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A novel square, broadband, and low loss holey core/cladding waveguide has been designed for chip-to-chip communications. The square grid geometry allows for polarization division multiplexing with minimum cross-talk. The design shows a three-fold loss reduction compared to a solid core waveguide.

We evaluated the timeliness of androgen deprivation therapy dosing, the impact of dosing nonadherence on testosterone, and the frequency of testosterone and prostate specific antigen testing in patients with prostate cancer.We retrospectively analyzed the records of 22,860 patients with prostate cancer treated with luteinizing hormone-releasing hormone agonists. Analyses were done using 2 definitions of month, including a 28-day month (late dosing after day 28, 84, 112 or 168) and an extended month (late after day 32, 97, 128 or 194) for 1, 3, 4 and 6-month formulations, respectively. The prevalence of late dosing, associated testosterone values, and the frequency of testosterone and prostate specific antigen testing were assessed. Statistical significance was assessed with the unpaired t-test.Of the injections 84% and 27% were late for the 28-day and extended month analyses, respectively. For the 28-day month 60% and 29% of injections were late by more than 1 and more than 2 weeks, respectively. Of testosterone values 4% were greater than 50 ng/dl for early/on time injections using both definitions, and 15% and 27% were greater than 50 ng/dl when late, and for the 28-day month and the extended month, respectively. For early/on time vs late injections 22% vs 31% of testosterone values were greater than 20 ng/dl for the 28-day month and 21% vs 43% for the extended month. Mean testosterone was higher when lateLuteinizing hormone-releasing hormone agonists were frequently (84%) administered later than the schedules used in pivotal trials. Nearly half of the late testosterone values for the extended month were greater than 20 ng/dl and mean testosterone was almost double the castration level. Elevated testosterone remained unidentified with infrequent testing.

195 Background: This study evaluated the ability of the combined clinical cell-cycle risk score (CCR) to prognosticate the risk of prostate cancer metastasis in men receiving dose-escalated radiation therapy (RT) with or without androgen deprivation therapy (ADT). Methods: The CCR score is a validated model that combines the cell cycle progression score (CCP) with the UCSF Cancer of the Prostate Risk Assessment score (CAPRA). The CCR score and a CCR-based multimodality threshold score (2.112) were evaluated in a retrospective, multi-institutional cohort of men with National Comprehensive Cancer Center (NCCN) intermediate- or high-risk localized disease (N = 741) who received single (RT) or multimodality therapy (ADT with RT). Effects of prognostic variables were analyzed using Kaplan-Meier and Cox regression methods. Results: Median follow-up was 5.9 years. CCR predicted metastasis [hazard ratio (HR) 2.21, 95% Confidence Interval (CI) 1.70-2.87, p < 0.001]. The CCR score was a better prognosticator of metastasis (C-index 0.78) than either NCCN-risk group (C-index 0.70), CAPRA score (C-index 0.71), or CCP score (C-index 0.69) alone. In bivariate analyses, the CCR score remained highly prognostic for metastasis when comparing any ADT vs none (HR 2.19, 95% CI 1.62 to 2.97, p < 0.001), ADT duration as a continuous variable (HR 2.05, 95% CI 1.54-2.72, p < 0.001), or ADT use given as less than or at the recommended duration for each NCCN risk group (HR 2.22, 95% CI 1.71-2.88, p < 0.001). Men with CCR scores either below or above the threshold (2.112) had a 10-year risk of metastasis of 4.2% and 25.3%, respectively. For men below the threshold receiving RT alone versus RT+ADT, the 10-year risk of metastasis was 4.2% and 3.9%, respectively. Conclusions: CCR is a highly precise and accurate predictor of metastasis in men undergoing dose-escalated RT, with or without ADT. CCR adds clinically actionable information relative to guideline recommended therapies that are based on NCCN risk groups or CAPRA alone. Men with scores below the multimodality threshold may not significantly reduce their 10-year risk of metastasis with the addition of ADT.

Background A clinical need exists for a biomarker test to accurately delineate aggressive prostate cancer (AgCaP), and thus better assist clinicians and patients decision-making on whether to proceed to prostate biopsy. Objectives To develop a blood test for AgCaP and compare to PSA, %free PSA, proPSA, and prostate health index (PHI) tests. Design, settings and participants Patient samples from the MiCheck-01 trial were used for development of the MiCheck test. Methods Serum analyte concentrations for cellular growth factors were determined using a custom-made Luminex-based R&D Systems multianalyte kit. Outcome measurements and statistical analysis Bayesian model averaging and random forest approaches were used to identify clinical factors and growth factors able to distinguish between men with AgCaP (Gleason Score [GS] ≥3+4) from those with non-AgCaP (GS 3+3). Logistic regression and Monte Carlo cross-validation identified variable combinations in order to able to maximize differentiation of AgCaP from non-AgCaP. Results The MiCheck logistic regression model was developed and comprises the following variables: serum prostate-specific antigen (PSA), patient age, Digital Rectal Exam (DRE) status, Leptin, IL-7, vascular endothelial growth factor, and Glypican-1. The model differentiated AgCaP from non-AgCaP with an area under the curve of 0.83 and was superior to PSA, %free PSA and PHI in all patient groups, regardless of PSA range. Applying the MiCheck test to all evaluable biopsy patients from the MiCheck-01 study demonstrated that up to 30% of biopsies could be avoided while delaying diagnosis of only 6.8% of GS ≥3+4 cancers, 5% of GS ≥4+3 cancers and no cancers of GS 8 or higher. Conclusions The MiCheck test outperforms PSA, %free PSA and PHI tests in differentiating AgCaP vs. non-AgCaP patients. The MiCheck test could result in a significant number of biopsies being avoided with a low number of patients experiencing a delayed diagnosis.

Background Increasing numbers of patients are presenting with aggressive prostate cancer (CaP); therefore, there exists a need to optimally identify these patients pre-biopsy. Objectives To compare the accuracy of total prostate specific antigen (PSA), %free PSA, and prostate health index (PHI) to differentiate between patients without CaP, with non-aggressive (Gleason 3 + 3, non-AgCaP) and with aggressive (Gleason ≥ 3 + 4, AgCaP) in a contemporary US population. Design, settings, and participants Serum samples were collected from 332 US patients scheduled for biopsy due to an elevated age-adjusted PSA. Site and Central biopsy pathologic assessment were performed. Outcome measurements and statistical analysis Testing of PSA, free PSA, proPSA, and PHI was performed along with central pathology review. Test performance using logistic regression analysis for differentiating CaP from non-CaP as well as non-AgCaP from AgCaP was evaluated. Results and limitations Central pathology review resulted in 32 upgrades including 14 Gleason 3 + 3 scores being upgraded to AgCaP with final distribution of 148 no-CaP, 64 non-AgCaP, and 120 AgCaP patients. Receiver operator curve (ROC) analysis of the different tests showed that PHI performed best at differentiating CaP from no-CaP subjects (area under the receiver operator curve 0.79). In contrast, the different tests were essentially equivalent in differentiating AgCaP vs. non-AgCaP. Conclusions In this recent US study of prebiopsy patients we observed a high proportion of AgCaP patients consistent with previous studies in contemporary US populations. Central Gleason review is recommended for multi-institutional studies comparing biomarkers. PHI was superior to PSA, free PSA, %free PSA, and proPSA in detecting CaP in this population but was not superior at differentiating AgCaP from non-AgCaP.

A square holey cladding waveguide is designed and fabricated to support TE and TM polarizations for 180 GHz to 360 GHz chip-to-chip communication. The mode profile and normalized output power of the waveguide are simulated. A fabricated waveguide is tested using a vector network analyzer for mode mapping and loss measurements. The mode profile was mapped using a 250 μm pinhole stepped across the waveguide cross section. The waveguide loss is measured using a free space dielectric material characterization method. Here a taper with an aperture comparable to the core size was used. The taper provides easy alignment and higher coupling efficiency.

Purpose Research suggests levels of discrimination among mental health service users in England are high, but fell over the course of the first phase of the Time to Change programme to reduce stigma and discrimination (2008–2011). The aim of this study was to determine changes in discrimination levels, both overall and by the area of life in which discrimination is experienced, since Time to Change began and over the first year of its second phase (2011–2012). Method Separate samples of mental health service users were interviewed annually from 2008 to 2012 using the Discrimination and Stigma Scale. In 2011 and 2012, social capital was also measured using the Resource Generator-UK. Results Sample percentages of participants reporting the experience of discrimination in one or more life areas for years 2008–2012 were 91.4, 86.5, 86.2, 87.9 and 91.0 %, respectively. A multivariable logistic regression model was performed to test for significant differences by study year, weighted to match the study population and adjusted for employment status and diagnosis as potential confounding factors. The odds of reporting discrimination in one or more life areas were significantly lower as compared to 2008 for all subsequent years except for 2012 (0.76, 95 % CI 0.49–1.19). However, a weighted multiple regression model provided evidence of decreased mean overall discrimination in 2012 as compared to 2008 (mean decrease −7.57, 95 % CI −11.1 to −4.0, p

Purpose Medical treatment for men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia is 5α-reductase inhibitor monotherapy or coadministration with an α-blocker. We assessed the effects of tadalafil 5 mg coadministered with finasteride 5 mg during 26 weeks on lower urinary tract symptoms and sexual symptoms. Materials and Methods In an international, randomized, double-blind, parallel study of men 45 years old or older who were 5α-reductase inhibitor naïve and had an I-PSS (International Prostate Symptom Score) of 13 or greater and prostate volume 30 ml or greater, 350 were treated with placebo/finasteride and 345 received tadalafil/finasteride for 26 weeks. Changes in lower urinary tract symptoms secondary to benign prostatic hyperplasia were assessed with the I-PSS, erectile dysfunction improvements were assessed with the IIEF-EF (International Index of Erectile Function-Erectile Function) in sexually active men and safety was assessed by evaluating adverse events. Results Least squares mean changes from baseline in I-PSS after 4, 12 and 26 weeks of tadalafil/finasteride coadministration were -4.0, -5.2 and -5.5, respectively. Corresponding values for placebo/finasteride coadministration were -2.3, -3.8 and -4.5 (p ≤0.022 at all visits favoring tadalafil/finasteride coadministration). I-PSS subscores (storage and voiding) and quality of life index were also numerically improved with tadalafil/finasteride coadministration. Least squares mean changes from baseline in IIEF-EF with tadalafil/finasteride coadministration were 3.7 after 4 weeks, and 4.7 after 12 and 26 weeks. Corresponding values for placebo/finasteride coadministration were -1.1, 0.6 and -0.0 (p

Summary Background: Evidence has emerged in recent decades about effective and ineffective methods to reduce mental illness related stigma and discrimination. As more European countries start national anti-stigma campaigns, there is potentially more to learn from their experiences, but also a risk that, with such rapid developments, lessons may be missed. Aim: This scoping review aims to identify and discuss European stigma reduction campaigns conducted to date. Methods: We searched electronic databases, hand-searched reference lists of identified articles and contacted stigma experts to enquire about ongoing initiatives. Results: We identified anti-stigma campaigns in 21 European countries and regions. We found considerable variation in their content, delivery formats, duration and target groups. Conclusions: Although anti-stigma campaigns have been implemented in many European countries, the level of attention paid to sharing lessons learned is variable. It is vital that campaigns are evaluated, to maximise their potential impact both on the target population, and that the findings are disseminated widely to allow international learning.

Loudspeaker design requires accurate models of driver voice coil impedance. This paper examines three model classes (standard, Leach, and van Maanen) from the audio literature and compares them using Bayesian model comparison via nested sampling. Data is generated from impedance measurements of two commercial loudspeaker drivers. We conclude that, for most design tasks involving these drivers, the van Maanen model with 3 lossy inductance groups is the most appropriate model.

A holey cladding dielectric waveguide with square cross section is designed, simulated, fabricated and characterized. The TOPAS waveguide is designed to be single mode across the broad frequency range of 180 GHz to 360 GHz as shown by finite-difference time domain simulation and to robustly support simultaneous TE and TM mode propagation. The square fiber geometry is realized by pulling through a heat distribution made square by appropriate furnace design. The transmitted mode profile is imaged using a vector network analyzer with a pinhole at the receiver module. Good agreement between the measured mode distribution and the calculated mode distribution is demonstrated.

BACKGROUND:Despite increasing calls for shared decision making (SDM), the precise mechanisms for its attainment are unclear. Sharing decisions in mental health care may be especially complex. Fluctuations in service user capacity and significant power differences are particular barriers.OBJECTIVE AND DESIGN:We trialled a form of facilitated SDM that aimed to generate patients' treatment preferences in advance of a possible relapse. The 'Joint Crisis Plan' (JCP) intervention was trialled in four mental health trusts in England between 2008 and 2011. This qualitative study used grounded theory methods to analyse focus group and interview data to understand how stakeholders perceived the intervention and the barriers to SDM in the form of a JCP.RESULTS:Fifty service users with psychotic disorders and 45 clinicians participated in focus groups or interviews between February 2010 and November 2011. Results suggested four barriers to clinician engagement in the JCP: (i) ambivalence about care planning; (ii) perceptions that they were 'already doing SDM'; (iii) concerns regarding the clinical 'appropriateness of service users' choices'; and (iv) limited 'availability of service users' choices'. Service users reported barriers to SDM in routine practice, most of which were addressed by the JCP process. Barriers identified by clinicians led to their lack of constructive engagement in the process, undermining the service users' experience.CONCLUSIONS:Future work requires interventions targeted at the engagement of clinicians addressing their concerns about SDM. Particular strategies include organizational investment in implementation of service users' choices and directly training clinicians in SDM communication processes.

The T2K Fine Grained Detector (FGD) is an active neutrino target that uses segmented scintillator bars to observe short-range particle tracks. 8448 multipixel photon counters (MPPCs) coupled to wavelength shifting fibres detect scintillator light. An application specific integrated circuit (ASIC) shapes the MPPC waveform and uses a switched capacitor array (SCA) to store up to 511 analog samples over 10.22 μs. High and low attenuation channels for each MPPC improve dynamic range. 12-bit serial quad-ADCs digitize ASIC analog output and interface with a field programmable gate array (FPGA). Each FPGA simultaneously reads out four ADCs and saves the synchronized samples in an external digital memory. The system produces 13.5 MB of uncompressed data with a target trigger rate of 20 Hz, and requires zero suppression to reduce data size and readout time. Firmware based data compression uses an online pulse-finder that decides whether to output pulse height information, a section of waveform, or to suppress all data. The front end FPGA transfers formatted data to data concentrator cards (DCCs) through a 2 Gb/s optical fiber interface using an efficient custom protocol. We have evaluated the performance of the FGD electronics system and the quality of its online data compression through the course of a physics data run. The average size of a compressed data acquisition is measured as 44 ~ kB.

A girl with aniridia, microphthalmia, microcephaly and café au lait macules was found to have mutations in PAX6, NF1 and OTX2. A novel PAX6 missense mutation (p.R38W) was inherited from her mother whose iris phenotype had not been evident because of ocular neurofibromatosis. Analysis of the NF1 gene in the proband, prompted by the mother's diagnosis and the presence of café au lait spots, revealed a nonsense mutation (p.R192X). Subsequently an OTX2 nonsense mutation (p.Y179X) was identified and shown to be inherited from her father who was initially diagnosed with Leber's congenital amaurosis. Since individual mutations in PAX6, OTX2 or NF1 can cause a variety of severe developmental defects, the proband's phenotype is surprisingly mild. This case shows that patients with complex phenotypes should not be eliminated from subsequent mutation analysis after one or even two mutations are found.

Highly unsaturated fatty acid (HUFA) synthesis in Atlantic salmon (Salmo salar) was known to be influenced by both nutritional and environmental factors. Here we aimed to test the hypothesis that both these effectors involved similar molecular mechanisms. Thus, HUFA biosynthetic activity and the expression of fatty acyl desaturase and elongase genes were determined at various points during an entire 2 year production cycle in salmon fed diets containing either 100% fish oil or diets in which a high proportion (75% and 100%) of fish oil was replaced by C18 polyunsaturated fatty acid-rich vegetable oil. The results showed that HUFA biosynthesis in Atlantic salmon varied during the growth cycle with peak activity around seawater transfer and subsequent low activities in seawater. Consistent with this, the gene expression of Delta6 desaturase, the rate-limiting step in the HUFA biosynthetic pathway, was highest around the point of seawater transfer and lowest during the seawater phase. In addition, the expression of both Delta6 and Delta5 desaturase genes was generally higher in fish fed the vegetable oil-substituted diets compared to fish fed fish oil, particularly in the seawater phase. Again, generally consistent with this, the activity of the HUFA biosynthetic pathway was invariably higher in fish fed diets in which fish oil was substituted by vegetable oil compared to fish fed only fish oil. In conclusion, these studies showed that both nutritional and environmental modulation of HUFA biosynthesis in Atlantic salmon involved the regulation of fatty acid desaturase gene expression.

BACKGROUND: Ghrelin, a 28 amino-acid peptide secreted primarily from the stomach has been identified as the endogenous ligand for the growth hormone secretagogue receptor. Ghrelin is suppressed in the postprandial state and has been linked to both type II diabetes and obesity. AIMS: To investigate the effects of a period of overfeeding with high-fat dietary supplements on plasma ghrelin levels in nonobese men. METHODS: Six healthy males (21–34 y; BMI 21–24 kg/m2) underwent the dietary intervention after completing diet and exercise diaries for 7 days. For 3 further weeks subjects followed their own diet diary supplemented with 125 ml single cream and 50 g roasted peanuts (88 g fat, 15 g Protein, 8 g carbohydrate) every day. Oral fat tolerance tests (OFTT) were undertaken at baseline, 7, 14 and 21 days of fat supplementation. The diet was increased in energy by 3.9 MJ/day and from a mean of 29–45% energy intake from fat with a small weight gain noted each week (P=0.009). RESULTS: Ghrelin concentrations were significantly reduced during the baseline OFTT. The postprandial ghrelin response (AUC) was significantly reduced following 2 weeks of dietary supplementation (P=0.005) increasing the suppression of plasma ghrelin by 18% despite only a 3% increase in body weight. Plasma triacylglycerol (P=0.009) and leptin (P=0.035) concentrations were also elevated and postprandial pancreatic polypeptide levels decreased (P=0.038) following dietary-supplementation. CONCLUSIONS: These results suggest that the metabolic profile associated with obesity, including a reduction in plasma ghrelin levels, may be related to recent dietary energy intake and precedes the development of significant adiposity.

A five-year, large- and small-scale, static and dynamic experimental research program, in which more than 700 tests were conducted, has demonstrated that unreinforced masonry infills are more ductile and resist lateral loads more effectively than anticipated by conventional code procedures. The tests were conducted both in the laboratory and on existing structures at the Department of Energy’s Y-12 National Security Complex. The experimental data indicate that the combination of a steel frame and infill material efficiently resists lateral loads—the infilling provides significant lateral stiffness while the surrounding frame adds ductility and confinement to the overall system. The results from approximately 25 moderate- and full-scale tests on infills showed that with simulated seismic loads the frames confined the masonry, and the load-carrying capacity of the infill was considerably above the load that caused initial cracking. This finding was a significant departure from classical code approaches that...

This study presents the recent progress made in developing a spiral fiber tracker (SFT) for use in the experiment TREK/E36 planned at the Japan Proton Accelerator Research Complex. This kaon decay experiment uses a stopped positive kaon beam to search for physics beyond the Standard Model through precision measurements of lepton universality and through searches for a heavy sterile neutrino and a dark photon. Detecting and tracking positrons and positive muons from kaon decays are of importance in achieving high-precision measurements; therefore, we designed and are developing the new tracking detector using a scintillating fiber. The SFT was completely assembled, and in a bench test, no dead channel was determined., Proceedings of 2nd International Symposium on Science at J-PARC (J-PARC 2014), to be published in JPS Conf. Proc., 6 pages, 5 figures

PURPOSE:Recent legislation and guidance in England emphasises the importance of service user choice in care planning. However, it is not obvious how best to facilitate choices in care planning, and some clinicians are concerned that service users may make 'unwise' decisions. This study aimed to examine mental health service users' preferences and priorities in the event of a future mental health crisis or relapse.METHOD:Thematic analysis of 221 joint crisis plans (JCP) developed by service users and their clinical team as part of the CRIMSON randomised controlled trial. Participants had a diagnosis of a psychotic disorder, at least one psychiatric admission in the past 2 years, contact with a community mental health team, and complex care needs.RESULTS:Two major categories of preferences were identified: first the manner in which crisis care would be delivered; and second, specific treatment interventions. Most service users requested full involvement in decisions about their care, clear and consistent treatment plans, access to familiar clinicians who knew them well, and to be treated with respect and compassion. Some service users requested hospitalisation, but the majority preferred alternatives. The most frequently preferred intervention was care by a home treatment team. Just under half made a treatment refusal, the majority being for specific medications, alternatives were offered.CONCLUSIONS:Joint crisis planning resulted in service users making choices that were clinically reasonable. The technique employed by JCPs appeared to empower service users by engaging them in a productive dialogue with their clinicians.

Aims.To explore the role of psychiatric admission, diagnosis and reported unfair treatment in the relationship between ethnicity and mistrust of mental health services.Methods.The Mental Illness-Related Investigations on Discrimination (MIRIAD) study was a cross-sectional study of 202 individuals using secondary mental health services in South London. Two structural equation models were estimated, one using Admission (whether admitted to hospital for psychiatric treatment in the past 5 years) and one using involuntary admission to hospital in the past 5 years.Results.Increased mistrust was directly associated with the latent variable ‘unfair treatment by mental health services and staff’ and with Black or mixed ethnicity in both models. Those with a diagnosis of schizophrenia spectrum (as compared to depression and bipolar disorder) had a lower average score on the latent variable, suggesting that on average they reported less unfair treatment. We found evidence of increased reporting of unfair treatment by those who had an admission in the past 5 years, had experienced involuntary admission, and for people of Black of mixed Black and White ethnicity.Conclusions.Neither prevalence of schizophrenia spectrum nor rates of hospital admission explained the greater mistrust of mental health services found among people of Black and mixed Black and White ethnicity compared with White ethnicity. Rather, people of Black and mixed Black and white ethnicity may be more likely to experience unfair treatment, generating mistrust; furthermore, this group is more likely to express mistrust even after accounting for reporting of unfair treatment by mental health services and staff.

Bait stations were located near ground-level or elevated 1.5 ‐ 2 m above the ground, and the amounts of bait eaten from them by captive and wild possums (Trichosurus vulpecula) were measured. The percentage of possums killed by ground level or elevated bait stations containing cholecalciferol or 1080 baits was also monitored. The per capita amounts of bait eaten by captive possums was significantly higher at ground level than at elevated bait stations. Wild possums also ate more bait from ground-level than elevated bait stations, but this difference was mainly attributed to fewer possums finding elevated bait stations. There was no difference in the kills achieved with baits containing cholecalciferol and 1080. However, the kills at ground-level stations (84%, n=9) were higher than at elevated stations (52%, n=10). Because pest controllers routinely place bait stations up trees out of reach of domestic livestock and ground-birds, the implications of prefeeding elevated bait stations to improve the percentage of possums killed should be evaluated.

We have determined the effects of three radiographic contrast media on platelet aggregation and degranulation in vitro. Aggregation was measured as loss of single platelets, and degranulation was measured as P-selectin expression using flow cytometry. Iopamidol added to hirudinized blood induced aggregation directly and also potentiated that induced by weak platelet agonists such as adenosine diphosphate (ADP). Iodixanol also potentiated platelet aggregation, but ioxaglate inhibited it. Iopamidol also caused marked platelet degranulation. The pro-aggregatory effect of iopamidol was evident in non-anticoagulated blood as well as in hirudinized blood, but not in citrated blood. In platelet-rich plasma (PRP) prepared from hirudinized blood neither iopamidol nor iodixanol directly induced platelet aggregation, but they rendered platelets hypersensitive to ADP. ADP antagonists inhibited the platelet aggregation and degranulation induced by iopamidol in whole blood, whereas aspirin, an inhibitor of thromborane A2 synthesis, did not. These data are consistent with clinical reports of increased thromboembolic risk with non-ionic low-osmolar media, and raise concerns about the routine use of these contrast media during diagnostic and interventional arteriographic procedures. Routine use of citrate in previous experiments may have masked a pro-aggregatory effect of some contrast media.

Parts 1 and 2 of this paper gave a design overview and described the dynamics of a prototype two-degree-of-freedom pneumatic suspension for an ambulance stretcher. This concluding part briefly reviews laboratory shaker table and ambulance road test performance of the suspension with passive pneumatic damping. The suspension system is found to offer compact low-cost isolation with lower natural frequencies than achieved in earlier mechanical systems.

1. An investigation into the distribution of light intensity across the rat retina was carried out on excised, intact rat eyes exposed to Ganzfeld illumination from a helium-neon laser (543 nm). 2. Some of the light entering the eyes exits through the sclera where its intensity can be monitored with an optical 'pick-up' that samples the intensity coming from a small region of external sclera and underlying retina. The spatial resolution of the pick-up is such that it samples light that has passed through ca 2 % of the rods in the rat eye. 3. Some of the laser light is absorbed by the rod pigment, rhodopsin, which gradually bleaches. Bleaching in the retina, in turn, causes an exponential increase in intensity emanating from the sclera. By monitoring this intensity increase, we are able to measure two important parameters in a single bleaching run: the local rhodopsin concentration and the local intensity falling on the rods. 4. With an ocular transmission photometer, we have measured both the local intensity and the local rhodopsin concentration across wide regions of rat retina. Both pigmented and albino rats were studied. 5. The distributions of rhodopsin and intensity were both nearly uniform; consequently, the product, (rhodopsin concentration) x (intensity), was similarly nearly equal across the retina. This means that the initial rate of photon absorption is about the same at all retinal locations. 6. Interpreted in terms of photostasis (the regulation of daily photon catch), this means that the rate of photon absorption is about the same in each rod, viz. 14 400 photons absorbed per rod per second. Since this rate of absorption is sufficient to saturate the rod, one possible purpose of photostasis is to maintain the rod system in a saturated state during daylight hours.

Part 1 of this paper gave an overview of the design and dynamics of a two-degree-of-freedom pneumatic stretcher suspension. Part 2 reviews pneumatic damping methods and then investigates system isolation performance using capillary and orifice damping restrictions. These restrictors are compared by numerical simulation of the suspension response when subjected to vertical transient inputs from the ambulance floor. Very good isolation of the stretcher patient is shown to be possible when a suitable damping restriction is used. Brief observations are also made regarding expected suspension performance in pitch and the potential improvement from introducing semi-active pneumatic damping. Part 3 will report results of suspension tests on a laboratory shaking table and in an ambulance.

Objective—To assess whether a normal electrocardiogram can identify good left ventricular function and obviate the need for routine left ventriculography in patients undergoing cardiac catheterisation for suspected coronary artery disease. Design—A prospective study of patients undergoing cardiac catheterisation. Setting—A regional cardiac centre. Patients—The electrocardiograms, coronary angiograms, and left ventriculograms of 391 consecutive patients undergoing investigations for suspected coronary artery disease were entered into the study. Patients with arrhythmias and cardiac pathologies other than coronary artery disease were excluded. Main outcome measures—The electrocardiogram was assessed using a 29 point QRS scoring system, and classified by two cardiologists and a trainee cardiologist as normal or abnormal. Left ventricular function was assessed by digital ventriculography. Results—The sensitivity, specificity, and negative predictive value of a QRS score of 0 (normal QRS complexes) for discriminating good left ventricular function (ejection fraction ⩾ 50%) were 92.6%, 41.5%, and 97.2%, respectively. The figures for a normal electrocardiogram as assessed by a doctor were 96.3%, 40.4%, and 98.6% for cardiologist A; 96.3%, 37.4%, and 98.4% for cardiologist B; and 94.4%, 49.6%, and 98.2% for the cardiology trainee. Conclusions—If a cardiologist judges the ECG to be normal, left ventriculography is unnecessary and a formal QRS score does not improve reliability of this clinical judgment. Adopting this strategy would save £30-40 000 in consumables and 65-87 hours of catheter laboratory and staff time for a department catheterising 3000 patients with suspected coronary artery disease annually. Keywords: cardiac catheterisation; electrocardiogram; left ventricular ejection fraction

Ambulance suspensions often give a poor ride, which may result in deterioration in the condition of ill or injured patients. Suspension of the ambulance stretcher itself is a lower cost option than a purpose- built ambulance suspension and may offer superior isolation of the patient from road-induced disturbances. This paper describes the development of a pneumatic stretcher suspension offering both pitch and heave isolation. Design and theoretical considerations are outlined, and preliminary performance figures reported. Subsequent parts of this paper will explore the dynamics of the system with pneumatic damping and report on the performance of the prototype suspension for a range of patient masses, damping levels and floor vibration inputs.

This paper presents a method for designing intermodal freight rail-to-highway terminals using Bayesian model selection. Each model consists of a unique network of cities and rail terminals. The model parameters are the amount of freight flowing on each individual path in the network. The prior distribution constrains the freight flowing on each path between each pair of origin and destination cities to Gaussian distributions with means corresponding to the estimated freight demand between the cities. The likelihood function favors low total cost in the network and penalizes routing schemes that exceed terminal capacities. Nested sampling is used to compute the Bayesian evidence for each model. The paper describes the generation of, results from, and conclusions drawn from a realistic test case.

BACKGROUND: Many physicians now use serum prostate-specific antigen (PSA) to screen for prostate cancer in asymptomatic men. Whether or not a prostate biopsy should also be performed depends on an accurate definition of what constitutes a normal PSA value. Until recently, studies conducted to establish normal serum PSA values have involved study populations that have included few African-American men. PURPOSE: We sought to compare serum PSA levels and PSA density (i.e., serum PSA level/prostate volume ratio) in African-American and white men without histologic evidence of prostate cancer. METHODS: We reviewed the medical records of 826 consecutive men who underwent one or more prostate biopsies at the Veterans Affairs Medical Center in Shreveport, LA, from January 1993 through December 1995. In this retrospective review, we recorded patient's age, race, serum PSA level, digital rectal examination result, ultrasound-determined prostate volume, indications for biopsy, and biopsy results. Data from a total of 752 consecutive men who were either white or African-American and whose indication for biopsy included a serum PSA of greater than 4.0 ng/mL and/or an abnormal digital rectal examination were analyzed. To examine possible differences in serum PSA level, PSA density, prostate volume, and patient age, the two-sided Student's t test was employed. Multivariate linear regression analysis was used to determine if serum PSA levels were associated with the patient's age, race, or prostate volume in men without prostate cancer. RESULTS: Of the 752 men included in this analysis, 254 had histologic evidence of prostate cancer and 498 did not. Of the 498 men without prostate cancer, 367 (74%) men were white and 131 (26%) were black. There were no racial differences in age or calculated prostate volume. Serum PSA levels and calculated PSA density, however, were significantly (both P < .0001) higher in African-American men that in white men. A multivariate linear regression analysis indicated that race and prostate volume were independent variables associated with serum PSA level. For African-American and white men, serum PSA values of greater than 4 ng/mL were associated with prostate cancer with sensitivities of 89.5% and 81.9%, respectively, and specificities of 38.2% and 52.3%, respectively. CONCLUSION: Among biopsied men without histologic evidence of prostate cancer, African-Americans have a significantly higher PSA level and PSA density than similarly aged white men. IMPLICATIONS: Published criteria for normal PSA level and density have been derived primarily from white men and may not be directly applicable to other populations. Race-specific data are needed to fully optimize PSA as a tumor marker in racial populations that are at high risk for prostate cancer death.

The aim was to examine four prominent user-based computer software usability evaluation methods. Four evaluation methods (logged data, questionnaire, inter view, and verbal protocol analysis) were used to evaluate three different business software types (spreadsheet, word processor, and database) using a between-groups design, involving 148 individuals of mixed age and gender. Comparisons were made to examine the efficiency of each evaluation method in terms of its ability to highlight usability problems both between and within the evaluation strategy. Here, the verbal protocol analysis was found to be most efficient. The possibility of further efficiency gains by using two evaluation methods was also examined, where it was found that no statistically significant improvement was obtained over the verbal protocol analysis used by itself. Ways in which the utility of the methods may be enhanced was also discussed.

Survival and changes in body mass of whole-body irradiated mice were determined to examine the radiorecovery and prophylactic-treatment efficacies of manganese(lIl)2(ll)(μ3-O)(μ-3,5-diisopropylsali-cylate)6(Mn3(O)(3,5-DIPS)6). To determine the radiorecovery efficacy, four groups of 25 C57BL/6 female mice were LD50/30 γ-irradiated and treated with 0, 30,40 or 50 umol Mn3(O)(3,5-DIPS)6/kg of body mass 3 h after irradiation. Survival increased from 28% in the vehicle-treated control group to 84% (p ≤0.00007), 92% (p ≤ 0.00005), or 88% (p ≤ 0.00002) in the 30, 40 or 50 µmol/kg-treated groups, respectively. Postirradiation treatment with Mn3(O)(3,5-DIPS)6 enabled rapid recovery of radiation-induced loss of body mass and an overall elevated body mass when compared with the vehicle-treated control mice. To determine the combined prophylactic/therapeutic activity of this complex, four groups of 25 C57BL/6 female mice were treated with 50 umol Mn3(O)(3,5-DIPS)6/kg of body mass 3 h prior to LD100/30 γ-irradiation and then treated with 0,10,20 or 40 umol Mn3(O)(3,5-DIPS)6/kg on days 2, 4 and 6 after irradiation. Survival rates were increased to 28% (p ≤ 0.006), 12% or 16% in the 10, 20 or 40 μmol/kg postirradiation-treated mice compared with no survival in control animals. Body mass determinations revealed that mice treated with the 10 μmol/kg dose recovered from the radiation-induced loss of body mass at a more rapid pace than all other mice. These results support the hypothesis that Mn3(O)(3,5-DIPS)6 is an effective radiorecovery/radioprotective agent and that it is effective when given in a combined prophylactic/therapeutic regimen to LD100/30 whole-body-irradiated mice.

The knowledge of the nature of vaccinia virus gained in recent years and the methods of preparing relatively pure suspensions of the virus which have been developed justify the hope that the technique of vaccination against smallpox may be improved. The potency of vaccine lymph and its relative freedom from bacterial contaminants have been regulated under the Therapeutic Substances Act for several years past; nevertheless, for prophylactic purposes, it is desirable to introduce the use of pure bacteria-free virus in a measured volume of known potency. The usual method of vaccination which involves scratching the skin and applying to the scratch a variable amount of virus-containing lymph cannot be described as an accurate procedure and, unless proper precautions are taken, may invite local secondary bacterial infection. If it could be shown that a satisfactory immunity follows the intracutaneous injection of a measured amount of a bacteria-free suspension of virus, this method would possess obvious advantages; the usual dressing could be dispensed with, the amount of scarring, and the local secondary bacterial infection which is associated with vaccination would be reduced or abolished. In our opinion, the value of vaccinial scars has been exaggerated; they may be useful as visible evidence that the patient has been successfully vaccinated sometime in the past, but they are not an indication of existing immunity to smallpox. It is not usually suggested that any other measure of prophylactic inoculation should be accompanied by a permanent scar as a record of immunization.

This is a data analysis guide to the JINR system developed by Roger Henderson. It is intended as a complete guide to the data format and the calibration parameters utilized for the analysis of the data. This guide will provide the basic structure of the data files, the description of the individual data items, and the basic equations developed for the calculation of the results. Currently (7/17/2009), calculation of the calibration parameters is not a covered topic. It is intended that this will be covered in a future update.

The Fine Grained Detector (FGD) is one of the sub-systems of the T2K experiment at J-PARC. The trajectories of charged particles produced by neutrinos interacting within the FGD will be reconstructed and used to determine the neutrino interaction point and the neutrino energy, together with other detectors. The FGD also provides some particle identification capabilities by measuring energy loss. The FGD consists of 8448 scintillator bars read out by wavelength-shifting fiber coupled to Multi-Pixel Photon Counters (MPPC). The FGD active volume is surrounded by 3 different boards: Frontend Boards (FEB) which use the SCA ASIC (AFTER) for waveform recording, the Crate Master Board (CMB) for local data collection, and the Light Pulser Boards for calibration purposes are surrounding the active volume of the FGD. The data are then sent by optical links to the Data Concentrator Cards (DCC), then by Ethernet link to the back-end computer. The FGD has the capability to generate a trigger which is sent through LVDS links to the main Trigger module. The monitoring of all the on-detector electronics is managed by means of an independent data path using the Midas Slow-Control Bus (MSCB).

Thrombolysis is advocated as the treatment of choice for hemodynamically important pulmonary embolism. This paper reports the case of a patient with subacute massive pulmonary embolism in which thrombolysis was not considered appropriate because transesophageal echocardiography demonstrated a patent foramen ovale and impending paradoxical embolism.

IN May 1988, the World Health Assembly declared that the World Health Organization was committed to the global eradication of poliomyelitis by the year 2000.1 The eradication of poliomyelitis, as with smallpox, involves the additional criterion of the elimination of indigenous transmission of wild virus. This paper reviews the progress that has been achieved, outlines current objectives, and highlights the research and development required to meet the target of global eradication. Background The initiative for the global eradication of poliomyelitis is being coordinated by the Expanded Programme on Immunization (EPI), established by the World Health Assembly in 1974. The initial . . .

MOSQITO is the initial version of a sever flow quality model being developed by Hydraulics Research Ltd and the Water Research Centre as part of the UK River Basin Management programme. MOSQITO I simulates the time-varying behaviour of suspended solids, biochemical oxygen demand, chemical oxygen demand, ammoniacal nitrogen and hydrogen sulphide on catchment surfaces and in sewer systems. The model produces discharge pollutographs for these determinands which can be used as input to a river water quality model. MOSQITO consists of four sub-models which represent washoff from catchment surfaces, foul water inflow, pollutant behaviour in pipes and channels, and pollutant behaviour in ancillary structures within drainage systems. These sub-models are linked to the flow simulation model incorporated in the WALLRUS package which is the latest computer implementation of the Wallingford Procedure. The rationale behind the model, its structure and its operational basis have been discussed elsewhere (Moys and Henderson, 1988) and are therefore described briefly so that emphasis can be placed on the aspects which follow. Calibration and verification of the model are being carried out using data from a variety of experimental catchments in the UK. These catchments have been selected to exhibit a wide range of characteristics and include separate and combined sewer systems. Results of the calibration work are presented together with illustrations of the performance of the various sub-models and the overall model.

The heart rate response of 59 patients aged 17-79 years implanted with seven different types of rate responsive pacemakers was evaluated during graded exercise treadmill testing and during standardised daily activities. The heart rate response in patients with pacemakers was compared with the chronotropic response in 20 healthy controls of similar age and sex distribution who performed identical protocols. All pacemaker types adequately simulated the control heart rate response during the graded exercise treadmill test except during the early stages of exercise. However, during everyday activities, the response of ventricular rate responsive (VVIR) pacemakers was varied. Activity sensing systems rapidly overresponded to staircase descent, to changes in walking speed, and to suitcase lifting with the pacemaker arm, and these systems did not respond to mental stress. "Physiological" sensors (QT and minute ventilation units) responded slowly to rapid changes in physiological demand. The QT pacemaker patients did respond to mental stress but showed a paradoxical increase in rate during the recovery phases of burst exercise protocols such as staircase ascent/descent and walking deceleration. Dual chamber pacemakers in VDD, DDD, and DDDR modes most closely simulated the normal chronotropic response during everyday activities. Graded exercise treadmill testing, in isolation, may not be the best way to asses or program the heart rate response in patients with the heart rate adaptive pacemakers because changes in heart rate during everyday activities may deviate considerably from the normal sinus response despite satisfactory simulation of the normal chronotropic response during treadmill testing.

Summary The historical development of the Employment Medical Advisory Service is described, and the Service's present organization is related to its range of activities, including its role as a source of information and advice on occupational health. The Employment Medical Advisory Service's influence on the development of occupational health practice, the collection of new knowledge and its adaptability in changing social and employment conditions is described, and examples of its work are given.

A millimetre-wave integrated vehicle antenna sensor has been developed as part of a 3-year collaborative project called SLIMSENS (short and long range integrated multifunction radar and communications sensors). The antenna combines simultaneous 76 GHz long and short range radar (ACC, SRR) and 63 GHz communications functions in a common aperture, allowing easier integration and reducing the number of sensor units on the vehicle. (5 pages)

The body mass index (BMI) is often used as a predictor of overweight and obesity. There is, however, an important debate among international specialists as to what the risk limits should be, and where the cut-off points should be located. In the United States, for instance, adults with a BMI between 25 and 30 are considered overweight, while adults with a BMI of 30 or higher are considered obese. Nevertheless some researchers, especially in developing countries, claim that the limits established for the US are too permissive, and that the threshold to define obese adults should be set lower for other nationalities and ethnicities. This paper analyzes the mortality risks for different BMI levels of two populations of American adult men. The first population lived during the last quarter of the 19th century and the early 20th century. These men were drawn from a random sample of Union Army veterans who fought during the American Civil War (1861–1865). A contemporary sample of men was drawn from the first wave of the National Health and Nutrition Examination Survey (NHANES I) conducted between 1971 and 1975. The results indicate that the frontier of overweight and obesity are expanding over time, such that the potential risk is nowadays associated with higher levels of BMI. The finding may imply that differences in BMI cut-off points are not only cross ethnic, but also occur for similar ethnicities across time.

Genital presentation of filarial disease is not uncommon in endemic areas of the world. Acute, febrile illness involving the epididymis and spermatic cord (funiculoepididymitis) is one of many such presentations. With an internationally mobile society, physicians today, even in nonendemic areas, may encounter patients with filarial infestations. We report the first case of presumptive diagnosis of this disease using scrotal ultrasound.

The study aimed to describe changes in the distribution of body mass index (BMI) among white non-Hispanic US men aged 40-69 years throughout the 20th century.The subjects were 12 312 randomly drawn Union Army veterans examined between 1890 and 1900, and 4059 NHANES (National Health and Nutrition Examination Survey) participants examined between 1976 and 2000.The study compared descriptive statistics of the age- and year-specific distributions of BMI.Between 1890 and 2000, median BMI of men aged 50-59 years increased by 5.7 kg/m(2) (25%), while the standard deviation almost doubled. In this age group, the current distribution of BMI is less right-skewed than in the earlier cohort. Obesity prevalence increased from 3.4% to 35%. In 1890-1894, median BMI declined with age, but by 2000 the age pattern had been reversed. The average annual growth rate of median BMI was lowest between 1900 and 1976 and has been rising to 0.5% per annum between 1988 and 2000.The increase in median BMI accounts for 75% of the rise in obesity prevalence between 1890 and 2000. The remainder must be attributed to changes in other features of the distribution, most notably the increased variance of BMI.