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Pulmonary coccidioidomycosis is caused by inhaling airborne arthroconidia of Coccidioides, a soil-dwelling fungus endemic to the desert southwestern United States. Although uncommon, disseminated coccidioidal infection can be associated with well-defined risk factors, such as cell-mediated immunodeficiency, certain racial heritages (e.g. African or Filipino), male sex, or pregnancy. Before widespread use of computed tomography (CT), the presence or persistence of mediastinal lymphadenopathy was postulated to be a risk factor for disseminated coccidioidal infection. To investigate the use of CT scanning to identify the presence of mediastinal lymphadenopathy in patients with pulmonary coccidioidomycosis, and to correlate such lymphadenopathy with disseminated coccidioidal infection, we performed a retrospective review of patients with pulmonary coccidioidomycosis who were evaluated by chest CT. Two radiologists independently interpreted 150 CT scans from patients with pulmonary coccidioidomycosis. Forty-nine patients met CT criteria for mediastinal lymphadenopathy, whereas 101 patients did not. Disseminated coccidioidal infection was observed in 5 (10%) of the 49 patients with mediastinal lymphadenopathy and in 6 of the 101 (6%; P = .34) without such adenopathy. Among patients with coccidioidomycosis, patients with mediastinal lymphadenopathy, as assessed by CT, had a higher rate of disseminated infection, but the difference was not statistically significant., (© 2012 Blackwell Verlag GmbH.)

Members of the genus Sphingomonas are important catalysts for removal of polycyclic aromatic hydrocarbons (PAHs) in soil, but their activity can be affected by various stress factors. This study examines the physiological and genome-wide transcription response of the phenanthrene-degrading Sphingomonas sp. strain LH128 in biofilms to solute stress (invoked by 450 mM NaCl solution), either as an acute (4-h) or a chronic (3-day) exposure. The degree of membrane fatty acid saturation was increased as a response to chronic stress. Oxygen consumption in the biofilms and phenanthrene mineralization activities of biofilm cells were, however, not significantly affected after imposing either acute or chronic stress. This finding was in agreement with the transcriptomic data, since genes involved in PAH degradation were not differentially expressed in stressed conditions compared to nonstressed conditions. The transcriptomic data suggest that LH128 adapts to NaCl stress by (i) increasing the expression of genes coping with osmolytic and ionic stress such as biosynthesis of compatible solutes and regulation of ion homeostasis, (ii) increasing the expression of genes involved in general stress response, (iii) changing the expression of general and specific regulatory functions, and (iv) decreasing the expression of protein synthesis such as proteins involved in motility. Differences in gene expression between cells under acute and chronic stress suggest that LH128 goes through changes in genome-wide expression to fully adapt to NaCl stress, without significantly changing phenanthrene degrading activity.

Rotation of an elastic medium gives rise to a shift of frequency of its acoustic modes, i.e., the time-period vibrations that exist in it. This frequency shift is investigated by applying perturbation theory in the regime of small ratios of the rotation velocity and the frequency of the acoustic mode. In an expansion of the relative frequency shift in powers of this ratio, upper bounds are derived for the first-order and the second-order terms. The derivation of the theoretical upper bounds of the first-order term is presented for linear vibration modes as well as for stable nonlinear vibrations with periodic time dependence that can be represented by a Fourier series.

The purpose of this article is 2-fold: to emphasize the importance of a reproductive life plan and to define its key elements. We review the 2006 recommendations from the Centers for Disease Control and Prevention (CDC) regarding ways to improve the delivery of preconception health care to women in the United States, with particular focus on encouraging individual reproductive responsibility throughout the life span and on encouraging every woman to develop a reproductive life plan. We propose recommendations for the content of a reproductive life plan and explore ways to incorporate the guidelines from the CDC into clinical practice. By encouraging women to consider their plans for childbearing before they become pregnant, clinicians have the opportunity to influence behavior before pregnancy, which may decrease the incidence of unintended pregnancies and adverse pregnancy outcomes., (© 2011 by the American College of Nurse‐Midwives.)

Here we describe a virus discovery protocol for a range of different virus genera, that can be applied to biopsy-sized tissue samples. Our viral enrichment procedure, validated using canine and human liver samples, significantly improves viral read copy number and increases the length of viral contigs that can be generated by de novo assembly. This in turn enables the Illumina next generation sequencing (NGS) platform to be used as an effective tool for viral discovery from tissue samples., (© 2011 Daly et al.)

Lymphangioleiomyomatosis (LAM) is a rare disease of unknown cause that traditionally affects young women of reproductive age. It is characterized by a proliferation of atypical smooth muscle cells, preferentially along the bronchovascular structures, that causes progressive respiratory failure. LAM is almost universally fatal without a lung transplant, although new clinical trials are ongoing. Because of its rareness and nonspecific presenting symptoms, patients often receive a missed or delayed diagnosis. We present the case of a 51-year-old postmenopausal woman who had hemoptysis ultimately determined to be due to LAM. As is common for patients with LAM, the initial chest radiograph was unremarkable, whereas subsequent computed tomography (CT) demonstrated the distinctive pulmonary parenchymal cysts. Biopsy of an HMB-45-positive, para-aortic lymphangiomyoma provided further confirmation of the diagnosis. LAM may be more common than previously recognized, and it is imperative for primary care providers to be able to recognize this disease so they can make prompt referrals to appropriate specialty centers.

In medicine, the challenges faced by female faculty members who are attempting to achieve academic advancement have been well described. Various strategies have been proposed to increase academic productivity to aid the promotion of women in medicine. We propose an innovative collaboration strategy that encourages completion of an academic writing project. This strategy acknowledges the challenges inherent in achieving work-life balance and utilizes a collaborative work style with a group of peer physicians. The model is designed to encourage the completion and collation of independently prepared sections of an academic paper within a setting that emphasizes social networking and collaboration. This approach has many similarities to the construction of a quilt during a "quilting bee."

Background: Coccidioidomycosis is a fungal infection acquired via inhalation of airborne fungal arthrospores of Coccidioides species in regions of endemicity in the deserts of the southwestern United States and northern Mexico. In recent years, the incidence of coccidioidomycosis has increased in areas of endemicity, and previous studies have found the highest incidence of coccidioidal infection in Arizona among persons in older age groups., Methods: We conducted a retrospective review of data for all patients with coccidioidomycosis who were treated at our institution that compared clinical manifestations of coccidioidomycosis in patients aged >or=60 years with those in patients aged <60 years., Results: We compared 210 patients aged >or=60 years with 186 patients aged <60 years. No significant differences were observed with regard to manifestations of coccidioidomycosis, even after adjustment for comorbid conditions, excluding immunosuppression. Regardless of age, when coccidioidal illnesses in immunosuppressed patients were compared with those in nonimmunosuppressed patients, immunosuppressed patients were significantly more likely to have extrapulmonary dissemination of infection, to require hospitalization, and to have progressive infection or to die of coccidioidomycosis. Univariate logistic regression identified immunosuppression as the only marker that increased risk of extrapulmonary dissemination of infection (odds ratio, 2.13;P=.05), hospitalization (odds ratio, 2.68; P<.001), and death (odds ratio, 8.39; P<.001). Multivariate analysis revealed that neither age nor an interaction of age and immunosuppression had a significant impact on coccidioidal manifestations., Conclusions: Coccidioidomycosis is a serious illness in all patients, but its different manifestations in older-aged persons, compared with those in younger-aged persons, may be related to immunosuppression rather than age alone.

A theoretical description is given for the propagation of surface acoustic wave pulses in anisotropic elastic media subject to the influence of nonlinearity. On the basis of nonlinear elasticity theory, an evolution equation is presented for the surface slope or the longitudinal surface velocity associated with an acoustic pulse. It contains a non-local nonlinearity, characterized by a kernel that strongly varies from one propagation geometry to another due to the anisotropy of the substrate. It governs pulse shape evolution in homogeneous halfspaces and the shapes of solitary surface pulses that exist in coated substrates. The theory describing nonlinear Rayleigh-type surface acoustic waves is extended in a straightforward way to surface waves that are localized at a one-dimensional acoustic waveguide like elastic wedges.

Background: In the United States, female physicians working in academic medical practices are less likely to achieve the academic rank of associate professor or professor than are male physicians of comparable seniority. Lack of mentoring has been suggested as a possible contributor to this difference., Methods: In this paper, we describe a facilitated peer mentorship pilot program that was developed to meet the unique needs of women faculty. Experienced female physicians acted as facilitators to a group of junior women who served as their own peer mentors. Outcome measures for the program included comparison of a pretest and a posttest completed by the peer mentor participants, a skills acquisition survey, published papers, and academic advancement of participants., Results: All the peer participants realized increased academic activity in the form of published papers and promotion in academic rank, skills acquisition, and enthusiasm for continuance of the program., Conclusions: This new model of facilitated peer mentorship demonstrated success in a small-scale pilot program. Expansion of this program and other creative solutions to the lack of mentoring for women may result in greater numbers of women achieving academic advancement.

The sodium salt of the Hhpp ligand, Hhpp = 1,3,4,6,7,8-hexahydro-2H-pyrimido[1,2-a]pyrimidine, a 6,6 bicyclic, guanidine system, reacts with (THT)AuCl (THT = tetrahydrothiophene) in THF or CH2Cl2 to form the Au(II) complex, [Au2(hpp)2Cl2]. The Au(II) complex forms either by oxidation with solvents such as CH2Cl2 or disproportionation of Au(I) with concomitant Au(0) formation. The reaction in ethanol gives the colorless tetranuclear Au(I) complex, [Au4(hpp)4]. The tbo ligand, Htbo = 1,4,6-triazabicyclo[3.3.0]oct-4-ene a bicyclic 5,5 guanidine system, behaved differently from the hpp ligand, and only the colorless tetranuclear gold complex, [Au4(tbo)4], formed in THF, CH2Cl2, or ethanol. The X-ray structure of the oxidized species, [Au2(hpp)2Cl2], shows a Au(II)-Au(II) distance of 2.4752(9) A, the shortest gold-gold bond reported prior to the characterization here of the [(PhCOO)6Au4(hpp)2Ag2], Au(II)-Au(II) = 2.4473(19) A. A preliminary description of the formation of this material, obtained by reacting [Au2(hpp)2Cl2] with Ag(OOCPh), is included in this paper. The four Au(I) atoms in the tetranuclear complexes are arranged in a parallelogram with Au-Au distances ranging from 2.8975(5)-2.9392(6) A in [Au4(hpp)4] and 3.1139(12)-3.2220(13) A in [Au4(tbo)4]. density functional theory (DFT) and MP2 calculations on [Au2(hpp)2Cl2] find that the highest occupied molecular orbital (HOMO) is predominately hpp and chlorine-based with some Au-Au delta* character. The lowest unoccupied molecular orbital (LUMO) has metal-to-ligand (M-L) and metal-to-metal (M-M) sigma* character (approximately 50% hpp/chlorine, and 50% gold). DFT calculations on [Au4(hpp)4] show that the HOMO and HOMO-1 are each a mixture of metal-metal antibonding character and metal-ligand antibonding character and that the LUMO is predominately metal based s character (85% Au and 15% hpp).

End-of-life care (ELC) on a paediatric intensive care unit (PICU) is a fundamental aspect of clinical practice and yet often remains a highly emotive and challenging issue. Every year, many children die in PICU often following the withdrawal of life-sustaining treatment, and as health professionals we have a duty to provide ELC that meets the needs of the dying child and their family. To achieve this, there is a growing emphasis on incorporating parental views on withdrawal of intensive care especially in time and place. Home care of the dying child enables the child to die at home in familiar surroundings and with the people who love them the most. This service is essentially child centred and acknowledges the unique and pivotal position that parents have in their child's life by empowering them to have control over the time and place of death. This is a vitally important aspect of end-of-life in PICU and underpins the ethos of this area of practice. We present a series of case reviews of patients cared for within a 12-month period, where intensive care was withdrawn distant from the PICU environment and address the challenges and considerations surrounding this area of practice.

Solitary acoustic pulses can propagate along the surface of a coated homogeneous and inhomogeneous medium. It is shown how these nonlinear surface acoustic waves evolve out of initial pulselike conditions generated by pulsed laser excitation and how they can be monitored by optical detection. The solitary pulse shapes at the surface are computed on the basis of an evolution equation with nonlocal nonlinearity. They depend on the anisotropy of the substrate. Various approaches for the derivation of the evolution equation from nonlinear elasticity theory are critically compared. The behavior of the solitary pulses in collisions is investigated and is found to strongly depend on the linear dispersion law. The nontrivial depth dependence of these solitary pulses is also analyzed.

The problem of the existence of evelope solitons in elastic plates and at solid surfaces covered by an elastic film is revisited with special attention paid to nonlinear long-wave short-wave interactions. Using asymptotic expansions and multiple scales, conditions for the existence of envelope solitons are established and it is shown how their parameters can be expressed in terms of the elastic moduli and mass densities of the materials involved. In addition to homogeneous plates, weak periodic modulation of the plate's material parameters are also considered. In the case of wave propagation in an elastic plate, modulations of weakly nonlinear carrier waves are governed by a coupled system of partial differential equations consisting of evolution equations for the complex amplitude of the carrier wave (the nonlinear Schrödinger equation for envelope solitons and the Mills-Trullinger equations for gap solitons), and the wave equation for long-wavelength acoustic plate modes. In contrast to this situation, envelope solitons of surface acoustic waves in a layered structure are normally described by the nonlinear Schrödinger equation alone. However, at higher orders of the carrier wave amplitude, the envelope soliton is found to be accompanied by a quasistatic long-wavelength strain field, which may be localized at the surface with penetration depth into the substrate of the order of the inverse amplitude or which may radiate energy into the bulk. A new set of modulation equations is derived for the resonant case of the carrier wave's group velocity being equal to the phase velocity of long-wavelength Rayleigh waves of the uncoated substrate.

The propagation of Rayleigh waves is investigated in a solid substrate of linear material covered by a film consisting of a material with large nonlinear elastic moduli. For this system, a nonlinear evolution equation is derived that may be regarded as a special case in a wider class of evolution equations with a specific type of nonlocal nonlinearity. Periodic pulse train solutions are computed. For a certain member of the class of nonlinear evolution equations, several families of solitary wave solutions and their associated periodic stationary wave solutions are derived analytically.

Objectives: Amylin is a novel 37 amino acid that is secreted together with insulin from the pancreas in response to enteral nutrient intake. As a potent inhibitor of gastric motility it plays an important role in the control of carbohydrate absorption. In this study we aimed to determine the relationship between amylin levels and gastric emptying in critically ill children., Design: Prospective interventional study., Setting: Tertiary paediatric intensive care unit., Patients: Twenty-three patients were studied following admission to a paediatric intensive care unit. The median age (25th-75th centiles) was 5.8 years (1.5-11.6) and weight 20 kg (12.8-47.5)., Interventions: Patients were defined as feed-intolerant on the basis of gastric residual volume greater than 125% 4 h after a feed challenge. Three objective measures of gastric emptying were then calculated from a 6 h paracetamol absorption test. Blood glucose, serum insulin and amylin levels were averaged across the paracetamol absorption test period., Measurements and Results: Eight patients were classified as feed-intolerant (nTOL) and 15 as feed-tolerant (TOL) [median gastric residual volumes 321% (261-495) and 4% (0-6), respectively]. Gastric emptying was delayed in the feed-intolerant group as assessed by all paracetamol absorption test parameters ( p< or =0.01). The median serum amylin concentration was significantly higher in the feed-intolerant group [nTOL 47.0 (37.7-54.8) versus TOL 22.7 (13.6-26.7) pmol/l, p<0.0001]. A positive correlation between serum amylin and insulin was observed ( r=0.46, p=0.02) but not between amylin and glucose ( r=0.25, p=0.23)., Conclusions: The use of gastric residual volumes to define feed intolerance is justified in critically ill children. High serum amylin levels are associated with delayed gastric emptying in these patients. The correlation between serum amylin and insulin levels indicates a degree of preservation of pancreatic hormonal co-release.

The formation of solitary elastic surface pulses from laser-generated pulselike initial conditions is reported. The nonlinearity of the medium is compensated by both normal dispersion and anomalous dispersion, which were realized by coating isotropic fused silica by a metal and titanium nitride film, respectively. As an anisotropic material, silicon covered with an oxide layer was studied. The experimental results agree with numerical simulations carried out with a nonlocal evolution equation, which describes nonlinear propagation of surface acoustic waves in a dispersive medium.

A numerical linear stability analysis has been carried out for stationary spatially localized solutions of several systems of coupled nonlinear partial differential equations (PDE's) with two and more complex variables. These coupled PDE's have recently been discussed in the literature, mostly in the context of physical systems with a frequency gap in the dispersion relation of their linear excitations, and they are extensions of the Mills-Trullinger gap soliton model. Translational and oscillatory instabilities are identified, and their associated growth rates are computed as functions of certain parameters characterizing the solitary waves.

A 48 yr old HIV seropositive female presented with a right breast mass and bilateral axillary lymphadenopathy. Fine needle biopsy (FNB) revealed an adenocarcinoma with abundant mucin production and features suggestive of a cribriform and micropapillary ductal carcinoma in situ (DCIS). Histopathological examination of the tumor confirmed an invasive mixed colloid carcinoma with extensive DCIS. There have been 4 previous reports in the literature of breast carcinoma associated with HIV seropositivity. This case initially diagnosed by FNB is the first case reported in Australia. In spite of the somewhat more favourable histological type of breast carcinoma, this tumor shows numerous unfavourable prognostic factors and has had an aggressive clinical course with relapse of disease in the contralateral breast and distant metastases within 4 wks of surgery, probably related to the patient's immunodeficiency.

A 37-year-old man presented to the emergency department after an attempt to self-treat his priapism with saltpeter (K+NO3). Initially he had a potassium of 7.6 with electrocardiographic changes and a markedly elevated CO2. The potassium and carbon dioxide normalized in less than 24 hours with standard treatment for hyperkalemia. Hyperkalemia is expected with large oral potassium ingestion; and the elevated CO2 was spurious, caused by the misreading of serum nitrates by the Ektachrom 700 system. Ingestion of K+NO3 should be added to the differential of hyperkalemia with a markedly elevated CO2.