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Free-space volumetric displays, or displays that create luminous image points in space, are the technology that most closely resembles the three-dimensional displays of popular fiction. Such displays are capable of producing images in 'thin air' that are visible from almost any direction and are not subject to clipping. Clipping restricts the utility of all three-dimensional displays that modulate light at a two-dimensional surface with an edge boundary; these include holographic displays, nanophotonic arrays, plasmonic displays, lenticular or lenslet displays and all technologies in which the light scattering surface and the image point are physically separate. Here we present a free-space volumetric display based on photophoretic optical trapping that produces full-colour graphics in free space with ten-micrometre image points using persistence of vision. This display works by first isolating a cellulose particle in a photophoretic trap created by spherical and astigmatic aberrations. The trap and particle are then scanned through a display volume while being illuminated with red, green and blue light. The result is a three-dimensional image in free space with a large colour gamut, fine detail and low apparent speckle. This platform, named the Optical Trap Display, is capable of producing image geometries that are currently unobtainable with holographic and light-field technologies, such as long-throw projections, tall sandtables and 'wrap-around' displays.

This paper presents a finite element model of the ankle, taking into account the effects of muscle forces, determined by a musculoskeletal analysis, to investigate the contact stress distribution in the tibio-talar joint in patients with triple arthrodesis and in normal subjects. Forces of major ankle muscles were simulated and corresponded well with the trend of their EMG signals. These forces were applied to the finite element model to obtain stress distributions for patients with triple arthrodesis and normal subjects in three stages of the gait cycle, i.e. heel strike, midstance, and heel rise. The results demonstrated that the stress distribution patterns of the tibio-talar joint in patients with triple arthrodesis differ from those of normal subjects in investigated gait cycle stages. The mean and standard deviations for maximum stresses in the tibo-talar joint in the stance phase for patients and normal subjects were 9.398e7 ± 1.75e7 and 7.372e7 ± 4.43e6 Pa, respectively. The maximum von Mises stresses of the tibio-talar joint for all subjects in the stance phase found to be on the lateral side of the inferior surface of the joint. The results also indicate that, in patients with triple arthrodesis, increasing gastrocnemius-soleus muscle force reduces the stress on the medial malleolus compared with normal subjects. Most of stresses in this area are between 45 and 109 kPa, and will decrease to almost 32 kPa in patients after increasing of 40% in gastrocnemius-soleus muscle force.

Considerable uncertainty exists about the defining brain changes associated with bipolar disorder (BD). Understanding and quantifying the sources of uncertainty can help generate novel clinical hypotheses about etiology and assist in the development of biomarkers for indexing disease progression and prognosis. Here we were interested in quantifying case-control differences in intracranial volume (ICV) and each of eight subcortical brain measures: nucleus accumbens, amygdala, caudate, hippocampus, globus pallidus, putamen, thalamus, lateral ventricles. In a large study of 1710 BD patients and 2594 healthy controls, we found consistent volumetric reductions in BD patients for mean hippocampus (Cohen's d=-0.232; P=3.50 × 10 -7 ) and thalamus (d=-0.148; P=4.27 × 10 -3 ) and enlarged lateral ventricles (d=-0.260; P=3.93 × 10 -5 ) in patients. No significant effect of age at illness onset was detected. Stratifying patients based on clinical subtype (BD type I or type II) revealed that BDI patients had significantly larger lateral ventricles and smaller hippocampus and amygdala than controls. However, when comparing BDI and BDII patients directly, we did not detect any significant differences in brain volume. This likely represents similar etiology between BD subtype classifications. Exploratory analyses revealed significantly larger thalamic volumes in patients taking lithium compared with patients not taking lithium. We detected no significant differences between BDII patients and controls in the largest such comparison to date. Findings in this study should be interpreted with caution and with careful consideration of the limitations inherent to meta-analyzed neuroimaging comparisons.

Background: Primary carnitine deficiency (PCD) is a disorder of fatty acid oxidation with a high prevalence in the Faroe Islands. Only patients homozygous for the c.95A>G (p.N32S) mutation have displayed severe symptoms in the Faroese patient cohort. In this study, we investigated carnitine levels in skeletal muscle, plasma, and urine as well as renal elimination kinetics before and after intermission with L-carnitine in patients homozygous for c.95A>G., Methods: Five male patients homozygous for c.95A>G were included. Regular L-carnitine supplementation was stopped and the patients were observed during five days. Blood and urine were collected throughout the study. Skeletal muscle biopsies were obtained at 0, 48, and 96 h., Results: Mean skeletal muscle free carnitine before discontinuation of L-carnitine was low, 158 nmol/g (SD 47.4) or 5.4% of normal. Mean free carnitine in plasma (fC0) dropped from 38.7 (SD 20.4) to 6.3 (SD 1.7) μmol/L within 96 h (p < 0.05). Mean T 1/2 following oral supplementation was approximately 9 h. Renal reabsorption of filtered carnitine following oral supplementation was 23%. The level of mean free carnitine excreted in urine correlated (R (2) = 0.78, p < 0.01) with fC0 in plasma., Conclusion: Patients homozygous for the c.95A>G mutation demonstrated limited skeletal muscle carnitine stores despite long-term high-dosage L-carnitine supplementation. Exacerbated renal excretion resulted in a short T 1/2 in plasma carnitine following the last oral dose of L-carnitine. Thus a treatment strategy of minimum three daily separate doses of L-carnitine is recommended, while intermission with L-carnitine treatment might prove detrimental.

The velocity-space sensitivities of fast-ion diagnostics are often described by so-called weight functions. Recently, we formulated weight functions showing the velocity-space sensitivity of the often dominant beam-target part of neutron energy spectra. These weight functions for neutron emission spectrometry (NES) are independent of the particular NES diagnostic. Here we apply these NES weight functions to the time-of-flight spectrometer TOFOR at JET. By taking the instrumental response function of TOFOR into account, we calculate time-of-flight NES weight functions that enable us to directly determine the velocity-space sensitivity of a given part of a measured time-of-flight spectrum from TOFOR.

Collective Thomson scattering (CTS) measurements provide information about the composition and velocity distribution of confined ion populations in fusion plasmas. The bulk ion part of the CTS spectrum is dominated by scattering off fluctuations driven by the motion of thermalized ion populations. It thus contains information about the ion temperature, rotation velocity, and plasma composition. To resolve the bulk ion region and access this information, we installed a fast acquisition system capable of sampling rates up to 12.5 GS/s in the CTS system at ASDEX Upgrade. CTS spectra with frequency resolution in the range of 1 MHz are then obtained through direct digitization and Fourier analysis of the CTS signal. We here describe the design, calibration, and operation of the fast receiver system and give examples of measured bulk ion CTS spectra showing the effects of changing ion temperature, rotation velocity, and plasma composition.

Background/objective: Mid-upper-arm circumference (MUAC) is a simple method of assessing nutritional status in children above 6 months of age. In 2007 World Health Organization (WHO) introduced a MUAC z-score for children above 3 months of age. We evaluated whether MUAC or MUAC z-score had the best ability to identify children with high short-term mortality risk in Guinea-Bissau., Subjects/methods: The Bandim Health Project visits children 3-monthly until 3 years of age. MUAC is measured and deaths are registered. We studied a high-mortality cohort of children born in 1995-96 and a lower mortality cohort of children born in 2005-06. The prognostic ability of MUAC and MUAC z-score to predict mortality within 1 and 3 months after the MUAC assessment were compared by area under the receiver operating characteristic curve, sensitivity and positive predictive value., Results: Compared with MUAC z-score, MUAC identified as malnourished more girls than boys (prevalence ratio (PR)=1.74 (1.52;2.01)) and more children aged 6-11 months than children aged 12-35 months (1.59 (1.38;1.82)). There was no difference in the prognostic ability of MUAC and MUAC z-score to predict mortality for children aged 6-35 months. The prognostic ability was higher when mortality was lower. MUAC performed well in the youngest infants., Conclusion: In the age group 6-35 months, MUAC and MUAC z-score had the same prognostic ability to predict short-term mortality. As MUAC is easier to use in field settings, there is no need to use MUAC z-score to identify children with a high-mortality risk.

Methane (CH4), a highly potent greenhouse gas, has repeatedly been identified as a significant contributor to global warming. In this connection, ruminants, animals that produce large quantities of methane, have been singled out as an area for reduction with regard to their emissions to the atmosphere. In an analysis of recently published data, we identify the underlying mechanisms of methane production in ruminants and focus on the efficacy of different fat sources in terms of their ability to reduce methane production. Specific attention has been placed on in vivo studies involving cattle and sheep, as well as studies based on a large number of animals (>10), recorded over a longer period (>21 days), and employing reliable techniques for the quantification of methane production. Data clearly indicate that supplementary fat, given to ruminants inhibits methane production, with medium-chain fatty acids (laurin, myristic acid) as well as poly-unsaturated fatty acids (linoleic and especially linolenic acid) having a significant effect. It is also apparent that conflicting findings between individual published trials can largely be resolved when one takes into consideration differences in experimental design, the composition of the basic feeds, the fat sources used, and the number of animals involved.

Background: Antipsychotics are perceived to be over-used in the management of behavioural problems in people with an intellectual disability (ID). Published guidelines have set good practice standards for the use of these drugs for behavioural indications. We sought to identify the range of indications for which antipsychotic drugs are prescribed in people with ID and to audit clinical practice against the standards., Method: Data were collected from the clinical records of individuals with ID who were under the care of mental health services in the UK, and prescribed an antipsychotic drug., Results: The sample comprised 2319 patients from 39 clinical services. Twenty-seven per cent of the patients had a diagnosis of a psychotic illness (ICD-10 F20-29) and 27% an affective illness (ICD-10 F30-39). The proportion who did not have a psychiatric diagnosis ranged from 6% of those with borderline/mild ID to 21% of those with severe/profound ID. Overall, the most common indications for prescribing an antipsychotic drug were comorbid psychotic illness, anxiety and agitation, and a range of behavioural disturbances. The prevalence of use of antipsychotic drugs to manage challenging behaviour in the absence of concomitant mental illness increased with the severity of ID and accounted for almost half of prescriptions in those with severe/profound ID. Adherence to the audit standards related to documentation of clinical indications and review of efficacy was high. Side effect monitoring was less assiduous., Conclusions: In clinical practice, most prescriptions for antipsychotic drugs in people with ID are consistent with the evidence base and the overall quality of prescribing practice, as measured against recognised standards, is good, although in some patients potentially remedial side effects may not be detected and treated., (© 2011 The Authors. Journal of Intellectual Disability Research © 2011 Blackwell Publishing Ltd.)

Functional MRI mapping of language areas in children frequently employs a covert verb generation task. Because responses are not monitored, the relationship between fMRI activation and task performance is unknown. We compared fMRI activation during covert and overt verb generation to performance during the overt task. 15 children, ages 11-13 years, listened to concrete nouns and responded with related verbs covertly and overtly. A clustered fMRI acquisition allowed for recording of overt responses without motion artifacts. Region of interest analysis was also performed in areas that exhibited correlation between activation and performance during overt verb generation in left inferior frontal and left superior temporal gyri (along with their right hemisphere homologues). Regression analysis determined that during both covert and overt generation, left hemisphere regions showed positive correlations with average counts of verbs generated during the overt task. These results suggest that increased verb generation performance leads to increased activation. In addition, overt performance may be used as an estimator of covert performance., (© Georg Thieme Verlag KG Stuttgart · New York.)

This paper introduces a general optimisation-based method for identification of biomechanically relevant parameters in kinematically determinate and over-determinate systems from a given motion. The method is designed to find a set of parameters that is constant over the time frame of interest as well as the time-varying system coordinates, and it is particularly relevant for biomechanical motion analysis where the system parameters can be difficult to accurately determine by direct measurements. Although the parameter identification problem results in a large-scale optimisation problem, we show that, due to a special structure in the linearised Karush–Kuhn–Tucker optimality conditions, the solution can be found very efficiently. The method is applied to a set of test problems relevant for gait analysis. These involve determining the local coordinates of markers placed on the model, segment lengths and joint axes of rotation from both gait and range of motion experiments.

Although measurement of maximum voluntary biting force is an important indicator of health of the masticatory system, few commercially available transducers have been validated for routine clinical use. The T-Scan III system records distribution of relative forces around the tooth row during clenching, but not absolute forces. This study assesses the reliability of T-Scan sensors with and without protection materials and develops calibration curves that allow measurement of absolute forces with the T-Scan III.

In this paper, we introduce a new general method for kinematic analysis of rigid multi body systems subject to holonomic constraints. The method extends the standard analysis of kinematically determinate rigid multi body systems to the over-determinate case. This is accomplished by introducing a constrained optimisation problem with the objective function given as a function of the set of system equations that are allowed to be violated while the remaining equations define the feasible set. We show that exact velocity and acceleration analysis can also be performed by solving linear sets of equations, originating from differentiation of the Karush-Kuhn-Tucker optimality conditions. The method is applied to the analysis of an 18 degrees-of-freedom gait model where the kinematical drivers are prescribed with data from a motion capture experiment. The results show that significant differences are obtained between applying standard kinematic analysis or minimising the least-square errors on the two fully equivalent 3D gait models with only the way the experimental data is processed being different.

Bubble chambers were the dominant technology used for particle detection in accelerator experiments for several decades, eventually falling into disuse with the advent of other techniques. We report here on a new application for these devices. We operated an ultraclean, room-temperature bubble chamber containing 1.5 kilograms of superheated CF3I, a target maximally sensitive to spin-dependent and -independent weakly interacting massive particle (WIMP) couplings. An extreme intrinsic insensitivity to the backgrounds that commonly limit direct searches for dark matter was measured in this device under operating conditions leading to the detection of low-energy nuclear recoils like those expected from WIMPs. Improved limits on the spin-dependent WIMP-proton scattering cross section were extracted during our experiments, excluding this type of coupling as a possible explanation for a recent claim of particle dark-matter detection.

Rather than being a static property of hospitals and other healthcare facilities, safety is dynamic and often on short time scales. In the past most healthcare delivery systems were loosely coupled-that is, activities and conditions in one part of the system had only limited effect on those elsewhere. Loose coupling allowed the system to buffer many conditions such as short term surges in demand. Modern management techniques and information systems have allowed facilities to reduce inefficiencies in operation. One side effect is the loss of buffers that previously accommodated demand surges. As a result, situations occur in which activities in one area of the hospital become critically dependent on seemingly insignificant events in seemingly distant areas. This tight coupling condition is called "going solid". Rasmussen's dynamic model of risk and safety can be used to formulate a model of patient safety dynamics that includes "going solid" and its consequences. Because the model addresses the dynamic aspects of safety, it is particularly suited to understanding current conditions in modern healthcare delivery and the way these conditions may lead to accidents.

In the present study, an outbreak of proliferative dermatitis in musk ox (Ovibos moschatus), Sichuan takin (Budorcas taxicolor tibetana) and domestic Shetland sheep (Ovis aries) in a zoo is described. Skin lesions consisted of severe, persistent, multifocal, proliferative dermatitis in musk ox, and mild, transient, focal, dermatitis in the Sichuan takin and Shetland sheep. Parapoxviruses were isolated from skin lesions, and characterized by restriction enzyme analysis and partial gene sequencing. The results of this investigation indicate that the outbreak of proliferative dermatitis was due to infection by a single parapoxvirus, which is genetically closely related to other orf virus (ORFV) strains but distant to bovine papular stomatitis virus (BPSV) and pseudocowpox virus (PCPV).

During recent years the significance of the concept of human error has changed considerably. The reason for this has partly been an increasing interest of psychological research in the analysis of complex real life phenomena, and partly the changes of modern work conditions caused by advanced information technology. Consequently, the topic of the present contribution is not a definition of the concept or a proper taxonomy. Instead, a review is given of two professional contexts for which the concept of error is important. Three cases of analysis of human-system interaction are reviewed: (1). traditional task analysis and human reliability estimation; (2). causal analysis of accidents after the fact, and (3). design of reliable work conditions in modern sociotechnical systems. It is concluded that "errors" cannot be studied as a separate category of behaviour fragments; the object of study should be cognitive control of behaviour in complex environments.

Summary: We describe the case of a three-year-old Danish boy born at term by Cesarean due to cardiac insufficiency in the last trimestre of intra-uterine life for which he is being treated with cardiac drugs. At birth, he was noted to have bilateral ocular malformations on the upper eyelids, and diffuse scalp lipoma and alopecia. Due to the retarded growth (score - 3D) he had a MRI and angiography which demonstrated a high flow fistula on the basilar tip artery and another one on the MCA branch treated by endovascluar approach. Intracranial arachnoid cysts, dysplastic cortex, ventricular enlargement and lipoma were noted too, establishing the diagnosis of Encephalocraniocutaneous Lipomatosis Syndrome, a rare disease, especially in bilateral presentation. To our knowledge this is the first observation of ECCL associated with intracranial pial arteriovenous fistulas.

Development of anti-retroviral regimens with enhanced efficacy against brain HIV-1 is essential if viral eradication is to be achieved. To address this, a severe combined immune deficiency mouse model of HIV-1 encephalitis was used to assay the effect of protease-containing and protease-sparing drug regimens on viral replication in brain macrophages. Here, HIV-1-infected human monocyte-derived macrophages (MDM) are inoculated into basal ganglia, causing a multinucleated giant cell encephalitis reminiscent of human disease. Drugs were administered at the time of MDM inoculation and continued until sacrifice. Immunohistochemical tests evaluated ongoing viral replication, glial immunity, and neuronal survival. Treatment with ddI/d4T decreased the numbers of infected cells by 75%, while ddI/d4T/amprenavir or ZDV/3TC/ABC diminished infection by 98%. Triple drug regimens decreased astrogliosis by > or = 25%. This small-animal model may be used to screen drug regimens that affect ongoing HIV-1 replication within its brain sanctuary., (Copyright 2001 Academic Press.)

This study evaluated the association between depressive symptoms and health related quality of life (HRQoL) in patients with chronic pulmonary disease using both general and disease-specific HRQoL measures. A cross-sectional analysis of HRQoL measures completed by patients enrolled in the Department of Veteran Affairs Ambulatory Care Quality Improvement Project. 1252 patients with chronic pulmonary disease screened positive for emotional distress and returned the Hopkins Symptom Checklist-20 (SCL-20). 733 of 1252 had a score of 1.75 or greater on the SCL-20 indicating significant depressive symptoms. Depressive symptoms were associated with statistically significantly worse general and pulmonary health as reflected by lower scores on all sub-scales of both the Medical Outcomes Short Form-36 and the Seattle Obstructive Lung Disease Questionnaire. In fact, 11% to 18% of the variance in physical function sub-scales was attributed to depressive symptoms alone. Patients with chronic pulmonary disease and depressive symptoms reported significantly more impaired functioning and worse health status when compared to those patients without depressive symptoms. Because there are highly effective treatments for depression, selective screening of patients with chronic pulmonary disease for depression may identify a group that could potentially benefit from treatment interventions.

This paper introduces the min/max criterion for simulation of muscle recruitment in multiple muscle systems. The criterion is introduced and justified by comparison to two known criterion types: the polynomial criterion and the soft saturation criterion. The comparison is performed on a planar three-muscle elbow model performing a dumbbell curl. A generalized form of the soft saturation criterion is introduced, and it is shown that the min/max criterion can be interpreted as the limit of the classical criteria when the exponents in their mathematical expressions approach infinity. We finally show how the min/max criterion can be cast into a form that allows for efficient and robust numerical solution by linear programming. It is concluded that the min/max criterion possesses a number of attractive physiological as well as algorithmic advantages.

The effects of anti-inflammatory drugs on glial immunity and neuropathology were determined in a severe combined immune deficiency (SCID) mouse model of HIV-1 encephalitis. HIV-1-infected human monocyte-derived macrophages (MDM) are stereotactically inoculated into basal ganglia resulting in a multinucleated giant cell encephalitis. A platelet activating factor antagonist and a matrix metalloproteinase inhibitor, which also inhibits tumor necrosis factor alpha release, were administered to animals at the time of the MDM inoculation. The drugs administered in combination markedly reduced brain inflammation, astrogliosis and microglia activation. These findings demonstrate that reduction of brain inflammatory responses, independent of viral replication, can affect HIVE pathology in an animal model system of disease.

Society is becoming increasingly dynamic and integrated owing to the extensive use of information technology. This has several implications that pose new challenges to the human factors profession. In an integrated society, changes and disturbances propagate rapidly and widely and the increasing scale of operations requires also that rare events and circumstances are considered during systems design. In this situation, human factors contributions should be increasingly proactive, not only responding to observed problems, but also, they should be based on models of adaptive human behaviour in complex, dynamic systems. The paper suggests some methodological issues to consider for human factors analyses by designers, evaluators and teachers.

Many uncertainties surround the definition, frequency, and significance of dysplastic nevi in children. Consequently the management of dysplastic nevi in the pediatric population has been largely derived from the studies of adults. Biopsies are usually performed on this young age group because of lesion change or abnormal appearance. One might therefore assume that the frequency of histologically diagnosed dysplastic nevi would be higher in children than in adults. We decided to attempt to verify this assumption by determining the frequency of dysplastic nevi diagnosed histologically in the pediatric population. To do this we reviewed 199 cutaneous pathology reports of nevi removed from patients less than 18 years old and submitted to a community-based dermatopathology laboratory. The diagnosis of dysplastic nevus was made based on histologic criteria recommended by the World Health Organization Melanoma Program. We found that 3 of 199 nevi submitted for histologic analysis met the histologic criteria for dysplastic nevus. There were no melanomas. Our data suggest that there is an extremely low frequency of histologically confirmed dysplastic nevi within the general pediatric population.

Objectives: To compare the efficacy of the nucleoside reverse transcriptase inhibitors (NRTIs) abacavir, zidovudine (AZT), lamivudine (3TC), didanosine (ddI), and stavudine (d4T) to inhibit viral replication in brain macrophages. A severe combined immunodeficiency (SCID) mouse model of HIV-1 encephalitis (HIVE) was used to monitor spreading viral infection in the CNS., Background: The development of antiretroviral therapies with CNS efficacy against neuroinvasive virus is important if eradication of HIV-1 can be achieved within critical "hidden reservoirs.", Methods: HIV-1-infected human monocyte-derived macrophages (MDMs) (after a single round of viral replication) were inoculated into the caudate and putamen of SCID mice. This resulted in the spreading of viral infection with a concomitant multinucleated giant cell encephalitis (astrogliosis, microglial activation, and neuronal injury). NRTIs were administered to animals at the time of intracerebral MDM inoculations and continued until the time of sacrifice. Antiretroviral effects were assessed by viral load and percentages of infected MDMs., Results: In brains of SCID mice with HIVE, abacavir and lamivudine reduced HIV-1 p24 antigen-positive cells by 80% and 95%, respectively, whereas both decreased viral load by approximately 1 log. Zidovudine, didanosine, and stavudine showed variable effects., Conclusion: Abacavir and lamivudine showed significant antiretroviral activity in SCID mice with HIVE when compared with other NRTIs. The extrapolation of these results to humans with HIV-1 dementia awaits future investigations.

The numbers of immune-activated brain mononuclear phagocytes (MPs) affect the progression of human immunodeficiency virus (HIV)-1-associated dementia (HAD). Such MPs originate, in measure, from a pool of circulating monocytes. To address the mechanism(s) for monocyte penetration across the blood-brain barrier (BBB), we performed cross-validating laboratory, animal model, and human brain tissue investigations into HAD pathogenesis. First, an artificial BBB was constructed in which human brain microvascular endothelial and glial cells-astrocytes, microglia, and/or monocyte-derived macrophages (MDM)-were placed on opposite sides of a matrix-coated porous membrane. Second, a SCID mouse model of HIV-1 encephalitis (HIVE) was used to determine in vivo monocyte blood-to-brain migration. Third, immunohistochemical analyses of human HIVE tissue defined the relationships between astrogliosis, activation of microglia, virus infection, monocyte brain infiltration, and beta-chemokine expression. The results, taken together, showed that HIV-1-infected microglia increased monocyte migration through an artificial BBB 2 to 3.5 times more than replicate numbers of MDM. In the HIVE SCID mice, a marked accumulation of murine MDM was found in areas surrounding virus-infected human microglia but not MDM. For human HIVE, microglial activation and virus infection correlated with astrogliosis, monocyte transendothelial migration, and beta-chemokine expression. Pure cultures of virus-infected and activated microglia or astrocytes exposed to microglial conditioned media produced significant quantities of beta-chemokines. We conclude that microglial activation alone and/or through its interactions with astrocytes induces beta-chemokine-mediated monocyte migration in HAD.

Objectives: To describe the outcome of nursing home (NH) care for a previously established cohort of residents with active, inactive or no alcohol use disorder (AUD), and to examine demographic variables, health services utilization, mortality and drinking behaviors in this group., Design: Retrospective cohort study with participant interviews at NH admission and 3 years later., Setting: Urban Veterans Affairs (VA) Medical Center and Nursing Home Care Unit (NHCU)., Participants: Patients older than age 50 admitted consecutively to a VA NHCU between July 1991 and February 1993 who completed a structured interview, N = 117., Main Outcome Measures: AUD as determined by DSM-III-R criteria. Demographics, health services utilization and mortality as abstracted from the VA medical record., Results: Health service utilization as measured by care episodes was not significantly different in the three groups (active, inactive and no AUD), but subjects with AUD had documented health services use related to alcoholism, including hospitalizations for alcohol-related illness, placements in long-term care facilities to control drinking and death from alcohol-related causes. The mean age at death was significantly younger for study participants with active or inactive AUD compared to those with no AUD: 67.7, 70.4 and 77.9 years, respectively (p < 0.004). Of the 21 participants with active AUD at NHCU entry, 11 resumed drinking after discharge and six still met criteria for active AUD 3 years later., Conclusions: The subset of NHCU patients with active AUD continued to incur alcohol-related hospitalizations and institutionalizations following NHCU discharge and suffered early mortality relative to their peers. Effective models of care for this subset of patients should be sought.

The effects of acute exposure of the opioid peptide [D-Ala2,N-MePhe4, Gly-ol5]enkephalin (DAMGO) on the mu-opioid receptor were examined in Chinese hamster ovary (CHO) K-1 and baby hamster kidney stable transfectants. In the CHO cell line, acute 1-hr treatment with DAMGO decreased the density of receptors without affecting the affinity or proportion of agonist-detected sites and attenuated the ability of the agonist to inhibit forskolin-stimulated cAMP accumulation. In contrast, similar 1-hr treatment of baby hamster kidney cells did not affect receptor density or agonist ability to inhibit cAMP accumulation, but longer duration of agonist exposure resulted in a reduction in membrane receptor, identical to the CHO cells. These results suggested that for the mu-opioid receptor, alteration in receptor density was the major determinant for the observed agonist-induced desensitization. Consistent with this notion, the ratio of the DAMGO concentration yielding half-maximal occupation of the mu receptor to that yielding half-maximal functional response was < 1. This suggests the necessity for a high mu receptor occupancy rate for maximal functional response, so that any loss of cell surface opioid-binding sites was a critical determinant in reducing the maximal response. This hypothesis was further supported by the observation that irreversible inactivation of fixed proportions of opioid-binding sites with beta-chlorn-altrexamine demonstrated that there were few spare receptors, which is in contrast to what has been reported for other G protein-coupled receptors, including the delta-opioid receptor. Taken together, these data suggest that the opioid agonist DAMGO has a high affinity for the mu receptor but must occupy > 70% of the available receptors to generate the maximal second messenger-linked response.

The kidney is a site of synthesis for several polypeptide growth factors including epidermal growth factor (EGF) and insulin-like growth factor I (IGF-I). Interactions between growth hormone (GH) and growth factors have been described that regulate renal growth factor expression. For example, GH and EGF each enhances the expression of IGF-I in kidney. To further define interrelationships in this renal GH-growth factor axis, we characterized the effect of GH on renal EGF expression in hypophysectomized, pituitary-intact (normal) rats, and hypersomatotropic rats. Levels of extractable immunoreactive mature EGF, levels of a 142-kDa EGF-precursor present in renal membrane fractions, and levels of EGF mRNA were significantly reduced in kidneys from hypophysectomized rats compared with levels in normal rats. Each was increased significantly after the administration of GH to hypophysectomized rats. In contrast, induction of hypersomatotropism in normal rats by injection of GH for 17 days did not affect levels of extractable mature EGF or EGF mRNA measured in kidneys. We conclude that GH enhances the renal synthesis of EGF in hypopituitary, but not in hypersomatotropic states.

Objective: To study the time course of nocturnal episodic and constant hypoxaemia during the first five nights after a major abdominal operation in patients not given supplementary oxygen., Design: Open study., Subjects: 17 patients undergoing major elective operations and with no recognised risk factors., Main Outcome Measures: Arterial oxygen saturation measured by pulse oximetry., Results: The level of constant hypoxaemia was lowest during night 2 (p < 0.01) as was the time spent below 90% saturation (p < 0.01) compared with the other four postoperative nights. Episodic hypoxaemia was most common during night 3 (p < 0.05). It was not possible to predict the postoperative occurrence of hypoxaemia from the preoperative spirometric measurements. Preoperative awake arterial oxygen saturation correlated significantly with mean constant hypoxaemia on postoperative nights 1, 3, 4, and 5, but not with episodes of sudden desaturation after operation. Preoperative overnight oximetry correlated significantly with constant hypoxaemia on all five postoperative nights and with episodic hypoxaemia on nights 3 and 4., Conclusion: In the light of these results which show the natural history of postoperative hypoxaemia without supplementary oxygen, and because postoperative hypoxaemia may be associated with dysfunction of organ systems after major operations, controlled studies of supplementary oxygen in the late postoperative period are warranted.

Changes of intracellular sodium concentrations are often an indication of disease or malfunction. In this work, shift reagent-aided 23Na NMR spectroscopic determination of intracellular sodium was adapted to measurements with perfused cells embedded in agarose gel threads. Ehrlich ascites tumor cells (EHR2) and their multidrug-resistant counterparts (EHR2/DNR+) were immobilized and perfused until the metabolic steady state had been reached as shown by 31P NMR spectroscopy. Subsequent addition of 5 mM dysprosium(III) bis(tripolyphosphate) to the perfusion medium caused a separation of extracellular and intracellular 23Na NMR signals, making quantification of the intracellular sodium possible. The dysprosium shift reagent was apparently nontoxic to the cells, as shown by the unchanged level of ATP and other intracellular phosphates. NMR visibility of the intracellular sodium was determined in suspensions of EHR2 and EHR2/DNR+ cells by treatment with digitonin; the increase of intensity of the extracellular sodium resonance observed after the digitonin treatment corresponded well (97 +/- 3%) to the sum of intracellular and extracellular sodium observed with intact cells prior to the digitonin treatment. The resistant EHR2/DNR+ cells contained a moderately higher intracellular sodium level than the wild-type EHR2 cells, 1.02 +/- 0.10 and 0.77 +/- 0.07 mumol Na/mg protein, respectively. Closely similar levels of intracellular sodium were found by flame photometry. Thus, 23Na NMR offers a reliable method for noninvasive quantification of intracellular sodium in perfused cancer cells.

Steady-state 31P NMR spectra of wild type EHR2 Ehrlich ascites tumor cells and multidrug resistant EHR2/DNR+ cells, immobilized in agarose threads, and continuously perfused with medium, showed temperature-dependent differences in the levels of intracellular phosphate metabolites. At 37 degrees C, the EHR2/DNR+ cells contained four times more phosphocreatine (PCr) than the EHR2 cells. At 20 degrees C, the EHR2 cells contained 80% more of phosphodiesters (PDE), the levels of PCr being equal. The quantitative metabolite level data are based on T1 relaxation times data and are normalized for the protein content of the cells. Perfusion of the cells with azide, an inhibitor of mitochondrial respiration, had no effect on the ATP level, and caused no changes in glucose consumption and lactate production. Azide perfusion, combined with glucose depletion, caused rapid drop in the ATP content, which was reestablished after renewed perfusion with glucose. Similarly, perfusion with 2,4-dinitrophenol, an uncoupler of the respiration chain, had no effect on the phosphate metabolites. These results demonstrate that aerobic glycolysis is the main route by which glucose is metabolised under the conditions used (glucose concentration in medium 2 g/L). Rates of uptake and phosphorylation of 2-deoxy-D-glucose were measured by following the formation of intracellular [6-13C]2-deoxy-D-glucose-6-phosphate by 13C NMR; at 37 degrees C the observed rates for EHR2 and EHR2/DNR+ cells were equal, about 10 nmol/(min x mg protein), whereas at 20 degrees C the wild type cells produced the 6-phosphate at an approximately twice the rate found for the resistant cells [about 4 and 2 nmol/(min x mg protein), respectively].(ABSTRACT TRUNCATED AT 250 WORDS)

Pulmonary diffusing capacity (DICO), together with spirometric variables, arterial oxygen tension (paO2) and cardiac output were determined before and at intervals after maximal arm cranking, treadmill running and ergometer rowing. Independent of the type of exercise, D1CO increased immediately post-exercise from a median 13.6 (range 7.3-16.3) to 15.1 (9.3-19.6) mmol min-1 kPa-1 (P < 0.01). However, it decreased to 11.6 (6.9-15.5) mmol min-1 kPa-1 (P < 0.01) after 24 h with cardiac output and paO2 at resting values, and D1CO normalized after 20 h. Thoracic electrical impedance at 2.5 and 100 kHz increased slightly post-exercise, indicating a decrease in thoracic fluid balance, and there were no echocardiographic signs of left ventricular failure at the time of the decrease in D1CO. Also, active muscle (limb) circumference and volume, and an increase in haematocrit from 43.8 (38.0-47.0) to 47.1 (42.7-49.8) (P < 0.01), had normalized at the time of the decrease in D1CO. Vital capacity, forced vital capacity, forced expiratory volume in 1 s, peak and peak mid-expiratory flows did not change. However, total lung capacity increased from 6.8 (5.0-7.6) to 7.0 (5.1-7.8) litres (P < 0.05) immediately after exercise and remained elevated at 6.9 (5.1-8.7) litres (P < 0.05) when a decrease in D1CO was noted. The results demonstrate that independent of the type of maximal exercise, an approximate 15% reduction in D1CO takes place 2-3 h post-exercise, which normalizes during the following day of recovery.

An extensive screening among microorganisms for the presence of post-proline-specific endopeptidase activity was performed. This activity was found among ordinary bacteria from soil samples but not among fungi and actinomycetes. This result is in contrast to the previous notion that this activity is confined to the genus Flavobacterium. A proline endopeptidase was isolated from a Xanthomonas sp. and characterized with respect to physicochemical and enzymatic properties. The enzyme is composed of a single peptide chain with a molecular weight of 75,000. The isoelectric point is 6.2. It is inhibited by diisopropylfluorophosphate and may therefore be classified as a serine endopeptidase. The activity profile is bell shaped with an optimum at pH 7.5. By using synthetic peptide substrates and intramolecular fluorescence quenching it was possible to study the influence of substrate structure on the rate of hydrolysis. The enzyme specifically hydrolyzed Pro-X peptide bonds. With Glu at position X, low rates of hydrolysis were observed; otherwise the enzyme exhibited little preference for particular amino acid residues at position X. A similar substrate preference was observed with respect to the amino acid residue preceding the prolyl residue in the substrate. The enzyme required a minimum of two amino acid residues toward the N terminus from the scissile bond, but further elongation of the peptide chain by up to six amino acid residues caused only a threefold increase in the rate of hydrolysis. Attempts to cleave at the prolyl residues in oxidized RNase failed, indicating that the enzyme does not hydrolyze long peptides, a peculiar property it shares with other proline-specific endopeptidases.

A hybrid protein system was used for the study of protein transport in plant cells. A nucleotide sequence (vic) encoding a putative signal peptide of 15 amino acid residues, derived from the published aa sequence of one Pisum vicilin, was synthesized and fused in frame to the gus gene encoding a bacterial cytosolic beta-glucuronidase (GUS). When the hybrid vic::gus gene was expressed in tobacco cells using the cauliflower mosaic virus 35S promoter, the hybrid GUS protein was targeted to, and glycosylated inside the rough endoplasmic reticulum. Glycosylation could be blocked with the antibiotic tunicamycin. The study of transient expression in protoplasts showed that extracellular secretion efficiency was low, which may be due to the nature of the GUS protein.

Iododeoxyuridine is a halogenated pyrimidine and non-hypoxic cell radiosensitizer currently being used in clinical trials. The amount of radiosensitization by IdUrd is related to the amount of incorporation of the drug into a cell's DNA. These experiments were carried out in three human tumor cell lines (lung, glioma, and melanoma) in monolayer culture exposed to concentrations of IdUrd from 0.1-10 microM for one and three cell cycles before irradiation to determine incorporation and sensitization as a function of drug exposure. Except for the lung cell line, which required greater than 1 microM IdUrd, these cells demonstrate radiosensitization when exposed to 0.1 microM or greater of IdUrd. Maximum sensitization occurred at 10 microM IdUrd for all the cell lines at three cell cycles. The percent thymidine replacement by IdUrd increased with increasing concentrations, but was cell line dependent. Maximum percent replacement occurred at 10 microM at three cell cycles for all the cell lines: lung = 22.4%, glioma = 32.0%, and melanoma = 39.1%. The relationships between percent thymidine replacement and sensitization are not identical across these human tumor cell lines. If IdUrd is going to be a successful radiosensitizer in clinical trials, sustained plasma levels of 10 microM or greater for at least three cell cycles should be achieved during irradiation. This may be best accomplished with repeated short exposures to IdUrd (three cell cycles or approximately 4 days in these cell lines) every 1-2 weeks during radiation. Measurements of thymidine replacement in a tumor biopsy should be attempted prior to radiation to develop a predictive assay for radiosensitization.

We measured arterial oxygen saturation before and immediately after randomly allocated 6 min of "all-out" maximal arm cranking, treadmill running, and ergometer rowing in 10 men and women with a median maximal oxygen uptake of 4.47 (range 3.22-5.34) 1.min-1. Arterial saturation for oxygen was unaltered after arm cranking, but decreased 1.7 (-2.5-6.0) % (P less than 0.05) after running, and 2.2 (1.0-8.7) % (P less than 0.01) after rowing. Arterial saturation was inversely related to capillary blood lactate, which reached 11.8 (7.4-14.0), 12.6 (8.9-18 2), and 14.3 (12.0-19.3) mmol.l-1 (P less than 0.01), respectively, and arterial bicarbonate fell to 15.0 (13.0-23.6), 12.4 (7.2-20.4), and 10.8 (0.0-12.5) mmol.l-1 (P less than 0.01). Thus, pH decreased to 7.25 (7.22-7.40), 7.17 (6.95-7.35), and 7.09 (6.84-7.19) (P less than 0.01). When measured immediately post-exercise, arterial oxygen tension was unchanged or elevated from rest, eliminating the possibility that the arterial desaturation was caused by a pulmonary diffusion limitation. The results of this investigation show that arterial desaturation associated with maximal exercise takes place in proportion to the involved muscle mass, as do deviations in blood lactate, bicarbonate, and hydrogen concentrations.

The present paper reports on the antibiotic resistance of E. coli isolated from Danish piglets and calves in 1987-1988, and compares the results with similar investigations performed during the periods 1971-1972 and 1977-1978. Rectal swabs from 52 piglets and from 78 calves were examined. All the animals studied harboured resistant E. coli. This is a significant increase compared to the previously conducted investigations. The number of strains having three or more resistance markers did not differ significantly from the previous findings. The spectrum of resistance markers among Danish piglets and calves had increased through all three investigations and resistance to chloramphenicol was still found to be considerable 10 years after the withdrawal of chloramphenicol as a therapeutic drug for farm animals in Denmark in 1978. Certain resistance patterns (sulfonamide + streptomycin, sulfonamide + streptomycin + tetracycline, sulfonamide + streptomycin + tetracycline + ampicillin) were found to be shared by numerous strains, suggesting a genetic linkage of the resistance markers.

Present technology is characterized by complexity, rapid change and growing size of technical systems. This has caused increasing concern with the human involvement in system safety. Analyses of the major accidents during recent decades have concluded that human errors on part of operators, designers or managers have played a major role. There are, however, several basic problems in analysis of accidents and identification of human error. This paper addresses the nature of causal explanations and the ambiguity of the rules applied for identification of the events to include in analysis and for termination of the search for 'causes'. In addition, the concept of human error is analysed and its intimate relation with human adaptation and learning is discussed. It is concluded that identification of errors as a separate class of behaviour is becoming increasingly difficult in modern work environments. The influence of this change on the control of safety of large-scale industrial systems is discussed.

The fluorescent probe, fura 2, is widely used to measure agonist-induced changes in intracellular calcium concentration ([Ca2+]i) in cultured cells. However, in many instances, the results obtained in the same cell type have differed from one study to the next. The possibility that such differences might be due to experimental conditions was examined by using fura 2 in four different cell types responding to appropriate agonists when the cells were incubated in either CO2/HCO3-- or HEPES-buffered media. Examined were: 1) the response of rat glomerular mesangial cells to arginine vasopressin, 2) the response of vascular smooth muscle cells to angiotensin II, 3) the response of adrenal glomerulosa cells to angiotensin II, and 4) the response of hypothalamic cells to insulin-like growth factor-1. In each cell type there was a significant difference in the pattern of agonist-induced change in [Ca2+]i when HEPES vs. CO2/HCO3- was used as the buffer system: in HEPES buffer, agonist addition led to a transient rise in [Ca2+]i followed by a fall to a sustained plateau 27 to 34 nM higher than the original basal value, whereas in CO2/HCO3- buffer, agonist addition led to an identical transient increase in [Ca2+]i followed by a fall to a value within 10 nM or less of the preagonist level. The plateau value of [Ca2+]i in the different buffers was examined in relationship to known differences in intracellular pH (pHi). It was found that measurements of [Ca2+]i with fura 2 were influenced by shifts in pHi that occur when cells are incubated in either HEPES-buffered or CO2/HCO3- media of differing pHo values. However, at any given value of pHi, the apparent [Ca2+]i measured in cells incubated in HEPES-buffered media was slightly higher than in cells incubated in CO2/HCO3- buffered media.

The arrhythmogenic effects of flecainide in atrial fibrillation and flutter were assessed in a consecutive material of 100 patients without severe heart failure (NYHA class I or II). Severe arrhythmogenic events occurred in 9% (4-16%) of the patients: within the first 5 days of treatment in seven patients, and in two patients after 60 and 240 days of flecainide treatment. Patients with proarrhythmic events tended to be older and to have a longer QRS duration. Following flecainide therapy conversion to sinus rhythm was achieved in 21 of 43 patients (49%) with atrial fibrillation and in 10 of 29 (34%) with atrial flutter. It is concluded that flecainide, although an effective antiarrhythmic drug, has potential proarrhythmic effects and therefore cautious use of this drug is mandatory.

In vitro reaction of DNA with styrene-7,8-oxide (styrene oxide) produced five adducts, as determined by 32P-postlabeling. When styrene oxide was reacted in vitro with deoxyribonucleotides, five adducts were observed from 2'-deoxyguanosine-3'-monophosphate, two from 2'-deoxyadenosine-3'-monophosphate, none from 2'-deoxythymidine-3-monophosphate or 2'-deoxycytidine-3'-monophosphate. Chromatographic comparison of the adducts formed in DNA with those formed with the deoxyribonucleotides suggests that deoxyguanosine is the primary site of DNA modification. Treatment of 9L cells with 1 mM styrene oxide resulted in the formation of several DNA adducts as detected by the postlabeling procedure. Our results indicate that 32P-postlabeling can be used to investigate DNA adducts formed by styrene oxide.

A report of two cases of recurrent stromal endometriosis, both the patients having positive estrogen receptors in the tumor tissue. They were first treated with tamoxifen, which failed to halt growth of the tumor. After a month's subsequent treatment with progesterone the tumor regressed and the patients' condition improved.