Search

ABSTRACTThis work presents the integration of an elemental analyzer (EA) and an isotope ratio mass spectrometer (IRMS) into the 6 MV AMS system at the Institute for Nuclear Physics, University of Cologne. The AMS measurement of δ13C values for IAEA-C6 reference material resulted in –11.39(226)‰, compared to –10.28(32)‰ obtained by IRMS. The EA-IRMS system was also tested with IAEA-C3, IAEA-C5, and IAEA-C7 reference materials, yielding –24.79(9), –25.18(15), and –14.76(18)‰ respectively. Compared to the IAEA information values given as –24.91(49), –25.49(72) and –14.48(21)‰ respectively. To investigate an observed sample mass dependency, environmental samples from Spitzbergen were examined, showing δ13C values of –25.17(55), –25.80(31), and –26.17‰ in Cologne, while Hamburg recorded –24.8(1), –25.5(1), and –26.2(13)‰. In summary, this new setup could enable online analysis and quasi-simultaneous measurements of 14C, δ13C, and δ15N for ultra-small samples, utilizing precise δ13C values from IRMS for fractionation correction of the 14C/14C isotopic ratio.

We examined the effects of perceived career barriers on career decidedness among first-generation college (FGC) students (n = 149) and non-FGC students (n = 182) at a 4-year university (mean [...]

You are at the place in your life and career where you are comfortable in your job, but you want to do more. Something is missing, and you have a [...], New nurse managers and nurses who wish to transition into management positions often look for guidance in improving their skills for the next level and to succeed in the job. This article provides guidelines and pragmatic advice for those who aspire to become a manager, started in their management role recently, and want to become successful in their current role and beyond. Key Words: Nurse manager, promotion, career, mentor.

When an editor I know took the helm of a magazine published by an esteemed liberal arts university in the northeast, the words 'alumni review' had been in the publication's [...]

ABSTRACTThis article explores the potential contribution that security risk assessments and a security programme on commercial private game reserves in the Limpopo Province of South Africa can make to ensure the safety and security, not only of their visitors, but also of the wildlife and natural assets of a game reserve. Not all commercial private game reserves can afford an extensive security programme and the person in charge may not be a security and/or a risk management expert, therefore the need arises for the development of a fundamental and straightforward security programme.

To review and update the literature regarding outcomes following surgical management of chronic, grade III posterolateral corner (PLC) injuries, with an emphasis on estimating failure rates based upon objective parameters in light of the 2019 expert consensus, while secondarily comparing the failure rates of anatomic versus non-anatomic reconstruction techniques.

Study Design Retrospective cohortObjective Anterior lumbar interbody fusion (ALIF) may be complicated by subsidence, which can lead to significant morbidity including pain, disc space collapse, neural compression, segmental kyphosis, instability, and vertebral body fracture. This study sought to identify patient and procedural risk factors for subsidence in patients undergoing ALIF.Methods This study analyzed consecutive patients who underwent ALIF at a single institution with a minimum of 2 years follow-up. Patients were grouped as either Non-Subsidence (NS-ALIF) or Cage Subsidence (CS-ALIF) based on the final postoperative radiograph. Demographic variables, operative characteristics, and radiographic outcomes were evaluated to identify significant predictors on univariate and multivariate statistics.Results 144 patients (170 levels) were included with an average follow-up of 50.70 ± 28.44 months (4.23 years). The incidence of subsidence was 22.94% (39/170 levels). On univariate statistics, the CS-ALIF group was significantly older (P = .020), had higher BMI (P = .048), worse ASA (P = .001), higher prevalence of comorbid osteoporosis (P < .001), and a more anteriorly placed interbody device (P = .005). On multivariate analysis, anterior cage placement remained the only significant predictor (OR: 1.08, 95% CI: 1.03–1.14; P = .003). There was a significantly higher rate of subsequent adjacent segment surgery among the CS-ALIF group (P = .035).Conclusion Factors contributing to subsidence in ALIF included older age, higher BMI, severe ASA, and osteoporosis, while anterior cage placement remained the only independent predictor on multivariate analysis. Subsidence was associated with a higher rate of subsequent adjacent segment surgery. Surgical technique should optimize placement of the interbody cage and avoid overstuffing the disc space.

Wire arc additive manufacturing (WAAM) integrates benefits of automation and mass customization to improve efficiency through near-net part production. While WAAM is well researched, there remain significant challenges as the complex relationship between robot, welder, and process parameters can lead to inaccuracy in geometry and variations in material properties. This research proposes a novel framework for quantifying the WAAM process and proposes dynamic adaptive strategies for improving production. This paper introduces the concept of an equivalent contact surface (ECS) for quantifying the additive welding process. Adaptive methods are then identified to optimize WAAM production. In conclusion, this paper provides an outlook on future research directions for continuing the development of this dynamic WAAM process.

Patient Care Technicians Managing Hemodialysis Central Venous Catheter Care: Pro Paul N. Bennett If you are reading this article, you are likely to have already developed your own views on [...], In the United States, the responsibilities and scope of practice of nephrology nurses and patient care technicians working in hemodialysis units vary from state to state. This occurs in relation to the care and management of central venous catheters (CVCs) used for hemodialysis. The aim of this article is to review the pros and cons of non-nursing staff performing the management and care of CVCs. The pros include decreasing nursing task time, allowing nurses to devote their time to other higher functioning roles, while the cons include lack of technician skill, education, and experience to perform CVC management and care. Key Words: Central venous catheters, hemodialysis, patient care technicians, nephrology nurses, patient care, patient safety.

Introduction A culturally competent health care provider understands cultural attitudes, values, beliefs, and practices and uses them to guide care for patients, taking into consideration their specific history and needs [...], Purpose: Culturally competent health care providers understand cultural attitudes, values, beliefs and practices and are able to use this knowledge to guide patient care. Rising oral health disparities among racial and ethnic minorities require that dental educators emphasize the attainment of cultural competence in order to prepare students to effectively care for patients with backgrounds different from their own. This study investigated the role of community rotations on the cultural competence of second-year Texas dental hygiene students. Methods: A modified version of the validated self-assessing Clinical Cultural Competency Questionnaire (CCCQ) was given to students at twelve Texas dental hygiene programs with a 100% response rate (239/239). Data analysis was performed using the Kendall tau correlation for associations and Kruskal-Wallis and Mann-Whitney U tests for differences among and between groups. Results: Students scored highest in attitude (86th percentile). Time spent in community rotations (p=0.009), number of community rotations (p=0.028), racial/ethnic diversity of program clinic patients (p=0.042), and training hours (p=0.044) were associated with increased cultural competence scores. Students with over 50 community rotation hours (p=0.006) scored significantly higher than students with less than 50 hours. Generally, those with four rotations (p=0.002) scored highest. Those with public clinic (p=0.049) and school (p=0.044) rotations scored significantly higher than those without these experiences. Those with nursing home (p=0.009) and hospital (p=0.026) experience scored lower than those without these experiences. Students seeing the most racially/ethnically diverse patients in program clinics scored higher (p=0.014) than students seeing less diverse patients. Those with 6-10 training hours scored higher (p=0.013) than those with other training levels. Hispanics scored significantly higher than whites in skill and overall cultural competence (p[less than or equal to] 0.005). Conclusion: Dental hygiene programs should invest time in cultural competence training and choose a robust program of community rotations, while considering the diversity of the student body and clinic patient pool to enhance graduates&apos; cultural competence. Keywords: cultural competence, cultural diversity, community rotations, dental hygiene education This manuscript supports the NDHRDA priority area, Professional development: education (evaluation)

The article focuses on the availability of inorganic phosphorus sources in poultry diets and their impact on poultry nutrition. Topics include the differences in phosphorus digestibility among various inorganic phosphate sources, the influence of water solubility on phosphorus availability, and the presence of undesirable elements in phosphorus sources that must be regulated.

AbstractIn inertial confinement fusion target design, the shape discrepancy between the cylindrical hohlraum and the spherical capsule creates a low mode asymmetry in the implosion. One way to correct such asymmetry is to shim the target capsule surface with extra mass in specific locations following a three-dimensional P4 Legendre mode. Previously, the desired surface pattern was precision machined out of the capsule. The resulting 2DConA experiments that investigated the implosion’s shape demonstrated the shimming method’s success. However, machining leaves large defects on the capsule surface that will degrade neutron yield in a DT implosion. An alternative shimming approach is to grow the pattern on the capsule surface using a glow discharge polymerization coating process in a stencil lithography application. In this paper, we discuss the fabrication, characterization, and challenges of making shimmed target capsules with this new method.

The Southern African Development Community (SADC) region, a regional economic body comprised of 16 member states, is one of our planet’s most vulnerable regions to natural hazards, and has a complex disaster risk profile. The region has sustained several disasters over the past decades. These events include annual floods in 2004–2019 and extreme droughts (1990–1993); other climate-induced disasters, such as cyclones, also have had devastating impacts, particularly on the Indian Ocean island states and east coast countries. To reduce the risk and impacts of disasters, governments must invest in disaster risk reduction (DRR). However, interventions aimed at reducing social and economic vulnerability and investing in long-term mitigation activities are often few, poorly funded, and insignificant in comparison with money spent on humanitarian assistance, disaster relief, and post-disaster reconstruction. This study investigated whether DRR is adequately funded within SADC member states in light of the high stakes in human life, infrastructure, and economic losses and the potential savings involved. The study applied a qualitative research design with data collected through semistructured interviews and focus group discussions. Respondents were selected purposefully and through snowball sampling with a total of 67 respondents from Botswana, Eswatini, Namibia, South Africa, and Zimbabwe participating in the study. The study findings reveal that DRR is inadequately funded in all the member states consulted in comparison to funding allocated to disaster response. In light of the underfunding experienced by DRR activities, this study provides a platform for lobbying and advocacy for adequate funding for DRR.

Study Design: Retrospective cohort study.Objectives: The current evidence regarding how level of lumbar pedicle subtraction osteotomy (PSO) influences correction of sagittal alignment is limited. This study sought to investigate the relationship of lumbar level and segmental angular change (SAC) of PSO with the magnitude of global sagittal alignment correction.Methods: This study retrospectively evaluated 53 consecutive patients with adult spinal deformity who underwent lumbar PSO at a single institution. Radiographs were evaluated to quantify the effect of PSO on lumbar lordosis (LL), thoracic kyphosis (TK), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), T1-spinopelvic inclination (T1SPI), T1-pelvic alignment (TPA), and sagittal vertical axis (SVA).Results: Significant correlations were found between PSO SAC and the postoperative increase in LL (r= 0.316, P= .021) and PT (r= 0.352, P= .010), and a decrease in TPA (r= −0.324, P= .018). PSO level significantly correlated with change in T1SPI (r= −0.305, P= .026) and SVA (r =−0.406, P= .002), with more caudal PSO corresponding to a greater correction in sagittal balance. On multivariate analysis, more caudal PSO level independently predicted a greater reduction in T1SPI (β = −3.138, P= .009) and SVA (β = −29.030, P= .001), while larger PSO SAC (β = −0.375, P= .045) and a greater number of fusion levels (β = −1.427, P= .036) predicted a greater reduction in TPA.Conclusion: This study identified a gain of approximately 3 degrees and 3 cm of correction for each level of PSO more caudal to L1. Additionally, a larger PSO SAC predicted greater improvement in TPA. While further investigation of these relationships is warranted, these findings may help guide preoperative PSO level selection.

Unsettled Scores: Politics, Hollywood, and the Film Music of Aaron Copland & Hanns Eisler by Sally Bick. Urbana, IL: University of Illinois Press. 2019. 232 pp., illus. Hardcover: $99.00, Paperback: [...]

Introduction Minority populations are increasing in the U.S. (1) Clear evidence exists that there are disparities in health care among these diverse populations within the U.S. (2) Minorities need and [...], Purpose: The purpose of this study was to identify the cultural climate of southwestern dental colleges, from the perspective of dental hygiene and dental students. Methods: The Cultural Attitudes and Climate Questionnaire was used to measure cultural climate. It contained 57 items related to campus experiences, cultural comfort, diversity awareness, racial pressures, fair treatment, respect, lack of support, patient care and overall satisfaction. The survey was administered to 508 dental and dental hygiene students at 5 dental colleges. Results: The response rate was 41% (n = 239/508). Students reported not experiencing racial conflict or pressures (71 to 90%), being treated fairly and with respect (86 to 90%) and being comfortable interacting with and treating other cultures (70 to 91%). They also practiced culturally appropriate behaviors (54 to 92%). Those reporting diversity training (77.8%) were more likely to engage in 3 of the 6 awareness practices (p < 0.033). Although all groups agreed their educational experience was rewarding (89.5%), African-Americans reported a significantly lower level of agreement than Whites (p = 0.003) and Asians (p = 0.008). Among all groups, satisfaction with their educational experience was significantly correlated with fair treatment (rho = 0.441 to 0.511, p < 0.001) and respect for other cultures (rho = 0.391 to 0.441, p < 0.001). Conclusion: The students generally reported a positive cultural climate. Improvements could be made by focusing on fair treatment, respect for cultures and the African-American experience. Cultural competence training could be key to improving cultural climate, as positive outcomes from training were identified. Keywords: cultural climate, academic success, dental, dental hygiene, diversity, cultural competence, training This study supports the NDHRA priority area, Health Promotion/ Disease Prevention: Investigate how diversity among populations impacts the promotion of oral health and preventive behaviors.

We present the first direct indoor measurements of VOC-induced nitrate radical (NO3) reactivity (kNO3) together with measurements of nitric oxide (NO), nitrogen dioxide (NO2), ozone (O3) and dinitrogen pentoxide (N2O5) inside a laboratory during a four-day period in October 2021 in a suburban area (Mainz, Germany). Indoor mixing ratios of O3ranged from <2–28 ppbv and those of NO2from 4.5–27 ppbv. The rapid ventilation of the room (air change rates of ∼4 h−1) meant that indoor mixing ratios mirrored the variability in NO2and O3outdoors. NO3production rates were between <0.02 and 0.12 pptv s−1with indoor N2O5mixing ratios increasing to 4–29 pptv during five NO-depleted day- or nighttime periods when kNO3was between 0.04 and 0.2 s−1. Steady-state calculations resulted in a peak NO3mixing ratio of 6 pptv. A comparison of measured N2O5mixing ratios to those derived from steady-state calculations and the equilibrium coefficient for the NO2, NO3, N2O5system showed very good agreement, indicating that heterogeneous reactions do not contribute significantly to the overall NO3loss rate (LNO3). During these five periods, NO3was mostly lost to NO and VOCs, the latter contributing on average 65% to LNO3. This pilot study underlines the necessity of further indoor NO3reactivity measurements and that the nitrate radical can be a significant indoor oxidizing agent when the room is sufficiently ventilated during episodes of moderate outdoor air pollution.

Background:Acute kidney injury (AKI) is a well-recognized complication of coronavirus disease 2019 (COVID-19). The short and long-term outcomes of patients who develop AKI have not been well characterized. Methods:In this multicenter retrospective cohort study, we describe the clinical characteristics and outcomes of critically ill adults with severe COVID-19 and AKI. Patient-level variables were extracted from the electronic medical record. Using nadir-to-peak serum creatinine, AKI was defined using the KDIGO definition. Multivariable logistic regression analyses examined factors associated with development of moderate-to-severe (stage 2–3) AKI, severe (stage-3) AKI, and the composite of renal replacement therapy (RRT) or in-hospital death. Results:Among 459 critically ill adults with COVID-19, 371 (80.1%) developed AKI, with 179 (37.9%) developing stage-3 AKI. Male gender, black and Asian/Native American race, lower baseline estimated glomerular filtration rate (eGFR), higher body mass index (BMI), and higher Acute Physiology and Chronic Health Evaluation (APACHE) IV score were more prevalent among patients with severe AKI, as were systemic markers of inflammation. On multivariable analysis, male gender, black and Asian/Native American race, higher APACHE IV score, lower baseline eGFR, and higher BMI (mainly the highest BMI stratum ≥35 kg/m2) were independently associated with higher stages of AKI severity. Male gender, lower baseline eGFR, and higher APACHE IV score were also independently associated with the composite of RRT or in-hospital death. Moderate-to-severe AKI and severe AKI were independently associated with in-hospital death, and there was a significant interaction between BMI and moderate-to-severe AKI for the outcome of in-hospital death. Among 83 (18.1%) patients who required RRT, 27 (32.5%) survived, and 12 (44.4%) remained dialysis-dependent at discharge. At 3 and 6 months, 5 (41.7%) and 4 (33.3%) remained dialysis-dependent, respectively. Conclusions:AKI is common in critically ill adults with COVID-19. Several patient-level risk factors are associated with higher stages of AKI severity. BMI might be an effect modifier of AKI severity for in-hospital death. Among AKI survivors, there is a high rate of short- and long-term dialysis dependence.

HEALTHY CAMPUS 2010 Healthy Campus 2010 provided a vision for achieving improved health for all students at institutions of higher education. Healthy Campus 2010 identified a set of 10-year health [...], Reviewing population-based assessments of health status, needs and assets of students and evaluating health improvement initiatives based on measurable goals and objectives is an effective practice and is required to create healthy campus communities and enhance academic performance. Healthy People 2010 (HP 2010) conducted a midcourse review, and in following the HP 2010 example, we conducted a midcourse review of over 170 objectives for this Healthy Campus 2010 midcourse review. The American College Health Association --National College Health Assessment (ACHA-NCHA) data from 455, 732 college students at over 389 institutions of higher education, plus data from the National Institutes on Drug Abuse: Monitoring the Future (2006) survey, was used for this research study. These two data sets were used because there are no other data sets on the college age population. The authors calculated progress quotients to determine percent of target achieved for 87 objectives. This article describes progress toward achieving Healthy Campus 2010 goals and objectives as found in Healthy Campus 2010: Making It Happen (ACHA, 2000). The article lists related initiatives and explains the midcourse review process, how objectives were selected, and how targets were determined. The focus of this article is on progress quotients and percent of targets achieved for over 80 objectives from 16 of the 28 Healthy People 2010 focus areas (United State Department of Health and Human Services, 2001). Additionally, two sets of objectives were developed as key indicators of student health and academic performance. These included the top 10 for each of the following: health impediments, and medical and mental health. Results indicate that 6% of the objectives and sub-objectives met or exceeded the target, 37% moved toward the targets, 10% remained the same and 43% moved away from the targets, and 5% did not have data allowing calculations. The information presented in this article can be used by college health professionals in their development of community based interventions that can be targeted and tailored to the individual. The Healthy Campus 2010 midcourse review expands the understanding of the trends and health improvement initiatives.

[ILLUSTRATION OMITTED] [ILLUSTRATION OMITTED] WHILE SURROUNDED BY HUNDREDS OF CERAMICS at the Taiwan Ceramics Biennial 2008, I stayed for a long time before a simple, wide cylindrical piece by Dutch [...]

Purpose: The purpose of this study was to determine changes in students&apos; cross-cultural effectiveness using the Cross-Cultural Adaptability Inventory (CCAI[TM]). The inventory assessed strengths and weaknesses in 4 skill areas: Emotional Resilience, Flexibility/Openness, Perceptual Acuity, and Personal Autonomy. Methods: The CCAI[TM] was administered to 30 dental hygiene students during Orientation. Age and dental assisting experience were recorded to determine if those variables affected skill areas. The inventory was re-administered at the end of the first and second years of the program. Data from the 3 time periods were analyzed using t-tests (a=0.05) for the 4 skill areas. These scores were totaled and used to determine differences due to dental assisting experience or age. Results: T-tests found no significant differences ([alpha]=0.05) for the 4 skill areas and for total scores between administrations of the inventory. Age and dental assisting experience did not affect results. Conclusions: No significant improvement in students&apos; cross-cultural effectiveness over the course of the 2-year curriculum was determined using the CCAI[TM]. Results of each student&apos;s performance, however, were not shared until graduation. Sharing results earlier would have allowed students to identify strengths and weaknesses in their cross-cultural effectiveness. This knowledge may have motivated them to improve their skills when exposed to patient experiences and curricular content promoting cross-cultural effectiveness. Programs which decide to use this inventory may want to consider using a strategy of surveying and sharing results at appropriate points during the curriculum. Key Words: cultural competence, diversity, dental hygiene, Introduction The American Dental Education Association (ADEA) resolution 12H2000 states that "All dental education institutions should include cultural and linguistic concepts as an integral component of their curricula to facilitate [...]

Proteomic absolute quantitation strategies mainly rely on the use of synthetic stable isotope-labeled peptides or proteins as internal standards, which are highly costly and time-consuming to synthesize. To circumvent this limitation, we recently developed a coulometric mass spectrometry (CMS) approach for absolute quantitation of proteins without the use of standards, based on the electrochemical oxidation of oxidizable surrogate peptides, followed by mass spectrometry measurement of the peptide oxidation yield. Previously, CMS was only applied for single-protein quantitation. In this study, first, we demonstrated absolute quantitation of multiple proteins in a mixture (e.g., β-lactoglobulin B, α-lactalbumin, and carbonic anhydrase) by CMS in one run, without using any standards. The CMS quantitation result was validated with a traditional isotope dilution method. Second, CMS can be used for absolute quantitation of a low-level target protein in a mixture; for instance, 500 ppm of PLBL2, a problematic host cell protein (HCP), in the presence of a highly abundant monoclonal antibody (mAb) was successfully quantified by CMS with no use of standards. Third, taking one step further, this study demonstrated the unprecedented quantitative analysis of deamidated peptide products arising from the mAb heavy chain deamidation reaction. In particular, absolute quantitation of the deamidation succinimide intermediate which had not been performed before due to the lack of standard was conducted by CMS, for the first time. Overall, our data suggest that CMS has potential utilities for quantitative proteomics and biotherapeutic drug discovery.

Desorientierung kann ein frühes Merkmal eines Delirs sein. Für die Überwachung eines Delirs testet die im deutschsprachigen Raum weit verbreitete „Confusion Assessment Method for Intensive Care Unit“ (CAM-ICU) die Orientierung nicht, da intubierte Intensivpatienten sich nicht verbal äußern können. Die Mehrheit der Patienten auf deutschen Intensivstationen ist aber nicht beatmet, sie könnten hinsichtlich ihrer Orientiertheit befragt werden. Die vorliegende Studie untersuchte, ob sich durch das Kriterium „Desorientierung“ bei extubierten Patienten im Vergleich zur CAM-ICU divergierende Befunde ergeben und ob sich die Sensitivität der CAM-ICU durch Kombination mit dem Merkmal „Desorientierung“ („CAM-IMC“) erhöhen lassen. Insgesamt 86 gepaarte Untersuchungen fanden bei 50 extubierten Patienten statt. Ein Delir fand sich bei 19,8 % (n= 17) aller Untersuchungen. Die CAM-ICU hatte eine Sensitivität von 71 % (95%-KI: 44–90 %) und eine Spezifität von 100 % (95–100 %). Für „Desorientierung“ als alleiniges Delir-Merkmal fand sich eine Sensitivität von 77 % (50–93 %) und eine Spezifität von 93 % (89–100 %). Die CAM-IMC erreichte eine Sensitivität von 88 % (64–99 %) bei einer Spezifität von 100 % (95–100 %). Die „Receiver-Operating-Characteristics(ROC)-Analyse“ fand mit einer „area under the curve“ (AUC) von 0,941 (95%-KI: 0,851–1,000) für die CAM-IMC den höchsten Wert im Vergleich zu den anderen Delir-Tests (CAM-ICU, AUC 0,853 [0,720–0,986]; Desorientierung, AUC 0,868 [0,745–0,991]). Diese Arbeit unterstreicht die Wertigkeit des Merkmals „Desorientierung“ für Delir-Tests bei verbal kommunikationsfähigen Patienten und erklärt einige diskrepante Beurteilungen schwierig einzuschätzender Patienten in der täglichen Praxis. Die CAM-IMC scheint als Delir-Test für extubierte Patienten günstigere Eigenschaften als die CAM-ICU zu haben und sollte eingehender überprüft werden.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2007.08.015 Byline: Wolfgang Schiller (a), Heike Rudorf (b), Christoph B. Welzel (a), Martin J. Kiderlen (a), Chris Probst (a), Oliver Dewald (a), Armin Welz (a) Abstract: Sutureless anastomoses for coronary artery surgery are being investigated for a minimally invasive setup because they are easy to perform and less time-consuming than are sutured anastomoses. The short-term effects of the biocompatible adhesive BioGlue on vascular tissue have been described as potentially unfavorable. The present study investigates the medium-term macroscopic and histologic effects associated with the use of BioGlue on rabbit carotid arteries. Author Affiliation: (a) Clinic for Cardiac Surgery, University Clinic Bonn, Bonn, Germany (b) Faculty of Veterinary Medicine, Department of Medical Imaging, University of Ghent, Merelbeke, Belgium. Article History: Received 14 March 2007; Revised 24 July 2007; Accepted 30 August 2007

For psychodynamic thinking and understanding to feel relevant to psychiatric residents in current training programs, it must focus on the clinical problems they encounter with patients. It must be presented in everyday language and in a form applicable to their own clinical experience. Abstract theory or 'deep' formulation may alienate rather than attract interest.

Study Design: Retrospective case series.Objective: The purpose of this study is to evaluate the clinical and radiographic outcomes following revision surgery following Harrington rod instrumentation.Methods: Patients who underwent revision surgery with a minimum of 1-year follow-up for flatback syndrome following Harrington rod instrumentation for adolescent idiopathic scoliosis were identified from a multicenter dataset. Baseline demographics and intraoperative information were obtained. Preoperative, initial postoperative, and most recent spinopelvic parameters were compared. Postoperative complications and reoperations were subsequently evaluated.Results: A total of 41 patients met the inclusion criteria with an average follow-up of 27.7 months. Overall, 14 patients (34.1%) underwent a combined anterior-posterior fusion, and 27 (65.9%) underwent an osteotomy for correction. Preoperatively, the most common lower instrumented vertebra (LIV) was at L3 and L4 (61%), whereas 85% had a LIV to the pelvis after revision. The mean preoperative pelvic incidence–lumbar lordosis mismatch and C7 sagittal vertical axis were 23.7° and 89.6 mm. This was corrected to 8.1° and 28.9 mm and maintained to 9.04° and 34.4 mm at latest follow-up. Complications included deep wound infection (12.2%), durotomy (14.6%), implant related failures (14.6%), and temporary neurologic deficits (22.0%). Eight patients underwent further revision surgery at an average of 7.4 months after initial revision.Conclusions: There are multiple surgical techniques to address symptomatic flatback syndrome in patients with previous Harrington rod instrumentation for adolescent idiopathic scoliosis. At an average of 27.7 months follow-up, pelvic incidence–lumbar lordosis mismatch and C7 sagittal vertical axis can be successfully corrected and maintained. However, complication and reoperation rates remain high.

In a burning plasma state1–7, alpha particles from deuterium–tritium fusion reactions redeposit their energy and are the dominant source of heating. This state has recently been achieved at the US National Ignition Facility8using indirect-drive inertial-confinement fusion. Our experiments use a laser-generated radiation-filled cavity (a hohlraum) to spherically implode capsules containing deuterium and tritium fuel in a central hot spot where the fusion reactions occur. We have developed more efficient hohlraums to implode larger fusion targets compared with previous experiments9,10. This delivered more energy to the hot spot, whereas other parameters were optimized to maintain the high pressures required for inertial-confinement fusion. We also report improvements in implosion symmetry control by moving energy between the laser beams11–16and designing advanced hohlraum geometry17that allows for these larger implosions to be driven at the present laser energy and power capability of the National Ignition Facility. These design changes resulted in fusion powers of 1.5 petawatts, greater than the input power of the laser, and 170 kJ of fusion energy18,19. Radiation hydrodynamics simulations20,21show energy deposition by alpha particles as the dominant term in the hot-spot energy balance, indicative of a burning plasma state.

This paper focuses on how inflation interacts with taxes and interest rates to affect capital formation.(1) It uses a simple credit-market framework to explain how inflation magnifies the distorting effects [...]

Although multi-sectoral coordination in disaster risk management has been progressing in South Africa for over two decades, there has been limited commitment to an integrated regime in managing marine oil spill incidents. Poor incident management persists despite the availability of data, protocols, legislation, and resources housed in different government and private sector entities. This study identified practices that enhance a coordination process for the effective management of oil spill pollution. A grounded theory approach is applied to the coordination issue, which is characterized by an interactive process of simultaneously considering theoretical grounding during our empirical research. Empirical evidence includes observations of 47 meetings and three oil spill exercises with 79 delegates from 32 different organizations, which supports the coordination process of instituting a national Incident Management System for marine oil spills in South Africa. An additional 44 individual open-ended questionnaires supplement this earlier body of evidence for data triangulation and validation. Analysis of development of the Incident Management System process revealed that, when designing a novel long-term project that is reliant on a shared vision from multiple organizations, enhanced coordination and collaboration for successful implementation is dependent on the following practices: (1) obtaining political commitment, (2) bridging knowledge gaps, and (3) sharing resources.

Obtaining a burning plasma is a critical step towards self-sustaining fusion energy1. A burning plasma is one in which the fusion reactions themselves are the primary source of heating in the plasma, which is necessary to sustain and propagate the burn, enabling high energy gain. After decades of fusion research, here we achieve a burning-plasma state in the laboratory. These experiments were conducted at the US National Ignition Facility, a laser facility delivering up to 1.9 megajoules of energy in pulses with peak powers up to 500 terawatts. We use the lasers to generate X-rays in a radiation cavity to indirectly drive a fuel-containing capsule via the X-ray ablation pressure, which results in the implosion process compressing and heating the fuel via mechanical work. The burning-plasma state was created using a strategy to increase the spatial scale of the capsule2,3through two different implosion concepts4–7. These experiments show fusion self-heating in excess of the mechanical work injected into the implosions, satisfying several burning-plasma metrics3,8. Additionally, we describe a subset of experiments that appear to have crossed the static self-heating boundary, where fusion heating surpasses the energy losses from radiation and conduction. These results provide an opportunity to study α-particle-dominated plasmas and burning-plasma physics in the laboratory.

Forecasts are regularly used in making fiscal and monetary policy decisions. For many decisionmakers, the likely short-term effect of a proposed action is a major concern in deciding whether to [...]

Since early 1993, the Research Department of the Federal Reserve Bank of St. Louis has made the data and programs for articles published in the Bank's Review available to the [...]

Significant illness or disability in the therapist will have complex repercussions upon the treatment process. This discussion focuses primarily on the multiple possible countertransference responses that the therapist may experience, and on the importance for the patient that the therapist acknowledge them. Suggestions are offered to help the therapist accomplish this.

IT WAS LONG AGO THAT I SAW WAYNE FISCHER'S CERAMICS FOR the first time. And since then I have never forgotten them. They stood in the diffused light of a [...]