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.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

3D Simulations Capture the Persistent Low-Mode Asymmetries Evident in Laser-Direct-Drive Implosions on OMEGA

Spherical implosions in inertial confinement fusion are inherently sensitive to perturbations that may arise from experimental constraints and errors. Control and mitigation of low-mode (long wavelength) perturbations is a key milestone to improving implosion performances. We present the first 3D radiation-hydrodynamic simulations of directly driven inertial confinement fusion implosions with an inline package for polarized crossed-beam energy transfer. Simulations match bang times, yields (separately accounting for laser-induced high modes and fuel age), hot spot flow velocities and direction, for which polarized crossed-beam energy transfer contributes to the systematic flow orientation evident in the OMEGA implosion database. Current levels of beam mispointing, imbalance, target offset, and asymmetry from polarized crossed-beam energy transfer degrade yields by more than 40%. The effectiveness of two mitigation strategies for low modes is explored.

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.

Sugar or salt ("SOS"): A protocol for a UK multicentre randomised trial of mannitol and hypertonic saline in severe traumatic brain injury and intracranial hypertension

Hyperosmolar solutions are widely used to treat raised intracranial pressure following severe traumatic brain injury. Although mannitol has historically been the most frequently administered, hypertonic saline solutions are increasingly being used. However, definitive evidence regarding their comparative effectiveness is lacking. The Sugar or Salt Trial is a UK randomised, allocation concealed open label multicentre pragmatic trial designed to determine the clinical and cost-effectiveness of hypertonic saline compared with mannitol in the management of patients with severe traumatic brain injury. Patients requiring intensive care unit admission and intracranial pressure monitoring post-traumatic brain injury will be allocated at random to receive equi-osmolar boluses of either mannitol or hypertonic saline following failure of routine first-line measures to control intracranial pressure. The primary outcome for the study will be the Extended Glasgow Outcome Scale assessed at six months after randomisation. Results will inform current clinical practice in the routine use of hyperosmolar therapy as well as assess the impact of potential side effects. Pre-planned longer term clinical and cost effectiveness analyses will further inform the use of these treatments.

Intra-articular anaesthesia of the equine stifle improves foot lameness

BACKGROUND

Equine diagnostic anaesthesia can be a useful tool in challenging lameness examinations. However, anaesthetics diffuse over time leading to nonspecific desensitisation of periarticular structures. Nerves that convey sensation from the distal limb to the central nervous system pass in close proximity to the caudal stifle joint capsule. Therefore, diffusion of intra-articular (IA) anaesthetics could cause inadvertent desensitisation of the distal limb resulting in a false diagnosis of stifle lameness.

OBJECTIVES

To determine if IA stifle anaesthesia can alleviate lameness originating in the distal limb.

STUDY DESIGN

Crossover experiment.

METHODS

Nine horses were fitted with a circumferential hoof clamp to induce a moderate unilateral hindlimb lameness. Intra-articular stifle anaesthesia was performed and gait was evaluated every 10 min during the 90-min trial using an inertial sensor system. Push-off and landing components of the lameness were assessed by measuring the mean inter-stride difference between the maximum and minimum heights of the pelvis respectively. Differences were compared using a Wilcoxon signed-rank test.

RESULTS

Overall, horses with hoof clamp-induced foot pain had a reduction in push-off lameness after IA stifle anaesthesia. The mean change in diffmax at 90 min was -4.3 mm (P = 0.005) for the experimental group vs. -2.3 mm (P = 0.2) for the control group. Lameness decreased over time, with an average improvement of 23% at 30 min, 33% at 60 min and 38% at 90 min. There was high inter-horse variability; 3/9 horses improved by ~50% within 30 min, while 2/9 improved by ~30% and 4/9 had minimal (<10%) or no improvement in lameness. Improvement after IA stifle anaesthesia was not related to the severity of baseline lameness (P = 0.3-0.7).

MAIN LIMITATIONS

Limited clinical applicability of our lameness induction model.

CONCLUSIONS

Intra-articular stifle anaesthesia reduces foot lameness in a third of horses by up to 50% within 30 min. Clinically, the results of IA stifle anaesthesia should be considered in the light of these findings before treatment recommendations are made, as additional diagnostics may be required to rule out pain originating in the distal limb.

A landscape of hairy and twisted: hunting for new trichome mutants in the Saskatoon Arabidopsis T-DNA population

A total of 88 new Arabidopsis lines with trichome variation were recovered by screening 49,200 single-seed descent T3 lines from the SK activation-tagged population and from a new 20,000-line T-DNA insertion population (called pAG). Trichome variant lines were classified into 12 distinct phenotype categories. Single or multiple T-DNA insertion sites were identified for 89% of these mutant lines. Alleles of the well-known trichome genes TRY, GL2 and TTG1 were recovered with atypical phenotype variation not reported previously. Moreover, atypical gene expression profiles were documented for two additional mutants specifying TRY and GL2 disruptions. In remaining mutants, ten lines were disrupted in genes coding for proteins not implicated in trichome development, five were disrupted in hypothetical proteins and 11 were disrupted in proteins with unknown function. The collection represents new opportunities for the plant biology community to define trichome development more precisely and to refine the function of individual trichome genes.

Development and validation of a computer-based algorithm to identify foreign-born patients with HIV infection from the electronic medical record

OBJECTIVE

To develop and validate an efficient and accurate method to identify foreign-born patients from a large patient data registry in order to facilitate population-based health outcomes research.

METHODS

We developed a three-stage algorithm for classifying foreign-born status in HIV-infected patients receiving care in a large US healthcare system (January 1, 2001-March 31, 2012) (n = 9,114). In stage 1, we classified those coded as non-English language speaking as foreign-born. In stage 2, we searched free text electronic medical record (EMR) notes of remaining patients for keywords associated with place of birth and language spoken. Patients without keywords were classified as US-born. In stage 3, we retrieved and reviewed a 50-character text window around the keyword (i.e. token) for the remaining patients. To validate the algorithm, we performed a chart review and asked all HIV physicians (n = 37) to classify their patients (n = 957).We calculated algorithm sensitivity and specificity.

RESULTS

We excluded 160/957 because physicians indicated the patient was not HIV-infected (n = 54), "not my patient" (n = 103), or had unknown place of birth (n = 3), leaving 797 for analysis. In stage 1, providers agreed that 71/95 foreign language speakers were foreign-born. Most disagreements (23/24) involved patients born in Puerto Rico. In stage 2, 49/50 patients without keywords were classified as US-born by chart review. In stage 3, token review correctly classified 55/60 patients (92%), with 93% (CI: 84.4, 100%) sensitivity and 90% (CI: 74.3, 100%) specificity compared with full chart review. After application of the three-stage algorithm, 2,102/9,114 (23%) patients were classified as foreign-born. When compared against physician response, estimated sensitivity of the algorithm was 94% (CI: 90.9, 97.2%) and specificity 92% (CI: 89.7, 94.1%), with 92% correctly classified.

CONCLUSION

A computer-based algorithm classified foreign-born status in a large HIV-infected cohort efficiently and accurately. This approach can be used to improve EMR-based outcomes research.

Linkage to care following community-based mobile HIV testing compared with clinic-based testing in Umlazi Township, Durban, South Africa

OBJECTIVES

The aim of the study was to assess HIV prevalence, disease stage and linkage to HIV care following diagnosis at a mobile HIV testing unit, compared with results for clinic-based testing, in a Durban township.

METHODS

This was a prospective cohort study. We enrolled adults presenting for HIV testing at a community-based mobile testing unit (mobile testers) and at an HIV clinic (clinic testers) serving the same area. Testers diagnosed with HIV infection, regardless of testing site, were offered immediate CD4 testing and instructed to retrieve results at the clinic. We assessed rates of linkage to care, defined as CD4 result retrieval within 90 days of HIV diagnosis and/or completion of antiretroviral therapy (ART) literacy training, for mobile vs. clinic testers.

RESULTS

From July to November 2011, 6957 subjects were HIV tested (4703 mobile and 2254 clinic); 55% were female. Mobile testers had a lower HIV prevalence than clinic testers (10% vs. 36%, respectively), were younger (median 23 vs. 27 years, respectively) and were more likely to live >5 km or >30 min from the clinic (64% vs. 40%, respectively; all P < 0.001). Mobile testers were less likely to undergo CD4 testing (33% vs. 83%, respectively) but more likely to have higher CD4 counts [median (interquartile range) 416 (287-587) cells/μL vs. 285 (136-482) cells/μL, respectively] than clinic testers (both P < 0.001). Of those who tested HIV positive, 10% of mobile testers linked to care, vs. 72% of clinic testers (P < 0.001).

CONCLUSIONS

Mobile HIV testing reaches people who are younger, who are more geographically remote, and who have earlier disease compared with clinic-based testing. Fewer mobile testers underwent CD4 testing and linked to HIV care. Enhancing linkage efforts may improve the impact of mobile testing for those with early HIV disease.

Measurement of electron temperature of imploded capsules at the National Ignition Facility

The electron and ion temperatures of the imploded core plasma are two of the most important metrics of inertial confinement fusion experiments. We have developed a technique for inferring electron temperatures from the contrast of x-ray images observed through a group of x-ray filters. Generally, the plasma electron temperature exhibits spatial and temporal variations, so time-averaged and time-resolved measurements are expected to yield somewhat different results. By analyzing the intensity of images observed with both a time-integrated detector (imaging plates) and a time-resolved detector (gated micro-channel plate), we found the electron temperature observed from x-ray images to be systematically higher than the ion temperature inferred from fusion neutron spectroscopy.

Relationship between glycated haemoglobin levels and mean glucose levels over time

AIMS/HYPOTHESIS

HbA(1c), expressed as the percentage of adult haemoglobin that is glycated, is the most widely used measure of chronic glycaemia. Achieving near-normal HbA(1c) levels has been shown to reduce long-term complications and the HbA(1c) assay is recommended to determine whether treatment is adequate and to guide adjustments. However, daily adjustments of therapy are guided by capillary glucose levels (mmol/l). We determined the relationship between an accurate measure of mean glucose levels over time and the HbA(1c) level, and whether HbA(1c) can be expressed in the same units as self-monitoring results.

METHODS

Twenty-two participants with diabetes and three non-diabetic participants were included in this longitudinal observational study. Mean glucose levels were measured by continuous glucose monitoring (CGM), which measures interstitial glucose levels every 5 min, for 12 weeks. Capillary measurements were obtained four times per day to confirm the accuracy of CGM. HbA(1c) was measured at baseline and every 4 weeks.

RESULTS

The HbA(1c) results at weeks 8 and 12 correlated strongly (r = 0.90) with the CGM results during the preceding 8 and 12 weeks. A curvilinear (exponential) relationship and a linear regression captured the relationship with similarly high correlations, which allowed transformation of HbA(1c) values to a calculated mean glucose level.

CONCLUSIONS AND INTERPRETATION

HbA(1c) correlates closely with a complete measure of average glycaemia over the preceding 8-12 weeks. The translation of HbA(1c) to an average glucose level for reporting and management purposes is feasible.

A critical review of the inter-relationship between skin vulnerability and urinary incontinence and related nursing intervention

The literature reveals there has been limited critical discussion of the inter-relationship between urinary incontinence, the vulnerability of the skin and the clinical implications. This paper critically re-examines the literature to identify and apply relevant scientific principles and evidence to inform effective intervention. It includes background on the structure, function and disruption to the skin's barrier. The implications for fundamental and largely taken-for-granted nursing practices, such as washing the skin, are examined. The current state of knowledge is analysed, specifying the types of evidence available and its weaknesses, highlighting implications for a research agenda.

Students' opinion of tobacco control policies recommended for US colleges: a national survey

OBJECTIVE

Comprehensive tobacco control policies for US colleges and universities have been proposed by several groups in order to counter the rising use of tobacco by students enrolled in these institutions. Student opinion of these policies is not known, and concern about student opposition is one barrier that deters administrators from adopting the policies. This study measured student support for recommended college tobacco control policies.

DESIGN

Mailed survey of US college students (2001 Harvard School of Public Health College Alcohol Study).

SETTING

119 nationally representative, four-year colleges and universities in the USA.

PARTICIPANTS

10,904 randomly selected undergraduate students enrolled at participating schools.

MAIN OUTCOME MEASURES

Students' opinion of 7 proposed tobacco control policies.

RESULTS

A majority of students supported each policy. Over three quarters of students favoured smoke-free policies for all college buildings, residences, and dining areas, while 71% supported prohibiting tobacco advertising and sponsorship of campus social events, 59% favoured prohibiting tobacco sales on campus, and 51% supported smoke-free campus bars. All policies had more support among non-smokers than smokers (p < 0.001). Among smokers, support for policies was inversely related to intention to quit and intensity of tobacco consumption. Because college students' tobacco consumption is low, a majority of smokers favoured banning smoking in college buildings and dining areas and prohibiting tobacco marketing on campus.

CONCLUSIONS

Student support for proposed campus tobacco control policies is strong, even among smokers, and broadly based across demographic subgroups. These findings should provide reassurance to college administrators who are considering adopting these policies.

Tobacco use by Massachusetts public college students: long term effect of the Massachusetts Tobacco Control Program

OBJECTIVE

To assess tobacco use among Massachusetts public college students and compare students who attended high school in Massachusetts and were exposed to the Massachusetts Tobacco Control Program (MTCP) with students who attended high school outside Massachusetts and were unexposed to the programme.

DESIGN

Analysis of the 1999 Massachusetts College Alcohol Survey.

SETTING

Four year public colleges and universities in Massachusetts (n = 11).

SUBJECTS

1252 randomly selected students (response rate 56%).

MAIN OUTCOME MEASURES

Self report of current (past 30 day), past year, and lifetime use of cigarettes, cigars, and smokeless tobacco.

RESULTS

One third of students had used a tobacco product in the past month and 46.4% had used tobacco in the past year. Cigarettes accounted for most of this tobacco use. Total tobacco use was higher among males than females but cigarette smoking did not differ by sex. Tobacco use was lower among athletes and higher among students who used alcohol or marijuana. Current tobacco use was lower among public college students who had attended high school in Massachusetts compared with those who attended high school in another state (31.5% v 42.6%, p = 0.006). This difference persisted after adjustment for age, sex, race, parental education, and students' college residence (adjusted odds ratio (OR) 0.67, 95% confidence interval (CI) 0.46 to 0.97, p = 0.034).

CONCLUSION

Tobacco use is common among Massachusetts public college students. Students who were exposed to the MTCP during high school are less likely to use tobacco than their peers who were not exposed to this programme. The MTCP may have reduced tobacco use among this group of young adults.

Clinical predictors of prolonged delay in return of the international normalized ratio to within the therapeutic range after excessive anticoagulation with warfarin

BACKGROUND

An elevated international normalized ratio (INR) increases the risk for major hemorrhage during warfarin therapy. Optimal management of patients with asymptomatic elevations in INR is hampered by the lack of understanding of the time course of INR decay after cessation of warfarin therapy.

OBJECTIVE

To identify predictors of the rate of INR normalization after excessive anticoagulation.

DESIGN

Retrospective cohort study.

SETTING

Outpatient anticoagulant therapy unit.

PATIENTS

Outpatients with an INR greater than 6.0 were identified from August 1993 to September 1998. Patients in whom two doses of warfarin were withheld and a follow-up INR was obtained on the second calendar day were enrolled. No patient received vitamin K(1).

MEASUREMENTS

The INR was measured 2 days after an INR greater than 6.0 was recorded.

RESULTS

Of 633 study patients with an initial INR greater than 6.0, 232 (37%) still had an INR of 4.0 or greater after two doses of warfarin were withheld. Patients who required larger weekly maintenance doses of warfarin were less likely to have an INR of 4.0 or greater on day 2 (adjusted odds ratio per 10 mg of warfarin, 0.87 [95% CI, 0.79 to 0.97]). Other risk factors for having an INR of 4.0 or greater on day 2 included age (odds ratio per decade of life, 1.18 [CI, 1.01 to 1.38]), index INR (odds ratio per unit, 1.25 [CI, 1.14 to 1.37]), decompensated congestive heart failure (odds ratio, 2.79 [CI, 1.30 to 5.98]), and active cancer (odds ratio, 2.48 [CI, 1.11 to 5.57]).

CONCLUSIONS

Steady-state warfarin dose, advanced age, and extreme elevation in INR are risk factors for prolonged delay in return of the INR to within the therapeutic range. Decompensated congestive heart failure and active cancer greatly increase this risk.

Color Doppler imaging of untreated and irradiated choroidal melanomas

PURPOSE

We examined untreated and irradiated choroidal melanomas with color Doppler imaging (CDI), a noninvasive method providing quantitative measures of blood flow, to determine if the tumor vessel damage associated with irradiation can be detected using this technology.

METHODS

CDI was performed on 122 untreated and 76 previously irradiated tumors using a Q2000 color Doppler ultrasound unit. Spectral analysis was performed on all detectable vascular regions within the tumor to obtain estimates of the peak systolic and end diastolic flow velocities and resistive index ((syst-diast)/syst).

RESULTS

Vessels were detected in 93% of the untreated tumors and in 63% of the treated tumors (p<0.001, X2), and the median number of vascular regions found was higher among untreated tumors (3 vs 1, p=0.001, Wilcoxon Rank Sum). The effect of treatment status on the detection of tumor vessels was significant (p=0.039), controlling for age, sex, largest tumor pretreatment diameter, and tumor height at CDI in a logistic regression model. Mean resistive index was lower in the untreated tumors (0.53 vs 0.58, p=0.0050), controlling for tumor height and other covariates in an analysis of variance.

CONCLUSIONS

On examination with CDI, irradiated tumors had fewer detectable vascular regions and greater resistance to flow than untreated tumors, a pattern consistent with known radiation effects.

Cambial-region-specific expression of the Agrobacterium iaa genes in transgenic aspen visualized by a linked uidA reporter gene

The level of indole-3-acetic acid (IAA) was locally modified in cambial tissues of transgenic aspen (Populus tremula L. x Populus tremuloides Michx.). We also demonstrate the use of a linked reporter gene to visualize the expression of the iaa genes. The rate-limiting bacterial IAA-biosynthetic gene iaaM and the reporter gene for beta-glucuronidase (GUS), uidA, were each fused to the cambial-region-specific Agrobacterium rhizogenes rolC promoter and linked on the same T-DNA. In situ hybridization of the iaaM gene confirmed that histochemical analysis of GUS activity could be used to predict iaaM gene expression. Moreover, quantitative fluorometric analysis of GUS activity allowed estimation of the level of de novo production of IAA in transgenic lines carrying a single-copy insert of the iaaM, uidA T-DNA. Microscale analysis of the IAA concentration across the cambial region tissues showed an increase in IAA concentration of about 35% to 40% in the two transgenic lines, but no changes in the radial distribution pattern of IAA compared with wild-type plants. This increase did not result in any changes in the developmental pattern of cambial derivatives or the cambial growth rate, which emphasizes the importance of the radial distribution pattern of IAA in controlling the development of secondary xylem, and suggests that a moderate increase in IAA concentration does not necessarily stimulate growth.

A randomized controlled trial of varying radiation doses in the treatment of choroidal melanoma

OBJECTIVE

To determine if a reduction in proton radiation dose from the standard dose of 70 cobalt gray equivalents (CGE) to 50 CGE would decrease radiation-induced complications, thereby improving visual prognosis, without compromising local tumor control for patients with uveal melanoma at high risk of these complications.

DESIGN

Randomized, double-masked clinical trial.

PARTICIPANTS

A total of 188 patients with small or medium-sized choroidal melanomas (<15 mm in diameter and <5 mm in height) near the optic disc or macula (within 4 disc diameters of either structure).

METHODS

Patients were treated with proton beam therapy at doses of either 50 CGE or 70 CGE between October 1989 and July 1994, and followed up biannually through April 1998. Outcomes included visual acuity, radiation complications, melanoma recurrence, and metastasis.

RESULTS

Proportions of patients retaining visual acuity of at least 20/200 were similar in the 2 dose groups at 5 years after radiation (approximately 55%). Similar numbers of patients in each group experienced tumor regrowth (2 patients at 50 CGE vs 3 patients at 70 CGE; P>.99) and metastasis (7 patients at 50 CGE vs 8 patients at 70 CGE;P=.79). Five-year rates of radiation maculopathy also were similar (for both groups, approximately 75% for tumors within 1 disc diameter and 40% for tumors >1 disc diameter from the macula). Rates of radiation papillopathy were nonsignificantly decreased in the 50-CGE treatment group when tumors were located 1 disc diameter or less from the optic disc (P=.20). Patients treated with the lower dose also experienced significantly less visual field loss.

CONCLUSIONS

This level of dose reduction did not result in a lesser degree of visual acuity loss. The lower-dose group did experience significantly less visual field loss. Local tumor recurrence and metastatic death rates were similar in both dose groups. Arch Ophthalmol. 2000;118:773-778

Accurate and high resolution in situ hybridization analysis of gene expression in secondary stem tissues

Accurate in situ hybridization analysis in secondary stem tissues of plants has been hindered by specific characteristics of these tissues. First, secondary cell walls non-specifically bind probes used for in situ hybridization thus preventing gene expression analysis in the lignified regions of the stem, such as the xylem. Second, the mRNA in the cambial meristem and its recent derivatives are prone to inadequate fixation when conventional techniques are used. Here we describe an in situ hybridization technique which uses fast freezing and freeze substitution to cryoimmobilize the mRNA followed by embedding in a methacrylate resin for high-resolution analysis of gene expression. By using a transgenic poplar line harbouring rolC:uidA, rolC:iaaM, the gene expression pattern could be compared with histochemical GUS staining. This in situ hybridization technique results in superior preservation of cellular contents, retention of mRNA in all cell types in the poplar stem, a significant reduction of non-specific binding to secondary cell walls and a resolution not previously possible in secondary tissues. This technique will be particularly valuable for the expression analysis of genes involved in xylogenesis and wood formation.

Iris color as a prognostic factor in ocular melanoma

BACKGROUND

Ocular melanoma may be more prevalent among patients with light irises than those with dark irises.

OBJECTIVE

To examine a large clinical series of patients with intraocular melanoma to determine if light irises are associated with increased risk of death from these tumors.

METHODS

A total of 1162 patients treated with proton irradiation between 1984 and 1996 were observed through 1997.

RESULTS

Iris color in the patients was blue or gray in 48%, green or hazel in 30%, and brown in 23%. Tumors in patients with blue or gray irises were less heavily pigmented (P<.001) and closer to the optic disc and macula (P<.001). Five- and 10-year metastasis-related death rates were 0.14 and 0.21, respectively, for those with blue or gray irises and 0.10 and 0.15, respectively, for those with darker irises (P = .02). In a Cox proportional hazards regression controlling for tumor characteristics, patients with blue or gray irises died of metastatic disease at a rate 1.90 times (95% confidence interval, 1.26-2.85) that of patients with brown irises. The rate of metastatic death was not significantly elevated for those with green or hazel irises (relative risk, 1.43; 95% confidence interval, 0.91-2.23).

CONCLUSION

Patients with blue or gray irises appear to be at increased risk of metastatic death from choroidal melanoma, independent of other risk factors.

Gene discovery in the wood-forming tissues of poplar: analysis of 5, 692 expressed sequence tags

A rapidly growing area of genome research is the generation of expressed sequence tags (ESTs) in which large numbers of randomly selected cDNA clones are partially sequenced. The collection of ESTs reflects the level and complexity of gene expression in the sampled tissue. To date, the majority of plant ESTs are from nonwoody plants such as Arabidopsis, Brassica, maize, and rice. Here, we present a large-scale production of ESTs from the wood-forming tissues of two poplars, Populus tremula L. x tremuloides Michx. and Populus trichocarpa 'Trichobel.' The 5,692 ESTs analyzed represented a total of 3,719 unique transcripts for the two cDNA libraries. Putative functions could be assigned to 2,245 of these transcripts that corresponded to 820 protein functions. Of specific interest to forest biotechnology are the 4% of ESTs involved in various processes of cell wall formation, such as lignin and cellulose synthesis, 5% similar to developmental regulators and members of known signal transduction pathways, and 2% involved in hormone biosynthesis. An additional 12% of the ESTs showed no significant similarity to any other DNA or protein sequences in existing databases. The absence of these sequences from public databases may indicate a specific role for these proteins in wood formation. The cDNA libraries and the accompanying database are valuable resources for forest research directed toward understanding the genetic control of wood formation and future endeavors to modify wood and fiber properties for industrial use.

Characterization of an AGAMOUS homologue from the conifer black spruce (Picea mariana) that produces floral homeotic conversions when expressed in Arabidopsis

Advances in elucidating the molecular processes controlling flower initiation and development have provided unique opportunities to investigate the developmental genetics of non-flowering plants. In addition to providing insights into the evolutionary aspects of seed plants, identification of genes regulating reproductive organ development in gymnosperms could help determine the level of homology with current models of flower induction and floral organ identity. Based upon this, we have searched for putative developmental regulators in conifers with amino acid sequence homology to MADS-box genes. PCR cloning using degenerate primers targeted to the MADS-box domain revealed the presence of over 27 MADS-box genes within black spruce (Picea mariana), including several with extensive homology to either AP1 or AGAMOUS, both known to regulate flower development in Arabidopsis. This indicates that like angiosperms, conifers contain a large and diverse MADS-box gene family that probably includes regulators of reproductive organ development. Confirmation of this was provided by the characterization of an AGAMOUS-like cDNA clone called SAG1, whose conservation of intron position and tissue-specific expression within reproductive organs indicate that it is a homologue of AGAMOUS. Functional homology with AGAMOUS was demonstrated by the ability of SAG1 to produce homeotic conversions of sepals to carpels and petals to stamens when ectopically expressed in transgenic Arabidopsis. This suggests that some of the genetic pathways controlling flower and cone development are homologous, and antedate the 300-million-year-old divergence of angiosperms and gymnosperms.

Lens changes after proton beam irradiation for uveal melanoma

PURPOSE

Because limited data exist on the incidence of lens changes after therapeutic intraocular irradiation, we studied a group of patients who underwent proton irradiation for uveal melanoma, in order to estimate cumulative rates of radiation-induced posterior subcapsular opacities and age-related lens changes at specific time points. after irradiation.

METHODS

Cumulative rates for each type of opacity were estimated from among the 383 patients, treated between 1987 and 1989, who had clear lenses or minimal lens changes before irradiation. Cox's proportional hazards model was used to evaluate the independent effects of tumor and treatment-related characteristics on the development of posterior subcapsular opacities in these patients. Risk factors for posterior subcapsular opacities were evaluated.

RESULTS

By three years after irradiation, posterior subcapsular opacities had developed in 42% of the patients, and rates increased significantly with lens dose and with tumor height. The risk of posterior subcapsular opacities was over three times higher when the lens received a substantial dose of irradiation (adjusted relative risk, 3.25; 95% confidence interval, 1.60-6.59), as compared with minimal dose, and was three times higher when the tumor was highly elevated (adjusted relative risk, 3.05; 95% confidence interval, 1.45-6.40) as compared with minimally elevated lesions. Opacities in the other segments of the lens were age related.

CONCLUSIONS

These data show that patients receiving therapeutic intraocular irradiation have a high risk of developing posterior subcapsular opacities. As expected, the leading risk determinant of posterior subcapsular change is the amount of irradiation received by the lens.

Assuring the quality of in-home supportive services: an evolving challenge

This article reports on the Ohio Quality Assurance Project, a two year demonstration. The project developed a model quality assurance system for in-home supportive services funded by Title III of the Older Americans Act including home health aide, personal care, homemaker, transportation and escort, home delivered meals, chore and home maintenance services. Using four planning and service areas in the state of Ohio comprising over 40 countries, the project developed, implemented and evaluated quality assurance standards and monitoring activities for Older Americans Act services. In addition, a second part of the project included in-depth case studies with consumers receiving in-home care.

Cryptosporidium merozoite isolation and purification using differential centrifugation techniques

Simple modifications to a recently published merozoite purification procedure (Bjorneby et al., J. Immunol. 145:298, 1990) increased yields 3- to 5-fold. Calves were infected with 2.5 x 10(8) Cryptosporidium parvum oocysts and sacrificed 65 h post-infection. The ilium and caecum were removed. The tissue was sieved through a large strainer (2 mm2) to produce a homogeneous suspension. Red blood cells were removed by differential centrifugation (600 g); merozoites remained in the supernatant. The merozoites were pelleted (2,100 g) and washed in modified Hank's balanced salt solution deficient in Mg+2 and Ca+2. Percoll purification (density 1.070 g/ml and centrifugation speed of 22,000 g for 30 min) yielded 8 x 10(8) merozoites. Nineteen monoclonal antibodies (MAb) detected by either an enzyme-linked immunosorbent assay or an immunofluorescence assay, have been generated against the merozoite stage. Gels of proteins separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and silver-stained showed that sporozoites and merozoites have many common lower molecular weight proteins. Western blots of sporozoite and merozoite antigens reacted with anti-sporozoite MAb showed several cross-reacting antigens shared by these life-cycle stages.

Patient equipment management: integrating a flexible alternative to purchase or lease

As hospital CSS and OR departments work together to manage patient equipment, alternatives to purchase are available that can provide them with needed flexibility and responsiveness. A rental equipment provider that can meet the standards demanded for quality health care can become a valuable asset when developing and refining a hospitalwide equipment management program. But in order to receive the level of quality and service they should expect, hospitals must continually communicate their changing needs while holding their providers accountable to established standards.