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Our laboratory has previously demonstrated that application of an antimicrobial spray product containing titanium dioxide (TiO2) generates an aerosol of titanium dioxide in the breathing zone of the applicator. The present report describes the design of an automated spray system and the characterization of the aerosol delivered to a whole body inhalation chamber. This system produced stable airborne levels of TiO2 particles with a median count size diameter of 110 nm. Rats were exposed to 314 mg/m3 min (low dose), 826 mg/m3 min (medium dose), and 3638 mg/m3 min (high dose) of TiO2 under the following conditions: 2.62 mg/m3 for 2 h, 1.72 mg/m3 4 h/day for 2 days, and 3.79 mg/m3 4 h/day for 4 days, respectively. Pulmonary (breathing rate, specific airway resistance, inflammation, and lung damage) and cardiovascular (the responsiveness of the tail artery to constrictor or dilatory agents) endpoints were monitored 24 h post-exposure. No significant pulmonary or cardiovascular changes were noted at low and middle dose levels. However, the high dose caused significant increases in breathing rate, pulmonary inflammation, and lung cell injury. Results suggest that occasional consumer use of this antimicrobial spray product should not be a hazard. However, extended exposure of workers routinely applying this product to surfaces should be avoided. During application, care should be taken to minimize exposure by working under well ventilated conditions and by employing respiratory protection as needed. It would be prudent to avoid exposure to children or those with pre-existing respiratory disease. [ABSTRACT FROM AUTHOR]

In September 2003, a consortium of bioterrorism and health education experts from the University of Louisville, the University of Kentucky, the Kentucky Department for Public Health, and the Louisville Metro Health Department received funding from the Health Resources and Services Administration (HRSA) to develop a broadly based bioterrorism education program for health professionals in the Commonwealth of Kentucky and the surrounding region. This grant will fund a series of presentations tailored to the needs of professionals in medicine, dentistry, public health, nursing, behavioral medicine, allied health, pharmacy, veterinary medicine, and agriculture, providing coordinated training both on site and through distance learning technology. This article outlines the major grant-funded activities envisioned for the grant years 2003 through 2005, focusing on the use of standardized patients and computerized biosimulators, the transdisciplinary partnerships of the universities involved, and the essential collaboration provided by the state and local health departments. [ABSTRACT FROM AUTHOR]

Objective: To establish rates of and risk factors for cardiac complications after noncardiac surgery in veterans.Design: Prospective cohort study.Setting: A large urban veterans affairs hospital.Participants: One thousand patients with known or suspected cardiac problems undergoing 1,121 noncardiac procedures.Measurements: Patients were assessed preoperatively for important clinical variables. Postoperative evaluation was done by an assessor blinded to preoperative status with a daily physical examination, electrocardiogram, and creatine kinase with MB fraction until postoperative day 6, day of discharge, death, or reoperation (whichever occurred earliest). Serial electrocardiograms, enzymes, and chest radiographs were obtained as indicated. Severe cardiac complications included cardiac death, cardiac arrest, myocardial infarction, ventricular tachycardia, and fibrillation and pulmonary edema. Serious cardiac complications included the above, heart failure, and unstable angina.Main Results: Severe and serious complications were seen in 24% and 32% of aortic, 8.3% and 10% of carotid, 11.8% and 14.7% of peripheral vascular, 9.0% and 13.1% of intraabdominal/intrathoracic, 2.9% and 3.3% of intermediate-risk (head and neck and major orthopedic procedures), and 0.27% and 1.1% of low-risk procedures respectively. The five associated patient-specific risk factors identified by logistic regression are: myocardial infarction < 6 months (odds ratio [OR], 4.5; 95% confidence interval [CI], 1.9 to 12.9), emergency surgery (OR, 2.6; 95% CI, 1.2 to 5.6), myocardial infarction > 6 months (OR, 2.2; 95% CI, 1.4 to 3.5), heart failure ever (OR, 1.9; 95% CI, 1.2 to 3.0), and rhythm other than sinus (OR, 1.7; 95% CI, 0.9 to 3.2). Inclusion of the planned operative procedure significantly improves the predictive ability of our risk model.Conclusions: Five patient-specific risk factors are associated with high risk for cardiac complications in the perioperative period of noncardiac surgery in veterans. Inclusion of the operative procedure significantly improves the predictive ability of the risk model. Overall cardiac complication rates (pretest probabilities) are established for these patients. A simple nomogram is presented for calculation of post-test probabilities by incorporating the operative procedure. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To establish rates of and risk factors for cardiac complications after noncardiac surgery in veterans. DESIGN: Prospective cohort study. SETTING: A large urban veterans affairs hospital. PARTICIPANTS: One thousand patients with known or suspected cardiac problems undergoing 1,121 noncardiac procedures. MEASUREMENTS: Patients were assessed preoperatively for important clinical variables. Postoperative evaluation was done by an assessor blinded to preoperative status with a daily physical examination, electrocardiogram, and creatine kinase with MB fraction until postoperative day 6, day of discharge, death, or reoperation (whichever occurred earliest). Serial electrocardiograms, enzymes, and chest radiographs were obtained as indicated. Severe cardiac complications included cardiac death, cardiac arrest, myocardial infarction, ventricular tachycardia, and fibrillation and pulmonary edema. Serious cardiac complications included the above, heart failure, and unstable angina. MAIN RESULTS: Severe and serious complications were seen in 24% and 32% of aortic, 8.3% and 10% of carotid, 11.8% and 14.7% of peripheral vascular, 9.0% and 13.1% of intraabdominal/intrathoracic, 2.9% and 3.3% of intermediate-risk (head and neck and major orthopedic procedures), and 0.27% and 1.1% of low-risk procedures respectively. The five associated patient-specific risk factors identified by logistic regression are: myocardial infarction < 6 months (odds ratio [OR], 4.5; 95% confidence interval [CI], 1.9 to 12.9), emergency surgery (OR, 2.6; 95% CI, 1.2 to 5.6), myocardial infarction > 6 months (OR, 2.2; 95% CI, 1.4 to 3.5), heart failure ever (OR, 1.9; 95% CI, 1.2 to 3.0), and rhythm other than sinus (OR, 1.7; 95% CI, 0.9 to 3.2). Inclusion of the planned operative procedure significantly improves the predictive ability of our risk model. CONCLUSIONS: Five patient-specific risk factors are associated with high risk for cardiac complications in the perioperative period of... [ABSTRACT FROM AUTHOR]

To determine the current level of use, characteristics, and perceived value of the clinicopathologic conference (CPC), we sent a 22-item survey questionnaire to the program directors of internal medicine residency training programs. Of the 278 residency training programs that returned questionnaires, 221 (80%) indicated that they held CPCs regularly. The conference received a mean rating (Likert scale 1 = best to 5 = worst) of 2.2 (95% confidence interval 2.2, 2. 3) for both its perceived educational value and its popularity. The CPC remains widely used in internal medicine training programs. Although relatively few programs have rigorous guidelines for preparation and evaluation of their presentations, the CPC is generally viewed as being popular and having sound educational value. [ABSTRACT FROM AUTHOR]

Abstract: We studied the dietary intake of persons age 18 and over participating in the 1976-80 National Health and Nutrition Examination Survey (NHANES II). We compared the diets of those on a "low cholesterol" diet (dieters, n = 296) with the diets of individuals not following a special diet (non-dieters, n = 10,052). Dietary intakes were assessed by 24-hour recall and food frequency reports and were adjusted for differences in age, sex, race, education, smoking, and socioeconomic status by multivariate statistical techniques. Dieters consumed 16 percent (99% confidence interval- -24, -9) fewer calories than non-dieters, and had decreased intake of saturated fat by 25 percent (-34, -15) and cholesterol by 21 percent (-32, -10). However, their intake of vitamin A, thiamine, riboflavin, niacin, calcium, and iron were not significantly different from non-dieters and their ascorbic acid intake was 18 percent (1, 36) higher. The nutrient density (nutrient/1000 kcal) among dieters was increased over non-dieters by 35 percent (-3, 72) for vitamin A, 35 percent (1, 70) for thiamine, 30 percent (-4, 65) for riboflavin, 27 percent (9, 44) for niacin, 60 percent (40, 80) for vitamin C, 14 percent for calcium (-5, 32), and 15 percent for iron (6, 25). Compared with non-dieters, dieters consumed 27 percent (9, 45) more poultry and 39 percent (12, 66) more fish, but consumed 30 percent (-44, -16) less eggs and 15 percent (-24, -6) less meat. (Am J Public Health 1990; 80:698-703.) [ABSTRACT FROM AUTHOR]

Focuses on the signs and symptoms most helpful in diagnosing appendicitis. Presence of a positive psoas sign, fever, or migratory pain to the right lower quadrant which suggests an increased likelihood of appendicitis; Presence of vomiting before pain which makes appendicitis unlikely; Review of the literature evaluating the operating characteristics of the most useful elements of the history and physical examination for the diagnosis of appendicitis.

Presents studies comparing the smoking behavior of veterans and nonveterans. Objectives of the study; Methods use by the researcher; Results of the study; Conclusions.

We surveyed faculty and residents from seven hospitals affiliated with three academic internal medicine training programs about their perceptions of the informational and service benefits vs the risks of ethical compromise involved in interactions with pharmaceutical sales representatives. Questionnaires were returned by 467 (81%) of 575 physicians surveyed. Residents and faculty generally had somewhat negative attitudes toward the educational and informational value of detailing activities at their institutions but indicated that representatives supported important conferences and speakers. Residents were more likely than faculty to perceive contacts with sales representatives as potentially influencing physician decision making. Sixty-seven percent of faculty and 77% of residents indicated that physicians could be compromised by accepting gifts. More than half of the physicians who suggested that such compromise was possible indicated that acceptance of gifts worth more than +100 from drug companies would be likely to compromise a physician's independence and objectivity. A majority of both faculty and house staff favored eliminating presentations by pharmaceutical representatives at their hospitals. Only 10% thought they had had sufficient training during medical school and residency regarding professional interaction with sales representatives. [ABSTRACT FROM AUTHOR]

Examines the beliefs of influential academic internal medicine faculty and their house staff regarding the informational and educational roles of pharmaceutical sales representatives (PR). Attitudes of residents and faculty toward interaction with PR; Influence factor scores stratified by perceived potential for compromise.

Evaluates the use of Fisher's Exact Test in articles published 1983 and 1987 in six medical journals. Data showing that the use of Fisher's Exact Test without specification as a one- or two-tailed version misrepresenting the statistical significance of data; Uniform specification statement that should be required for all manuscripts to correct potential errors in interpretation.

Presents letters to the editor in the February 15, 1994 issue of the 'Annals of Internal Medicine.'

We investigated whether printed or videotaped information is more effective in enhancing colon cancer knowledge. Subjects (n = 1100) were randomized into three groups: to receive a booklet, view a videotape, or receive no intervention. Subjects receiving the intervention showed increased knowledge compared with control subjects (booklet = 23%) and videotape = 26% vs no intervention = 3%). Findings suggest that personalized educational materials are effective in enhancing colon cancer knowledge. [ABSTRACT FROM AUTHOR]

Abstract: The records of 847 elderly clinic patients were reviewed and the 95 primary care physicians who managed their care were surveyed to determine factors related to their ordering of influenza immunization. Overall, 41 percent of the eligible patients were offered vaccine (range 0-90 percent). Physician offering of vaccine was unrelated to patient age, sex, or race but was higher in patients seen on multiple visits (47 vs 39 percent) and in those vaccinated during the prior year (61 vs 35 percent). Physician offering of vaccine was not associated with perceived incidence of severe side effects or estimates of vaccine efficacy. [ABSTRACT FROM AUTHOR]

Describes a design study with the objective of optimizing spectral performance of an elliptical wiggler to be installed at the Lawrence Berkeley Laboratory Advanced Light Source in Berkeley, California. Theoretical background; Calculations; Characteristics of an optimum set point for a particular photon energy.

The long trace profiler (Takacs et al.) has found significant applications in measuring the surfaces of synchrotron optics. However, requirements of small slope errors at all spatial wavelengths of the synchrotron optics mandate more accurate slope measurements. A straightness reference for the long trace profiler greatly increases the accuracy of the instrument. Methods of using the straightness reference by interpreting the sequential interference patterns are discussed and results of measurements are presented. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor of the 'Journal of the American Medical Association concerning traveler's immunization.

A letter to the editor is presented in response to the article "Radiographic Appearance of Primary Tuberculosis," published in the previous issue.

Findings from epidemiological studies suggest that occupational exposure to whole-body vibration (WBV) may increase the risk of miscarriage and contribute to a reduction in fertility rates in both men and women. However, workers exposed to WBV may also be exposed to other risk factors that contribute to reproductive dysfunction. The goal of this experiment was to examine the effects of WBV on reproductive physiology in a rat model. Male and female rats were exposed to WBV at the resonant frequency of the torso (31.5 Hz, 0.3 g amplitude) for 4 hr/day for 10 days. WBV exposure resulted in a significant reduction in number of developing follicles, and decrease in circulating estradiol concentrations, ovarian luteinizing hormone receptor protein levels, and marked changes in transcript levels for several factors involved in follicular development, cell cycle, and steroidogenesis. In males, WBV resulted in a significant reduction in spermatids and circulating prolactin levels, elevation in number of males having higher circulating testosterone concentrations, and marked alterations in levels of transcripts associated with oxidative stress, inflammation, and factors involved in regulating the cell cycle. Based upon these findings data indicate that occupational exposure to WBV contributes to adverse alterations in reproductive physiology in both genders that may lead to reduction in fertility. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor responding to comments made on the authors' article about the use of Fisher's exact test in medicine.

The role of the recruitment-derecruitment of small structures in the lung (lung units) as the lung increases and decreases in volume has been debated. The objective of this study was to develop a model to estimate the change in the number and volume of open lung units as an excised lung is inflated-deflated between minimum and maximum lung volume. The model was formulated based on the observation that the compliance of the slowly changing quasi-static pressure-volume (P-V) curve of an excised rat lung can differ from the compliance of a faster changing small sinusoidal pressure volume perturbations superimposed on the cwve. In those regions of the curve where differences in compliance occur, the lung tissue properties exhibit nonlinear characteristics, which cannot be linearized using "incremental" or "small signal" analysis. The model attributes the differences between the perturbation and quasi-static compliance to an additional nonlinear compliance term that results from the sequential opening and closing of lung units. Using this approach, it was possible to calculate the normalized average volume and the normalized number of open units as the lung is slowly inflated-deflated. Results indicate that the normalized average volume and the normalized number of open units are not linearly related to normalized lung volume, and at equal lung volumes the normalized number of open units is greater and the normalized average lung unit volume is smaller during lung deflation when compared to lung inflation. In summary, a model was developed to describe the recruitment-derecruitment process in excised lungs based on the differences between small signal perturbation compliance and quasi-static compliance. Values of normalized lung unit volume and the normalized number of open lung units were shown to be nonlinear functions of both transpulmonary pressure and normalized lung volume. [ABSTRACT FROM AUTHOR]

Background: Healthcare-associated infections are a major source of morbidity and mortality in the United States. Infection Preventionists (IPs) are healthcare workers tasked at overseeing the prevention and control of these infections, but they may have difficulties obtaining up-to-date information, primarily in rural states. The objective of this study was to evaluate the importance of public health involvement on the knowledge-sharing network of IPs in a rural state. Findings: A total of 95 attendees completed our survey. The addition of public health professionals increased the density of the network, reduced the number of separate components of the network, and reduced the number of key players needed to contact nearly all of the other network members. All network metrics were higher for public health professionals than for IPs without public health involvement. Conclusions: The addition of public health professionals involved in healthcare infection prevention activities augmented the knowledge sharing potential of the IPs in Iowa. Rural states without public health involvement in healthcare-associated infection (HAI) prevention efforts should consider the potential benefits of adding these personnel to the public health workforce to help facilitate communication of HAI-related information. [ABSTRACT FROM AUTHOR]

The objective of this paper was to determine predictors of complementary and alternative medicine (CAM) use among individuals with specific health problems. Data were derived from the 1998 Medical Expenditure Panel Survey (MEPS). After adjustment for potential confounders, individuals with perceived barriers to obatining care were more likely to useanyCAM treatment (OR 2.16), herbal therapy (OR 2.70) and spiritual care (OR 3.99) for a specific health problem. Individuals dissatisfied with their family’s access to care were more likely to use acupuncture (OR 3.43). Dissatisfaction with quality of care was associated with increased use of spiritual therapy (OR 4.74). Perceptions of inadequate access to health care may contribute to utilization of CAM therapies; such therapies in this instance appear to be used as analternativeto mainstream medicine. [ABSTRACT FROM AUTHOR]

Wearing a facial mask can limit COVID-19 transmission. Measurements of communities' mask use behavior have mostly relied on self-report. This study's objective was to devise a method to measure the prevalence of improper mask use and no mask use in indoor public areas without relying on self-report. A stratified random sample of retail trade stores (public areas) in Louisville, Kentucky, USA, was selected and targeted for observation by trained surveyors during December 14–20, 2020. The stratification allowed for investigating mask use behavior by city district, retail trade group, and public area size. The total number of visited public areas was 382 where mask use behavior of 2,080 visitors and 1,510 staff were observed. The average prevalence of mask use among observed visitors was 96%, while the average prevalence of proper use was 86%. In 48% of the public areas, at least one improperly masked visitor was observed and in 17% at least one unmasked visitor was observed. The average prevalence of proper mask use among staff was 87%, similar to the average among visitors. However, the percentage of public areas where at least one improperly masked staff was observed was 33. Significant disparities in mask use and its proper use were observed among both visitors and staff by public area size, retail trade type, and geographical area. Observing unmasked and improperly masked visitors was more common in small (less than 1500 square feet) public areas than larger ones, specifically in food and grocery stores as compared to other retail stores. Also, the majority of the observed unmasked persons were male and middle-aged. [ABSTRACT FROM AUTHOR]

Objective: To estimate the association between weather and COVID-19 fatality rates during US stay-at-home orders. Methods: With a county-level longitudinal design, this study analyzed COVID-19 deaths from public health departments' daily reports and considered exposure as the 18 to 22 day-period before death. Models included state-level social distancing measures, Census Bureau demographics, daily weather information, and daily air pollution. The primary measures included minimum and maximum daily temperature, precipitation, ozone concentration, PM2.5 concentrations, and U.V. light index. Results: A 1 °F increase in the minimum temperature was associated with 1.9% (95% CI, 0.2% to 3.6%) increase in deaths 20days later. An ozone concentration increase of 1 ppb (part per billion) decreased daily deaths by 2.0% (95% CI, 0.1% to 3.6%); ozone levels below 38 ppb negatively correlated with deaths. Conclusions: Increased mobility may drive the observed association of minimum daily temperature on COVID-19 deaths. [ABSTRACT FROM AUTHOR]

Studies health care workers three years after initial vaccination with hepatitis B vaccine to determine the prevalence of immunity indicated by levels of antibody to hepatitis B surface antigen. Reason for the exposure of hospital workers to hepatitis B virus; Comparison of hospital employees with low and high levels of anti-hepatitis B surface antigen; Efficacy of hepatitis B vaccine in inducing immunity to hepatitis B virus infection.

Abstract Welding fumes were reclassified as a Group 1 carcinogen by the International Agency for Research on Cancer in 2017. Gas metal arc welding (GMAW) is a process widely used in industry. Fume generated from GMAW-mild steel (MS) is abundant in iron with some manganese, while GMAW-stainless steel (SS) fume also contains significant amounts of chromium and nickel, known carcinogenic metals. It has been shown that exposure to GMAW-SS fume in A/ J mice promotes lung tumors. The objective was to determine if GMAW-MS fume, which lacks known carcinogenic metals, also promotes lung tumors in mice. Male A/ J mice received a single intraperitoneal injection of corn oil or the initiator 3-methylcholanthrene (MCA; 10 μg/g) and, one week later, were exposed by whole-body inhalation to GMAW-MS aerosols for 4 hours/day x 4 days/week x 8 weeks at a mean concentration of 34.5 mg/m3. Lung nodules were enumerated by gross examination at 30 weeks post-initiation. GMAW-MS fume significantly increased lung tumor multiplicity in mice initiated with MCA (21.86 ± 1.50) compared to MCA/air-exposed mice (8.34 ± 0.59). Histopathological analysis confirmed these findings and also revealed an absence of inflammation. Bronchoalveolar lavage analysis also indicated a lack of lung inflammation and toxicity after short-term inhalation exposure to GMAW-MS fume. In conclusion, this study demonstrates that inhalation of GMAW-MS fume promotes lung tumors in vivo and aligns with epidemiologic evidence that shows MS welders, despite less exposure to carcinogenic metals, are at an increased risk for lung cancer. [ABSTRACT FROM AUTHOR]

The goal of this study was to investigate the impact of multiple exposomal factors (genetics, lifestyle factors, environmental/occupational exposures) on pulmonary inflammation and corresponding alterations in local/systemic immune parameters. Accordingly, male Sprague-Dawley (SD) and Brown Norway (BN) rats were maintained on either regular (Reg) or high fat (HF) diets for 24wk. Welding fume (WF) exposure (inhalation) occurred between 7 and 12wk. Rats were euthanized at 7, 12, and 24wk to evaluate local and systemic immune markers corresponding to the baseline, exposure, and recovery phases of the study, respectively. At 7wk, HF-fed animals exhibited several immune alterations (blood leukocyte/neutrophil number, lymph node B-cell proportionality)—effects which were more pronounced in SD rats. Indices of lung injury/inflammation were elevated in all WF-exposed animals at 12wk; however, diet appeared to preferentially impact SD rats at this time point, as several inflammatory markers (lymph node cellularity, lung neutrophils) were further elevated in HF over Reg animals. Overall, SD rats exhibited the greatest capacity for recovery by 24wk. In BN rats, resolution of immune alterations was further compromised by HF diet, as many exposure-induced alterations in local/systemic immune markers were still evident in HF/WF animals at 24wk. Collectively, HF diet appeared to have a greater impact on global immune status and exposure-induced lung injury in SD rats, but a more pronounced effect on inflammation resolution in BN rats. These results illustrate the combined impact of genetic, lifestyle, and environmental factors in modulating immunological responsivity and emphasize the importance of the exposome in shaping biological responses. • 7wk HF diet altered general immune status markers—more pronounced in SD rats. • HF diet exacerbated WF-induced acute lung inflammation—more pronounced in SD rats. • Overall, BN rats were slower to recover from WF exposure than SD rats. • Recovery at 24wk was significantly compromised in BN rats fed HF diet. • Environmental, behavioral, and genetic exposomal factors impact biological responses. [ABSTRACT FROM AUTHOR]

We present a modulation transfer function (MTF) calibration method based on binary pseudo-random (BPR) one-dimensional sequences and two-dimensional arrays as an effective method for spectral characterization in the spatial frequency domain of a broad variety of metrology instrumentation, including interferometric microscopes, scatterometers, phase shifting Fizeau interferometers, scanning and transmission electron microscopes, and at this time, x-ray microscopes. The inherent power spectral density of BPR gratings and arrays, which has a deterministic white-noise-like character, allows a direct determination of the MTF with a uniform sensitivity over the entire spatial frequency range and field of view of an instrument. We demonstrate the MTF calibration and resolution characterization over the full field of a transmission soft x-ray microscope using a BPR multilayer (ML) test sample with 2.8 nm fundamental layer thickness. We show that beyond providing a direct measurement of the microscope's MTF, tests with the BPRML sample can be used to fine tune the instrument's focal distance. Our results confirm the universality of the method that makes it applicable to a large variety of metrology instrumentation with spatial wavelength bandwidths from a few nanometers to hundreds of millimeters. [ABSTRACT FROM AUTHOR]

Few patients with community-acquired pneumonia (CAP) require admission to the intensive care unit (ICU-CAP). However, they represent the most severe form of the disease. An understanding of the etiologic agents of ICU-CAP may lead to better treatment decisions and patient outcomes. The objective of this study was to determine the incidence of respiratory viruses in patients with ICU-CAP. This was an observational study conducted in six Kentucky hospitals from December 2008 through October 2011. A case of ICU-CAP was defined as a patient admitted to an ICU with the diagnosis of CAP. The Luminex xTAG multiplex polymerase chain reaction (PCR) assay was used for viral identification. A total of 468 adult and pediatric patients with ICU-CAP were enrolled in the study. A total of 92 adult patients (23 %) and 14 pediatric patients (19 %) had a respiratory virus identified. Influenza was the most common virus identified in adults and the second most common in pediatric patients. This study suggests that respiratory viruses may be common etiologic agents of pneumonia in patients with ICU-CAP. The Centers for Disease Control and Prevention (CDC) recommend empiric anti-influenza therapy during the winter for hospitalized patients with CAP. This study supports this recommendation in patients with ICU-CAP. [ABSTRACT FROM AUTHOR]

We present a variable line-space grating spectrometer for soft x-rays that covers the photon energy range between 130 and 650 eV. The optical design is based on the Hettrick–Underwood principle and tailored to synchrotron-based studies of radiation-sensitive biological samples. The spectrometer is able to record the entire spectral range in one shot, i.e., without any mechanical motion, at a resolving power of 1200 or better. Despite its slitless design, such a resolving power can be achieved for a source spot as large as (30×3000) μm2, which is important for keeping beam damage effects in radiation-sensitive samples low. The high spectrometer efficiency allows recording of comprehensive two-dimensional resonant inelastic soft x-ray scattering (RIXS) maps with good statistics within several minutes. This is exemplarily demonstrated for a RIXS map of highly oriented pyrolytic graphite, which was taken within 10 min. [ABSTRACT FROM AUTHOR]

Context Influenza vaccination lowers, but does not eliminate, the risk of influenza. Making a reliable, rapid clinical diagnosis is essential to appropriate patient management that may be especially important during shortages of antiviral agents caused by high demand. Objectives To systematically review the precision and accuracy of symptoms and signs of influenza. A secondary objective was to review the operating characteristics of rapid diagnostic tests for influenza (results available in <30 min). Data Sources Structured search strategy using MEDLINE (January 1966-September 2004) and subsequent searches of bibliographies of retrieved articles to identify articles describing primary studies dealing with the diagnosis of influenza based on clinical signs and symptoms. The MEDLINE search used the Medical Subject Headings EXP influenza or EXP influenza A virus or EXP influenza A virus human or EXP influenza B virus and the Medical Subject Headings or terms EXP sensitivity and specificity or EXP medical history taking or EXP physical examination or EXP reproducibility of results or EXP observer variation or symptoms.mp or clinical signs.mp or sensitivity.mp or specificity.mp. Study Selection Of 915 identified articles on clinical assessment of influenza-related illness, 17 contained data on the operating characteristics of symptoms and signs using an independent criterion standard. Of these, 11 were eliminated based on 4 inclusion criteria and availability of nonduplicative primary data. Data Extraction Two authors independently reviewed and abstracted data for estimating the likelihood ratios (LRs) of clinical diagnostic findings. Differences were resolved by discussion and consensus. Data Synthesis No symptom or sign had a summary LR greater than 2 in studies that enrolled patients without regard to age. For decreasing the likelihood of influenza, the absence of fever (LR, 0.40; 95% confidence interval [CI], 0.25-0.66), cough (LR, 0.42; 95% CI, 0.31-0.57), or nas... [ABSTRACT FROM AUTHOR]

We consider the initial-value problem for the radially symmetric nonlinear Schrödinger equation with cubic nonlinearity (NLS) in d = 2 and 3 space dimensions. To approximate smooth solutions of this problem, we construct and analyze a numerical method based on a standard Galerkin finite element spatial discretization with piecewise linear, continuous functions and on an implicit Crank­Nicolson type time-stepping procedure. We then equip this scheme with an adaptive spatial and temporal mesh refinement mechanism that enables the numerical technique to approximate well singular solutions of the NLS equation that blow up at the origin as the temporal variable t tends from below to a finite value t[this equation cannot be represented in Ascii text]. For the blow-up of the amplitude of the solution we recover numerically the well-known rate (t[this equation cannot be represented in Ascii text] - t)-1/2 for d = 3. For d = 2 our numerical evidence supports the validity of the log log law [1n 1n [this equation cannot be represented in Ascii text]/(t[this equation cannot be represented in Ascii text] - t)] 1/2 for t extremely close to t[this equation cannot be represented in Ascii text]. The scheme also approximates well the details of the blow-up of the phase of the solution at the origin as t → t[this equation cannot be represented in Ascii text]. [ABSTRACT FROM AUTHOR]

Abstract: Amphetamine-derived medications are being prescribed with increasing frequency to younger pediatric patients to treat attention deficit hyperactivity disorder. Although choreiform movements were reported in adults with amphetamine abuse and in those under therapeutic treatment for attention deficit hyperactivity disorder, previous literature concerning the pediatric population is spare. We describe two children who developed chorea after ingesting amphetamine-derived medications prescribed to treat attention deficit hyperactivity disorder. Patient 1, a 10-year-old boy, accidently received an extra dose of lisdexamfetamine dimesylate the night before the onset of acute chorea involving his arms, legs, and trunk. Patient 2, an 8-month-old boy, accidentally ingested his stepbrother’s mixed amphetamine salts (Adderall XR) and developed acute chorea. Benzodiazepines, diphenhydramine, benztropine, and opioids did not suppress the chorea in either case. The 10-year-old received haloperidol, which significantly improved his abnormal findings, and he returned to baseline in approximately 48 hours. The 8-month-old was observed in the pediatric intensive care unit, and his signs resolved by 72 hours. Our cases demonstrate that choreiform movements of sustained duration can occur in children with acute supratherapeutic ingestions of amphetamine-derived medications. [Copyright &y& Elsevier]

Solid-based surface high-harmonic generation from a tape is experimentally studied. By operating at mildly relativistic normalized laser strengths a0<=0.2, harmonics up to the 17th order are efficiently produced in the coherent wake emission (CWE) regime. CWE pulse properties, such as divergence, energy, conversion efficiency, and spectrum, are investigated for various tape materials and drive laser conditions. A clear correlation between surface roughness and harmonic beam divergence is found. At the measured pulse properties for the 15th harmonic (conversion efficiency ∼6.5×10-7, divergence ∼7-15 mrad), the 100-mJ-level drive laser produces several MWs of extreme ultra-violet pulses. The spooling tape configuration enables multi-Hz operation over thousands of shots, making this source attractive as a seed to the few-Hz laser-plasma-accelerator-driven free-electron laser (FEL). Models indicate that these CWE pulses with MW level powers are sufficient for seed-induced bunching and FEL gain. [ABSTRACT FROM AUTHOR]

Using B-mode ultrasonography, cigarette smoking was found to be a strong, independent risk factor for extracranial carotid atherosclerosis in 1692 black and white men and women admitted for diagnostic evaluation of the carotid arteries. We found that the difference in mean plaque thickness was smaller between past smokers and nonsmokers than between current smokers and nonsmokers, suggesting that the rate of progression of carotid atherosclerosis may be slower in people who quit smoking compared with people who continue to smoke. [ABSTRACT FROM AUTHOR]