulator MnBi_{2}Te_{4}. Here, using static and time resolved angle-resolved photoemission spectroscopy (ARPES), we find a significant ARPES intensity change together with a gap opening on a Rashba-like conduction band. Comparison with a model simulation strongly indicates that the surface magnetism on cleaved MnBi_{2}Te_{4} is the same as its bulk state. The inability of surface ferromagnetism to open a gap in the topological surface state uncovers the novel complexity of MnBi_{2}Te_{4} that may be responsible for the low quantum anomalous Hall temperature of exfoliated MnBi_{2}Te_{4}.

Australian consensus statements for the regulation, production and use of faecal microbiota transplantation in clinical practice

OBJECTIVE

Faecal microbiota transplantation (FMT) has proved to be an extremely effective treatment for recurrent Clostridioides difficile infection, and there is interest in its potential application in other gastrointestinal and systemic diseases. However, the recent death and episode of septicaemia following FMT highlights the need for further appraisal and guidelines on donor evaluation, production standards, treatment facilities and acceptable clinical indications.

DESIGN

For these consensus statements, a 24-member multidisciplinary working group voted online and then convened in-person, using a modified Delphi approach to formulate and refine a series of recommendations based on best evidence and expert opinion. Invitations to participate were directed to Australian experts, with an international delegate assisting the development. The following issues regarding the use of FMT in clinical practice were addressed: donor selection and screening, clinical indications, requirements of FMT centres and future directions. Evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.

RESULTS

Consensus was reached on 27 statements to provide guidance on best practice in FMT. These include: (1) minimum standards for donor screening with recommended clinical selection criteria, blood and stool testing; (2) accepted routes of administration; (3) clinical indications; (4) minimum standards for FMT production and requirements for treatment facilities acknowledging distinction between single-site centres (eg, hospital-based) and stool banks; and (5) recommendations on future research and product development.

CONCLUSIONS

These FMT consensus statements provide comprehensive recommendations around the production and use of FMT in clinical practice with relevance to clinicians, researchers and policy makers.

Phase diagram of Bi2Sr2CaCu2O8+δ revisited

In cuprate superconductors, the doping of carriers into the parent Mott insulator induces superconductivity and various other phases whose characteristic temperatures are typically plotted versus the doping level p. In most materials, p cannot be determined from the chemical composition, but it is derived from the superconducting transition temperature, Tc, using the assumption that the Tc dependence on doping is universal. Here, we present angle-resolved photoemission studies of Bi2Sr2CaCu2O8+δ, cleaved and annealed in vacuum or in ozone to reduce or increase the doping from the initial value corresponding to Tc = 91 K. We show that p can be determined from the underlying Fermi surfaces and that in-situ annealing allows mapping of a wide doping regime, covering the superconducting dome and the non-superconducting phase on the overdoped side. Our results show a surprisingly smooth dependence of the inferred Fermi surface with doping. In the highly overdoped regime, the superconducting gap approaches the value of 2Δ0 = (4 ± 1)kBTc.

Impact of unit-wide chlorhexidine bathing in intensive care on bloodstream infection and drug-resistant organism acquisition

BACKGROUND

Chlorhexidine gluconate (CHG) bathing has been reported to decrease bloodstream infections and colonisation of multidrug-resistant organisms (MROs) in intensive care units (ICUs). However, its effectiveness in an Australian setting has not been assessed.

OBJECTIVE

To test whether the introduction of ICU-wide CHG bathing in place of triclosan would affect rates of the primary outcome of central line-associated bloodstream infections (CLABSI), or the secondary outcomes of ICU-acquired positive blood cultures or other clinical specimens, and MRO colonisation including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE).

METHODS

We conducted a single-centre, sequential, before-and-after observational study. Patient microbiological and clinical data were compared in the 12 months before and after the introduction of CHG bathing in the ICU.

RESULTS

A total of 4262 ICU admissions were studied, 2117 before and 2145 during the CHG-bathing period. There were no significant changes in the rates of CLABSI (from 1.69/1000 central venous catheter-days [95% CI, 0.68-3.48] to 1.33 [95% CI, 0.49-2.90]; P = 0.68), or ICU-acquired positive blood cultures (from 5.14/1000 patientdays [95% CI, 3.45-7.39] to 4.45 [95% CI, 3.00-6.36]; P = 0.58). However, we observed a lower incidence of MRSA acquisition during the CHG-bathing period (mean difference, -2.13 [95% CI, -3.65 to -0.60] per 1000 patient-days; P = 0.007). There was no difference in the rate of isolates involving other pathogens including VRE.

CONCLUSIONS

In a tertiary Australian ICU, routine CHG bathing compared with triclosan did not affect the rates of ICU-acquired CLABSI or positive blood cultures. However, it significantly decreased the incidence of MRSA acquisition.

Mycobacterium chimaera and cardiac surgery

There is an ongoing investigation into infections with non-tuberculous mycobacteria associated with contaminated heater-cooler units used in cardiac surgery. The overall risk is low, but surgical site and disseminated infections have been reported, including one possible case in Australia, mainly with surgery involving implantation of prosthetic material. Mycobacterium chimaera infection should be considered in patients who have previously undergone surgery with cardiopulmonary bypass and who present with cardiac or disseminated infection or sternal wound infection unresponsive to standard antibiotic therapy. Where cases are suspected, patients should be investigated and managed in consultation with an infectious diseases physician and/or clinical microbiologist. If cases are confirmed or heater-cooler devices are found to be contaminated, details should be reported to the hospital infection control team, the jurisdictional health department, the Therapeutic Goods Administration and the Australian distributor of the affected heater-cooler unit(s). Measures to manage risk should include communicating with relevant hospital departments, ensuring that the manufacturer's updated instructions for use are followed, regular testing of machines, and reviewing the location of machines when in use.

Australian Group on Antimicrobial Resistance Australian Enterococcal Sepsis Outcome Programme annual report, 2014

From 1 January to 31 December 2014, 27 institutions around Australia participated in the Australian Enterococcal Sepsis Outcome Programme (AESOP). The aim of AESOP 2014 was to determine the proportion of enterococcal bacteraemia isolates in Australia that were antimicrobial resistant, and to characterise the molecular epidemiology of the Enterococcus faecium isolates. Of the 952 unique episodes of bacteraemia investigated, 94.4% were caused by either E. faecalis (54.9%) or E. faecium (39.9%). Ampicillin resistance was detected in 0.6% of E. faecalis and in 89.4% of E. faecium. Vancomycin non-susceptibility was reported in 0.2% and 46.1% of E. faecalis and E. faecium respectively. Overall 51.1% of E. faecium harboured vanA or vanB genes. For the vanA/B positive E. faecium isolates, 81.5% harboured vanB genes and 18.5% vanA genes. The percentage of E. faecium bacteraemia isolates resistant to vancomycin in Australia is significantly higher than that seen in most European countries. E. faecium consisted of 113 pulsed-field gel electrophoresis pulsotypes of which 68.9% of isolates were classified into 14 major pulsotypes containing 5 or more isolates. Multilocus sequence typing grouped the 14 major pulsotypes into clonal cluster 17, a major hospital-adapted polyclonal E. faecium cluster. The geographical distribution of the 4 predominant sequence types (ST203, ST796, ST555 and ST17) varied with only ST203 identified across most regions of Australia. Overall 74.7% of isolates belonging to the four predominant STs harboured vanA or vanB genes. In conclusion, the AESOP 2014 has shown enterococcal bacteraemias in Australia are frequently caused by polyclonal ampicillin-resistant high-level gentamicin resistant vanA or vanB E. faecium, which have limited treatment options.

Rural Stroke Caregivers: A Qualitative Study of the Positive and Negative Response to the Caregiver Role

Caregivers are often referred to as the "hidden patients." Rarely has caregiving research focused on the positive aspects of caregiving. The purpose of this study was to investigate the lived experiences of caregivers of stroke survivors who have been in the caregiver role for at least 6 months poststroke. The conceptual framework was based on a combination of Lazarus' stress and coping theory and Weiner's attribution theory. A qualitative cross-sectional design was employed. It involved a sample of 10 caregivers from a rural county in Wyoming. A total of 24 categories were identified and five themes emerged: (1) a sense of loyalty; (2) acceptance; (3) a sense of "feeling good"; (4) satisfaction is associated with helping others; and (5) burden is associated with lifestyle change. Participants in this study reported several positive outcomes as well as some negative outcomes in regard to their role as caregivers.

Spin-orbit interactions and the nematicity observed in the fe-based superconductors

High-resolution angle-resolved photoelectron spectroscopy is used to examine the electronic band structure of FeTe_{0.5}Se_{0.5} near the Brillouin zone center. A consistent separation of the α_{1} and α_{2} bands is observed with little k_{z} dependence of the α_{1} band. First-principles calculations for bulk and thin films demonstrate that the antiferromagnetic coupling between the Fe atoms and hybridization-induced spin-orbit effects lifts the degeneracy of the Fe d_{xz} and d_{yz} orbitals at the zone center leading to orbital ordering. These experimental and computational results provide a natural microscopic basis for the nematicity observed in the Fe-based superconductors.

The electron spectro-microscopy beamline at National Synchrotron Light Source II: a wide photon energy range, micro-focusing beamline for photoelectron spectro-microscopies

A comprehensive optical design for a high-resolution, high-flux, wide-energy range, micro-focused beamline working in the vacuum ultraviolet and soft x-ray photon energy range is proposed. The beamline is to provide monochromatic radiation to three photoelectron microscopes: a full-field x-ray photoelectron emission microscope and two scanning instruments, one dedicated to angle resolved photoemission spectroscopy (μ-ARPES) and one for ambient pressure x-ray photoelectron spectroscopy and scanning photoelectron microscopy (AP-XPS/SPEM). Microfocusing is achieved with state of the art elliptical cylinders, obtaining a spot size of 1 μm for ARPES and 0.5 μm for AP-XPS/SPEM. A detailed ray tracing analysis quantitatively evaluates the overall beamline performances.

Reconstructed Fermi surface of underdoped Bi2Sr2CaCu2O(8+δ) cuprate superconductors

The Fermi surface topologies of underdoped samples of the high-T(c) superconductor Bi2Sr2CaCu2O(8+δ) have been measured with angle resolved photoemission. By examining thermally excited states above the Fermi level, we show that the observed Fermi surfaces in the pseudogap phase are actually components of fully enclosed hole pockets. The spectral weight of these pockets is vanishingly small at the magnetic zone boundary, creating the illusion of Fermi "arcs." The area of the pockets as measured in this study is consistent with the doping level, and hence carrier density, of the samples measured. Furthermore, the shape and area of the pockets is well reproduced by phenomenological models of the pseudogap phase as a spin liquid.

Properties of hydrogen terminated diamond as a photocathode

Electron emission from the negative electron affinity (NEA) surface of hydrogen terminated, boron doped diamond in the [100] orientation is investigated using angle resolved photoemission spectroscopy (ARPES). ARPES measurements using 16 eV synchrotron and 6 eV laser light are compared and found to show a catastrophic failure of the sudden approximation. While the high energy photoemission is found to yield little information regarding the NEA, low energy laser ARPES reveals for the first time that the NEA results from a novel Franck-Condon mechanism coupling electrons in the conduction band to the vacuum. The result opens the door to the development of a new class of NEA electron emitter based on this effect.

Nonequilibrium band mapping of unoccupied bulk states below the vacuum level by two-photon photoemission

We demonstrate angle-resolved, tunable, two-photon photoemission (2PPE) to map a bulk unoccupied band, viz. the Cu sp band 0 to 1 eV below the vacuum level, in the vicinity of the L point. This short-lived bulk band is seen due to the strong optical pump rate, and the observed transition energies and their dispersion with photon energy ℏω, are in excellent agreement with tight-binding band-structure calculations. The variation of the final-state energy with ℏω has a measured slope of ∼1.64 in contrast to values of 1 or 2 observed for 2PPE from two-dimensional states. This unique variation illustrates the significant role of the perpendicular momentum ℏk_{⊥} in 2PPE.

Role of insecticides in reducing thrips injury to plants and incidence of tomato spotted wilt virus in Virginia market-type peanut

Tomato spotted wilt virus (family Bunyaviridae, genus Tospovirus, TSWV), transmitted by many thrips species, is a devastating pathogen of peanut, Arachis hypogaea L. TSWV has become a serious problem in the Virginia/Carolina peanut-growing region of the United States. During 2002, TSWV was present in 47% of the North Carolina hectarage and caused a 5% yield reduction in Virginia. Factors influencing levels of TSWV in runner market-type peanut cultivars, which are primarily grown in Alabama, Flordia, Georgia, and Texas, have been integrated into an advisory to help those peanut growers reduce losses. An advisory based on the southeast runner market-type version is currently under development for virginia market-type peanut cultivars that are grown primarily in the Virginia/ Carolina region. A version based on preliminary field experiments was released in 2003. One factor used in both advisories relates to insecticide use to reduce the vector populations and disease incidence. This research elucidated the influence of insecticides on thrips populations, thrips plant injury, incidence of TSWV, and pod yield in virginia market-type peanut. Eight field trials from 2003 to 2005 were conducted at two locations. In-furrow application of aldicarb and phorate resulted in significant levels of thrips control, significant reductions in thrips injury to seedlings, reduced incidence of TSWV, and significant increases in pod yield. Foliar application of acephate after aldicarb or phorate applied in the seed furrow further reduced thrips plant injury and incidence of TSWV and improved yield. These findings will be used to improve the current virginia market-type TSWV advisory.

High-energy kink observed in the electron dispersion of high-temperature cuprate superconductors

Photoemission studies show the presence of a high-energy anomaly in the observed band dispersion for two families of cuprate superconductors, Bi2Sr2CaCu2O8+delta and La 2-x BaxCuO4. The anomaly, which occurs at a binding energy of approximately 340 meV, is found to be anisotropic and relatively weakly doping dependent. Scattering from short range or nearest neighbor spin excitations is found to supply an adequate description of the observed phenomena.

Characteristics of pesticide pyrotechnic smoke devices

Pesticide smoke generating products are widely used by amateurs and professionals but there is little published information available about their burn and deposition characteristics to enable the risks associated with using these devices to be assessed. This paper investigates their burn characteristics, deposition patterns, pesticide air concentrations and potential exposure to operators. Thirteen firings were carried out in different spaces with different ventilation conditions. Three types of devices were investigated: dicloran, permethrin and red dye. Pesticide air concentrations increased after firing, reaching a maximum determined by the room volume in approximately 10 min and decreasing exponentially as a result of ventilation and deposition. Ejected pesticide was present in the aerosol phase but there were only occasional traces of vapour. Settlement of pesticide was affected by surface orientation, height, sampling material and the pesticide-to-space volume ratio. The manufacturer's recommended treatment period for dicloran of 4 h followed by half an hour of ventilation may be insufficient to reduce pesticide to safe levels for re-entry under very calm conditions.

Orbital dependence of the fermi liquid state in Sr2RuO4

We have used angle-resolved photoemission spectroscopy to determine the bulk electronic structure of Sr(2)RuO(4) above and below the Fermi liquid crossover near 25 K. Our measurements indicate that the properties of the system are highly orbital dependent. The quasi-2D gamma band displays Fermi liquid behavior while the remaining low energy bands show exotic properties consistent with quasi-1D behavior. In the Fermi liquid state below 25 K, the gamma band dominates the electronic properties, while at higher temperatures the quasi-1D beta and alpha bands become more important.

Effects of trichloroethylene and its metabolite trichloroacetic acid on the expression of vimentin in the rat H9c2 cell line

Trichloroethylene (TCE) and its metabolite trichloroacetic acid (TCAA) are environmental contaminants with specific toxicity for the embryonic heart. In an effort to identify the cellular pathways disrupted by TCE and TCAA during heart development, we investigated their effects on expression of vimentin, a marker of cardiac differentiation. Previous studies had shown that the level of vimentin transcript was inhibited in rat embryonic heart after maternal exposure to TCE via drinking water. In the same study, maternal exposure to TCAA produced the opposite effect, inducing an increased level of vimentin mRNA. In this study, we selected an in vitro system, the rat cardiac myoblast cell line H9c2, to further characterize the molecular mechanisms used by TCE and TCAA to disrupt normal heart development. In particular, we investigated the effects of both toxicants on vimentin, at both the RNA and protein levels, using dose-response and time course curves. Our experimental findings indicate that vimentin expression is affected by TCE and TCAA in H9c2 cells similarly as in vivo. The work is significant because it provides a suitable in vitro model for studies looking at toxicant effects on myocardiac cells, and it suggests that vimentin is a good marker of TCE exposure in the embryonic heart.

Operator exposure when applying amenity herbicides by all-terrain vehicles and controlled droplet applicators

A total of 33 surveys of amenity herbicides took place during 1998-1999. These surveys concentrated on two application methods: all-terrain vehicles (ATVs) and controlled droplet applicators (CDAs). The purpose of these surveys was to measure surface deposition and potential inhalation exposure of the operators to the spray fluid used. This paper recommends that the following indicative values should inform risk assessments for these types of application. ATV: The potential dermal exposure (PDE) to spray fluid (21 sample sets) ranged between 0.7 and 6.8 ml/h of spray fluid, median 2.0 ml/h based on patch samplers. Exposure to the hands, as collected on cotton gloves, ranged between 0.6 and 13.6 ml/h, median 3.0 ml/h. Potential exposure to spray fluid by inhalation was found in 85% of the samples, range 7-37 mg/m(3), median of non-zero values at 16 mg/m(3). CDA: The PDE to spray fluid (12 sample sets) ranged between 0.003 and 0.826 ml/h of fluid, median 0.133 ml/h, based on patch samplers. Exposure to the hands, as collected on cotton gloves inside protective gloves, ranged up to 0.06 ml/h, median 0.004 ml/h, and on socks ranged up to 0.05 ml/h, median 0.001 ml/h. Potential exposure by inhalation was low: detected in just 33% of the samples, range 0.02-0.61 mg/m(3), median 0.12 mg/m(3).

Quasiparticle line shape of Sr2RuO4 and its relation to anisotropic transport

The bulk-representative low-energy spectrum of Sr2RuO4 can be directly measured by angle-resolved photoemission. We find that the quasiparticle spectral line shape of Sr2RuO4 is sensitive to both temperature and momentum. Along the (0,0)-(pi,0) direction, both gamma and beta bands develop a sharp quasiparticle peak near k(F) at low temperatures, but as the temperature increases the spectra quickly lose coherent weight and become broad backgrounds above approximately 130 K, which is the metal-nonmetal crossover temperature, T(M), in the c-axis resistivity. However, spectra along the (0,0)-(pi,pi) direction evolve smoothly across T(M). A simple transport model can describe both in-plane and c-axis resistivity in terms of the quasiparticle line shape. Comparisons are also made to the cuprates, with implications for two dimensionality, magnetic fluctuations, and superconductivity.

Quasiparticle spectra, charge-density waves, superconductivity, and electron-phonon coupling in 2H-NbSe2

High-resolution photoemission has been used to study the electronic structure of the charge-density wave (CDW) and superconducting dichalcogenide, 2H-NbSe2. From the extracted self-energies, important components of the quasiparticle interactions have been identified. In contrast to previously studied TaSe2, the CDW transition does not affect the electronic properties significantly. The electron-phonon coupling is identified as a dominant contribution to the quasiparticle self-energy and is shown to be very anisotropic (k dependent) and much stronger than in TaSe2.

Coherence incoherence and dimensional crossover in layered strongly correlated metals

The properties of an interacting electron system depend on the electron correlations and the effective dimensionality. For example, Coulomb repulsion between electrons may inhibit, or completely block, conduction by intersite electron hopping, thereby determining whether a material is a metal or an insulator. Furthermore, correlation effects increase as the number of effective dimensions decreases; in three-dimensional systems, the low-energy electronic states behave as quasiparticles, whereas in one-dimensional systems, even weak interactions break the quasiparticles into collective excitations. Dimensionality is particularly important for exotic low-dimensional materials where one- or two-dimensional building blocks are loosely connected into a three-dimensional whole. Here we examine two such layered metallic systems with angle-resolved photoemission spectroscopy and electronic transport measurements, and we find a crossover in the number of effective dimensions from two to three with decreasing temperature. This is apparent from the observation that, in the direction perpendicular to the layers, the materials have an insulating character at high temperatures but become metal-like at low temperatures, whereas transport within the layers remains metallic over the whole temperature range. We propose that this change in effective dimensionality correlates with the presence of coherent quasiparticles within the layers.

Quasiparticle liquid in the highly overdoped Bi(2)Sr(2)CaCu(2)O(8+delta)

Results from the study of a highly overdoped (OD) Bi(2)Sr(2)CaCu(2)O(8+delta) with a T(c) = 51 K using angle-resolved photoemission spectroscopy are presented. We observe a sharp peak in the spectra near ( pi,0) that persists well above T(c), a nodal self-energy which approaches that seen for the Mo(110) surface state, and a more k-independent line shape at the Fermi surface than the lower-doped cuprates. This allows for a realistic comparison of the lifetime values to the experimental resistivity measurements. These observations point to the validity of the quasiparticle picture for the OD even in the normal state.

Peanut hull pellets as a single use sorbent for the capture of Cu(II) from wastewater

This paper investigates the ability of peanut hulls and peanut hull pellets to adsorb copper from dilute aqueous metal ion solutions in batch and fixed bed systems. The kinetics of copper uptake onto the media have been investigated in batch systems and the influence of pH and particle size on the rate and extent of copper capture determined. The Langmuir and Freundlich isotherm theories were determined; the Langmuir model was found to best represent the equilibrium isotherm data. In normalized kinetic tests at least 75% of copper removal occurred within the first 20 min; 92% removal was effected within the first 50 min. The rate of uptake was optimum within the pH range 5-7.5, and media capacities remained relatively constant at a pH above 4.0. Bench-scale column studies were performed using peanut hull pellets. The overall capacity of pelletized peanut hulls was higher than for unmodified peanut hulls. Due to their demonstrated ability for Cu(II) uptake and favorable structural characteristics, pelletized peanut hulls could gain use as a low-cost, once-through biomass filter medium for copper-bearing waste streams.

Treatment failure due to methicillin-resistant Staphylococcus aureus (MRSA) with reduced susceptibility to vancomycin

We report the first instance in Australia of treatment failure due to a strain of methicillin-resistant Staphylococcus aureus (MRSA) with reduced susceptibility to vancomycin--heteroresistant vancomycin-intermediate S. aureus (hVISA). The infection occurred in a 41-year-old man with multiple risk factors. No transmission of the organism to other patients or the environment was detected. This case may herald the beginning of a new phase of staphylococcal resistance in Australia.

Doping and temperature dependence of the mass enhancement observed in the cuprate Bi(2)Sr(2)CaCu(2)O(8+delta)

High-resolution photoemission is used to study the electronic structure of the cuprate superconductor, Bi(2)Sr(2)CaCu(2)O(8+delta), as a function of hole doping and temperature. A kink observed in the band dispersion in the nodal line in the superconducting state is associated with coupling to a resonant mode observed in neutron scattering. From the measured real part of the self-energy it is possible to extract a coupling constant which is largest in the underdoped regime, then decreasing continuously into the overdoped regime.

The regioselective aminohydroxylation of allylic carbamates

The synthesis and aminohydroxylation of a series of acyclic allylic carbamates is described: the formation of a putative O=Os=NR linkage between the transition metal and substrate is proposed to account for the high levels of regioselectivity that were observed; proof of the structure of one of the aminohydroxylation products was obtained through X-ray crystallography.

Determination of organo-zinc based fungicides in timber treatments employing gas chromatographic analysis with mass selective detection and/or inductively coupled plasma atomic emission spectroscopy

A method for the determination of zinc octoate (zinc 2-ethylhexanoate) and acypetacs zinc in occupational hygiene samples and wood treatments formulations is described. The zinc carboxylates are liquid-liquid partitioned between toluene and 1 M HCl, with the liberated acids being extracted into the toluene and zinc (chloride) into the acid. The carboxylic acids are then methylated using trimethylsilyldiazomethane-methanol and the resultant methyl esters are selectively and sensitively analysed by gas chromatography with mass selective detection (GC-MS). Alternatively, the zinc content of the acid extract can be analysed by inductively coupled plasma atomic emission spectroscopy (ICP-AES). GC-MS is the preferred method of analysis for zinc octoate, where a single analyte (methyl-2-ethylhexanoate) is produced for analysis. Because acypetacs zinc contains a complex mixture of carboxylates, quantitative GC-MS analysis of the methyl esters produced is impractical and ICP-AES is the preferred method for quantitation. In this case, GC-MS can be used to confirm the identity of the product used. The analysis of occupational hygiene samples (cotton pads, gloves and socks as well as Tenax tubes and GF/A filters) spiked with metal carboxylates is demonstrated. Recoveries around 70-90% and reproducibilities of 5-23% (n=6-8) were typically achieved for the determination of tin octoate (a surrogate for zinc octoate) at spiking levels ranging from 4 to 190 microg per sampling device. Recoveries around 102-106% and reproducibilities of 10-12% (n=5-6) were typically achieved for acypetacs zinc at spiking levels ranging from 100 mg per sampling device. Reaction yields for the octoate methylation reaction were in the region of 85-87%. The method was used to monitor for occupational exposure to zinc octoate and acypetacs zinc during the application of wood treatments to fences.

Trichloroethylene, trichloroacetic acid, and dichloroacetic acid: do they affect fetal rat heart development?

Trichloroethylene (TCE), trichloroacetic acid (TCA), and dichloroacetic acid (DCA) are commonly found as groundwater contaminants in many regions of the United States. Cardiac birth defects in children have been associated with TCE, and laboratory studies with rodents report an increased incidence of fetal cardiac malformations resulting from maternal exposures to TCE, TCA, and DCA. The objective of this study was to orally treat pregnant CDR(CD) Sprague-Dawley rats with large bolus doses of either TCE (500 mg/kg), TCA (300 mg/kg), or DCA (300 mg/kg) once per day on days 6 through 15 of gestation to determine the effectiveness of these materials to induce cardiac defects in the fetus. All-trans retinoic acid (RA) dissolved in soybean oil was used as a positive control. Soybean oil is commonly used as a dosing vehicle for RA teratology studies and was also used in this study as a dosing vehicle for TCE. Water was used as the dosing vehicle for TCA and DCA. Fetal hearts were examined on gestation day (GD) 21 by an initial in situ, cardiovascular stereomicroscope examination, and then followed by a microscopic dissection and examination of the formalin-fixed heart. The doses selected for TCA and DCA resulted in a modest decrease in maternal weight gain during gestation (3% to 8%). The fetal weights on GD 21 in the TCA and DCA treatment groups were decreased 8% and 9%, respectively, compared to the water control group and 21% in the RA treatment group compared to soybean oil control group. The heart malformation incidence for fetuses from the TCE-, TCA-, and DCA-treated dams did not differ from control values on a per fetus or per litter basis. The rate of heart malformations, on a per fetus basis, ranged from 3% to 5% for TCE, TCA, and DCA treatment groups compared to 6.5% and 2.9% for soybean oil and water control groups. The RA treatment group was significantly higher with 33% of the fetuses displaying heart defects. For TCE, TCA, and DCA treatment groups 42% to 60% of the litters contained at least one fetus with a heart malformation, compared to 52% and 37% of the litters in the soybean oil and water control groups. For the RA treatment group, 11 of 12 litters contained at least one fetus with a heart malformation. Further research is needed to quantify the spontaneous rates of heart defects for vehicle control rats and to explain the disparity between findings in the present study and other reported findings on the fetal cardiac teratogenicity of TCE, TCA, and DCA.

Maintenance of soft tissue changes after rigid versus wire fixation for mandibular advancement, with and without genioplasty

OBJECTIVE

This multisite prospective randomized clinical trial examined 2-year longitudinal soft tissue profile changes after bilateral sagittal split osteotomy for mandibular advancement by using rigid or wire fixation, with and without genioplasty.

STUDY DESIGN

The study sample consisted of 127 subjects. The rigid-fixation group (n = 78) received 2-mm bicortical position screws, whereas the wire-fixation group (n = 49) received inferior border wires. In the rigid-fixation group, 35 subjects underwent genioplasty, whereas 24 subjects underwent genioplasty in the wire-fixation group. Soft tissue profile changes of labrale inferius, B-point, and pogonion were obtained from digitized cephalometric films taken immediately before surgery and up to 2 years after surgery.

RESULTS

Regardless of fixation technique, subjects who had genioplasty in conjunction with the mandibular advancement had the largest surgical movement and the largest postsurgical change (P <.05). When all variables were constant, fixation technique was associated with maintenance of soft tissue change. Subjects who underwent rigid fixation maintained more soft tissue change than patients who underwent wire fixation.

CONCLUSIONS

These findings suggest that subjects undergoing rigid fixation and genioplasty maintained the most soft tissue advancement.

Mycobacterium ulcerans in wild animals

Mycobacterium ulcerans infection, or Buruli ulcer, is the third most frequent mycobacterial disease in humans, often causing serious deformities and disability. The disease is most closely associated with tropical wetlands, especially in west and central Africa. Most investigators believe that the aetiological agent proliferates in mud beneath stagnant waters. Modes of transmission may involve direct contact with the contaminated environment, aerosols from water surfaces, and water-dwelling fauna (e.g. insects). Person-to-person transmission is rare. Trauma at the site of skin contamination by M. ulcerans appears to play an important role in initiating disease. Once introduced into the skin or subcutaneous tissue, M. ulcerans multiplies and produces a toxin that causes necrosis. However, the type of disease induced varies from a localised nodule or ulcer, to widespread ulcerative or non-ulcerative disease and osteomyelitis. Although culture of M. ulcerans from a patient was first reported in 1948, attempts to culture the mycobacterium from many specimens of flora and fauna have been unsuccessful. Failure to cultivate this organism from nature may be attributable to inadequate sampling, conditions of transport, decontamination and culture of this fastidious heat-sensitive organism, and to a long generation time relative to that of other environmental mycobacteria. Nevertheless, recent molecular studies using specific primers have revealed M. ulcerans in water, mud, fish and insects. Although no natural reservoir has been found, the possibility that M. ulcerans may colonise microfauna such as free-living amoebae has not been investigated. The host range of experimental infection by M. ulcerans includes lizards, amphibians, chick embryos, possums, armadillos, rats, mice and cattle. Natural infections have been observed only in Australia, in koalas, ringtail possums and a captive alpaca. The lesions were clinically identical to those observed in humans. Mycobacterium ulcerans infection is a rapidly re-emerging disease in some developing tropical countries. The re-emergence may be related to environmental and socioeconomic factors, for example, deforestation leading to increased flooding, and population expansion without improved agricultural techniques, thus putting more people at risk. Eradication of diseases related to these factors is difficult. Whether wild animals have a role in transmission is an important question that, to date, has been virtually unexplored. To address this question, surveys of wild animals are urgently required in those areas in which Buruli ulcer is endemic.

Enterococcal vanB resistance locus in anaerobic bacteria in human faeces

While developing a rapid method to detect carriers of vancomycin-resistant enterococci (VRE), we found the vanB gene by PCR in 13 of 50 human faecal specimens that did not contain culturable VRE. Passaging under antibiotic selection allowed us to isolate two species of anaerobic bacteria that were vanB PCR positive, vancomycin resistant, and teicoplanin sensitive. Sequence analysis of the 16S rRNA genes showed that one isolate resembled Eggerthella lenta (98% identity), and the other Clostridium innocuum (92% identity). Southern hybridisation and nucleotide sequencing showed a vanB locus homologous to that in VRE. We propose that vanB resistance in enterococci might arise from gene transfer in the human bowel.

Immune response to infection with Mycobacterium ulcerans

Mycobacterium ulcerans is a slow-growing, acid-fast bacillus that causes chronic necrotizing skin ulcers known as Buruli ulcers. Previously reported information on immunity to this mycobacterium is limited. We examined immune responses to M. ulcerans and M. bovis BCG in patients with M. ulcerans disease and in 20 healthy control subjects (10 tuberculin test positive and 10 tuberculin test negative). Cell-mediated immunity was assessed by stimulating peripheral blood mononuclear cells (PBMC) with whole mycobacteria and then measuring PBMC proliferation and the production of gamma interferon (IFN-gamma). Humoral immunity was assessed by immunoblotting. PBMC from all subjects showed significantly greater proliferation and IFN-gamma production in response to stimulation with living mycobacteria compared with killed cells. However, PBMC from subjects with past or current M. ulcerans disease showed significantly reduced proliferation and production of IFN-gamma in response to stimulation with live M. ulcerans or M. bovis than PBMC from healthy, tuberculin test-positive subjects (P < 0.001) and showed results in these assays comparable to those of tuberculin test-negative subjects (P > 0.2). Serum from 9 of 11 patients with M. ulcerans disease, but no control subject, contained antibodies to M. ulcerans. The results indicate that patients with M. ulcerans infection mount an immune response to M. ulcerans as evidenced by antibody production, but they demonstrate profound systemic T-cell anergy to mycobacterial antigens. These findings may explain some of the distinct clinical and pathological features of M. ulcerans-induced disease.

A virtual medical record for guideline-based decision support

A major obstacle in deploying computer-based clinical guidelines at the point of care is the variability of electronic medical records and the consequent need to adapt guideline modeling languages, guideline knowledge bases, and execution engines to idiosyncratic data models in the deployment environment. This paper reports an approach, developed jointly by researchers at Newcastle and Stanford, where guideline models are encoded assuming a uniform virtual electronic medical record and guideline-specific concept ontologies. For implementing a guideline-based decision-support system in multiple deployment environments, we created mapping knowledge bases to link terms in the concept ontology with the terminology used in the deployment systems. Mediation components use these mapping knowledge bases to map data in locally deployed medical record architectures to the virtual medical record. We discuss the possibility of using the HL7 Reference Information Model (RIM) as the basis for a standardized virtual medical record, showing how this approach also complies with the European pre-standard ENV13606 for electronic healthcare record communication.

Charge-density-wave-induced modifications to the quasiparticle self-energy in 2H- TaSe2

The self-energy of the photohole in 2H-TaSe2 is measured by angle-resolved photoemission spectroscopy as a function of binding energy and temperature. In the charge-density wave (CDW) state, a structure in the self-energy is detected at approximately 65 meV that cannot be explained by electron-phonon scattering. A reduction in the scattering rates below this energy indicates the collapse of a major scattering channel with the formation of the CDW state accompanying the appearance of a bosonic "mode" in the excitation spectrum of the system.

Comparative genetic analysis of Mycobacterium ulcerans and Mycobacterium marinum reveals evidence of recent divergence

Previous studies of the 16S rRNA genes from Mycobacterium ulcerans and Mycobacterium marinum have suggested a very close genetic relationship between these species (99.6% identity). However, these organisms are phenotypically distinct and cause diseases with very different pathologies. To investigate this apparent paradox, we compared 3,306 nucleotides from the partial sequences of eight housekeeping and structural genes derived from 18 M. ulcerans strains and 22 M. marinum strains. This analysis confirmed the close genetic relationship inferred from the 16S rRNA data, with nucleotide sequence identity ranging from 98.1 to 99.7%. The multilocus sequence analysis also confirmed previous genotype studies of M. ulcerans that have identified distinct genotypes within a geographical region. Single isolates of both M. ulcerans and M. marinum that were shown by the sequence analysis to be the most closely related were then selected for further study. One- and two-dimensional pulsed-field gel electrophoresis was employed to compare the architecture and size of the genome from each species. Genome sizes of approximately 4.4 and 4.6 Mb were obtained for M. ulcerans and M. marinum, respectively. Significant macrorestriction fragment polymorphism was observed between the species. However, hybridization analysis of DNA cleaved with more frequently cutting enzymes identified significant preservation of the flanking sequence at seven of the eight loci sequenced. The exception was the 16S rRNA locus. Two high-copy-number insertion sequences, IS2404 and IS2606, have recently been reported in M. ulcerans, and significantly, these elements are not present in M. marinum. Hybridization of the AseI restriction fragments from M. ulcerans with IS2404 and IS2606 indicated widespread genome distribution for both of these repeated sequences. Taken together, these data strongly suggest that M. ulcerans has recently diverged from M. marinum by the acquisition and concomitant loss of DNA in a manner analogous to the emergence of M. tuberculosis, where species diversity is being driven mainly by the activity of mobile DNA elements.

Identification of Mycobacterium ulcerans in the environment from regions in Southeast Australia in which it is endemic with sequence capture-PCR

We recently described the use of PCR to identify the environmental source of Mycobacterium ulcerans during an outbreak of ulcerative disease that occurred in a localized region of southeast Australia. The PCR used was based on amplification of the M. ulcerans-specific insertion sequence, IS2404. In this study we developed a new test that is a substantial improvement over the original PCR method in terms of sensitivity, reliability, and ease of use. In the new method magnetic bead sequence capture-PCR is used to detect two M. ulcerans sequences (IS2404 and IS2606) and total mycobacterial 16S ribosomal DNA. We used sequence capture-PCR to test water and plant material collected over a 12-month period during 1998 and 1999 from sites near the centers of two distinct foci of M. ulcerans infections. A golf course irrigation system in one area and a small shallow lake in another area repeatedly were PCR positive for M. ulcerans. Nearby sites and sites unrelated to the endemic areas were negative. Based on the PCR data, a most-probable-number method was used to estimate the concentration of M. ulcerans cells in positive samples from both regions. This procedure resulted in average concentrations of 0.5 cell per 100 ml of water and 40 cells per 100 g of detritus. Loss of the PCR signal coincided with a decrease in ulcerative disease in each area. These results provide further evidence that M. ulcerans may be transmitted from a point environmental source and demonstrate the utility of magnetic bead sequence capture-PCR for identification of nonculturable microbial pathogens in the environment.

Temperature dependent scattering rates at the fermi surface of optimally doped Bi(2)Sr(2)CaCu(2)O(8+delta)

For optimally doped Bi(2)Sr(2)CaCu(2)O(8+delta), scattering rates in the normal state are found to have a linear temperature dependence over most of the Fermi surface. In the immediate vicinity of the (pi, 0) point, the scattering rates are nearly constant in the normal state, consistent with models in which scattering at this point determines the c-axis transport. In the superconducting state, the scattering rates away from the nodal direction appear to level off and become temperature independent.

Effect of anti-tuberculosis treatment on the tuberculin interferon-gamma response in tuberculin skin test (TST) positive health care workers and patients with tuberculosis

SETTING

Public hospital, Victoria, Australia.

OBJECTIVE

To evaluate the effect of multidrug treatment and isoniazid (INH) chemoprophylaxis on the tuberculin interferon-y assay (QIFN) in 19 patients with culture-confirmed Mycobacterium tuberculosis and 119 health care workers (HCWs) with tuberculin skin tests (TST) > or =15 mm.

DESIGN

Patients with M. tuberculosis were treated with standard medication and tested with QIFN at diagnosis and at regular intervals over a 12-month period. All HCWs, 59 (50%) of whom were prescribed INH chemoprophylaxis, were tested with QIFN at baseline, 2, 4, 6 and 12 months.

RESULTS

QIFN results in patients with tuberculosis were consistent and reproducible. At the initial time point QIFN assays were positive for M. tuberculosis in 67%, and once positive, the QIFN assay remained so over the 12-month period. In the HCWS, initial QIFN assays were positive in 73 (61%). During the 12-month study, 91 HCWs had a QIFN assay on at least two occasions. The overall reproducibility between tests was fair (kappa statistic = 0.45), and was little affected by administration of INH.

CONCLUSION

These data suggest that although the QIFN assay is generally positive in patients with proven tuberculosis, it does not provide clinically useful information during the first 12 months of treatment with multidrug chemotherapy or INH chemoprophylaxis.

A simple PCR method for rapid genotype analysis of Mycobacterium ulcerans

Two high-copy-number insertion sequences, IS2404 and IS2606, were recently identified in Mycobacterium ulcerans and were shown by Southern hybridization to possess restriction fragment length polymorphism between strains from different geographic origins. We have designed a simple genotyping method that captures these differences by PCR amplification of the region between adjacent copies of IS2404 and IS2606. We have called this system 2426 PCR. The method is rapid, reproducible, sensitive, and specific for M. ulcerans, and it has confirmed previous studies suggesting a clonal population structure of M. ulcerans within a geographic region. M. ulcerans isolates from Australia, Papua New Guinea, Malaysia, Surinam, Mexico, Japan, China, and several countries in Africa were easily differentiated based on an array of 4 to 14 PCR products ranging in size from 200 to 900 bp. Numerical analysis of the banding patterns suggested a close evolutionary link between M. ulcerans isolates from Africa and southeast Asia. The application of 2426 PCR to total DNA, extracted directly from M. ulcerans-infected tissue specimens without culture, demonstrated the sensitivity and specificity of this method and confirmed for the first time that both animal and human isolates from areas of endemicity in southeast Australia have the same genotype.

Attentional function in secondary school students receiving isoniazid prophylaxis for tuberculosis infection

Reports have suggested that isoniazid treatment may be associated with poor concentration and subtle reduction in memory. This study examines attentional function and processing speed in a group of 25 adolescents who received isoniazid prophylaxis for at least 6 months. As adolescents often face major educational assessment milestones, such cognitive side effects may have important implications. Participants were assessed before treatment, 1 month into treatment and at least 1 week after treatment cessation. Measures included the Paced Auditory Serial Addition Test and subtests of the appropriate Wechsler scale sensitive to attention and speed of information processing. Isoniazid does not appear to cause significant adverse effects on attentional function in adolescents.

Using scenarios in chronic disease management guidelines for primary care

The Prodigy system is a guideline-based decision-support system designed to assist general practitioners in England choose the appropriate therapeutic action for their patients. As part of the system, we developed a novel model for encoding clinical guidelines for managing patients with chronic diseases such as asthma and hypertension. The model structures a guideline as a set of choices to be made by the clinician. It models patient scenarios which drive decision making and are used to synchronize the management of a patient with guideline recommendations. The model is robust with respect to available input data and leaves the control of decision-making to the clinician. We have built execution engines to verify the computability of the model. We intend to test the model integrated in up to 200 live systems from at least four system vendors in English General practice.

Tuberculin-purified protein derivative-, MPT-64-, and ESAT-6-stimulated gamma interferon responses in medical students before and after Mycobacterium bovis BCG vaccination and in patients with tuberculosis

QuantiFERON-TB (QIFN) (CSL Limited) is a whole-blood assay for the recognition of infection with Mycobacterium tuberculosis. QIFN measures gamma interferon (IFN-gamma) production when purified protein derivatives (PPDs) of mycobacteria are incubated with venous blood samples. The specificity of QIFN in medical students before and after BCG immunization was assessed, and sensitivity in patients with tuberculosis was assessed. Antigens were PPD derived from M. tuberculosis and two M. tuberculosis-specific proteins, ESAT-6 and MPT-64. Of 60 medical students, all of whom had 0-mm tuberculin skin tests (TSTs) at study entry, 58 (97%) were initially classified as negative for M. tuberculosis infection by PPD QIFN. Five months after BCG immunization, 7 of 54 students (13%) had a TST result of >/=10 mm and 11 of 54 students (20%) tested positive by PPD QIFN. ESAT-6- and MPT-64-stimulated IFN-gamma responses in the medical students were negative prior to and after BCG immunization. For patients with active tuberculosis, 12 of 19 (63%) were positive by PPD QIFN, 11 of 19 (58%) were positive by ESAT-6 QIFN, and 0 of 12 were positive by MPT-64 QIFN. In conclusion, PPD QIFN was negative in 97% of a low-risk population who had not received BCG and who had negative TSTs. The specificities of both the TST and PPD QIFN were reduced following BCG immunization. PPD QIFN and ESAT-6 QIFN were of similar and moderate sensitivity in patients with active tuberculosis, but ESAT-6 QIFN is likely to be more specific because it is not influenced by past BCG exposure.

Evidence for quantum critical behavior in the optimally doped cuprate Bi(2)Sr(2)CaCu(2)O(8+delta)

The photoemission line shapes of the optimally doped cuprate Bi(2)Sr(2)CaCu(2)O(8+delta) were studied in the direction of a node in the superconducting order parameter by means of very high resolution photoemission spectroscopy. The peak width or inverse lifetime of the excitation displays a linear temperature dependence, independent of binding energy, for small energies, and a linear energy dependence, independent of temperature, for large binding energies. This behavior is unaffected by the superconducting transition, which is an indication that the nodal states play no role in the superconductivity. Temperature-dependent scaling suggests that the system displays quantum critical behavior.

Outcome of a screening program for vancomycin-resistant enterococci in a hospital in Victoria

OBJECTIVE

To screen for faecal colonisation with vancomycin-resistant enterococci (VRE) among potentially at-risk patients.

DESIGN

Infection control screening program.

SETTING

Monash Medical Centre (a tertiary care hospital), Melbourne, Victoria, in the seven months from June 1997.

PATIENTS

Patients in the Renal, Oncology and Intensive Care (ICU) Units.

MAIN OUTCOME MEASURES

Presence of VRE in a rectal swab or faecal specimen taken at admission and at regular intervals during inpatient stay; presence of vancomycin-resistance genes (vanA, vanB and vanC) assessed by polymerase chain reaction (PCR); genetic clonality of isolates assessed by pulsed-field gel electrophoresis (PFGE).

RESULTS

574 patients (356 renal, 134 ICU and 84 oncology) were screened; 12 were colonised with VRE--nine renal inpatients, two having peritoneal dialysis or incentre haemodialysis, and one ICU patient. Nine isolates were Enterococcus faecalis (seven positive for vanB and two negative for all three resistance genes) and three were Enterococcus faecium (all positive for vanB). Eight were high-level gentamicin resistant. PFGE suggested genetic clonality between the index isolate and five other isolates from renal patients. No specific clinical practice was associated with VRE colonisation. Attempts to clear rectal carriage with oral ampicillin/amoxycillin or bacitracin were of limited success. Although antibiotic prescribing in the Renal Unit was generally consistent with defined protocols, use of vancomycin and third-generation cephalosporins has been further restricted.

CONCLUSIONS

Renal inpatients in our institution appear most at risk of VRE colonisation (4.6% overall) and therefore of VRE infection. Routine screening, especially of potentially high-risk patients, should be considered in major Australian hospitals.

Respiratory symptoms and duration of residence in immigrant teenagers living in Melbourne, Australia

OBJECTIVE

Examination of the relation between respiratory symptoms and time since arrival in Australia in immigrant teenagers living in Melbourne.

DESIGN

Two stage, stratified, cross sectional survey.

SETTING

High schools (n = 51).

SUBJECTS

9794 people aged 13-19 years.

MAIN OUTCOME MEASURES

Prevalence of wheeze during a 12 month period, region of birth, duration of residence in Australia.

RESULTS

The estimated population 12 month period prevalence of wheeze was 18.9% (95% confidence interval (CI), 18.0 to 19.9). In subjects born outside Australia, residence for five to nine years in Australia was associated with a 2.1-fold (CI, 1.1 to 4.0) increase in the odds of self reported wheeze; after 10-14 years, this risk increased 3.4-fold (CI, 1.8 to 6.7). There was no difference in severity of wheeze, measured by reported frequency of attacks, between Australian born and non-Australian born subjects.

CONCLUSIONS

The notion of a continued secular increase in the prevalence of wheezing is not supported. There is a time dose effect on the prevalence of symptoms in subjects born outside Australia and now living in Melbourne, which is independent of age and country of birth.