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Dust events are intricate climatic processes, which can have adverse effects on human health, safety, and the environment. In this study, two data mining approaches, namely, back-propagation artificial neural network (BP ANN) and supporting vector regression (SVR), were used to estimate atmospheric visibility through the synergistic use of Moderate Resolution Imaging Spectroradiometer (MODIS) Level 1B (L1B) data and ground-based observations at fourteen stations in the province of Khuzestan (southwestern Iran), during 2009–2010. Reflectance and brightness temperature in different bands (from MODIS) along with in situ meteorological data were input to the models to estimate atmospheric visibility. The results show that both models can accurately estimate atmospheric visibility. The visibility estimates from the BP ANN network had a root-mean-square error (RMSE) and Pearson’s correlation coefficient (R) of 0.67 and 0.69, respectively. The corresponding RMSE and R from the SVR model were 0.59 and 0.71, implying that the SVR approach outperforms the BP ANN.

The use of TE_{12} in circular waveguide with smooth walls was suggested for low-loss transport of rf signals in multimoded systems [S. G. Tantawi et al., in Advanced Accelerator Concepts: Eighth Workshop, edited by Wes Lawson, AIP Conf. Proc. No. 472 (AIP, New York, 1999), pp. 967–974]. Such systems use the same waveguide to transport different signals over different modes. In this report we detail a series of experiments designed to measure the characteristics of this mode. We also describe the different techniques used to generate it and receive it. The experiments were done at X band around a frequency of 11.424 GHz, the frequency of choice for future linear colliders at X band [The NLC Design Group, Report No. LBNL-PUB-5424, SLAC Report No. 474, Report No. UCRL-ID 124161, 1996; The JLC Design Group, KEK-REPORT-97-1, 1997]. The transportation medium is 55 m of highly overmoded circular waveguide. The design of the joining flanges is also presented.

Introduction. Assessment of axillary lymph nodes in breast carcinoma is an important part of staging to guide appropriate clinical management. Lymph node inclusions of different types, including nevoid, squamous, and glandular, are rare but have been reported in multiple different anatomic locations including the axilla. These can result in diagnostic challenges and pose risks of misdiagnoses. Rarely, malignancies may arise intrinsic to otherwise incidental benign nodal inclusions. Case Presentation. We report a case of ductal carcinoma diagnosed within a squamous epithelial inclusion cyst within an axillary lymph node in a patient with pure ductal carcinoma in situ (DCIS) of the ipsilateral right breast. To our knowledge, this is the fifth report in the literature of breast carcinoma confirmed within an axillary inclusion in a patient with pure DCIS. Evaluation of the primary DCIS and lymph node inclusions, by routine and immunohistochemical stains, was performed for assessment. Discussion. The presence of lymph node inclusions can pose a challenge in assessment of benignity and malignancy, on frozen and permanent histologic sections. Pathologists should carefully evaluate lymph node inclusions to ensure that intrinsic malignancies are not missed within rare otherwise benign appearing incidental epithelial rests.

Abstract Ehlers-Danlos Syndrome (EDS) are a heterogeneous group of genetic connective tissue disorders, and typically manifests as weak joints that subluxate/dislocate, stretchy and/or fragile skin, organ/systems dysfunction, and significant widespread pain. Historically, this syndrome has been poorly understood and often overlooked. As a result, people living with EDS had difficulty obtaining an accurate diagnosis and appropriate treatment, leading to untold personal suffering as well as ineffective health care utilization. The GoodHope EDS clinic addresses systemic gaps in the diagnosis and treatment of EDS. This paper describes a leap forward—from lack of awareness, diagnosis, and treatment—to expert care that is tailored to meet the specific needs of patients with EDS. The GoodHope EDS clinic consists of experts from various medical specialties who work together to provide comprehensive care that addresses the multi-systemic nature of the syndrome. In addition, EDS-specific self-management programs have been developed that draw on exercise science, rehabilitation, and health psychology to improve physical and psychosocial wellbeing and overall quality of life. Embedded into the program are research initiatives to shed light on the clinical presentation, underlying mechanisms of pathophysiology, and syndrome management. We also lead regular educational activities for community health care providers to increase awareness and competence in the interprofessional management of EDS beyond our doors and throughout the province and country.

In the title solvated salt, C9H14N+·Cl−·C19H24O2·0.5C7H7, two molecules of 4,4′-(propane-2,2-diyl)bis(2,6-dimethylphenol) are linked via O—H...Cl hydrogen bonds to two chloride ions, each of which is also engaged in N—H...Cl hydrogen bonding to a 4-tert-butylpyridinium cation, giving a cyclic hydrogen-bonded entity centred at 1/2, 1/2, 1/2. The toluene solvent molecule resides in the lattice and resides on an inversion centre; the disorder of the methyl group requires it to have a site-occupancy factor of 0.5. No crystal packing channels are observed.

The title complex, [Ti2Cl4{CH3C(CH2O)2(CH2OH)}2], lies across a centre of symmetry with a diethyl ether solvent molecule hydrogen bonded to the –CH2OH groups on either side of it. The TiIV atom is coordinated in a distorted octahedral geometry by a tripodal ligand and two terminal chloride atoms. There are three coordination modes for the tripodal ligand distinguishable on the basis of their very different Ti—O bond lengths. For the terminal alkoxo ligand, the Ti—O distance is 1.760 (1) Å, the asymmetric bridge system has Ti—O bond lengths of 1.911 (1) and 2.048 (1) Å. The Ti—O bond length for the alcohol O atom is the longest at 2.148 (1) Å.

The title adduct, [TiCl2(C23H30O2)(C13H10O]·0.5C13H10·C4H10O, is a monomer with a trigonal–bypyramidal coordination sphere of the TiIV atom in which the ligand O atoms of the bidentate diphenolate anion are located in both apical and equatorial positions. Chloride ligands occupy the remaining two equatorial sites of the trigonal bypyramid with the fluoren-9-ol O atom occupying the other apical site. The hydroxy group H atom of this latter group is hydrogen bonded to an O atom of a non-coordinating diethyl ether molecule. The title compound also contains a further fluorene solvent molecule, which lies across a centre of symmetry and which is equally disordered over an inversion centre.

The molecule of the title compound, [Ti2(CH3)2(CH3O)2(C11H15O)4] or {[Ti(Me)(μ-OCH3)(OC6H3CMe3-2-Me-6)]2}, has a centrosymmetric, dimeric structure with a distorted square pyramidal array about each titanium atom. The methoxide ligands form an asymmetric bridge between the two TiIV atoms [Ti—O bond lengths of 1.9794 (12) and 2.0603 (12) Å] with the two phenolato ligands occupying the remaining basal sites [Ti—O 1.8218 (11) and 1.8135 (11) Å]. The Ti—O—C phenolato bond angles are similar at 161.24 (10) and 160.66 (11)°. The methyl ligand attached to the metal atom has a Ti—C bond length of 2.0878 (17) Å.

The MoVI atom in the title structure, [Mo(C10H13N)Cl2O(C10H8N2)]·0.5CH2Cl2, has a distorted octahedral coordination sphere with cis-orientated oxide and imide ligands, trans-chloride ligands and the 2,2′-bipyridine (bipy) ligand N atoms lying trans to the oxide and imide ligands. An imide-ligand tert-butyl-methyl-group H atom makes a close approach with the oxide ligand (distance = 2.53 Å) and the imide-ligand N atom (distance = 2.41 Å). Another imide-ligand tert-butyl-methyl-group H atom makes a close approach to a chloride ligand (distance = 2.82 Å). One bipy-ligand α-H atom makes a close approach to the oxide ligand (distance = 2.4 Å) and the other α-H atom makes a close approach to the imide-ligand phenyl-ring ortho-H atom (distance = 2.52 Å). These close approaches suggest the presence of weak intramolecular hydrogen bonds. The solvent molecule has been modelled under consideration of half-occupancy.

For the d0complex [{Zr(CpSiMe2H)Cl3}2] which contains a linear Si–HZr interaction across the dimer, DFT calculations are in good agreement with X-ray structures. The BP86 functional shows a slightly stronger interaction than B3LYP but for qualitative purposes either functional is sufficient. QTAIM analysis shows a bond critical point (bcp) for the interaction, a small negative value for the total energy density [H(r)] and the H atomic basin decreases in energy, E(H), and atomic volume compared to the free ligand. NBO analysis showed E(2) for Si–H σ to Zrdz2donation at 42.8 kcal mol−1and a 34% spatial overlap for the interaction consistent with an inverse hydrogen bond. The Wiberg bond index for the interaction is 0.1735 (0.7205 for the Si–H bond), ν(Si–H)and 1J(Si–H)at 2060 cm−1and 145.4 Hz compared to 2183 cm−1and 172.1 Hz in the free ligand. Using a “synthesis by computation” approach to forming like complexes, similar features were found for [{Hf(CpSiMe2H)Cl3}2]. The titanium complex [{Ti(CpSiMe2H)Cl3}2] does not contain any Si–HTi interaction as rotation about the C–Si bond of the ligand occurs to place the Si–H bond hydrogen closer to a terminal chloro ligand across the dimer. An increase in electron density on the metal in the d2complex [{Mo(CpSiMe2H)Cl3}2] results in a stronger interaction with a distinct QTAIM analysis bcp [ρ(r)0.0448 a.u.], a small negative value for H(r)and a much reduced H atomic volume. NBO analysis shows E(2) for Si–H σ to Modz2donation at 143.1 kcal mol−1and a 29% spatial overlap. Modz2to Si–H σ* donation (back donation) is minimal [E(2) 1.3 kcal mol−1, ∼1% spatial overlap]. The Wiberg bond index is 0.3114 (0.5667 for the Si–H bond), ν(Si–H)2015 cm−1and 1J(Si–H)120.6 Hz. [ABSTRACT FROM AUTHOR]

Soil health is one of the key factors in determining the sustainability of global agricultural systems and the stability of natural ecosystems. Microbial decomposition activity plays an important role in soil health; and gaining spatiotemporal insights into this attribute is critical for understanding soil function as well as for managing soils to ensure agricultural supply, stem biodiversity loss, and mitigate climate change. Here, a novel in situ electronic soil decomposition sensor that relies on the degradation of a printed conductive composite trace utilizing the biopolymer poly(3-hydroxybutyrate-co-3-hydroxyvalerate) as a binder is presented. This material responds selectively to microbially active environments with a continuously varying resistive signal that can be readily instrumented with low-cost electronics to enable wide spatial distribution. In soil, a correlation between sensor response and intensity of microbial decomposition activity is observed and quantified by comparison with respiration rates over 14 days, showing that devices respond predictably to both static conditions and perturbations in general decomposition activity., (© 2022 The Authors. Advanced Science published by Wiley-VCH GmbH.)

Study Objective: To determine the diagnostic accuracy of point-of-care ultrasound (POCUS) performed by experienced clinician sonologists compared to radiology-performed ultrasound (RADUS) for detection of clinically important intussusception, defined as intussusception requiring radiographic or surgical reduction., Methods: We conducted a multicenter, noninferiority, observational study among a convenience sample of children aged 3 months to 6 years treated in tertiary care emergency departments across North and Central America, Europe, and Australia. The primary outcome was diagnostic accuracy of POCUS and RADUS with respect to clinically important intussusception. Sample size was determined using a 4-percentage-point noninferiority margin for the absolute difference in accuracy. Secondary outcomes included agreement between POCUS and RADUS for identification of secondary sonographic findings., Results: The analysis included 256 children across 17 sites (35 sonologists). Of the 256 children, 58 (22.7%) had clinically important intussusception. POCUS identified 60 (23.4%) children with clinically important intussusception. The diagnostic accuracy of POCUS was 97.7% (95% confidence interval [CI] 94.9% to 99.0%), compared to 99.3% (95% CI 96.8% to 99.9%) for RADUS. The absolute difference between the accuracy of RADUS and that of POCUS was 1.5 percentage points (95% CI -0.6 to 3.6). Sensitivity for POCUS was 96.6% (95% CI 87.2% to 99.1%), and specificity was 98.0% (95% CI 94.7% to 99.2%). Agreement was high between POCUS and RADUS for identification of trapped free fluid (83.3%, n=40/48) and decreased color Doppler signal (95.7%, n=22/23)., Conclusion: Our findings suggest that the diagnostic accuracy of POCUS performed by experienced clinician sonologists may be noninferior to that of RADUS for detection of clinically important intussusception. Given the limitations of convenience sampling and spectrum bias, a larger randomized controlled trial is warranted., (Copyright © 2021 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

This paper is in response to the article entitled "Identifying potential types of guidance for supporting student inquiry when using virtual and remote labs in science: a literature review" by Zacharia et al. (2015). In their review, Zacharia et al. (2015) adopted de Jong and Lazondo's (2014) framework of five inquiry phases for online labs: orientation, conceptualization, investigation, conclusion, and discussion. Zacharia et al. reviewed the literature on Computer-supported Inquiry Learning (CoSIL), and identified best practices for each phase. They concluded, for example, that the orientation/conclusion/discussion phases received the least amount of guidance, while there were many more tools and strategies for providing guidance in the conceptualization/investigation phases. In this paper, we adopt the same inquiry framework as Zacharia et al. (2015) and report strategies that we learned from STEM faculty about how they supported and guided virtual student lab-based learning in these five phases during the recent COVID-19 shutdown. While Zacharia et al. identified tools and processes for enabling all five inquiry phases, add additional practical examples of faculty implementing these phases online as part of COVID-19 emergency remote teaching, and we provide insights for extending the 5-phase framework for future research., (© Association for Educational Communications and Technology 2020.)

Biodegradable electronics is a rapidly growing field, and the development of controllably biodegradable, high-conductivity materials suitable for additive manufacturing under ambient conditions remains a challenge. In this report, printable conductive pastes that employ poly(lactic acid) (PLA) as a binder and tungsten as a conductor are demonstrated. These composite conductors can provide enhanced stability in applications where moisture may be present, such as environmental monitoring or agriculture. Post-processing the printed traces using a solvent-aging technique increases their conductivity by up to 2 orders of magnitude, with final conductivities approaching 5000 S/m. Such techniques could prove useful when thermal processes including heating or laser sintering are limited by the temperature constraints of typical biodegradable substrates. Both accelerated oxidative and hydrolytic degradation of the printed composite conductors are examined, and a fully biodegradable capacitive soil moisture sensor is fabricated and tested.

Cyanide is a potent toxic agent, and the few available antidotes are not amenable to rapid deployment in mass exposures. As a result, there are ongoing efforts to exploit different animal models to identify novel countermeasures. We have created a pipeline that combines high-throughput screening in zebrafish with subsequent validation in two mammalian small animal models as well as a porcine large animal model. We found that zebrafish embryos in the first 3 days post fertilization (dpf) are highly resistant to cyanide, becoming progressively more sensitive thereafter. Unbiased analysis of gene expression in response to several hours of ultimately lethal doses of cyanide in both 1 and 7 dpf zebrafish revealed modest changes in iron-related proteins associated with the age-dependent cyanide resistance. Metabolomics measurements demonstrated significant age-dependent differences in energy metabolism during cyanide exposure which prompted us to test modulators of the tricarboxylic acid cycle and related metabolic processes as potential antidotes. In cyanide-sensitive 7 dpf larvae, we identified several such compounds that offer significant protection against cyanide toxicity. Modulators of the pyruvate dehydrogenase complex, as well as the small molecule sodium glyoxylate, consistently protected against cyanide toxicity in 7 dpf zebrafish larvae. Together, our results indicate that the resistance of zebrafish embryos to cyanide toxicity during early development is related to an altered regulation of cellular metabolism, which we propose may be exploited as a potential target for the development of novel antidotes against cyanide poisoning., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: a patent application has been submitted for the use of glyoxylate as a cyanide antidote. However, this does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Torsional deformities of the femur and/or tibia often go unrecognized in adolescents and adults who present with anterior knee pain, and patellar maltracking or instability. While open and arthroscopic surgical techniques have evolved to address these problems, unrecognized torsion may compromise the outcomes of these procedures. We collected a group of 16 consecutive patients (23 knees), with mean age of 17, who had undergone knee surgery before torsion was recognized and subsequently treated by means of rotational osteotomy of the tibia and/or femur. By follow-up questionnaire, we sought to determine the role of rotational correction at mean 59-month follow-up. We reasoned that, by correcting torsional alignment, we might be able to optimize long-term outcomes and avert repeated knee surgery. Knee pain was significantly improved after torsional treatment (mean 8.6 pre-op vs. 3.3 post-op, p < 0.001), while 70 % of patients did have some continued knee pain postoperatively. Only 43 % of patients had continued patellar instability, and 57 % could trust their knee after surgery. Activity level remained the same or increased in 78 % of patients after torsional treatment. Excluding planned rod removal, subsequent knee surgery for continued anterior knee pain was undertaken on only 3 knees in 2 patients. We believe that malrotation of the lower limb not only raises the propensity for anterior knee symptoms, but is also a under-recognized etiology in the failure of surgeries for anterior knee pain and patellar instability. Addressing rotational abnormalities in the index surgery yields better clinical outcomes than osteotomies performed after other prior knee surgeries.

The Health Information Technology for Economic and Clinical Health Act of 2009 and the Centers for Medicare & Medicaid Services "meaningful use" incentive programs, in tandem with the boundless additional requirements for detailed reporting of quality metrics, have galvanized hospital efforts to implement hospital-based electronic health records. As such, emergency department information systems (EDISs) are an important and unique component of most hospitals' electronic health records. System functionality varies greatly and affects physician decisionmaking, clinician workflow, communication, and, ultimately, the overall quality of care and patient safety. This article is a joint effort by members of the Quality Improvement and Patient Safety Section and the Informatics Section of the American College of Emergency Physicians. The aim of this effort is to examine the benefits and potential threats to quality and patient safety that could result from the choice of a particular EDIS, its implementation and optimization, and the hospital's or physician group's approach to continuous improvement of the EDIS. Specifically, we explored the following areas of potential EDIS safety concerns: communication failure, wrong order-wrong patient errors, poor data display, and alert fatigue. Case studies are presented that illustrate the potential harm that could befall patients from an inferior EDIS product or suboptimal execution of such a product in the clinical environment. The authors have developed 7 recommendations to improve patient safety with respect to the deployment of EDISs. These include ensuring that emergency providers actively participate in selection of the EDIS product, in the design of processes related to EDIS implementation and optimization, and in the monitoring of the system's ongoing success or failure. Our recommendations apply to emergency departments using any type of EDIS: custom-developed systems, best-of-breed vendor systems, or enterprise systems., (Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.)

Different physiological and behavioral events activate transcription of Arc/Arg3.1 in neurons in vivo, but the signal transduction pathways that mediate induction in particular situations remain to be defined. Here, we explore the relationships between induction of Arc/Arg3.1 transcription in dentate granule cells in vivo and activation of mitogen-activated protein (MAP) kinase as measured by extracellular-regulated kinase 1/2 (ERK1/2) phosphorylation. We show that ERK1/2 phosphorylation is strongly induced in dentate granule cells within minutes after induction of perforant path long-term potentiation (LTP). Phospho-ERK staining appears in nuclei within minutes after stimulation commences, and ERK phosphorylation returns to control levels within 60 min. Electroconvulsive seizures, which strongly induce prolonged Arc/Arg3.1 transcription in dentate granule cells, induced ERK1/2 phosphorylation in granule cells that returned to control levels within 30 min. Following 30, 60, and 120 min of exploration in a novel complex environment, Arc/Arg3.1 transcription was activated in many more granule cells than stained positively for p-ERK at all time points. Although Arc/Arg3.1 transcription was induced in most pyramidal neurons in CA1 following exploration, very few pyramidal neurons exhibited nuclear p-ERK1/2 staining. Local delivery of U0126 during the induction of perforant path LTP blocked transcriptional activation of Arc/Arg3.1 in a small region near the injection site and blocked Arc/Arg3.1 protein expression over a wider region. Our results indicate that activation of Arc/Arg3.1 transcription in dentate granule cells in vivo is mediated in part by MAP kinase activation, but other signaling pathways also contribute, especially in the case of Arc/Arg3.1 induction in response to experience.

Objective: to investigate perceptions of preterm birth, infections in pregnancy and perinatal mortality among women, men and health-care providers in Namitambo, Southern Malawi., Design: a qualitative study using focus-group discussions, critical incidence narrative and key informant interviews. The framework approach to qualitative analysis was used., Setting: Namitambo, a rural area in southern Malawi., Participants: women who have experienced preterm delivery, groups of mothers, fathers and grandmothers, health-care providers, traditional birth attendants and healers., Findings: four key inter-related themes grounded in community interpretative frameworks emerged: (1) community conceptualisations of preterm birth (the different terminologies used); (2) perceived causes of preterm birth (i.e. both 'modern' and 'traditional; illnesses, violence, witchcraft, ideas relating to impurity, heavy work, inadequate food and inappropriate use of medicine); (3) perceived strategies to prevent preterm birth (i.e. using formal health services, treatment for sexually transmitted infections, using condoms and stopping violence); and (4) barriers to realising these strategies, such as lack of food, money and women's autonomy in health seeking., Key Conclusions: similarities and differences exist in understanding between healthcare providers and the community. Additional dialogue and action is needed within the health sector and community to address the problem of preterm births. This includes strategies to enable health-care providers and community members to reflect on their perceptions and practices (e.g. through action research and interactive drama); identify and build on areas of common concern (i.e. poor pregnancy outcome) and enter into partnerships with non-formal providers. Action is also needed beyond the health sector (e.g. in campaigns to reduce gender-based violence).

Background: Negative nitrogen balance and skeletal muscle loss are common in critically injured patients and may contribute to morbidity, mortality and resource utilization. Juven, an enteral supplement which is a combination of beta-hydroxy-beta-methylbutyrate (HMB), arginine (ARG), and glutamine (GLN) has been shown to restore muscle in cachetic acquired immunodeficiency syndrome (AIDS) and cancer patients. More recently HMB has been shown to attenuate cancer-induced muscle loss by decreasing muscle proteolysis. The purpose of this study was to analyze whether HMB alone or in combination with ARG and GLN would have a similar effect on critically injured trauma patients. We hypothesized that nitrogen balance would be improved and muscle proteolysis decreased with HMB and HMB/ARG/GLN supplementation., Methods: There were 100 adult trauma patients with Injury Severity Score (ISS) >18 were enrolled in this prospective, randomized, blinded study. All patients received standard tube feeds and one of three iso-nitrogenous supplements; HMB, HMB/ARG/ GLN, or placebo (PLAC) for 28 days. Urine, serum, and clinical data were collected for 72 patients receiving at least 7 days of supplementation during the first 14 days of treatment. Urinary 3-methylhistidine (3-MH) was used as a proxy for muscle proteolysis., Results: The three groups were similar in age, gender, mechanism, and severity of injury, with the average ISS being 31.9. Utilizing covariant (ISS) repeated measure (days 1-14) mixed model (SAS) analysis, there was a significant treatment effect (p = 0.05) on nitrogen balance (g/d). Change in nitrogen balance from the first 7 days to the last 7 days was -4.3 for the HMB and -5.6 g/d HMB/ARG/GLN groups compared with -8.9 g/d for the PLAC group. 3-MH to creatinine ratios were not different in the PLAC group as compared with the HMB/ARG/GLN and HMB groups (Treatment Effect, p = 0.80)., Conclusions: These data suggest that supplementation with HMB alone may improve nitrogen balance in critically injured adult patients and that this effect is not a result of lowered muscle protein turnover as originally hypothesized.

Background: Ultrasound has become a routine part of care for pregnant women in most countries with developed health services. It is one of a range of techniques used in screening and diagnosis, but it differs from most others because of the direct access that it gives parents to images of the fetus. A review of women's views of ultrasound was commissioned as part of a larger study of the clinical and economic aspects of routine antenatal ultrasound use., Methods: Studies of women's views about antenatal screening and diagnosis were searched for on electronic databases. Studies about pregnancy ultrasound were then identified from this material. Further studies were found by contacting researchers, hand searches, and following up references. The searches were not intentionally limited by date or language. Studies that reported direct data from women about pregnancy ultrasound were then included in a structured review. Studies were not excluded on the basis of methodological quality unless they were impossible to understand. They were read by one author and tabulated. The review then addressed a series of questions in a nonquantitative way., Results: The structured review included 74 primary studies represented by 98 reports. Studies from 18 countries were included, and they employed methods ranging from qualitative interviewing to psychometric testing. The review included studies from the very early period of ultrasound use up to reports of research on contemporary practice. Ultrasound is very attractive to women and families. Women's early concerns about the safety of ultrasound were rarely reported in more recent research. Women often lack information about the purposes for which an ultrasound scan is being done and the technical limitations of the procedure. The strong appeal of diagnostic ultrasound use may contribute to the fact that pregnant women are often unprepared for adverse findings., Conclusions: Despite the highly varied study designs and contexts for the research included, this review provided useful information about women's views of pregnancy ultrasound. One key finding for clinicians was the need for all staff, women, and partners to be well informed about the specific purposes of ultrasound scans and what they can and cannot achieve.

Follow-up examination of 15 unselected children with aneuploid sex chromosome abnormalities has been made till between the age of 2 1/2 and 5 years. The mental development of the 15 children was in all cases within the normal range, but there was a tendency to some differences compared with their siblings.

Detergent Z demonstrated the most reliable cleaning and detergent delivery system. After the initial detergent evaluation, the data were compared against all detergents. It was found that acceptably cleaned items ranged from 37% to 85% per evaluation. Labor and material costs could be reduced greatly with the use of detergent Z, which had the best cleaning results. We also observed the advantage of a sensor in the detergent delivery system which can override some less obvious equipment malfunctions. Since detergent Z also exhibited the least amount of residue build-up, a savings in maintenance costs could be expected later on. The vendor of detergent Z showed great interest and concern for our department's needs and quality assurance by offering us numerous technical resources during the evaluation. One year following our detergent studies, detergent Z and its related line of cleaning products are being utilized in our hospital. We found that the four months spent analyzing detergents used in our utensil washers provided an interesting resource project that has been a positive investment in improved operations for the decontamination area. In Central Service alone, 61.7 hours a week were saved by the change in products. Quality of cleaning continues to be high. The practice of a weekly acid bath for the utensil washers has been discontinued; the acid bath will now be given when necessary, and has not been done since detergent Z was put into use six months ago. During the next fiscal year, savings of detergent, utilities and labor are conservatively projected at $30,000.