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We present a new method for determining the absolute harmonic content of an X-ray beam. The technique is applied to determine the harmonic content of a synchrotron beam to high-accuracy by measuring the X-ray attenuation of a large number of aluminium foils with thicknesses varying over several orders of magnitude. Earlier methods always determined relative quantities such as the effective harmonic content, which are dependant on experimental geometry and not transferable between detectors. We use a more fundamental and useful parameter: the harmonic-photon percentage. Copyright © 2009 John Wiley & Sons, Ltd.

The high incidence of coronary artery disease in patients with peripheral and cerebrovascular occlusive disease has been well established. While preoperative cardiac evaluation has been shown to be beneficial in patients undergoing elective aortic reconstruction, the role of preoperative cardiac testing in patients undergoing elective carotid endarterectomy has not been defined. In this study, the charts of 289 consecutive patients undergoing elective carotid endarterectomy between January 1, 1995, and December 31, 1995, were evaluated to determine the need for cardiac “clearance” prior to surgery. Ages ranged from 48 to 98, with a mean of 70.4 years. The male-to-female ratio was 165:124. Risk factors for coronary artery disease were also assessed: 203 patients (70%) were hypertensive, and 162 patients (56%) gave a history of smoking. An abnormalappearing preoperative EKG was identified in 139 patients (48%). Sixty-seven patients (23%) presented with a history of angina pectoris, and 80 patients (28%) had sustained a myocardial infarction in the past. No patient presented with unstable angina or angina at rest. No patient underwent coronary artery bypass grafting or coronary artery angioplasty immediately prior to carotid endarterectomy. Of the 289 endarterectomies 154 (53%) were performed under regional anesthesia. All patients were monitored with intraoperative arterial pressure catheters. There were no postoperative deaths. No patient sustained a documented postoperative myocardial infarction. One patient experienced chest pain for 24 hours postoperatively. This patient had a history of angina pectoris and a previous myocardial infarction. One patient had an episode of shortness of breath postoperatively. There were two postoperative strokes. These data suggest that patients with known or suspected coronary artery disease can safely undergo elective carotid endarterectomy without extensive cardiac testing prior to surgery.

This paper reports follow-up data on 50 male subfertility clinic attenders and compares outcome in those whose partners subsequently became pregnant and those who remained subfertile. At 18 months 30% of participants reported pregnancies. Data were collected on mood, life satisfaction and self-blame. Over time there were no significant within subject changes on any measures in either the subsequently pregnant or continuing subfertile group. At initial clinic attendance there was no significant difference between those whose partner subsequently became pregnant and those whose partner did not. At 18-month follow-up there was a significantly greater change in life satisfaction scores (in a positive direction) in the pregnant group as compared with continuing subfertile group.

Objective. To determine what patients considered important to gain from consultation, the extent to which these expectations were fulfilled and the relationship of this to patient satisfaction and distress. Congruence between patient and doctor expectations was also examined. Design. This was a questionnaire study using a repeated measures (pre- and post-consultation) design. Methods. Expectations of clinic attendance were assessed in 29 male clinic attenders. Participants completed questionnaires before and after consultation. Visual analogue scales were used to assess patient expectations of the consultation and the extent to which expectations were fulfilled. Results. Men rated increasing the chance of their partner conceiving as most important, with gaining information also rated highly. Informational expectations were rated more highly than discussing feelings. Following consultation, patients felt they had gained understanding and their expectations of having help with decision making were fulfilled. They rated their satisfaction with the consultation as high and distress during consultation low. Despite the fact that increasing chances of pregnancy was an important expectation, failure to fulfil this expectation did not relate to satisfaction. There was no significant correlation between doctor and patient ratings of distress. Conclusion. It appears that the medical consultation has a role beyond simply finding ways to increase the chance of pregnancy. For these men the benefits of increasing understanding seemed to outweigh the disappointment of not having pregnancy expectations increased as much as they had hoped for. Patients did not appear to be seeking emotional support from the consultation.

To indicate a prohibited activity, pictorials are frequently overlaid with a red circle and 45° left-to-right slash. Previous research suggests that the combination of the slash and symbol may affect the overall identifiability of the warning. The purpose of the present research was to determine whether people's judgments of four types of the circle-slash (a slash over the symbol, a slash under the symbol, a partial slash, and a translucent slash) would differ in perceived effectiveness. Sixteen pictorials with semantically different message content (e.g., NO TRUCKS, DO NOT CLIMB TOWER), in both left-facing and right-facing orientations were viewed by 60 participants. The results revealed that the over and under slashes were preferred to the translucent or partial slashes. Both orientation and slash type influenced preference for a subset of nonsymmetrical symbols. Some of the pictorials with the over slash were given lower evaluations when critical features were concealed. The general preference for the over and under slashes may be due to familiarity and its concordance with Gestalt principles of good figures. Implications for the development of prohibitive pictorials are discussed. Relevance to industry Pictorials are increasingly being used to communicate safety information in cases where the target audience may use different languages. The present research examines different versions of the circle-slash negation symbol for the purpose of determining when critical pictorial elements may be obscured. Implications for pictorial recognition are discussed.

Background: We have evaluated the efficacy of using three-dimensional reconstruction of amplitude Doppler imaging data to quantitatively assess carotid artery bifurcation stenoses. Methods: Sixty-four consecutive frames of amplitude (power) Doppler images are stored to be reassembled into a three-dimensional image representing the patent lumen. These images can then be rotated by any angle necessary to clearly view the vascular anatomy and to make quantitative ultrasound caliper measurements of the stenotic lumen and normal vessel caliber. Results: Three-dimensional Doppler images accurately classified 53 of 61 vessels (87%) into categories of stenosis compared with angiography. All stenoses with >60% diameter reduction were detected and classified as such, for a sensitivity of 100%. Conclusions: Three-dimensional vascular imaging based on amplitude (power) Doppler data provides an accurate noninvasive technique for quantitative diagnosis of carotid bifurcation atherosclerotic disease, with selectable viewing projections that eliminate vessel overlap and other artifacts, and complements the hemodynamic data already available with two-dimensional duplex ultrasound.183

Warning signs are intended to alert persons to potential dangers in the environment. Despite its importance, empirical studies measuring behavioral compliance with warnings are limited due to methodological difficulties and ethical considerations in conducting the research. The present study used a computer simulated world as a new method for studying behavioral compliance. Such simulations can be constructed to appear realistic, thus maintaining ecological validity, while allowing control over experimental conditions. Three factors (time stress, salience, and sign type) were manipulated to determine their effects on a simulated egress task from an underground mine. Gender was also introduced as an additional independent variable. Results indicated signs with salient features increased compliance compared to signs without those features. Time stress and sign type failed to show significant effects. In general, women complied more frequently than men. Use of computer simulated worlds in warning compliance research is discussed.

Gait analyses of rehabilitated individuals with anterior cruciate ligament (ACL) deficiency and reconstruction have identified the final adaptations of increased hip extensor torque and hamstring electromyography (EMG) and decreased knee extensor torque and quadriceps EMG during stance. The initial adaptations to injury and surgery are, however, unknown as are the factors that influence the development of the adaptations. Identification of the initial response to injury would provide a basis for determining whether the final adaptations are learned automatically or if they are the result of a lengthy training period in which various factors may affect their development. The purpose of the study was to evaluate the initial effects of ACL injury and reconstruction surgery on joint kinematics, kinetics, and energetics, during walking. Injured limbs from nine subjects with ACL injury were tested 2 wk after injury, and 3 and 5 wk after surgery. Ten healthy subjects were tested. Kinematic and ground reaction data were collected and combined with inverse dynamics to calculate the joint torques and powers. A knee extensor torque throughout most of stance was observed in the injured limbs at all test sessions. This result was in conflict with previous observations of reduced extensor torque or a flexor torque in rehabilitated patients with ACL reconstruction and patients with ACL deficiency. This result also differed from the typical midstance extensor then flexor torque in healthy control subjects. Trend analysis showed a significant (P < 0.001) change in average position at the hip and knee, extensor angular impulse at the hip, and positive work done at the hip 3 wk after surgery followed by a partial rehabilitation at 5 wk after surgery. Power and work produced at the knee were reduced fivefold (P < 0.001) after 5 wk of rehabilitation and did not recover to pre-surgical levels. The existence of a long-lasting knee extensor torque 2 wk after injury indicated that the adaptation process to ACL deficiency is lengthy, requiring many gait cycles, and that numerous factors could be involved in learning the adaptations.

The timing and magnitude of arterial dilation in response to increased flow velocities and the effect on wall shear stress were evaluated in a chronic nonatherogenic animal model. A 7 mm femoral arteriovenous fistula was constructed in one groin in 10 mongrel dogs, the other groin serving as a control. Duplex ultrasound was used at regular intervals to make bilateral measurements of systolic and diastolic luminal diameters, peak systolic velocity, and volume flows to allow estimation of wall shear stress and any vasodilation; measured systemic pulse pressure was used to calculate compliance. Data were acquired at baseline; immediately postoperatively; at one and two weeks, and at one, three, five, and seven months. There were no significant changes from baseline in control vessels at any time interval in blood flow (135 ±56 mL/min), lumen diameter (4.4 ±0.4 mm), wall shear stress (8.8 ±4.3 dynes/cm2), or compliance (0.14 ±0.04 %/mmHg). In the experimental vessels, baseline values were not significantly different from those seen on the control side. Immediate postoperative fistula flow was 1590 ±295 mL/minute, and these flow values were maintained throughout the study. Immediately postoperatively the luminal diameter increased to 5.6 ±0.5 mm with a calculated shear stress of 49.8 ±14.1 dynes/cm2(P < 0.001 compared with baseline). This increase in luminal diameter and the resulting shear stress remained essentially constant throughout the study, with values of 5.8 ±0.3 mm and 47.0 ± 11.5 dynes/cm2, respectively, at seven months. No significant changes in compliance were seen during the study. The authors conclude that increased blood flow alone causes early moderate arterial dilation but will not produce a complete normalization of wall shear stress. For that to occur, additional mechanisms may be involved relating increased shear stress and dysfunctional vascular endothelium, such as occurs in hypercholesterolemia.

Knee osteoarthritis (OA) contributes significantly to disability in older individuals, and racial/ethnic minorities are disproportionately affected. The present study aimed to characterize differences in clinical and experimental pain, including pain inhibition, among older African American (AA) and non-Hispanic white (NHW) subjects with knee OA.AA and NHW subjects with knee OA (n = 267) completed clinical and functional pain assessments, including quantitative sensory testing (QST). We hypothesized that, when compared to NHW subjects, AA subjects would display 1) lower pain tolerance and higher ratings of heat-, mechanical-, and cold-induced pain, 2) greater temporal summation of pain, 3) reduced pain inhibition, and 4) greater clinical pain and poorer function. In addition, we hypothesized that the findings from QST would significantly predict the severity of clinical pain within each race/ethnicity.AA subjects with knee OA displayed increased pain sensitivity, greater temporal summation, and reduced pain inhibition when compared to NHW subjects with knee OA. Moreover, AA subjects reported greater clinical pain and poorer function. Racial/ethnic differences in clinical pain became nonsignificant when the analyses were controlled for education and annual income, whereas differences in QST findings remained highly significant. Although the extent of pain inhibition predicted the severity of clinical pain in both groups, different QST measures were additionally predictive of clinical pain within each group.The results of this study establish that there are racial/ethnic differences in experimental and clinical pain and function in older individuals with knee OA. Our findings indicating that different QST measures were associated with clinical pain within the 2 racial/ethnic groups, whereas reduced pain inhibition was important in all participants, warrant further study in order to elucidate the common and group-specific pathophysiologic mechanisms contributing to clinical pain in OA.

This study tested the effects of aging and race on responses to noxious stimuli using a wide range of stimulus modalities. The participants were 53 non-Hispanic blacks and 138 non-Hispanic white adults, ages 45 to 76 years. The participants completed a single 3-hour sensory testing session where responses to thermal, mechanical, and cold stimuli were assessed. The results suggest that there are selected age differences, with the older group less sensitive to warm and painful heat stimuli than middle-aged participants, particularly at the knee. This site effect supports the hypothesis that the greatest decrement in pain sensitivity associated with aging occurs in the lower extremities. In addition, there were several instances where age and race effects were compounded, resulting in greater race differences in pain sensitivity among the older participants. Overall, the data suggest that previously reported race differences in pain sensitivity emerged in our older samples, and this study contributes new findings in that these differences may increase with age in non-Hispanic blacks for temporal summation and both heat and cold immersion tolerance. We have added to the aging and pain literature by reporting several small to moderate differences in responses to heat stimuli between middle- and older-age adults. Perspective This study found that the greatest decline in pain sensitivity with aging occurs in the lower extremities. In addition, race differences in pain sensitivity observed in younger adults were also found in our older sample.

Heart failure affects more than five million Americans. It is a health and financial burden on the US health care system. The 5-year mortality of heart failure with diabetes is about 50%. This article discusses the treatment of heart failure in the patient with diabetes, including developing effective communication skills between physicians and nurses, developing an effective plan for transitioning the patient between care settings, documenting patient visits consistently and clearly, and performing medication reconciliation at each visit. This article also discusses the need for monitoring readmission for heart failure, length of stay, discharge on beta-blocker, and vaccination rate.

Purpose: We have evaluated the progression of isolated superficial venous thrombosis to deep vein thrombosis in patients with no initial deep venous involvement. Methods: Patients with thrombosis isolated to the superficial veins with no evidence of deep venous involvement by duplex ultrasound examination were evaluated by follow-up duplex ultrasonography to determine the incidence of disease progression into the deep veins of the lower extremities. Initial and follow-up duplex scans evaluated the femoropopliteal and deep calf veins in their entirety; follow-up studies were done at an average of 6.3 days, ranging from 2 to 10 days. Results: From January 1992 to January 1996, 263 patients were identified with isolated superficial venous thrombosis. Thirty (11%) patients had documented progression to deep venous involvement. The most common site of deep vein involvement was progression of disease from the greater saphenous vein in the thigh into the common femoral vein (21 patients, 70%), with 18 of these extensions noted to be nonocclusive and 12 having a free-floating component. Three patients had extended above-knee saphenous vein thrombi through thigh perforators to occlude the femoral vein in the thigh, three patients had extended below-knee saphenous disease into the popliteal vein, and three patients had extended below-knee thrombi into the tibioperoneal veins with calf perforators. At the time of the follow-up examination all 30 patients were being treated without anticoagulation. Conclusions: Proximal saphenous vein thrombosis should be treated with anticoagulation or at least followed by serial duplex ultrasound evaluation so that definitive therapy may be initiated, if progression is noted. More distal superficial venous thrombosis should be carefully followed clinically and repeat duplex ultrasound scans performed, if progression is noted or patient symptoms worsen. (J Vasc Surg 1996;24:745-9.)

Purpose: To determine the effectiveness of propofol as adjunctive therapy in the treatment of drug-resistant discomfort in a terminally ill pediatric patient. Patient and Methods: A 3-year-old child with advanced rhabdomyosarcoma and severe drug-resistant discomfort was studied. Propofol was administered as adjunctive therapy to provide relief from severe discomfort. Results: Propofol was initiated with a loading dose of 1.2 mg/kg followed by a continuous intravenous infusion of 1.2 mg/kg/h. Over the next 10 days, additional loading doses were administered and the infusion rate was increased to a maximum of 32 mg/kg/h. After the addition of propofol, our patient's discomfort improved greatly without the occurrence of propofol-associated adverse events. Conclusions: Propofol appears to be an effective adjunct to opioids and a promising alternative to barbiturate therapy in the treatment of drug-resistant discomfort in terminally ill pediatric patients.

Purpose: We have prospectively evaluated the need for serial venous duplex ultrasound examinations in an inpatient population with an initially normal study result. Methods: Patients were selected for study on the basis of clinical suspicion of pulmonary embolism and possible lower extremity deep vein thrombosis, a comorbid condition contributing to a nondiagnostic ventilation/perfusion lung scan, and an initially normal bilateral venous duplex ultrasound examination that included complete evaluation of the femoropopliteal system and the deep calf veins. Repeat duplex examinations were done during the same hospital admission between 5 and 14 days after the initial study. Results: Ninety-four patients with an initially normal duplex ultrasound examination result had repeat studies done at an average of 7.9 ± 2.6 days. Ninety-two examination results remained normal bilaterally. Two patients had isolated intramuscular calf vein deep vein thrombosis: one in the gastrocnemius system of both calves with associated calf tenderness at 11-day follow-up and one in a mid-calf soleal vein without associated symptoms at 10 days. No patients had any evidence of deep vein thrombosis in the femoropopliteal or tibioperoneal venous systems. Conclusions: Serial follow-up duplex ultrasound evaluation is unnecessary after an initially complete, normal study in patients with symptoms who have suspected pulmonary embolism and nondiagnostic ventilation-perfusion lung scans. (J Vasc Surg 1996;24:732-7.)

This study investigated the contribution of unstable self-esteem as a predictor of cardiovascular reactivity (CVR) during a challenging and ego-threatening task. A sample of male and female adults monitored self-esteem perceptions multiple times daily to provide self-esteem stability scores. Participants also engaged in a competitive task that involved the rapid mental calculation of complex addition/ subtraction problems. The task was made more stressful through a manipulation in which participants were made aware that their performance was being monitored and evaluated. Self-esteem stability scores and cynicism scores were used as predictors of systolic and diastolic blood pressure increases and heart rate increases. Results obtained through multiple regression analyses revealed that for men, but not for women, self-esteem instability, relative to cynicism, was a better predictor of increases in systolic blood pressure and heart rate. Neither of these predictors accounted for reactivity in our sample of women, despite the fact that women displayed near equivalent levels of reactivity and equivalent degrees of self-esteem instability. Results suggest that, for men, self-esteem instability may play an important role in the prediction of cardiovascular reactivity to threat that is more dramatic than the contribution of cynicism. Results are also discussed relative to the observed gender differences.

A circle with a 45-degree slash overlayed on a pictorial has been increasingly used to depict a negation. However, in some cases this overlay could obscure critical parts of the symbol making the depiction difficult to recognise. The present study investigated whether participants would judge the acceptability of various kinds of circle-slash negation differently. Sixteen pictorials in both left-facing and right-facing orientations were combined with four versions of the red circle and slash: a conventional slash over the symbol, a slash under the symbol, a translucent slash, and a partial slash. Sixty participants rank ordered the combinations. The results generally indicated that the over and under versions were preferred to the translucent or partial slashes, an effect probably attributable to familiarity and Gestalt principles of good figures. Some symbols were differentially affected by orientation and slash type. The over slash versions were given lower evaluations when critical features were obscured. The results have implications for the development of symbols with the circle-slash negation for improved identifiability.

Background. Because of the rapid growth in requests for lower extremity venous duplex ultrasonographic examinations, we have evaluated test results to determine the appropriate indications for testing and whether there is overuse of this technique. Methods. We reviewed the records of all patients who had duplex ultrasonogram during an 18-month period to rule out deep vein thrombosis (DVT). Test outcome was evaluated with data on the age, gender, outpatient or inpatient status, duration of symptoms, physical findings, and risk factors of the patients. Results. We reviewed 3474 examinations; 1265 outpatients and 1231 inpatients were evaluated to rule out DVT, and 978 patients were evaluated to rule out a source of pulmonary embolism. More outpatients were female, and they tended to be younger; outpatients also had more acute femoropopliteal DVT. The presence of sudden onset of unilateral swelling was a strong predictor of acute DVT in all three groups: 52% of such patients were found to have DVT. Mild unilateral symptoms with a coexistent risk factor was associated with a 10% to 20% prevalence of acute DVT. Chronic unilateral swelling was associated with acute DVT only with a coexistent risk factor and only in 1% of such patients. Bilateral swelling was only associated with acute DVT in the inpatient population, with 17% of studies having positive results. If calf tenderness was the only symptom with no associated risk factors, seven (1.6%) of 415 patients had acute DVT and six of these were tibioperoneal. No patients with cellulitis or isolated joint pain had acute DVT. With clinically suspected pulmonary embolism in patients without associated symptoms or risk factors, 7 (1.5%) of 447 studies showed tibioperoneal disease with no acute femoropopliteal disease. Conclusions. The physical examination and clinical history of the patient remain important indicators of the presence (or absence) of lower extremity DVT and can guide the appropriate use of duplex ultrasonography for the diagnosis.

Individuals with anterior cruciate ligament (ACL) injury use greater extensor torques at the hip and ankle and lower extensor torques and joint power at the knee during gait compared to healthy subjects. These adaptations may be mediated by (1) altered neuromuscular strategies due to the injury, (2) training effects produced by rehabilitation protocols, and (3) training effects due to the functional knee brace (FKB) used during rehabilitation. The purpose of the study was to test the hypothesis that a FKB can cause individuals to walk and run with the torque and power patterns observed in rehabilitated ACL-injured individuals. Ten healthy subjects were tested walking and running with and without a FKB. Kinematic and ground reaction data were collected and combined with inverse dynamics to estimate the joint torques and powers. Data were analyzed with a two-way repeated measures ANOVA (gait vs knee condition). In walking, the hip and ankle extensor torques were 14.3% (p < 0.038) and 5.1% (p < 0.003) greater with FKB. In running, the hip extensor torque was 17.0% greater with FKB (p < 0.023). Knee torque was not different between conditions. In walking, the work performed at the hip and knee were 11.6% greater (p < 0.013) and 17.7% lower with FKB (p < 0.025), respectively. Results supported the hypothesis and it was concluded that a FKB may be one causative factor in the development of the unique joint torque and power patterns seen in ACL-injured gait.

Determination of the structural characteristics of angiogenesis requires a procedure protective of the forming vascular fibers and the endothelial cell monolayer exhibiting cord formation. This report describes in situ fixation of angiogenic cultures in 96-well plates and the subsequent double embedding processing for electron microscopy. Cross sections of the monolayer are obtained without damage of the incipient capillaries.

A high-resolution x-ray spectrometer utilizing a thin quartz transmission crystal and covering the 6 keV-18 keV energy range has been developed and tested. The spectrometer consists of a cylindrically bent crystal in a vacuum housing. The crystal position and the range of Bragg angles that are incident on the crystal can be adjusted to record an ≈4 keV wide spectrum in the 6 keV-18 keV range. The spectrometer is of the Cauchois type and has a compact linear geometry that is convenient for deployment at laser-produced plasma, EBIT, and other x-ray sources. Test spectra of the W L and Mo K lines from laboratory sources have linewidths as small as 11 eV, approaching the natural widths, and instrumental resolving power as high as 1800. Techniques for enhancing the energy resolution are experimentally demonstrated.

The present study assessed the comprehensibility and quality of warning pictorials in the presence and absence of explicit context. Context was provided by a photograph and a verbal description of an environmental scene in which the pictorial might appear. A total of 248 individuals performed a comprehension test on a randomly-assigned pictorial from each of three referent categories (Keep Out, Electrical Shock, and Do Not Dig). Following this task, 185 participants were shown five pictorials (four others plus the one they had seen) associated with each of the three referent categories and then rated and ranked them on their quality to convey the referent message effectively. Results indicated that the context manipulation enhanced comprehension for pictorials two out of three referent categories. Confidence intervals indicated that comprehension levels of all the Electrical Shock symbols would fall within the ranges specified by ISO's 67% and ANSI's 85% comprehension criteria. Three of the Do Not Dig pictorials and none of the Keep Out pictorials fell within the acceptable ISO and ANSI comprehension criteria. Statistically significant average point biserial correlations were obtained between the comprehension and quality scores for each referent category. Implications for warning pictorial test and design are discussed.

The ability to detect wires is an important capability of the cabinet x-ray imaging systems that are used in aviation security as well as the portable x-ray systems that are used by domestic law enforcement and military bomb squads. A number of national and international standards describe methods for testing this capability using the so called useful penetration test metric, where wires are imaged behind different thicknesses of blocking material. Presently, these tests are scored based on human judgments of wire visibility, which are inherently subjective. We propose a new method in which the useful penetration capabilities of an x-ray system are objectively evaluated by an image processing algorithm operating on digital images of a standard test object. The algorithm advantageously applies the Radon transform for curve parameter detection that reduces the problem of wire detection from two dimensions to one. The sensitivity of the wire detection method is adjustable and we demonstrate how the threshold parameter can be set to give agreement with human-judged results. The method was developed to be used in technical performance standards and is currently under ballot for inclusion in an international aviation security standard.

Records of 48 dogs (57 eyes) that underwent intracapsular lens extraction (ICLE) of displaced lenses were reviewed. Preoperatively, 73% (19/26 eyes) of eyes with anterior luxations had secondary glaucoma compared to 43% (10/23 eyes) with subluxations and 38% (3/8 eyes) with posterior luxations. Forty-one of 57 eyes (72%) had vision and intraocular pressure (IOP) less than 30 mm Hg four to six weeks after surgery. This percentage declined to 61% (22/36 eyes) in three months and 53% (8/15 eyes) in 12 months. Eyes with glaucoma before ICLE had a lower success rate (66%) than eyes without (82%). Since secondary glaucoma was the most common cause of failure, this study suggests that removal of a subluxated lens or a posteriorly luxated lens should be recommended before the lens moves into the anterior chamber.

The City of Atlanta has had a Sewer System Evaluation Survey (SSES) program underway since 2001. This program involves the inspection of the nearly 1580 miles of sanitary and combined sewer which includes all pipes of diameters less than 24”. The program uses a variety of techniques such as CCTV, dye and smoke testing, flow and rain monitoring. The data is used as the basis for determining where repairs, rehabilitation, upsizing or sewer replacement are needed. As this program draws to a close, Atlanta will continue to rely on this comprehensive set of information to make the tough decisions regarding allocation of limited financial resources for the future maintenance of its sewer system. This paper focuses on how Atlanta uses Geographical Information Systems (GIS) for Quality Assurance/Quality Control (QA/QC) of its SSES data, and how GIS is used to enhance the development of intelligent decisions with regards to both water and sewer system pipeline capacity upgrades and pipeline rehabilitation and replacement. These decisions will be at the core of Atlanta’s Asset Management Program. The City of Atlanta, Department of Watershed Management (DWM) has developed a robust process for the evaluation of SSES data. While the ultimate repository for this condition assessment data is the Hansen computerized maintenance management system (CMMS) software system, GIS plays a critical role in providing the spatial component and aid the QA/QC process. Additionally, GIS is used to develop maps of sewer system overflows and other events that provide information on system capacity and conditions. This paper will explain how GIS is used for the correlation of data from multiple sources (flooding, overflows, spills, pipe failures, aerial segments, customer complaints) and its contribution in on-going system maintenance efforts and capital programs. Development of a robust and sustainable long-term Asset Management Program for pipelines requires the ability to present knowledge about a systems condition to senior management using mechanisms that are data driven, and yet easily accessible. Options for extending the use of GIS functionality in various ways will be explored. Finally, the paper will draw conclusions on how to use these processes for decisionmaking in drinking water pipe system asset management. The DWM is currently engaged in an effort to locate, identify, operate and assess its drinking water valves and hydrants. The potential for sharing knowledge gleaned from the SSES experiences will be explored.

Dispositional optimism has been shown to beneficially influence various experimental and clinical pain experiences. One possibility that may account for decreased pain sensitivity among individuals who report greater dispositional optimism is less use of maladaptive coping strategies such as pain catastrophizing, a negative cognitive/affective response to pain. An association between dispositional optimism and conditioned pain modulation, a measure of endogenous pain inhibition, has previously been reported. However, it remains to be determined whether dispositional optimism is also associated with temporal summation (TS), a measure of endogenous pain facilitation. The current study examined whether pain catastrophizing mediated the association between dispositional optimism and TS among 140 older, community-dwelling adults with symptomatic knee osteoarthritis. Individuals completed measures of dispositional optimism and pain catastrophizing. TS was then assessed using a tailored heat pain stimulus on the forearm. Greater dispositional optimism was significantly related to lower levels of pain catastrophizing and TS. Bootstrapped confidence intervals revealed that less pain catastrophizing was a significant mediator of the relation between greater dispositional optimism and diminished TS. These findings support the primary role of personality characteristics such as dispositional optimism in the modulation of pain outcomes by abatement of endogenous pain facilitation and less use of catastrophizing. Perspective Results from this study further support the body of evidence that attests to the beneficial effects of positive personality traits on pain sensitivity and pain processing. Further, this study identified diminished pain catastrophizing as an important mechanism explaining the inverse relation between dispositional optimism and endogenous pain facilitation.

The experience of touch is significant; both in its positive implications and in how it attracts caution and controversy. Accordingly, physical contact within psychological therapy has been shown to improve well-being and the therapeutic relationship, yet the majority of therapists never or rarely use touch. This research aimed to explore psychological processes underlying touch through the Alexander Technique, a psycho-physical technique taught one to one using touch. Six individuals who had received the Alexander Technique were interviewed, and 111 completed surveys. Interview data suggested an incompatibility between touch and the spoken word, which was understood through the way touch lacks verbal discourses in our society. The largely simplistic and dichotomous verbal understanding we have (either only very positive or very negative) could help understand some of the societal-level caution surrounding touch. Touch was seen also as a nurturing experience by interviewees, which influenced inter-personal and intra-personal relational processes. Developmental models were used to frame the way touch strengthened the pupil-teacher relationship and the way pupils' intra-personal psychological change seemed linked to this relational experience. The surveys largely supported these findings, and discussion is made around the notable way pupils negatively interpreted the intention of the survey. Implications for the use of touch in psychological therapies are discussed, as are limitations and ideas for future research.Touch is a powerful experience, and physical contact within psychological therapy has been shown to improve well-being and the therapeutic relationship, yet the majority of therapists never or rarely use touch. The AT is an alternative therapeutic approach to psycho-physical well-being that offers an interesting model to study the impact of touch. Findings from those that have used the technique reaffirmed that touch can improve well-being and can be a powerful force in the 'therapeutic relationship'. Accounts drew strong parallels with developmental experiences, which may be of particular interest to those working psychodynamically. Findings also highlighted the lack of discourses our culture has for touch and how the ones we share can be super-imposed onto experiences. This should be kept in mind when discussing all types of physical contact with clients. Outcomes from AT pupils cannot be generalized to those seeking psychological support; however, the findings accentuated the power of holistic working. This is important as we begin to understand more around how emotions are held in the body.

Heparin-induced thrombocytopenia (HIT) is a potentially devastating form of drug-induced thrombocytopenia that occurs in patients receiving heparin for prevention or treatment of thrombosis. Patients with HIT develop autoantibodies to the platelet factor 4 (PF4)/heparin complex, which is termed the HIT Ab complex. Despite a decrease in the platelet count, the most feared complication of HIT is thrombosis. The mechanism of thrombosis in HIT remains poorly understood. We investigated the effects of the HIT Ab complex on tissue factor (TF) expression and release of TF-positive microparticles in peripheral blood mononuclear cells and monocytes. To model these effects ex vivo, we used a murine mAb specific for the PF4/heparin complex (KKO), as well as plasma from patients with HIT. We found that the HIT Ab complex induced TF expression in monocytes and the release of TF-positive microparticles. Further, we found that induction of TF is mediated via engagement of the FcγRI receptor and activation of the MEK1-ERK1/2 signaling pathway. Our data suggest that monocyte TF may contribute to the development of thrombosis in patients with HIT.

Background: Chronic pain conditions are characterized by significant individual variability complicating the identification of pathophysiological markers. Leukocyte telomere length (TL), a measure of cellular aging, is associated with age-related disease onset, psychosocial stress, and health-related functional decline. Psychosocial stress has been associated with the onset of chronic pain and chronic pain is experienced as a physical and psychosocial stressor. However, the utility of TL as a biological marker reflecting the burden of chronic pain and psychosocial stress has not yet been explored. Findings: The relationship between chronic pain, stress, and TL was analyzed in 36 ethnically diverse, older adults, half of whom reported no chronic pain and the other half had chronic knee osteoarthritis (OA) pain. Subjects completed a physical exam, radiographs, health history, and psychosocial questionnaires. Blood samples were collected and TL was measured by quantitative polymerase chain reaction (qPCR). Four groups were identified characterized by pain status and the Perceived Stress Scale scores: 1) no pain/low stress, 2) no pain/high stress, chronic pain/low stress, and 4) chronic pain/high stress. TL differed between the pain/stress groups ( p = 0.01), controlling for relevant covariates. Specifically, the chronic pain/high stress group had significantly shorter TL compared to the no pain/low stress group. Age was negatively correlated with TL, particularly in the chronic pain/high stress group ( p = 0.03). Conclusions: Although preliminary in nature and based on a modest sample size, these findings indicate that cellular aging may be more pronounced in older adults experiencing high levels of perceived stress and chronic pain.

Numerous human diseases arise because of defects in protein folding, leading to their degradation in the endoplasmic reticulum. Among them is cystic fibrosis (CF), caused by mutations in the gene encoding the CF transmembrane conductance regulator (CFTR ), an epithelial anion channel. The most common mutation, F508del, disrupts CFTR folding, which blocks its trafficking to the plasma membrane. We developed a fluorescence detection platform using fluorogen-activating proteins (FAPs) to directly detect FAP-CFTR trafficking to the cell surface using a cell-impermeant probe. By using this approach, we determined the efficacy of new corrector compounds, both alone and in combination, to rescue F508del-CFTR to the plasma membrane. Combinations of correctors produced additive or synergistic effects, improving the density of mutant CFTR at the cell surface up to ninefold over a single-compound treatment. The results correlated closely with assays of stimulated anion transport performed in polarized human bronchial epithelia that endogenously express F508del-CFTR. These findings indicate that the FAP-tagged constructs faithfully report mutant CFTR correction activity and that this approach should be useful as a screening assay in diseases that impair protein trafficking to the cell surface.

A thermally-activated micelle consisting of a crystallizable poly(caprolactone), PCL, core and a poly(ethylene glycol), PEG, corona was developed to contain magnetic nanoparticles and anti-cancer agent doxorubicin as well as display a targeting RGD peptide. This system has the potential to target cancer cells, deliver combination hyperthermia and chemotherapy, and offer magnetic resonance imaging contrast. The micelles self-assemble in aqueous solutions and form a crystalline core with a melting transition ranging from 40 to 50 °C, depending on the length of the PCL blocks, with dynamic light scattering showing micelle sizes typically ranging from 20 to 100 nm, depending on block lengths and added drug or nanoparticles. The micelles become unstable as they are heated above their melting point, creating a thermally-activated drug release mechanism. By adding magnetite (Fe3O4) nanoparticles into the PCL core, the micelles can be heated using an externally applied AC magnetic field to induce hyperthermia in combination with the thermally-activated drug release. The polymers and magnetic nanoparticles (MNPs) were synthesized and characterized in our laboratories. The melting transitions of the PCL micelle cores were investigated using microcalorimetry. The heating of nanoparticles and magnetomicelles was conducted using a custom-built hyperthermia coil capable of generating fields of several hundred Oersteds at frequencies ranging from 50 to 450 kHz. Heating of MNPs was maximized at high field intensities. RGD peptides were attached to the PEG corona using maleimide chemistry, and the ability of the RGD-derivatized micelles to target integrin-expressing cells was investigated using fluorescent dye PKH26 to identify the localization of micelles in cultured human kidney (293) cells in vitro. The crystallizable (and meltable) cores in these micelles were designed to overcome drug leakage common in liposome systems and release the drug on demand after a period of time for localization to integrin receptors.

Growing backlogs demand effective use of online databases. This study suggests a pattern of availability of Spanish and Portuguese language records on RLIN and OCLC, which can be used systematically by the cataloger in order to strategically move or eliminate a large backlog. An analysis of online search hit-rates suggested that items not cataloged for fifteen months after receipt, will not likely receive cataloging. After that period of time, the availability of records online does not increase and monographs should receive original cataloging, instead of being set aside again until further copy appears online.

A number of laboratory studies have confirmed the efficacy of opioid medication in reducing pain generated by a number of psychophysical modalities. However, one implicit assumption of clinical and experimental pain testing of analgesics is that the analgesic response is stable and will be comparable across repeated administrations. In the current study, the repeatability of opioid analgesia was assessed in a randomized, double-blinded study using three psychophysical pain modalities (e.g., thermal, pressure, and ischemic) over four medication sessions (two with active drug, two with placebo). Psychophysical responses were evaluated before and after IV administration of either morphine (0.08 mg/kg; n=52) or pentazocine (0.5 mg/kg; n=49). To determine the ability of a drug to reduce pain, four analytic methods (i.e., absolute change, percent change, ratio, and residualized change scores) were calculated to generate separate analgesic index scores for each measure and drug condition. All analgesic index scores demonstrated a greater analgesic responses compared to saline for both medications, but stability (i.e. test-retest correlations) of the opioid analgesic indices depended on the pain measurement. Ischemic pain outcomes were moderately stable across sessions for both opioid medications; however, heat and pressure analgesic index scores were moderately stable for only morphine and pentazocine, respectively. Finally, within stimulus modalities analgesic index scores were highly correlated with each other, suggesting that the different methods for computing analgesic responses provided comparable results. These results suggest that analgesic measures are able distinguish between active drugs. In addition, analgesic responses to morphine and pentazocine demonstrate at least moderate reliability.

An extension of the X-ray extended-range technique is described for measuring X-ray mass attenuation coefficients by introducing absolute measurement of a number of foils - the multiple independent foil technique. Illustrating the technique with the results of measurements for gold in the 38-50 keV energy range, it is shown that its use enables selection of the most uniform and well defined of available foils, leading to more accurate measurements; it allows one to test the consistency of independently measured absolute values of the mass attenuation coefficient with those obtained by the thickness transfer method; and it tests the linearity of the response of the counter and counting chain throughout the range of X-ray intensities encountered in a given experiment. In light of the results for gold, the strategy to be ideally employed in measuring absolute X-ray mass attenuation coefficients, X-ray absorption fine structure and related quantities is discussed.

Objective. Responses to opioid analgesics are highly variable, and the understanding of contributing factors is limited. This laboratory study was designed to examine the contributions of sex and race to inter-individual variability in response to opioids. Design. A randomized, double-blind, mixed design was implemented in the evaluation of analgesic response to a µ-opioid agonist and mixed agonist–antagonist, using three well-validated experimental pain assays (thermal, pressure, and ischemic). Subjects. Participants included a total of 142 healthy subjects (76 men/66 women), 119 non-Hispanic whites and 23 African Americans. Intervention. Three sessions of pain testing were completed prior to and following an intravenous administration of morphine (0.08 mg/kg), butorphanol (0.016 mg/kg), and placebo (saline) in counterbalanced order. Outcome Measures. A change score was calculated from the difference between the pre-drug and postdrug values. Three separate change scores (morphine, saline, and butorphanol) were computed for each experimental pain variable. Mixed-model analyses of covariance were performed on analgesic change scores. Results. Significant sex differences emerged for predrug pain measures with minimal differences for race. Sex differences in opioid analgesia were not demonstrated. However, significant race differences and race X drug interactions emerged for thermal, pressure, and ischemic pain measures. The pattern of results generally indicated that for pressure and ischemic pain, African American subjects showed greater analgesic responses to both medications compared with non-Hispanic whites. For thermal pain threshold, butorphanol but not morphine analgesia was greater for African American vs non-Hispanic whites. Conclusions. Findings are among the first to demonstrate race differences in a laboratory study of opioid analgesia.

Significant hematologic changes are known to occur following intraoperative autotransfusion of shed blood, but the clinical importance of cell washing prior to reinfusion has not been substantiated. To evaluate these changes and their relationship to the use of blood bank products and postoperative morbidity, 26 patients undergoing elective abdominal aortic aneurysm repair were prospectively randomized to reinfusion with washed shed blood or to the use of a collection system in which filtered, but unwashed, whole blood was reinfused intraoperatively. Each patient was evaluated with respect to standard metabolic and hematologic laboratory parameters preoperatively, immediately postoperatively, and 12 to 18 hours postoperatively. Patient demographic data were similar for both groups. Perioperative survival was 100% for both groups. Total blood loss and blood volume autotransfused were significantly greater in the unwashed cell group compared with the washed cell group (p = 0.00014 and p = 0.00011, respectively). Hemoglobin, fibrinogen, prothrombin time, and partial thromboplastin time levels were not significantly different between the two groups at any time perioperatively; fibrin split product and d-dimer levels were significantly higher in the unwashed cell group postoperatively (p = 0.016 and p0.001, respectively). Serum free hemoglobin levels were significantly higher in the immediate postoperative period in the unwashed cell group compared with the washed cell group (p = 0.0013); by 12 to 18 hours postoperatively, this difference was not significant. Haptoglobin levels were significantly lower in the unwashed cell group at both postoperative times (123 +/- 86 mg/dL versus 41 +/- 50 mg/dL, p = 0.0086; 102 +/- 66 mg/dL versus 24 +/- 36 mg/dL, p = 0.0001); however, there was no perioperative renal failure in either group. Furthermore, homologous blood product use was not significantly different between the two groups, with an average of 1.5 +/- 2.5 units of packed red blood cells given to patients in the unwashed cell group versus 0.8 +/- 1.7 units in the washed cell group (p = 0.419). Overall complications were higher and critical care and total hospital stays were longer in the unwashed cell group but did not result from autotransfusion of unwashed blood. We conclude that the intraoperative reinfusion of unwashed shed blood is safe and effective, causing transient hematologic abnormalities that normalize in the early postoperative period, and is not associated with increased mortality, or hematologic, cardiopulmonary, or renal complications.

The growing numbers of women faced with HIV infection and AIDS has specific counselling implications. This paper analyses the psychological needs of all women patients seen by the psychology department (n = 33) over the past 12 months. The mean age was 32.3 years. Psychological crisis was high. Four women reported rapes (three accounting for their HIV infection). Two women had suicide attempts (one on two occasions), Death experiences were notable, including multiple bereavement. Conjidentiality was problematic for many of the women. Problems were reported around pre- and post-test counselling which was absent for three women, and often surrounded the diagnosis of a loved one (child, husband or partner). Most women were first seen as in-patients (when disease progression was extensive) or when their partners or children were in-patients. Despite offers of out-patients follow-up, only four HIV + ve women attended, three of which were irregular. A group of ten women were only seen indirectly when p...

Prolonged intraoperative renal ischemia requires modalities to reduce the incidence of acute tubular necrosis, but there exists no definitive prophylactic regimen. We studied the effects of enalaprilat, an angiotensin-converting enzyme inhibitor, in an attempt to identify such a protective drug. Thirty-four mongrel dogs underwent 90 min of bilateral renal pedicle clamping. Group I was a control of 6 animals. Group II comprised 10 animals who received 12.5 g iv mannitol 15 min prior to clamping and 1 mg/kg iv furosemide immediately after clamp removal. Group III also comprised 10 animals who received enalaprilat 1 mg/kg iv enalaprilat each 15 min prior to clamp placement. Group IV consisted of 8 dogs, each of which received 12.5 g mannitol and 1 mg/kg iv enalaprilat 15 min prior to clamping and 1 mg/kg iv furosemide immediately upon removal of the clamps. Serum blood urea nitrogen (BUN) and creatinine levels were drawn preoperatively and at 12, 24, 48, and 72 hr postoperatively in each animal. The serum BUN levels in group III were significantly lower than those in group I at all times postoperatively (P < 0.05) and were not significantly different from those of group II at any time postoperatively. Similarly, the serum creatinine levels in group III were significantly lower than those of group I (P < 0.05) and were not significantly different from those in group II at any time postoperatively. Neither the serum BUN nor the serum creatinine levels in group IV were different from those of group I at any time postoperatively. We conclude that intravenous enalaprilat offers significant protection against postischemic renal failure and is as effective as a regimen of mannitol and furosemide. However, the combination of all three offers no protection whatsoever relative to controls.

Franketienne From the very beginning … the cry imposed its very particular syntax on the slave. For the Antillean, the word is, first and foremost, sound. Noise is speech. Clamor is discourse. This must be understood. —Edouard Glissant Of the three Spiralists, Franketienne has been perhaps the most overt in his attention to the specifically formal challenges to writing in and from a geographical space where the distance between the written and the real is so remarkable. Author of the world's first full-length novel in Haitian Creole, resolute refuser of exile, math teacher, and community leader, Franketienne's actions reveal a commitment to the insular collective that inspires his literary production. At the same time, however, the sesquipedalian acrobatics of his prose fiction certainly appear, at first (and second and third) glance, to be at odds with any sort of populist intent. Franketienne is aware of this apparent contradiction. In fact, he ultimately goes so far as to name it: “schizophonia,” officially introducing the term in the title of his 1993 spiral, L'Oiseau schizophone . Though this title appears some years after the publication of the three works discussed here, there is no question that the concepts it describes are present from Franketienne's first writings. Yves Chemla defines schizophonia as the attitude or position of the artist … who realizes little by little that the sounds s/he hears and that s/he produces are the only ones capable of evoking the chaos and the pollution that affect the world (as well as language itself) by means of neologism, lexical invention, rhymes and echoes, alliterations and encounters between sounds and images. (Chemla, “Iconographie”)

Historically and contemporarily, politically and literarily, Haiti has long been relegated to the margins of the so-called 'New World.' Marked by exceptionalism, the voices of some of its most important writers have consequently been muted by the geopolitical realities of the nation's fraught history. In Haiti Unbound, Kaiama L. Glover offers a close look at the works of three such writers: the Haitian Spiralists Frankétienne, Jean-Claude Fignolé, and René Philoctète. While Spiralism has been acknowledged by scholars and regional writer-intellectuals alike as a crucial contribution to the French-speaking Caribbean literary tradition, the Spiralist ethic-aesthetic not yet been given the sustained attention of a full-length study. Glover's book represents the first effort in any language to consider the works of the three Spiralist authors both individually and collectively, and so fills an astonishingly empty place in the assessment of postcolonial Caribbean aesthetics. Touching on the role and destiny of Haiti in the Americas, Haiti Unbound engages with long-standing issues of imperialism and resistance culture in the transatlantic world. Glover's timely project emphatically articulates Haiti's regional and global centrality, combining vital 'big picture' reflections on the field of postcolonial studies with elegant close-reading-based analyses of the philosophical perspective and creative practice of a distinctively Haitian literary phenomenon. Most importantly perhaps, the book advocates for the inclusion of three largely unrecognized voices in the disturbingly fixed roster of writer-intellectuals that have thus far interested theorists of postcolonial (Francophone) literature. Providing insightful and sophisticated blueprints for the reading and teaching of the Spiralists' prose fiction, Haiti Unbound will serve as a point of reference for the works of these authors and for the singular socio-political space out of and within which they write.