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Magneto-hydrodynamic (MHD) Alfv��n waves have been a focus of laboratory plasma physics and astrophysics for over half a century. Their unique nature makes them ideal energy transporters, and while the solar atmosphere provides preferential conditions for their existence, direct detection has proved difficult as a result of their evolving and dynamic observational signatures. The viability of Alfv��n waves as a heating mechanism relies upon the efficient dissipation and thermalization of the wave energy, with direct evidence remaining elusive until now. Here we provide the first observational evidence of Alfv��n waves heating chromospheric plasma in a sunspot umbra through the formation of shock fronts. The magnetic field configuration of the shock environment, alongside the tangential velocity signatures, distinguish them from conventional umbral flashes. Observed local temperature enhancements of 5% are consistent with the dissipation of mode-converted Alfv��n waves driven by upwardly propagating magneto-acoustic oscillations, providing an unprecedented insight into the behaviour of Alfv��n waves in the solar atmosphere and beyond., Letter: 7 pages, 4 figures. Supplementary Material: 22 pages, 10 figures

Empowered decision making can help establish innovative work cultures. OJECTIVE: This study used the Decisional Involvement Scale to determine differences in actual and preferred decisional involvement among staff RNs and administrators in Magnet®, Magnet-aspiring, and non-Magnet hospitals.: Two facilities were Magnet designated, 3 were Magnet aspiring, and 9 were non-Magnet. A total of 5000 staff RNs and administrators were asked to participate in the nonexperimental descriptive survey. RESUTS: The difference observed in actual global scale score by Magnet status was statistically significant (P = .01). Respondents in Magnet hospitals had the highest actual global scale score on average, followed by Magnet-aspiring, then non-Magnet.Decisional involvement is higher among Magnet-designated than non-Magnet facilities.

Objective To characterize communication strategies of labor and delivery nurses and their physician colleagues during perinatal decisions. Design A quantitative descriptive design was used. Setting A perinatal setting in an urban acute care facility. Participants Twenty‐nine perinatal nurses and 11 attending physicians. Methods A model of team communication derived from research on cockpit crew communication served as a framework for this analysis. Data were taken from transcriptions of audio‐taped conversations and discourse analysis. Results Findings indicated that nurses and physicians tended to use status‐based communication styles and rarely employed team‐centered communication strategies. Conclusion Nurse and physician status‐based communication styles may hinder optimal patient outcomes.

BACKGROUND Dramatic reductions in plasma HIV RNA levels are possible with current antiretroviral regimens; the effect of potent therapies and "undetectable" viral load on the perceived risk of HIV transmission and need for safer practices remains unknown. METHODS A questionnaire was developed to examine perceptions of HIV transmission risk and need for safer practices with unprotected anal, vaginal, and oral sex and intravenous drug use with needle sharing for HIV-discordant couples in which the HIV-infected partner was receiving no therapy, was receiving reverse transcriptase inhibitor therapy, and protease inhibitor (PI)-based therapy with viral load "undetectable". This was applied anonymously to 147 unselected HIV-infected individuals attending a university-based HIV clinic. RESULTS Almost all respondents believed that all sexual activities except oral sex were "very risky" and that safer practices were "extremely important" for those not receiving antiretroviral agents. Significantly fewer considered that anal or vaginal sex was "very risky" for those receiving PI therapy (90.9% and 86.0%, respectively), and fewer thought that safer practices for anal or vaginal sex were "very important" for those receiving PI therapy (93.0% and 91.6%, respectively). In total, 20.4% thought the risk of HIV transmission for at least one activity was reduced for those receiving PI therapy, and 19.0% believed that the need for safer practices was reduced by PI therapy. CONCLUSION A small but significant proportion of HIV-infected people perceive the need for safer practices to be reduced during antiretroviral therapy, particularly those containing PIs. Even if the risk is truly reduced, the importance of safer practices should be conveyed consistently and terms such as "undetectable" to describe HIV RNA responses should be avoided.

Tendon transfers are used to restore balance and function to a paralyzed, injured, or absent neuromuscular-motor unit. In general, tendon transfer is indicated for restoration of muscle function after peripheral nerve injury, injury to the brachial plexus or spinal cord, or irreparable injury to tendon or muscle. The goal is to improve the balance of a neurologically impaired hand. In the upper extremity, tendon transfers are most commonly used to restore function following injury to the radial, median, and ulnar nerves. An understanding of the general principles of tendon transfer is important to maximize the outcome.

Visual cortical surface area varies two- to threefold between human individuals, is highly heritable, and has been correlated with visual acuity and visual perception. However, it is still largely unknown what specific genetic and environmental factors contribute to normal variation in the area of visual cortex. To identify SNPs associated with the proportional surface area of visual cortex, we performed a genome-wide association study followed by replication in two independent cohorts. We identified one SNP (rs6116869) that replicated in both cohorts and had genome-wide significant association ( P combined = 3.2 × 10 −8 ). Furthermore, a metaanalysis of imputed SNPs in this genomic region identified a more significantly associated SNP (rs238295; P = 6.5 × 10 −9 ) that was in strong linkage disequilibrium with rs6116869. These SNPs are located within 4 kb of the 5′ UTR of GPCPD1 , glycerophosphocholine phosphodiesterase GDE1 homolog ( Saccharomyces cerevisiae ), which in humans, is more highly expressed in occipital cortex compared with the remainder of cortex than 99.9% of genes genome-wide. Based on these findings, we conclude that this common genetic variation contributes to the proportional area of human visual cortex. We suggest that identifying genes that contribute to normal cortical architecture provides a first step to understanding genetic mechanisms that underlie visual perception.

Although beta-conglycinin (7S globulin), a major soy storage protein, stimulates the expression of LDL receptors and the degradation of LDL by hepatocytes in vitro, the in vivo effects of dietary beta-conglycinin on the cardiovascular system are unknown. We assessed the effects of dietary beta-conglycinin and other soy peptide fractions on the development of atherosclerosis in atherosclerosis-susceptible mice. At 6 wk of age, male and ovariectomized female apolipoprotein (apo) E-null mice and LDL receptor-null, apoB transgenic mice were assigned randomly to treatment groups that differed only in the source of dietary protein: 1) casein/lactalbumin, 2) isoflavone-containing soy protein isolate, 3) beta-conglycinin, 4) glycinin (11S globulin, another major soy storage protein), 5) beta-conglycinin-devoid soy protein, and 6) W008 (a peptide fraction produced by hydrolysis and precipitation of soy protein isolate). After 4 mo, aortic atherosclerosis (cholesteryl ester content) and plasma lipoprotein cholesterol concentrations were quantified using GLC. Relative to mice fed casein/lactalbumin-based diets, the extent of atherosclerosis was reduced in ovariectomized female mice fed all soy protein-containing diets. Relative to mice fed isoflavone-containing soy protein isolate, atherosclerosis was reduced only in mice fed the beta-conglycinin-containing diet. Mean reductions were 39 and 67% (all P

It has been pointed out that an adenomatous formation composed of either tubal epithelium or endometrium, or in a few cases of both simultaneously, occurs rather frequently in the region of the uterine cornu and tubal isthmus. A previous operative trauma of this region is not essential for the production of such an adenomatous formation, nor is it necessarily associated with any previous inflammatory process. It may be considered then as a truly neoplastic formation or primary adenomyoma. From the types of epithelium described in these adenomyomas it is evident that they may arise from tubal epithelium as well as endometrium. The presence in a few cases of spaces lined by tubal epithelium as well as islands of true endometrium in the same specimen suggests the possibility of a metaplasia of one of these types of mucosa into the other. The finding of gland-like spaces lined by tubal epithelium but surrounded by endometrial stroma is even more suggestive of this possibility. The finding of ten cases in which the interstitial or isthmic portion of the tube is lined by endometrium rather than tubal mucosa is further evidence of the histologic variability of this region, and suggests again the possibility of a metaplasia of one of these types of mucosa into the other. Evidence gathered from the literature, particularly from the work of Sampson, tends to show that a number of cases reported as endometriosis are really cases of aberrant tubal epithelium. It is noted, however, that Sampson has called attention to this fact from time to time, and in a more recent work on “Endometriosis Following Salpingectomy” has stressed the probability of a metaplasia of tubal mucosa into endometrium. In a review of 24 cases diagnosed as endometriosis in our own laboratory it has been found that in a third of them the epithelial elements were definitely tubal in type. In some of them there was in addition to the tubal epithelium an endometrial-like stroma. In a few instances cysts lined by tubal epithelium and others with real endometrium occurred in the same case. In one very striking case the same hemorrhagic cyst of an ovary was lined in part by tubal epithelium, while another area of the cyst wall showed real endometrium with stroma and glands. Such cases lend additional evidence to the hypothesis that tubal epithelium may, by metaplasia, be transformed into endometrium.

Two cases of arrhenoblastoma of the ovary have been reported. Both occurred in relatively young women and in the right ovary. One was associated with rather marked virulism and microscopically was of the intermediate cell type. The other tumor, which was associated with only slight masculinization, was microscopically highly differentiated and resembled a tubular adenoma of Pick. The 17-ketosteroid exeretion was studied in one case and proved to be elevated preoperatively, falling to normal within twelve days postoperatively. Noopregnanediol was present in the urine in this case. A simple salpingo-oophorectomy was performed in one case, and the patient is well one year postoperatively with some regression of masculinization and regular menses. The other patient had a bilateral salpingo-oophorectomy and hysterectomy, and is well six months postoperatively.

While the tubal mucosa does not participate in the bleeding of the menstrual process, its epithelium exhibits a definite cyclical change comparable with that of the endometrium. It is, however, not nearly so conspicuous as the latter, being concerned more with microscopic changes in the cells rather than with the grosser changes in pattern seen in the endometrium. The present study, based upon the careful examination of the tubes, from 136 cases, in almost all of which the endometrium was also available for study, has demonstrated the following chief facts: 1. 1. The tubal epithelium consists of two chief types of cells, the ciliated and the nonciliated. The latter are often spoken of as “secretory” cells. A third type, the “peg” cells (“Stiftchenzellen,” “Schaltzellen”) are also described, but it is probable that these represent only a phase of the nonciliated cells. 2. 2. In the interval phase, the epithelium is uniformly tall, the ciliated cells being broad, with rounded nuclei near the free margin, while the nonciliated cells are rather narrower, the nuclei being more deeply placed and taking a deeper stain. 3. 3. In the premenstrual phase the ciliated cells become lower, so that the “secretory” cells project beyond them, giving the epithelial margin a ragged, uneven appearance. The “secretory” cells show a bulbous herniation into the lumen of the tube, often carrying the nucleus with it. This extrusion of nuclei is similar to that seen in many lower animals, but its significance is not known. In spite of the great loss of cells, mitoses are rarely seen in the tubal epithelium. 4. 4. During the stage of menstruation, the premenstrual changes are carried further, the epithelium becoming quite low. The ciliated cells, especially, remain broad and low, but the secretory cells also, having been emptied of their cytoplasm, are much lessened in height, the nuclei often being quite bare of cytoplasm. “Peg” cells are numerous, their appearance and distribution suggesting that they are merely emptied “secretory” cells. 5. 5. The postmenstrual phase is characterized first by a low epithelium, which quite rapidly, however, increases in height, so that by the third or fourth day after menstruation it is often almost as tall as during the interval phase. The cells are narrow, closely placed, and, after the first day or so, of uniform height. 6. 6. During pregnancy, the epithelium becomes even lower than in the menstrual stage, and in the later stages it may become almost flat in many places. Secretory changes are not seen at this time. 7. 7. Cilia can be demonstrated in all stages, especially through the examination of fresh tissues, by the technic described in the paper. They are also found in the tubal epithelium of young children and in women many years beyond the menopause. This suggests that they must have some other function than that of assisting in the propulsion of the ovum. Perhaps, as has been suggested by Hartman. their chief role may be that of keeping the tubal lumen cleansed of foreign particles of any kind. 8. 8. Efforts at differential staining of the secretion have thus far been unsuccessful. Neither glycogen nor mucin can be demonstrated, unlike the findings in the secreting endometrium. The various views as to the significance of this tubal secretion are discussed in the paper, although there is as yet no positive knowledge as to this point. 9. 9. The prepuberal tubal epithelium is rather low, but shows both chief types of cells. Cilia, however, are very sparse, and are usually not seen at all in fetal or very early postnatal life. 10. 10. The epithelium of the postmenopausal tube may remain quite high for a surprisingly long time, perhaps a number of years after the cessation of menstruation. Cilia, likewise, may persist for many years. Sooner or later, however, the tubal folds become rounded, of fibrous appearance, the epithelium becomes low or even quite flat, and cilia, of course, disappear. 11. 11. The tubal epithelium of tubes removed from patients suffering with hyperplasia of the endometrium was studied because the latter condition is unquestionably associated with a functional disturbance of the ovaries. Characteristically the epithelium was found to be high, uniform, compact, with narrow cells, most of which were ciliated. There was no evidence of secretory change. This bears out the view, for which there is other evidence, that the functional disturbance consists of an excess or persistence of the follicle stimulus, with an absence of the corpus luteum influence. 12. 12. The comparison of the tubal cycle in women with that of the lower animals, like the comparative study of the uterine and ovarian cycles, emphasizes the important differences, chronologic and histologic, which exist. For example, the estrus tube of the rodent resembles, not the menstrual or premenstrual tube of the human, but the interval phase. Since estrus in the lower type is undoubtedly due to the follicle hormone, it seems clear that in the human the maximum of follicle influence is reached during the interval phase, and that the later changes are due to the corpus luteum influence. To bear this out, the picture in the animal tube which resembles the human premenstrual tube is that seen in the metoestrum, during which stage the corpus luteum apparently plays the dominating role.

Durch Umsetzung der Bis-halogenmethyl-naphthaline (I) mit Polyethylenglykolen (II) werden Kronenether der allgemeinen Struktur (III), z.B. die Verbindungen (IV)-(IX), hergestellt.

s I N c E 1929 one of us (H. S. E.) has been interested in the urinary tract complications resulting from various types of gynecologic disease and from the methods of treatment of some of these disease entities. This interest was stimulated by 2 patients: one with a right ureteroperitoneal fistula and urinary ascites resulting from a surgical injury to the right ureter during hysterectomy for fibroids, the other with a vesicovaginal fistula, enormous hydroureters, terminal chronic pyelonephritis, and urinary ascites resulting from spontaneous perforation of the dilated left ureter, all of which followed irradiation therapy for carcinoma of the cervix. Reports of both of these cases were published in collaboration with Hunner,r, ’ and since that time a number of papers dealing with various aspects of such urologic complications have been presented and/or published either alone or with other members of our staff. The first of these reports resulting from a systematic study of the subject was pre

Acute gonorrhea/ urethritis in women has become rare, but chronic nonspecific granular urethritis is now frequent. Polyps are most often found associated with the latter, and may be responsible for the appearance of blood toward the end of each urination. Caruncles near the urethral meatus at times cause bleeding and pain, but they are usually symptomless and rarely undergo malignant degeneration. Obstruction of the urethra in children by folds of mucous membrane can cause symptoms of all degrees of severity including intractable enuresis and persistent infection; removal of such folds by fulguration or resection has often relieved these symptoms completely, but must be done with care to avoid producing incontinence and fistulas. The treatment of strictures is very difficult; scarring leads to rigidity of the urethral wall and incontinence at the sphincter, and the latter is not relieved by repeated dilatations. Urethral diverticula can be rendered visible by positive pressure urethrography; they sometimes afford an explanation of chronic or recurrent cystitis. Malignant tumors in and about the urethra are very difficult to treat surgically. Treatment by radiation has given better results in two series of malignant tumors in this location.

Whether there are geographic differences in clinical presentation of cryptococcosis in solid organ transplant (SOT) recipients in the United States (US) is not known.Patients comprised a cohort of 120 SOT recipients from US transplant centers who fulfilled the EORTC/MSG criteria for cryptococcal disease.Central nervous system, pulmonary, and cutaneous cryptococcal disease were observed in 51% (61/120), 64% (77/120), and 15% (18/120) of the patients, respectively. Cutaneous disease was documented in 9% (3/32) of the patients from South Atlantic region, 19% (6/32) from Mid Atlantic, 26% (6/23) from Southern, 7% (2/29) from Midwestern, and in 1 of 4 patients from the Northwestern region of the US. When controlled for age, immunosuppressive regimen, type of transplant, and renal failure at baseline, patients from the Southern compared with other regions of the US were significantly more likely to have cutaneous cryptococcal disease (OR 3.8, 95% CI 1.1-14, P=0.045).Post-transplant cryptococcosis is more likely to present with cutaneous disease in the Southern region compared with other regions in the US. This predilection for cutaneous cryptococcosis could not be explained on the basis of differences in immunosuppression or the type of transplant. Whether our findings are related to strain-related variations in characteristics of the yeast or other transplant variables remains to be determined.

Secondary anemia following excessive uterine hemorrhage constitutes a frequent and important complication of gynecologic disorders. When the bleeding is the result of such gross lesions as uterine fibroids, a severe degree of anemia may present a situation requiring considerable delicacy of judgment in its handling. A major surgical procedure is usually necessary to stop the excessive flow effectively and permanently, and before the surgeon is justified in operating the anemia must be effectively treated to an extent sufficient to render the procedure a safe risk; this must usually be accomplished in the all too brief interval between two prolonged and profuse menstrual periods. It is therefore essential that one have at one's disposal efficient and speedy methods of effecting such an improvement. For many years iron in one form or another has been the standard drug used in the treatment of such conditions, and more recently transfusion has proved to

History. —E. R., a colored woman, aged 34, was first admitted to the gynecologic service of the Johns Hopkins Hospital, Oct. 7, 1928, complaining of increased duration of the menstrual periods. There was nothing of significance in the family history so far as the present report is concerned. The past history was also irrelevant except as regarded the digestive system. The patient's appetite had always been good, but for several years she had been subject to "indigestion." at times with nausea, occurring usually at night. In the winter of 1927 she was troubled by frequent attacks of vomiting which were aggravated by eating, even when she was most careful about taking a moderate diet. There was often a feeling of fulness after eating and moderate pain, especially at night. These symptoms were associated with an obstinate chronic constipation. At this time she was treated in the gastro-intestinal division of the