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The Latarjet procedure traditionally has been performed with 2 screws in an open manner. Recently, cortical suture button fixation for coracoid transfer has been used in hopes of mitigating complications seen with screw placement. The aim of this study was to evaluate a cortical suture button and technique currently available in the United States compared with screw fixation in the Latarjet procedure in a cadaveric model.We randomly assigned 9 matched pairs of fresh-frozen cadaveric shoulders (N = 18) to undergo the Latarjet procedure with either screw fixation or cortical suture button fixation. After fixation, all shoulders underwent biomechanical testing with direct loading on the graft vas a material testing system. Cyclic testing was performed for 100 cycles to determine axial displacement with time; each graft was then monotonically loaded to failure.The maximum cycle displacement was significantly less for screw fixation vs. cortical suture button fixation (3.1 ± 1.3 mm vs. 8.9 ± 2.1 mm, P.0001). The total load at failure was 481.1 ± 88.8 N for screws and 175.5 ± 95.8 N for cortical suture buttons (P.0001). Bony damage to the surrounding anatomy was more extensive at failure in the screw-fixation group.At time zero, the cortical button fixation and technique did not resist direct loads to the graft as much as traditional screw fixation, although bony damage to the surrounding anatomy was more extensive in screw fixation than button fixation. In the event of unanticipated loading, this could place a patient at higher risk of graft migration, which could lead to unintended early outcomes. These results support the need for implants and techniques specifically tailored to the Latarjet procedure and should bring into question the adoption of a cortical button and technique not specific to the procedure.

Dietary supplementation of probiotics is growing as a scientifically valid alternative to antibiotics for enhancement of overall animal health and productivity in aquaculture. Strains of Bacillus subtilis are regarded as attractive probiotic candidates to the fish farming industry; however, there is a limited number of studies focused on the use of specific strains probiotics in tilapia, and therefore complicating replication. The objective of this study was to examine the effect of the strains NZ86 (NRRL B-50136) and O14VRQ (NRRL B-67221) of B. subtilis on various parameters of the innate immunity in Nile tilapia (Oreochromis niloticus) in a 51-day feeding trial. Supplementation of tilapia with either strain resulted in significant increases (p 0.05) in plasma lysozyme concentration of varying degrees throughout the trial. Meanwhile, alternative complement activity was significantly elevated (p 0.05) only after feeding of the NZ86 strain after 14 and 51 days. Conversely, supplementation with O14VRQ resulted in a significant increase (p 0.05) in the percent of neutrophils in the peripheral blood of tilapia by day 28. At the end of the trial, there was a trend towards increased phagocytic and respiratory burst activities observed in immune organ derived leukocytes. Feeding with either probiotic appeared to have an up-regulation on the gene expression of both pro-inflammatory cytokines in the intestine, yet only O14VRQ was significantly different than the control. Moreover, the occurrence of these results could be associated with supplementation of the probiotic strains, given that Bacillus bacteria were observed to populate the intestines of the dietary treatment groups. These results suggest the potential roles of these B. subtilis probiotic candidates to stimulate immune responses both locally and systemically in tilapia.

The use of prewetted disinfectant towelettes in health care settings proves challenging because they may dry quickly, reducing disinfection. This study examined the drying time of various commercial disinfectant towelettes and the efficacy of these towelettes over time to eliminate Staphylococcus aureus from glass surfaces. This study confirms that these disinfectants dry quickly. Further disinfection after drying time on glass is minimal, but dependent on the type of disinfectant.

Our national data and infrastructure security issues affecting the “bioeconomy” are evolving rapidly. Simultaneously, the conversation about cyber security of the U.S. food and agricultural system (cyber biosecurity) is incomplete and disjointed. The food and agricultural production sectors influence over 20% of the nation's economy ($6.7T) and 15% of U.S. employment (43.3M jobs). The food and agricultural sectors are immensely diverse and they require advanced technologies and efficiencies that rely on computer technologies, big data, cloud-based data storage, and internet accessibility. There is a critical need to safeguard the cyber biosecurity of our bio economy, but currently protections are minimal and do not broadly exist across the food and agricultural system. Using the food safety management Hazard Analysis Critical Control Point system concept as an introductory point of reference, we identify important features in broad food and agricultural production and food systems: dairy, food animals, row crops, fruits and vegetables, and environmental resources (water). This analysis explores the relevant concepts of cyber biosecurity from food production to the end product user (such as the consumer) and considers the integration of diverse transportation, supplier, and retailer networks. We describe common challenges and unique barriers across these systems and recommend solutions to advance the role of cyber biosecurity in the food and agricultural sectors.

Mechanically tenderized beef (MTB) products are non-intact beef products that have been tenderized using blades, needles, or other mechanical processes to improve consumer palatability. MTBs have been associated with outbreaks of Shiga toxin-producing Escherichia coli. MTB labeling was mandated in May 2016; however, consumer awareness of product and label is unclear. A national survey quantified consumer understanding and attitudes surrounding MTBs and its preparation. Many (64%) respondents were unaware that beef is mechanically tenderized; MTB label awareness was also low. Thirty-eight percent of respondents familiar with MTBs held positive attitudes towards MTBs due to price and convenience. Negative attitudes (24%) towards MTBs stemmed from concerns with the process, its “natural”-ness, and safety. Respondents regularly preparing MTBs reported using inside and/or outside color of the beef product (63%), texture (43%), juice/blood appearance (47%), smell (22%), and/or time (51%) to indicate doneness. While 20% of respondents used a thermometer, 62% reported “always” or “most of the time” preparing MTBs to 160℉. Contradictions may result from social desirability bias and optimism bias to portray selves in a positive light while believing personal preparation methods achieve safe results. Timely and targeted messaging with clear and standardized definitions, developed with consumers, are needed to bring awareness of MTBs and other food safety information to all populations.

BackgroundSince the beginning of the technology, there has been active debate about the role of human leucocyte antigen (HLA) matching in kidney allograft survival. Recent studies have reported diminishing importance of HLA matching, which have, in turn, been challenged by reports that suggest the c

Supplemental digital content is available in the text., Background Even in the modern era of kidney transplantation with improved surgical techniques, immunosuppression, and clinical care, HLA matching has been shown to be important in allograft survival in adults who receive an organ from either a deceased or living donor. We now explore the impact of genetic matching in pediatric first-kidney transplants. Methods Using the United Network for Organ Sharing data, we identified 18 602 first pediatric (

Background: Scaphoid and radial head fractures are two injuries derived from the common fall on outstretched hand. How these injuries are related has not been fully investigated. The aim of this study was to evaluate risk factors for having concomitant proximal radius and scaphoid fractures. The goal was to identify at-risk patient populations and drive improvement in diagnosis and management of these injuries. Methods: A retrospective review of the National Trauma Data Bank from 2007 through 2012 identified 11,309 patients with proximal radius fracture, and, as a proxy for low-energy injury, an injury severity score of less than 15. These patients were then categorized by presence of concomitant scaphoid injury. Presence of scaphoid fracture was then analyzed based on age, sex, race, trauma type, mechanism, and injury severity score. Results: Three hundred seventy-eight (3%) scaphoid fractures among the 11,309 proximal radius fractures were identified. Both age and sex reached statistical significance as risk factors for concomitant scaphoid and radial head injury. There was an incremental increase in risk for concomitant injury with younger age. Subset analysis demonstrated a 10% incidence of concomitant fractures in men aged 18 to 30 years. Discussion: This study provides a better understanding of how these two fractures are related. There is a markedly higher risk for concomitant injuries in male and young patients, especially those whose mechanism is a fall. Close examination of the wrist should be performed for any proximal radius fracture, and any pain should be a cause for further investigation of scaphoid injury.

Objective.To determine the patient- and device-specific risk factors for hospital-acquired peripherally inserted central venous catheter–related bloodstream infections (PICC BSIs) in adult patients.Design.Nested case-control study.Setting.Barnes-Jewish Hospital, a 1,252-bed tertiary care teaching hospital.Patients.Adult patients with PICCs placed from January 1, 2006, through July 31, 2008.Methods.PICC BSI cases were identified using the National Healthcare Safety Network definition. Uninfected control patients with PICCs in place were randomly selected at a 3: 1 ratio. Patient- and device-related variables were examined using multivariate analysis.Results.The overall PICC BSI rate was 3.13 per 1,000 catheter-days. Independent risk factors for PICC BSIs included congestive heart failure (odds ratio [OR], 2.0 [95% confidence interval (CI), 1.26–3.17];P= .003), intra-abdominal perforation (OR, 5.66 [95% CI, 1.76–18.19];P= .004),Clostidium difficileinfection (OR, 2.25 [95% CI, 1.17–4.33];P= .02), recent chemotherapy (OR, 3.36 [95% CI, 1.15–9.78];P= .03), presence of tracheostomy (OR, 5.88 [95% CI, 2.99–11.55];P< .001), and type of catheter (OR for double lumen, 1.89 [95% CI, 1.15–3.10];P= .01; OR for triple lumen, 2.87 [95% CI, 1.39–5.92];P= .004). Underlying chronic obstructive pulmonary disease (OR, 0.48 [95% CI, 0.29–0.78];P= .03) and admission to surgical (OR, 0.43 [95% CI, 0.24–0.79];P= .006) or oncology and orthopedic (OR, 0.35 [95% CI, 0.13–0.99];P= .05) services were less likely to be associated with having a PICC BSI.Conclusions.We identified several novel factors related to PICC BSIs. These factors may inform preventive measures.

Background Allografts from living donors survive longer than those from deceased donors but the role of HLA mismatching in living kidney donation is still in question. We examined the effect of HLA compatibility on kidney allograft survival from living donors by studying all first adult kidney transplants performed in the United States over 25 years. Methods Using the United Network for Organ Sharing data, we identified first kidney transplants between October 1, 1987, and December 31, 2013. Recipients were classified by their number of HLA mismatches and stratified by donor origin. Cox multivariate regression analyses adjusting for recipient and donor transplant characteristics were performed to determine impact of HLA compatibility on kidney allograft survival for all living donors and for living related and living unrelated subsets. Results There were 66 596 first adult transplants from living donors with 348 960 years of follow-up. We found a linear relationship between HLA mismatch and allograft survival. In adjusted analyses, among all living donors, 1 mismatch conferred a 44% higher risk, whereas 6 mismatches conferred a twofold higher risk of allograft failure. When using 0-mismatched full siblings as a reference, living-donor kidneys reduce the hazard of failure by approximately 34% when compared with deceased donors. Twenty-five years of transplant experience, stratified by donor source, was summarized and presented as a guide for allocation. Conclusions These data reinforce the importance of optimizing HLA matching to further improve survival in first adult kidney allografts in the future, especially in living unrelated donations, when possible.

Postprocessing contamination of the products in a processing plant has been identified as one of the major reasons for food contamination with Listeria; brining is one such postprocessing area. Our previous study has shown that the combinations of UV and antimicrobials reduces the number of this organism significantly in fresh brine, but brine is usually recycled from days to weeks depending on its use. Therefore, this study is focused on the reduction of L. monocytogenes in recycled chill brine (obtained from a frankfurter processor) using the combinations of UV and antimicrobial agents, such as citric acid (CA), hydrogen peroxide (HP) and dimethyl dicarbonate (DMDC). Results show that the combinations of UV and 2000 ppm and 4000 ppm HP were the most effective treatments in reducing the Listeria population with the total processing time of 120 min. Both of these treatments were found to be more effective than UV or HP alone. Additionally, all other treatments, such as the combinations of UV and CA (0.2 and 0.5%) and UV and DMDC (250 and 500 ppm) were comparatively less effective. This may be due to the presence of organic matter in spent brine, which may have reduced the penetration of UV and availability of antimicrobials for microbial interaction. PRACTICAL APPLICATIONS The brine solutions are generally recycled in industries for up to 4 weeks as per United States Department of Agriculture (USDA) guide. Thus, it is very important to study various treatments to process recycled brine that was used to process ready-to-eat (RTE) meat products to prevent foodborne diseases or outbreaks. The use of UV light and antimicrobial agents to control L. monocytogenes in recycled brines to product cooling in the RTE meat industry is described. The study provides information on exposure time to UV light and level of antimicrobial agent that result in inactivation of the pathogen. Industry may benefit from our research in their validation efforts to control L. monocytogenes for recycled brine in recirculating chill brine systems through the use of UV light and antimicrobial agents.

Over the past 10–15 years, equipment manufacturers have addressed the issues related to the use of telematics for construction equipment, trying to provide both the customer and themselves with relevant data to improve the functionality, operation, maintenance, and management of this equipment. Each manufacturer approached this task independently with varying ideas on how to best accomplish this.

Currently, there is not an understanding of the project factors having a statistically significant relationship with highway construction duration. Other industry sectors have successfully used statistical regression analysis to identify and model the project parameters related to construction duration. While the need is seen for such work in highway construction, there are very few studies which attempt to identify duration-influential parameters and their relationship with the highway construction duration. The purpose of this work is to describe the highway construction data needed for such a study, identify a data source, collect early-design project data, and prepare the data for statistical regression analysis. The Virginia Department of Transportation is identified as the optimal data source. The data collected include historical contract and project level parameters. To prepare for statistical regression analysis, the contract duration collected is converted to construction duration by a seasonal adjustment process which removes historically typical nonworking days.

Back pain is one of the major contributors to disability and loss of productivity in modern populations. However, osteological correlates of back pain are often absent or, as yet, unidentified. As bioarchaeologists depend on osteological evidence to interpret quality of life in the past, back pain, with its profound effects on modern populations, is largely overlooked in archaeological samples. This study addresses this shortcoming in bioarchaeological analysis by exploring the relationship between a defined vertebral osteological lesion, the Schmorl's node, and its effect on quality of life in a clinical population. Using patient insight, healthcare practitioner diagnoses and MR imaging analyses, this study investigates: (1) Schmorl's nodes and sociodemographic factors; (2) the number, location and quantitative aspects (e.g. length, depth, area) of Schmorl's nodes, and how these influence the reporting of pain; (3) the dynamic effects of Schmorl's nodes, in combination with other variables, in the reporting of pain; and (4) the perception and impact of pain that patients attribute to Schmorl's nodes with regard to quality-of-life issues. The results of this study indicate that Schmorl's nodes located in the central portion of the vertebral body are significantly associated with patient reporting of pain, and that the presence of osteophytes, in the affected vertebral region, may increase the likelihood that an individual will report pain. This finding provides bioarchaeologists with an osteological correlate to begin interpreting the presence and impact of pain in archaeological populations, with implications for scoring Schmorl's nodes. Copyright © 2007 John Wiley & Sons, Ltd.

Environmental sampling has become increasingly important in the food industry for monitoring the presence of specific pathogens such as Listeria monocytogenes and Salmonella enterica. Several microbiological media are available for storage and transport of environmental samples from the processing plant to the test laboratory. In this study, we quantified the survival of L. monocytogenes, S. Typhimurium, S. Enteritidis, and S. Typhi in environmental sampling media over several time and temperature combinations to determine optimum conditions for transport and storage. A cocktail of L. monocytogenes strains and Salmonella serotypes was separately added to tubes of Dey-Engley (D/E) Neutralizing Broth, Copan SRK solution, and Neutralizing Buffer and incubated at either –4, 4, 10, or 15C. Counts were made of the bacterial load after 0, 12, 24, and 48 h. Neutralizing Buffer and Copan SRK solution were best at maintaining bacterial concentrations at all temperatures. D/E Neutralizing Broth, at 10 and 15C, allowed significant bacterial growth. This study helped validate the use of these 3 media for environmental sample transport and storage at cold holding temperatures and demonstrated that, at elevated temperatures (>4C), it is preferable to use Neutralizing Buffer or Copan SRK solution for quantifying microbial recovery. E nvironmental sampling is a very important tool for studying the source, level, and dispersion of microbiological contamination in a defined area or facility. Two major microbial pathogens of concern in the food industry are Listeria monocytogenes and Salmonella spp. These 2 pathogens can be found in food processing facilities and are major concerns for public health officials. In the food industry, environmental sampling has become a common method for detecting microbial pathogens such as

The perception of wine aroma is an excellent example of the human ability to experience multiple sensations as a single gestalt, i.e. a configural perception or as a top-down process. For example, the same wine recognized as Riesling could, after some time spent on analysis, yield, “This Riesling has a moderate petrol aroma and a faint lemon smell.” Recent studies of binary mixtures showed that only similar odors cross-adapt while dissimilar odors suppress each other in mixtures, indicating a possible explanation for the suppression of fruity/floral by 2,2,1-trimethyl- dihydronaphthalene (TDN) in Riesling.

Gallbladder disease is a common source of morbidity in the Mexican American population. Genetic heritage has been proposed as a possible contributor, but evidence for this is limited. Because gallbladder disease has been associated with Native American heritage, genetic admixture may serve as a useful proxy for genetic susceptibility to the disease in epidemiologic studies. The objective of our study was to examine the possibility that gallbladder disease is associated with greater Native American admixture in Mexican Americans. This study used data from the Hispanic Health and Nutrition Examination Survey and was based on 1,145 Mexican Americans who underwent gallbladder ultrasonography and provided usable phenotypic information. We used the GM and KM immunoglobulin antigen system to generate estimates of admixture proportions and compared these for individuals with and without gallbladder disease. Overall, the proportionate genetic contributions from European, Native American, and African ancestries in our sample were 0.575, 0.390, and 0.035, respectively. Admixture proportions did not differ between cases and noncases: Estimates of Native American admixture for the two groups were 0.359 and 0.396, respectively, but confidence intervals for estimates overlapped. This study found no evidence for the hypothesis that greater Native American admixture proportion is associated with higher prevalence of gallbladder disease in Mexican Americans. Reasons for the finding that Native American admixture proportions did not differ between cases and noncases are discussed. Improving our understanding of the measurement, use, and limitations of genetic admixture may increase its usefulness as an epidemiologic tool as well as its potential for contributing to our understanding of disease distributions across populations.

Adrenal masses in cancer patients pose diagnostic problems. We report the case of a 59 years old male with a history of prostate cancer who presented to us with serially rising prostate specific antigen. On imaging studies he had bone lesions and in addition had a 1.7 cm left adrenal mass. Since metastasis to the adrenal gland has rarely been reported in prostate cancer, and since the radiological criteria in our case favored malignancy, we proceeded with hormonal evaluation and fine needle aspiration biopsy of the adrenal mass which proved it to be pheochromocytoma. This was followed by an uneventful adrenalectomy.

Objective. To determine if sex-specific differences in lymphocyte trafficking could contribute to increased disease severity in female mice. Methods. A lupus-like disease was induced by injecting male and female mice with procainamide-treated T cell clones. Trafficking was examined by labeling the injected cells with 51Cr or 5-chloromethylfluorescein diacetate. Results. Females developed more autoimmune liver disease and greater titers of anti-DNA antibodies than did males, and 2-7 times more cells accumulated in the female spleens. Splenectomy prevented the development of autoantibodies and renal and liver disease. Oophorectomy decreased the splenic homing, autoantibody titer, and liver disease severity, to levels found in males. Conclusion. T cells traffic differently to the spleen in male and female mice, and the spleen appears to be essential in the disease process. This suggests that differences in T cell homing could contribute to sex-specific disease severity in this murine model, and also possibly in human disease.

A sample of 1465 full heritage Piman Indians from Arizona were typed for the serological antigens of the HLA class I loci and then incorporated into a survival study that ended December 31, 1991. The total follow-up time was 11,749 person-years with an average of 8.0 years per person. During the study 298 persons died, 54 from cardiovascular disease (CVD). Allele HLA*A2 conferred a 4.94 fold rate for death from CVD (95% C.I. 1.91 – 12.77). When controlled for the potential confounding variables, cholesterol, mean blood pressure, smoking, body mass index, rheumatoid factor titer, and nephropathy, the mortality rate ratio (MRR) was 5.42 (95% C.I. 1.98 – 14.82). There was no statistically significant association of mortality with other HLA-A or HLA-B alleles, or for causes of death not related to cardiovascular disease.

Background.Limited data on the risk of peripherally inserted central venous catheter-associated bloodstream infections (PICC BSIs) in hospitalized patients are available. In 2007, dedicated intravenous therapy nurses were no longer available to place difficult peripheral intravenous catheters or provide PICC care Barnes-Jewish Hospital.Objectives.To determine the hospital-wide incidence of PICC BSIs and to assess the effect of discontinuing intravenous therapy service on PICC use and PICC BSI rates.Setting.A 1,252-bed tertiary care teaching hospital.Methods.A 31-month retrospective cohort study was performed. PICC BSIs were defined using National Healthcare Safety Network criteria.Results.In total, 163 PICC BSIs were identified (3.13 BSIs per 1,000 catheter-days). PICC use was higher in intensive care units (ICUs) than non-ICU areas (PICC utilization ratio, 0.109 vs 0.059 catheter-days per patient-day for ICU vs non-ICU; rate ratio [RR], 1.84 [95% confidence interval {CI}, 1.78-1.91]). PICC BSI rates were higher in ICUs (4.79 vs 2.79 episodes per 1,000 catheter-days; RR, 1.7 [95% CI, 1.10-2.61]). PICC use increased hospital-wide after the intravenous therapy service was discontinued (0.049 vs 0.097 catheter-days per patient-day; P = .01), but PICC BSI rates did not change (2.68 vs 3.63 episodes per 1,000 catheter-days; P = .06). Of PICC BSIs, 73% occurred in non-ICU patients.Conclusions.PICC use and PICC BSI rates were higher in ICUs; however, most of the PICC BSIs occurred in non-ICU areas. Reduction in intravenous therapy services was associated with increased PICC use across the hospital, but PICC BSI rates did not increase.

One of the value statements of the American College of Emergency Physicians states that, "Quality Emergency Medicine is best practiced by qualified, credentialed emergency physicians." 1 To address this value ACEP has established the following goal: "The number of board-certified physicians will be sufficient to meet the manpower needs of the public." 1 It is the position of ACEP that there is currently a severe shortage of appropriately trained and certified emergency physicians and, moreover, that the shortage will continue well into the next century. We discuss how ACEP arrived at this position and the role of academic emergency medicine in addressing this shortage. For many years, there has been a public debate as to whether there is a physician shortage or surplus. The Graduate Medical Education National Advisory Commission report of 1980 estimated that there would be 630,000 US physicians by 1990, with a surplus of 70,000. 2 This report also identified emergency medicine as a shortage specialty, indicating there would be a need for 14,000 emergency physicians in 1990, with a supply of only 8,000. Schwartz included such factors as increased provision of administrative and research activity by physicians and concluded that there would be a shortage of 7,000 physicians by the year 2,000. 3

Pressurized metered dose inhalers (pMDIs) are the most widely prescribed and economical respiratory drug delivery systems. Conventional pMDI actuators-those based on "two-orifice-and-sump" designs-produce an aerosol with a reasonable respirable fraction, but with high aerosol velocity. The latter is responsible for high oropharyngeal deposition, and consequently low drug delivery efficiency. Kos' pMDI technology is based on a proprietary vortex nozzle actuator (VNA), an innovative actuator configuration that seeks to reduce aerosol plume velocity, thereby promoting deep lung deposition. Using VNA development as a case study, this paper presents a systematic design optimization process to improve the actuator performance through use of advanced optical characterization tools. The optimization effort mainly relied on laser-based optical diagnostics to provide an improved understanding of the fundamentals of aerosol formation and interplay of various geometrical factors. The performance of the optimized VNA design thus evolved was characterized using phase Doppler anemometry and cascade impaction. The aerosol velocities for both standard and optimized VNA designs were found to be comparable, with both notably less than conventional actuators. The optimized VNA design also significantly reduces drug deposition in the actuator as well as USP throat adapter, which in turn, leads to a significantly higher fine particle fraction than the standard design (78 +/- 3% vs. 63 +/- 2% on an ex valve basis). This improved drug delivery efficiency makes VNA technology a practical proposition as a systemic drug delivery platform. Thus, this paper demonstrates how advanced optical diagnostic and characterization tools can be used in the development of high efficiency aerosol drug delivery devices.

The engineers of the United States Public Health Service have been instrumental in many of the greatest health achievements in the last century. They have contributed to key advancements in pubic health that improve and extend the lives of all Americans. Along with giving a short description and history of the Commissioned Corps of the US Public Health Service, this paper will outline these achievements and highlight some of the more important ones.

Two Mexican-Americans analyzed in the 206th International Cell Exchange express distinctive, short B39 antigens. The B39 variant carried by cell #821 was assigned serologically as ST16 by a number of laboratories, whereas that carried by cell #822 appeared "shorter" than ST16 (1). To determine the differences between these two antigens and their relationships to ST16 we sequenced HLA-B cDNA clones derived from B cell lines established from the lymphocytes of these two individuals. The

SummaryIndividual genetic admixture estimates (IA) from European Americans (EAs) were computed in 7,996 members of the Gila River Indian Community (Arizona). Parental populations for the analysis were European Americans and full-heritage Pima Indians. A logistic regression was performed on 7,796 persons, to assess association of IA with type 2 diabetes. The odds ratio, comparing diabetes risk in full-heritage EAs with full-heritage Pima Indians, was 0.329 (95% confidence interval [CI] 0.225–0.482). Proportional-hazards analysis was performed on 5,482 persons who were nondiabetic at their first examination and 1,215 subjects who developed diabetes during the study. The hazard risk ratio for IA was 0.455 (95% CI 0.301–0.688). Nondiabetic persons had significantly more European IA. In nondiabetic Pimans, multivariate linear regressions of quantitative predictors of type 2 diabetes mellitus, including fasting plasma glucose, 2-h post-load plasma glucose, and body-mass index, showed significant inverse relations with IA when controlled for sex and age. These results illustrate the ongoing evolution of populations by the mechanism of gene flow and its effect on disease risk in the groups with admixture. When the two parental populations differ in disease prevalence, higher or lower risk is associated with admixture, depending on the origin of the admixed alleles and the relative magnitude of the disease prevalence in the parental populations. These data also illustrate the strong genetic components in type 2 diabetes and are consistent with one susceptibility locus common to obesity and diabetes.

Clinically apparent renal cell carcinoma that has metastasized to the prostate is a rare finding. When identified, it has been associated with widespread metastatic disease and short-term survival. We present a case of metachronous renal cell carcinoma found only in the prostate with the longest reported interval of 9 years between radical nephrectomy and clinically apparent disease.

Micromirrors were fabricated in gallium phosphide by mass transport to provide spatial-mode control of vertical-cavity surface-emitting lasers (VCSEL's). The concave mirrors were used in an external-cavity configuration to provide spatial filtering in the far field. Single-mode cw lasing was demonstrated in 15-microm-diameter VCSEL's with currents as high as 6 times threshold. The fabrication process was extended to micromirrors in gallium arsenide by use of a replication and dry-etch transfer process.

Drs Kushner and Olson presented four cases of retinal hemorrhage following epidural steroid injections performed in our institution. A letter to the editor from Drs Poulton and Pero has been presented to us and a response has been requested. We wish to point out several errors or misconceptions that appear in one or both manuscripts. We do not believe that incremental doses of thiopental sodium, used to enhance patient comfort in a variety of regional blocks, including epidural steroid injections, should be characterized as general anesthesia. It is not uncommon for our patients to be awake as the injection is completed. Although Dr Kushner's report did describe the patient position as head down, we are assured that none of the nine anesthesiologists in our practice places patients with the head down. The stretcher remains horizontal. In fact, amazingly, some patients request pillows under their heads even in the prone position.

Cord plasmas have a higher concentration of IgG than do the mothers, although autologous, fetal immunoglobulin G is only a small fraction of the neonate's complement. Maternal IgG levels are significantly lower than the nonpregnant adult female, a loss of about one third, which cannot be explained completely by maternal immunization of the fetus.

Non-insulin-dependent diabetes mellitus is a common disease in the Pima Indians. It is familial and strongly related to obesity. Neel (1962) suggested that the introduction of a steady food supply to people who have evolved a "thrifty genotype" leads to obesity, insulin resistance, and diabetes. Our findings in the Pimas of differences in insulin sensitivity in different metabolic pathways suggest that the thrifty genotype involves the ability of insulin to maintain fat stores despite resistance to glucose disposal. The recent increase in diabetes incidence following the availability of an abundant food supply suggests that the ability to store energy efficiently during cycles of feast and famine may now lead to obesity, insulin resistance, and diabetes.

In the summer of 1914 Europeans went to war not only at the urging of those crowned rulers, diplomats, army officers and industrialists who had set the stage for the conflagration that followed, but also for their own causes. Even when public opinion did not decisively alter public policy, it helped to convince policymakers that their decisions enjoyed popular support. Widespread Russophobia was an important element in German public opinion in the decade before the war. Germans went off to war in the East in I9I4 with the feeling that they were at best defending Western civilization against Eastern barbarism and at least defending economic progress against political autocracy. Russia was a political anachronism staving off the forces of revolution; as such she symbolized a bastion of despotism for the German left (except for a brief moment in I905), and the threat of revolutionary Slavic upheaval for the establishment. Even the German middleclass reading public, with its new editions of Dostoevsky, Turgenev, Gogol, and Tolstoi, saw in Russia a fantasy-world both exotic and dangerous. One of the most important contributing factors to widespread fear of Russia in Germany after I900 was the mass migration of disaffected political refugees from Russia into Germany. Since the second quarter of the eighteenth century Germany had exerted a powerful cultural attraction on Russian intellectuals. But increasingly after I88I Germany became a centre of Russian exile political activity as well. The newer generation of Russians in Germany came for two main reasons: to obtain a professional education unobtainable in Russia, and to carry on political activity suspect at home. Highly critical of the regime from which they had fled, these emigres quite naturally passed along their own interpretation of events in Russia to those in Germany who cared to

In Pima Indians with Type 2 (insulin independent) diabetes mellitus, HLA-A2 allele frequencies were inversely associated with age, (0.72, 0.59, and 0.52 in those less than 35, 35 to 54, and 55 years old and over, respectively). This suggests that there may be a gene closely linked with the HLA-A locus which plays a role in the expression of diabetes in the Pimas by contributing to an earlier age of onset. HLA-A2 was found in 65% non-diabetic and 81% of 191 diabetic subjects (relative risk = 2.2).

Most laboratory instruments either produce or accept analog or continuous signals of some form. In order for a digital computer to be able to communicate with an analog instrument, digital-analog interconversions must be made. There are several different ways to construct devices to accomplish this. A digital-to-analog converter (DAC) can be constructed using a weighted resistor or ladder resistor network. The ladder resistor network is the more frequently used because it requires only two different values of precision resistors and is therefore cheaper to construct. However, the weighted resistor network is easier to conceptualize, and will be discussed first. Figure 5–1 shows the diagram of a typical four-bit DAC, constructed from a weighted resistor network. At any particular time, the value of the current at the inverting input of the operational amplifier is inversely proportional to the values of the resistors in the circuit and directly proportional to V R . The (inverted) output voltage, V out , depends on these parameters and on the value of R f . The exact relationship is shown in Eq. (5–1), where Lt denotes the logical state of the switch adjacent to the ith resistor. The quantity L is 1 for closed switches and 0 for open switches.

The basic programming approach described in this section may be implemented on Varian 620/i, 620/L, and 620/f computers. In addition, the Varian 73 computer can be used in the same way. Our development of real-time basic (rtb) for these systems has relied on simple modifications of the basic compiler as supplied by Varian. This compiler is a version of the language, originally developed at Dartmouth College, which includes all of the standard arithmetic operations as well as trigonometric functions and matrix-algebra routines. The standard Varian version of the language requires approximately seven thousand words of memory for the compiler, leaving the remainder available for user source code. A user may expand the available source-code area (thus allowing larger programs) by deletion of the matrix algebra and/or trigonometric function packages. This yields about 700 additional words of memory. Since this is a true interpretive compiler, all user source code and the compiler must be stored in core at run time. It is possible to modify the compiler to use a mass storage device (i.e., magnetic disk) to store user source code. At least one user has done this; however, such a procedure slows execution times and is not generally suitable for real-time experimentation. As released by Varian, basic contains no subroutines to support devices of the type needed in the laboratory (i.e., analog and digital I/O devices, control and sense lines, etc.).

The high-level programming language for on-line experimentation developed at Purdue University was built around the basic language and will be referred to as Purdue REAL-TIME BASIC (PRTB). The software was developed by modifying the BASIC Interpreter available from Hewlett-Packard (H.P. 20392). The modifications generated have involved the development of a series of machine-language subroutines which are directly callable from the BASIC software and which are designed to communicate in a variety of ways with experimental systems. The characteristics of the PRTB data-acquisition and control software are exactly analogous to those described in Sec. II.

In experiment 5, digital-to-analog and analog-to-digital conversions were discussed, and several ADC’s were constructed. Although the individual characteristics of the different ADC’s varied, all of them utilized the same basic design features shown in the block diagram of Fig. 7–1. Of the three functions shown, the voltage-comparison and reference-voltage-generation functions are relatively easy to implement, while the controller is considerably more difficult. A comparison of Figs. 7–1 and 5–9 shows that the first two functions can be performed by a single chip each (the 710 comparator and the Datei DAC-9), while the remaining components are all necessary for the control function. It is clear that Fig. 5–9 could be simplified considerably if one single unit could be found, which would handle all the necessary control and logic operations. It is in precisely such control and decision-making functions that laboratory computers are particularly useful.

SUMMARY Tissue typing was performed on lymphocytes of sixty-two patients with guttate psoriasis, in forty-four of whom this was the first manifestation of the disease. In 84% of cases, the guttate psoriasis was preceded by a clinical infection. A highly significant excess of antigen W17 (HLA-BW17) was found in patients when compared with a healthy population. In common with some other studies antigens HL-A 13 (HLA-B13), Wr5 (HLA-BW15) and W21 (HLA-BW21) were found in excess but these became non-significant after correction for the number of antigens studied. 68% of patients who had guttate psoriasis de novo, subsequently developed persistent plaque psoriasis.

Gas chromatography is an analytical technique to achieve quantitative separation of mixtures. It is applicable to any samples which can be vaporized and introduced to the separation process in a gaseous state. A schematic diagram of the chromatographic instrumentation is shown in Fig. 15–1. More detailed discussion of G.C. theory, instrumentation, and procedures are given in refs. E-1 and E-2.

With one exception, circuit layout and parts placement are not critical for any of the circuits involved. The exception is that, when they are required in the circuit, the 0.01-μF ceramic power-supply decoupling capacitors must be placed between the power-supply connections and ground as close to each logic device and operational amplifier as possible. This will prevent noise transients and oscillations from occurring as a result of power-supply-wiring inductances. In addition, reasonable care should be taken to prevent internal ground loops in the devices. Power-supply requirements are fairly noncritical. The supplies should, however, be regulated and have current capacities on the order of about 100 mA for the + 15-V unit, and about 200 mA for the + 5-V unit. Inexpensive epoxy-encapsulated units such as Computer Products (Fort Lauderdale, Fla.) Models PM529 (for +5-V unit) and PM552 (for ± 15-V unit) can be used.

In order for a computer to be able to monitor an experiment, the instrumentation must be tied in with the computer. Usually, a continuous (analog) signal must be monitored, and some sequence of events must be controlled by the computer (turn on a switch, start a clock, store data, calculate values, etc.). This sequence of events can be caused to occur by an appropriate combination of logic elements. These logic elements may be rather simple or highly complex. The simplest of these is called a gate and may be considered as a simple electronic on-off switch. When the switch is closed, a signal goes through; when open, it does not. Several of these on-off switches can be combined in such a way that they simulate simple logical expressions.

Experiments 3, 4, and 5 of the Logic Experiment section introduced you to the various devices which are necessary in order for the computer to acquire analog data in useful or digitized form. It is, of course, necessary that these devices be combined in such a way as to allow the computer complete control of the direct entry of the data. The necessary devices generally consist of four parts: an analog-to-digital converter to digitize the analog signal, a buffer register to store the digitized data temporarily, a time-base generator to determine the appropriate digitization frequency, and, finally, control logic to properly sequence the digitization of the analog signal and the transfer of the digital value into the computer.

An analysis of an implied assumption, that of Hardy-Wei n berg equilibrium, reveals that the single locus, recessive allele hypothesis for susceptibility to insulin-dependent diabetes mellitus has not been firmly and unequivocally rejected by the method of Rotter et al1.

A number of relatively inexpensive and versatile logic laboratory devices are commercially available in preassembled or “kit” forms. Most of these include, at a minimum, provisions for easy patchcord wiring of logic circuits, power supplies, a clock and two or more indicator lights and push buttons or switches. The price of such items is from $100 or less to well above $1,000. As one might expect, the more elaborate the system, the higher its cost. Because of the great variety of options available, a detailed list of specifications will not be included here. Rather, the minimal system will be described. This is adequate for performance of the digital logic experiments (Sec. I, Experiments 1–5 and Sec. II, Experiments 6 and 7), although the more elaborate (and more expensive) alternatives will certainly be equally suitable. One such device is the EL Instruments “Digi-designer.”