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Climate change is having profound effects on populations of fished species and the ecosystems on which they depend, lending to a growing body of work that advocates for climate resilience to be a priority in fishery management. Here, we provide a comprehensive analysis of the tools needed to manage for climate resiliency. The Antarctic region is among the most vulnerable to climate change, and thus, we then consider climate resilient management tools utilized by the Commission for the Conservation of Antarctic Marine Living Resources (CCAMLR), the body responsible for the management of Antarctic marine living resources as part of the Antarctic Treaty System. We note progress, gaps, and opportunities for implementation. Across the literature, ecosystem-based management was cited as an appropriate tool for climate resilience of marine ecosystems, as was the use of climate model outputs (projections and simulations), marine protected areas (MPAs), and dynamic stock assessments. CCAMLR has a unique position where its Convention effectively mandates the principles of an ecosystem-based precautionary approach for managing fisheries, and many of its Member States have been advocating for climate initiatives within this approach. While CCAMLR has made limited overall progress towards ensuring climate resilience, it has advanced in some areas, such as MPA implementation, developing a risk assessment for krill, and including statements on climate change in fishery reports, although there is much work to be done. While climate change remains a worldwide issue that must be addressed on a global scale, CCAMLR holds the responsibility for adaptively managing Southern Ocean marine living resources for climate resilience.

Aim To develop a simultaneous, evolutionary concept analysis of moral distress and moral uncertainty in the context of medical assistance in dying (MAiD). Background Moral distress is well represented in nursing literature but disagreement persists in how the concept is defined and understood. Moral uncertainty has not been investigated in-depth. Further definition and conceptual clarity is required to understand these concepts within the context of MAiD. Design Simultaneous concept analysis. Data sources Cumulative Index of Nursing and Allied Health Literature, Google Scholar, and PubMed databases were searched for articles in English. The final sample consisted of 44 documents published from 1984 to 2019. Method An adapted combination of Rodgers's Evolutionary Model and Haase et al's Simultaneous Concept Analysis method. Results Despite the significant overlap, moral distress and moral uncertainty have subtle distinguishing differences. Attributes of moral distress in the context of MAiD focus on knowing the right course of action but being unable to act, especially when conflict or suffering occurs. Attributes of moral uncertainty center on an inability to decide on which course of action to take or knowing what outcome is preferable. Conclusion More research is required to bring further clarity to these concepts and develop interventions to support nurses who receive requests for or participate in MAiD.

Heart failure (HF) costs $21 billion annually in direct health care costs, 80% of which is directly attributable to hospitalizations. The SHIFT clinical study demonstrated that ivabradine plus standard of care (SoC) reduced HF-related and all-cause hospitalizations compared with SoC alone.To estimate the budget impact of ivabradine from a U.S. commercial payer perspective.A budget impact model estimated the per-member-per month (PMPM) impact of introducing ivabradine to existing formularies by comparing a reference scenario (SoC) and a new drug scenario (ivabradine + SoC) in hypothetical 1 million-member commercial and Medicare Advantage plans. In both scenarios, U.S. claims data were used for the reference cumulative annual rates of hospitalizations (HF, non-HF cardiovascular [CV], and non-CV), and hospitalization rates were adjusted using SHIFT data. The model controlled for mortality risk using SHIFT and U.S. life table data, and hospitalization costs were obtained from U.S. claims data: HF-related = $37,507; non-HF CV = $28,951; and non-CV = $17,904. The annualized wholesale acquisition cost of ivabradine was $4,500, with baseline use for this new drug at 2%, increasing 2% per year.Based on the approved U.S. indication, approximately 2,000 commercially insured patients from a 1 million-member commercial plan were eligible to receive ivabradine. Ivabradine resulted in a PMPM cost savings of $0.01 and $0.04 in years 1 and 3 of the core model, respectively. After including the acquisition price for ivabradine, the model showed a decrease in total costs in the commercial ($991,256 and $474,499, respectively) and Medicare populations ($13,849,262 and $4,280,291, respectively) in year 1. This decrease was driven by ivabradine's reduction in hospitalization rates. For the core model, the estimated pharmacy-only PMPM in year 1 was $0.01 for the commercial population and $0.24 for the Medicare Advantage population.Adding ivabradine to SoC led to lower average annual treatment costs. The negative PMPM budget impact indicates that ivabradine is an affordable option for U.S. payers.This study was funded by Amgen. Patel is employed by Amgen; Kielhorn was employed by Amgen at the time of the study but is no longer affiliated with Amgen. Borer, Böhm, Ford, and Komajda have received scientific support, consultative fees, and/or speakers honoraria from Servier and Amgen in connection with SHIFT, the trial underlying this analysis. Borer also has received consultative fees from Celladon, Pfizer, ARMGO, Cardiorentis, Novartis, and Takeda USA. Kansal, Dorman, Krotneva, and Zheng are employees of Evidera, which was hired to assist with this study. Tavazzi has received research grants and consultation fees from Servier in connection with this study and has had advisory board memberships with Boston Scientific, Servier, Cardiorentis, Medtronic, St. Jude Medical, and CVie Therapeutics. Study concept and design were contributed by Dorman and Keilhorn, along with the other authors. Tavazzi, Komajda, Ford, BÖhm, and Borer oversaw collection of the data. Tavazzi, Komajda, Ford, BÖhm, and Borer (along with Karl Swedberg) formed the Executive Committee of SHIFT, the trial underlying this analysis. The manuscript was written by Kansal, along with the other authors, and revised by Borer and Patel, with assistance from the other authors.

We report clustering of sucrose molecules in dilute aqueous solutions, based on measurements of the electrical mobility spectrum of singly charged airborne clusters produced by electrospraying the solution. The spectrum contains peaks with a smooth envelope, except for one peak which has about twice the amplitude of the envelope. The mobility at this peak is found to be somewhat higher than would be expected based on the rest of the sequence, suggesting a more compact structure for this cluster. This "magic" peak is prominent for basic, but not acidic, solutions. It is argued that these observations demonstrate the existence of clusters of many sizes in the solution prior to electrospraying, including the "magic" cluster. A simplified model is presented which reproduces the observed features.

WOS: 000225815500005, The importance of natural antioxidants principally relates to their health-promoting properties. The discovery of new sources of established compounds or more potent compounds is a costly exercise and any technique capable of aiding this procedure would be highly significant. An approach combining chromatographic separation, component analysis and post-column identification of free radical scavenging has been reported. However, its effectiveness is dependent upon various factors and the number of samples analyzed without operator intervention is restricted. A more applicable technique using a 10% to 100% methanol with 2% acetic acid mobile phase and a citric acid-sodium citrate buffered methanolic 1,1-diphenyl-2-picrylhydrazyl free radical reagent is presented, whereby free radical scavengers can be detected within crude extracts of variable polarity without special considerations. As an illustration, acetone, 70% (aq.) methanol and acetonitrile-soluble extracts were prepared from sage (Salvia officinalis L.) for extraction of polar and non-polar radical scavengers and analyzed. Radical scavenging components were identified as carnosic, caffeic and rosmarinic acids and luteolin-7-O-glycoside. Others radical scavengers were tentatively identified as benzoic and hydroxycinnamic acid derivatives, flavonoids and diterpenoids. Through the application of this technique, carnosic acid and rosmarinic acid were identified as the principal free radical scavengers.

Satureja hortensis L. (summer savory) is an annual herb belonging to the family Lamiaceae. It is used as a condiment and as a plant in traditional folk medicine to treat infectious diseases and disorders. A number of studies have suggested that the activity of Satureja hortensis may relate to the antioxidant properties of its secondary metabolites. Therefore, this study attempts to characterise the antioxidant properties of an acidified aqueous methanol extract from commercially available material using Fe(III) reductive and DPPH , ABTS + and hydroxyl free radical-scavenging assays. The crude extract demonstrated promising in vitro activity and thus was further fractionated, by liquid–liquid partitioning against water, to determine which fraction possessed the most potent activity. The ethyl acetate-soluble fraction was the most effective fraction, with reductive activity of 2648 ± 41.4 μmol ascorbic acid/g extract, and DPPH and hydroxyl radical-scavenging IC 50 concentrations of 138 ± 6.0 and 45.0 ± 7.0 μg/ml, respectively. The TEAC value for this fraction was 2.59 ± 0.06 mM Trolox. The experimental results are discussed and potential applications are explored.

De-odourised aqueous extracts of four commonly consumed herbs belonging to the Lamiaceae family, i.e. oregano (Origanum vulgaris L.), rosemary (Rosmarinus officinalis L.), sage (Salvia officinalis L.) and thyme (Thymus vulgaris L.), were investigated for their antioxidant properties. Various experimental models were used for the characterisation of the activity, including iron reduction capacity, DPPH·, ABTS·+ and ·OH radical-scavenging activities and the capacity of the extracts to inhibit copper-induced oxidation of human low-density lipoproteins (LDL) ex vivo. The extracts showed varying degrees of reductive and radical scavenging capacity, and were capable of a marked prolongation of the lag-time in the LDL oxidation assay. The hierarchy of the observed antioxidant activity of the extracts was dependent on the type of assay used. The observed antioxidant characteristics were not fully related to the total phenolic contents of the extracts in any of the assays, but were presumably strongly dependent on rosmarinic acid, the major phenolic component present in this type of Lamiaceae extract.

An on-line HPLC-1,1-diphenyl-2-picrylhydrazyl (DPPH*) method has been improved for the detection of polar and nonpolar radical scavenging compounds from complex plant extracts. Eight water extracts were prepared from steam-distilled essential oil-extracted Lamiaceae plants (Origanum vulgare L., O. Onites L., O. Minutiflorum O. Schwartz et P. H. Davis, O. Syriacum L., Satureja cuneifolia Ten., Thymbra spicata L., Coridothymus capitatus (L.) Reichb. f., Majorana hortensis Moench). After the components within each extract had been separated by reverse phase chromatography using 10% to 100% methanol with 2% acetic acid as a mobile phase, analytes capable of scavenging a citric acid-sodium citrate buffered methanolic DPPH* solution were detected by post-column derivatization at 517 nm. The HPLC-DPPH* on-line method was applied to the qualitative and quantitative analysis of these Lamiaceae plant extracts. There was a strong correlation between the scavenging (negative) peak area and the concentration of the radical scavenging reference substances used. The radical scavenging compounds within the extracts were determined as benzoic acid and hydroxycinnamic acid derivatives, flavonoids and diterpenoids according to their retention time and UV spectral data. Rosmarinic acid and carnosic acid were identified as the dominant radical scavengers in these extracts by this method.

The antioxidant capacity of the synthetic antioxidants BHA, BHT, pyrogallol and α-tocopherol, the essential oils from black pepper, clove, geranium, melissa, nutmeg, oregano and thyme and 33 phytoconstituents were assessed in vitro, using an antioxidant assay. All die compounds demonstrated antioxidant capacity superior to the water soluble α-tocopherol analogue Trolox with the exception of the essential oil melissa and the phytoconstituents aromadendrene, myrcene and nerol. Clove, oregano and thyme were exceptionally potent in this assay, comparable with the activities of both BHA and pyrogallol. Eugenol, carvacrol, and thymol similarly demonstrated an equivalent degree of activity. These phytoconstituents are the major components present in clove, oregano and thyme essential oils, respectively.

Five essential oils, geranium, monarda, nutmeg, oregano and thyme, were evaluated for their antioxidant properties at final concentrations of 0.75 ppm to 100 ppm. Thiobarbituric acid reactive substances (TBARS) were measured in three avian assay systems based on egg yolk, one-day old chicken livers and muscle from mature chickens. All the oils demonstrated extensive antioxidant capacities. The egg yolk TBARS assay showed monarda, nutmeg and thyme essential oils to be the most effective while the chick liver assay revealed nutmeg oil to be the most active. The chicken muscle assay demonstrated equal activity for the oils of monarda, nutmeg, oregano and thyme. Based on this assay technique, oils demonstrating the most effective antioxidant capacities will be chosen for feeding trials to demonstrate their effectiveness in vivo upon polyunsaturated fatty acid (PUFA) metabolism during vital periods of the lifespan, in particular, the foetal/neonate and aging periods.

Introduction Directional deep brain stimulation (DBS) leads designed to preferentially stimulate structures at specific orientations relative to the DBS lead have recently shown promise during acute testing in patients ( [Contarino et al., 2014] , [Pollo et al., 2014] ). However, sustained improvement of DBS therapy using directional leads depends on identification of the orientation of these leads relative to brain structures of interest. The aim of this work is develop a method for reliable and automated identification of the orientation of directional leads from computed tomography (CT) data. Methods To determine the orientation of directional leads (Boston Scientific) from CT data, an algorithm for automated directional lead orientation detection was developed utilizing methods from image processing and registration methods. Clinical grade CT scans were acquired of directional lead phantoms with specific pre-determined orientation of the leads and the performance of the automated directional lead orientation detection algorithm was tested on these scans using cross-validation techniques. Results The algorithm determined the directional lead orientations with a median accuracy of less than 10° across a wide range of scan and algorithm parameters. Conclusions Post-operative CT imaging can be used to detect the orientation of a directional lead with an accuracy better than 10° with standard resolution CT scans, provided slice thickness and slice overlaps are chosen appropriately.

Management of chronic peritoneal ascites by transfer of the fluid to the right atrium via peritoneovenous shunt (PVS) is often complicated by occlusion of the peritoneal catheter by one, or a combination, of the following: 1) omental plugging of drain holes, 2) fibrin obstruction of the lumen, and 3) encapsulation of the peritoneal segment by a cocoon. A PVS design that includes an access port facilitates the reversal of fibrin obstruction by urokinase. Eight dogs with implanted PVS were tested weekly for patency (indicated by the flow rate of saline into the peritoneum via the access port) and performance (indicated by the percent transfer of saline from the peritoneum to the vasculature). In 256 test sessions performed to date, 15 catheter occlusions occurred. Nine of these were reversed by one or two flushes with 5,000 units of urokinase via the access port. The remaining six were found to be occluded by cocoons (two), omentum (three), and fibrin (one). Although it is an effective treatment for ascites, the PVS is not in common use, because it has a relatively high occlusion rate. The access port and other features of the authors' PVS are designed to reduce the incidence of PVS occlusion.

A new detector for macromolecular separations is described. The detector counts individual macromolecules (molecular weights greater than about 10,000) and reports counts per second. The chromatographic effluent is electrosprayed, neutralized, and swept to the detector by a stream of air. The detector is a condensation particle counter that detects individual particles by light scattering from droplets condensed on the particles. When used as the detector for a size exclusion separation of proteins, the detector has a linear range of 4 orders of magnitude with detection limits as low as 0.1 microgram/mL. The detector can be directly interfaced (no makeup flow) with effluent flows as low as 10 nL/min. A Monte Carlo model based on size measurements of the electrosprayed droplets correctly predicts the observed detector behavior.

Globular proteins ranging in molecular mass from 5.7 to 669 kDa were separated and analyzed using an aerosol technique based on the electrophoretic mobility of singly-charged molecular ions in air. The ions were produced by electrospraying and drying 100-nm-diameter droplets of a liquid suspension of the proteins, using ionized air to remove the droplet charge due to the spray process. The electrophoretic mobility was measured using a modified commercial continuous-flow differential mobility analyzer operated near atmospheric pressure. An unmodified commercial condensation particle counter was used for detection. The concentrations analyzed ranged from 0.02 to 200 μg of protein/mL of buffer, with a liquid sample flow rate of approximately 50 nL/min. Sampling time of 3 min was used for each complete distribution measured. The electrophoretic mobilities measured were determined entirely from air flow rates, apparatus geometry, and applied potentials. Results were expressed as electrophoretic mobility equivalent diameters using a Millikan formula.

Now that implantable drug infusion pumps are well established clinically, methods for diagnosing suspected pump failures are needed. The authors previously constructed a benchtop data acquisition and control apparatus to assist our work in developing new pump technology. Although this device is technically capable of in vivo pump monitoring, it is cumbersome. Thus, they recently created a portable interrogation unit with more limited features. This portable pump interrogation apparatus consists of a 32 bit MS-DOS labtop computer, data acquisition software, an analog/ASCII interface, a pressure transducer, and appropriate fluid conduits. Communication between the device and the implanted pump is via a percutaneous needle puncture of the drug reservoir refill septum. This procedure is identical to that employed in a standard pump refill. Pump performance is evaluated by incrementally filling the pump reservoir while simultaneously measuring reservoir pressure. The resulting data are presented on the computer screen as a plot of pressure versus volume that quickly and simply either eliminates or confirms the reservoir pressure source as a failure mode. Diagnostic runs are saved on file for archival purposes. Their benchtop apparatus has been a valuable and reliable tool over many years of use. The authors believe that their portable apparatus will be equally beneficial.

We present UTBB devices with a gate length (L G ) of 25nm and competitive drive currents. The process flow features conventional gate-first high-k/metal and raised source/drains (RSD). Back bias (V bb ) enables V t modulation of more than 125mV with a V bb of 0.9V and BOX thickness of 12nm. This demonstrates the importance and viability of the UTBB structure for multi-V t and power management applications. We explore the impact of GP, BOX thickness and V bb on local V t variability for the first time. Excellent A Vt of 1.27 mV·µm is achieved. We also present simulations results that suggest UTBB has improved scalability, reduced gate leakage (I g ) and lower external resistance (R ext ), thanks to a thicker inversion gate dielectric (T inv ) and body (T si ) thickness.

It is shown that virtual paths will be a substantial component of a resource management control hierarchy for the B-ISDN. Other components of this hierarchy include connection admission, usage parameter control, and reactive congestion control. An overview of this control hierarchy is provided. The role of virtual paths for cost-effective resource management and connection admission control in the B-ISDN is examined. Some strategies for reserving capacity on virtual paths are identified, and the use of virtual paths to simplify connection admission control is discussed. The reservation of capacity on virtual path connections is shown to result in substantial network cost savings for the case study considered. >

Water-soluble extracts from black thyme (Thymbra spicata L.), savory (Satureja cuneifolia Ten.), Spanish oregano (Coridothymus capitatus (L.) Reichb. f.), sweet marjoram (Majorana hortensis Moench), Syrian oregano (Origanum syriacum L.), Toka oregano (Origanum minutiflorum O. Schwarz et P. H. Davis), and Turkish oregano (Origanum onites L.) were screened for antioxidant properties in a battery of six in vitro assays. Total phenol content and qualitative-quantitative compositional analyses were also carried out. The extracts demonstrated varying degrees of efficacy in each screen. The savory extract was the most effective at reducing iron(III), scavenging 1,1-diphenyl-2-picrylhydrazyl radicals, inhibiting ascorbate- iron (III)-catalyzed hydroxyl radical-mediated brain phospholipid peroxidation, and site-specific hydroxyl radical-mediated 2-deoxy-D-ribose degradation. The Syrian oregano extract was the most effective chelator of iron(II), while Spanish and Turkish oregano extracts were the most effective inhibitors of nonsite-specific hydroxyl radical-mediated 2-deoxy-D-ribose degradation. All the extracts contained Folin-Ciocalteu reagent-reactive substances, which was confirmed by the presence of polar phenolic analytes (i.e., hydroxybenzoates, hydroxycinnamates, and flavonoids).

An implantable infusion pump which uses elastomer spring pressure to provide constant-rate drug delivery is described. Desirable features of the design are its low-cost construction, temperature and pressure insensitivity, high volumetric efficiency, and scale flexibility. Test results for prototype models are reported. Spring performance characteristics appear to be unaffected by long-term implantation. The results indicate that the pump is suitable for multiple-drug-delivery applications requiring more than an infusion port but needing a programmable device. >

The authors report a transducer structure that combines two orthogonal phase arrays that enable the real-time scanning of two orthogonal sectors. This biplane phased array is formed by partially dicing the opposite faces of a composite piezoelectric plate in orthogonal directions. Individual elements of the orthogonal arrays show broad radiation patterns close to the theoretical expectations for isolated elements. Arrays formed by patterning the electrode alone, without cross dicing, show a narrower directivity pattern for a single element. This narrowing is a refractive effect due to the relatively high acoustic velocities in the composite material as compared with the sound velocity in the propagation medium. It is noted that the concept of the biplane phased array forms the basis for a new class of transducer systems that combine two transducer arrays in a single piezocomposite plate. >

The volatile oils of black pepper [Piper nigrum L. (Piperaceae)], clove [Syzygium aromaticum (L.) Merr. & Perry (Myrtaceae)], geranium [Pelargonium graveolens L'Herit (Geraniaceae)], nutmeg [Myristica fragrans Houtt. (Myristicaceae), oregano [Origanum vulgare ssp. hirtum (Link) Letsw. (Lamiaceae)] and thyme [Thymus vulgaris L. (Lamiaceae)] were assessed for antibacterial activity against 25 different genera of bacteria. These included animal and plant pathogens, food poisoning and spoilage bacteria. The volatile oils exhibited considerable inhibitory effects against all the organisms under test while their major components demonstrated various degrees of growth inhibition.

A scanning mobility particle sizer (SMPS) allows size separation of gas phase particles according to their electrophoretic mobilities. The addition of an electrospray source (ES) recently allowed extension of SMPS analysis to the macromolecular range. We demonstrate here the application of ES-SMPS to nucleic acids analysis. Single- and double-stranded DNA molecules ranging from 6.1 kDa (single-stranded DNA 20 nucleotides in length) to 300 kDa (500 base-pair double-stranded DNA) were separated and detected by ES-SMPS at the picomole to femtomole levels. The measured electrophoretic mobility diameters were found to correlate with the analytes` molecular weights, while the peak areas could yield quantitative information. No fragmentation of DNA was observed under the conditions employed. Different apparent densities were observed for single-stranded and double-stranded DNAs, showing a different behavior for each type of biomolecule. The total analysis time was about 3 min/spectrum. Further optimization of ES-SMPS is expected to make it a fast and sensitive technique for biopolymer characterization. 96 refs., 10 figs., 1 tab.

Now that implantable drug infusion pumps are well established clinically, methods for diagnosing suspected pump failures are needed. The authors previously constructed a benchtop data acquisition and control apparatus to assist our work in developing new pump technology. Although this device is technically capable of in vivo pump monitoring, it is cumbersome. Thus, they recently created a portable interrogation unit with more limited features. This portable pump interrogation apparatus consists of a 32 bit MS-DOS labtop computer, data acquisition software, an analog/ASCII interface, a pressure transducer, and appropriate fluid conduits. Communication between the device and the implanted pump is via a percutaneous needle puncture of the drug reservoir refill septum. This procedure is identical to that employed in a standard pump refill. Pump performance is evaluated by incrementally filling the pump reservoir while simultaneously measuring reservoir pressure. The resulting data are presented on the computer screen as a plot of pressure versus volume that quickly and simply either eliminates or confirms the reservoir pressure source as a failure mode. Diagnostic runs are saved on file for archival purposes. Their benchtop apparatus has been a valuable and reliable tool over many years of use. The authors believe that their portable apparatus will be equally beneficial.

In the current era of cost containment in medicine, manufacturing economics have become increasingly important. The authors devised an implantable pump powered by spring force from an elastomeric Belleville washer, which is also the outer flexible wall of the drug reservoir. Use of formed and injection molded parts provides for low-cost manufacturing, in contrast to the precision welded alternative designs. Additional advantages include insensitivity to changes in ambient temperature and pressure. Finite element modeling of the elastomer spring allows prediction of the effects of parameter changes on performance, so that expansions and reductions of scale can be made without compromising the uniform spring rate of the device. A concern that subcutaneous fibrous encapsulation might markedly alter reservoir pressure was not supported by experimental data. In a unit implanted subcutaneously in a dog, reservoir pressures measured over a 4 year period were stable. This new, simple, implantable infusion pump can serve as an economical vehicle for prolonged parenteral drug treatment of ambulatory subjects in circumstances where continuous single-rate infusion is appropriate.

An orthopedic catheter for long-term access to the synovial joint is anchored by a hollow threaded tap that penetrates the capsule through a hole drilled in the surrounding bone. The proximal end of the catheter is connected to either an implantable drug infusion pump or an implantable access port for continuous or intermittent perfusion or sampling. Four catheters were evaluated in dogs. Three were attached to ports, the fourth to a pump. Water (one trial, 22 weeks) and hyaluronic acid (HA) (5 mg/ml; two trials of 8 weeks each) were administered through ports twice weekly in 1.5 ml boluses; 5 mg/ml HA was delivered by pump (1 trial of 33 weeks) at 0.31 ml/day.

Long-term intravascular catheterization carries a finite risk of catheter occlusion. A catheter tip valve design is presented (Buchwald-Wigness, Strato Medical Corporation, Beverly, MA) which incorporates features designed to decrease the risk of thromboembolism and reduce the need for maintenance procedures. Aspiration and infusion are controlled by separate valves, making it possible to engineer optimized inlet and outlet parameters. The outlet valve is an elastic sleeve expanded around the sidewall outlet ports which opens under injection pressure. The inlet valve is a tubular elastic element compressed against the inlet port from within the lumen, opening under aspiration pressure. A series of valves were prototyped with outlet pressures ranging from 2 to 100" H2O, and inlet pressures ranging from -40-70" H2O, and flowrates at 36" H2O of greater than 1,400 ml/hr. Dog implants of two prototypes with outlet valve pressures of 10" H2O, and inlet pressures of -40" H2O, demonstrated that dormant periods of up to 7.5 weeks could be achieved without detectable blood cell entry into the lumen. No significant hemolysis was observed in blood samples aspirated with a 6 cc syringe (8% scored "slightly hemolyzed" vs. 44% with the nonvalved controls) indicating that a hemodialysis application is likely.

The drinking behavior of 329 patrons was observed in three public drinking settings in Boston. Variations in drinking behavior and patron characteristics at each site were noted. Group setting was significantly related to duration of stay among males in two sites. Duration of stay was related to level of consumption in all sites for men and women. The relationship between companion status and drinking behavior varied by site and sex of patron.

A three-dimensional kinematic and kinetic analysis of the human wrist can lend useful data to understand carpal mechanics. This data would also be useful in implant design and evaluating surgical reconstructive procedures. A stereoscopic photographic technique using light-emitting diodes (LED’s) is described that records on film three-dimensional relative motion between two bone segments. The LED’s are inserted into the carpal bones at key ligamentous attachments. Kinetic data is generated by use of a force transducer. LED frames are mounted on both sides of the wrist joint and to the calibrated transducer so that the three-dimensional motion and force (moment) information is recorded at the same time. Wrist motion is generated both passively and dynamically by motors attached to the principle wrist tendons. The kinematic and kinetic data, recorded on film, is then digtized and analyzed by computer. Knowledge of the relative three-dimensional motion of the intercarpal and radiocarpal joints and the relative forces that are distributed through the various wrist ligaments will be produced by this instrumentation. Output computer graphics routines, including screw axis data, have been developed.

A rapid, microenzymatic method was used to measure cerebrospinal fluid lactate levels in 205 children with suspected bacterial meningitis. Fifty children with normal CSF containing fewer than 0.005 X 10(9)/l WBC, no segmented neutrophils, glucose 3.4 +/- 0.8 mmol/l (61.2 +/- 14.4 mg/100 ml), and a protein of less than 0.30 g/l had CSF lactate levels below 2.0 mmol/l (18 mg/100 ml) (mean and standard deviation 1.3 +/- 0.3 mmol/l (11.8 +/- 2.7 mg/100 ml)). In 31 cases of proved viral meningitis as with 58 cases of clinically diagnosed viral meningitis, levels were below 3.8 mmol/l (34.5 mg/100 ml), being 2.3 +/- 0.6 mmol/l (20.9 +/- 5.4 mg/100 ml), and 2.1 +/- 0.7 mmol/l (19.1 +/- 6.4 mg/100 ml) respectively. Sixty-six cases of bacterial meningitis had CSF lactate levels ranging from 3.9 mmol/l (35.4 mg/100 ml) to greater than 10.0 mmol/l (90.0 mg/100 ml). Longitudinal studies in 7 children with bacterial meningitis showed that cerebrospinal fluid lactate levels differentiated bacterial from viral meningitis up to 4 days after starting treatment with antibiotics. Use of CSF lactate measurement for monitoring the efficacy of treatment is illustrated in a case of bacterial meningitis due to Pseudomonas aeruginosa. The origin of the cerebrospinal fluid lactate acidosis and the role of lactate in the pathophysiological cycle leading to intensification of brain tissue hypoxia and cellular damage is discussed with respect to the short-term prognosis and the long-term neurological sequelae.