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AIM: To evaluate retinal parameters in a sample of healthy young Caucasian adults to define the normal or physiological range of inter-ocular asymmetry in this particular age and ethnic group. METHODS: Study sample consisted of 37 Caucasian children and young adults aged between 12 and 23y (spherical equivalent from -3.00 D to +4.00 D, anisometropia

O_LIThe larval stage in fish development is characterized as a critical period with unusually high mortality rates. Additional stress may be imposed on fish larvae as fresh waters brown in color due to increased inputs of dissolved organic matter from the terrestrial watershed. Both energy transfer and foraging efficacy are predicted to decrease as light availability declines with browning.nC_LIO_LIHere, we investigated the balance between indirect versus direct effects of browning on zooplankton-larval fish interactions. Experimental tanks were established in the laboratory where water color was altered with increasing concentrations of SuperHume (water color measured as absorbance at 440 nm = 1.6 - 10.8 m-1). Phytoplankton and zooplankton densities were monitored across treatments for one month to assess possible changes in community structure leading up to fish spawning (i.e., late Spring in central Virginia, USA). We then introduced larval largemouth bass to the tanks to assess indirect effects on larval fish feeding rate and growth. Additionally, direct effects on the foraging efficiency and selectivity of largemouth bass and bluegill were determined with separate short-term feeding experiments using the same experimental setup.nC_LIO_LIBrowning did not directly alter the ability of larval fish to see and capture prey across our brown water treatments. However, significant indirect effects on larval fish foraging, growth, and survival were observed as phytoplankton and zooplankton densities decreased with increasing water color.nC_LIO_LIOur data suggest lake browning will reduce energy transfer to larval fish, during a critical stage of development, due to a reduction in prey availability but not visual foraging.nC_LI

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care., Global changes in both diagnostic and therapeutic practices in colorectal cancer care were evident in this survey conducted to analyze the impact of COVID-19 outbreak. The importance of this finding is that changes were associated with differences in health care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical variations.

In the United States, the Emergency Medical Services (EMS) has evolved and expanded over the past 50 years to provide critical care to patients outside of the hospital. EMS patients have a varied level of acuity, and the system is designed to meet their needs and adjust based on the situation at hand. The current prehospital system is comprised of various levels of certified and licensed providers and agencies to ensure the public gets the best care before arriving at a medical facility. EMS providers interact with many different professions to ensure there is continuity and top-level care provided to the patient. Interprofessional Education (IPE) incorporating simulation-based activities are necessary to expand the understanding about EMS and scope of practice as well as the potential impact on treating patients outside of the hospital. Expanding the knowledge and inclusion of EMS in IPE activities will help enhance the overall professional impression of the vital resource EMS can have in health care delivery. It will improve and extend the continuum of care to the initial entry of the patient into the healthcare system and integrate the role EMS providers have in improving patient safety and patient outcomes.

Twelve laboratories from 7 countries compared the productivity of refrigerated (72 h at 5 to 10°C) preenrichment and enrichment broth cultures with a standard cultural procedure for detection of Salmonella in 466 naturally contaminated low and high moisture foods. Refrigerated preenrichment and enrichment cultures identified 92.5 and 94.2% of contaminated samples, respectively. Variations in the ability of laboratories to successfully recover salmonellae under refrigeration test conditions were notable. Three laboratories found complete agreement between results by the standard and refrigeration test procedures and 5 additional laboratories reported >90% accuracy; lowest recovery rate for combined refrigeration results was 77%. Sensitivity of the refrigeration techniques was markedly greater with low than high moisture foods where the latter contributed all but two of the 62 false-negative results encountered in this study. Ability of individual laboratories to recover Salmonella from refrigerated preenrichment and enrichment broth cultures was not significantly different for given food categories. Productivity of paired enrichment-plating media differed widely with food type. Selective enrichment in tetrathionate brilliant green and plating on bismuth sulfite agar showed greatest sensitivity for isolation of Salmonella in high but not in low moisture foods where productivity of the 4 enrichment-plating conditions used in this study was comparable. Results on recoverability of Salmonella from refrigerated broth cultures concur with findings of an earlier comparative study and strongly support incorporation of this novel approach in standard cultural methods for detection of Salmonella in foods.

Intrapartum fetal monitoring to assess fetal well-being during the labor and delivery process has been a central component of intrapartum care for decades. Today, electronic fetal monitoring (EFM) is the most common method used to assess the fetus during labor without substantial evidence to suggest a benefit. A Cochrane review of 13 trials, which included over 37,000 women, found that continuous EFM provided no significant improvement in perinatal death rate [risk ratio (RR) 0.86; 95% confidence interval (CI), 0.59-1.23] or cerebral palsy rate (RR 1.75; 95% CI, 0.84-3.63) as compared with intermittent auscultation; however, there was a significant decrease in neonatal seizures (RR 0.50; 95% CI, 0.31-0.80). In addition, there was a significant increase in cesarean delivery (RR 1.63; 95% CI, 1.29-2.07) and operative vaginal delivery (RR 1.15; 95% CI, 1.01-1.33). Despite the lack of scientific support to suggest that EFM reduces adverse neonatal outcomes, its use is almost universal in the hospital setting and very likely has contributed to the rise in cesarean rate.

Unintended pregnancy disproportionately affects younger, minority, and low-income women. The purpose of this analysis is to describe our recruitment strategies and to determine if targeted efforts to reach women at greatest risk for unintended pregnancy and sexually transmitted infection (STI) were successful.The Contraceptive CHOICE Project is a prospective cohort study providing reversible contraception at no cost to 10,000 women aged 14-45 years in the St. Louis area in order to evaluate method satisfaction and continuation and to reduce unintended pregnancies in the region. We describe four strategies for effective outreach and recruitment of high-risk women, including forming strong community partnerships. We analyze the evolution of baseline demographic and behavioral characteristics over the three waves of enrollment of the first 2,500 participants in order to assess whether our outreach efforts were successful.Overall,60% of participants were aged ≤25 years. There was a significant increase in the percentage of minority participants enrolled throughout the first 2,500 subjects (p 0.001). The number of women who reported trouble paying for basic necessities significantly increased over the three waves (p = 0.025). Throughout the three waves of enrollment, there was a significant increase in the number of women who tested positive for an STI at baseline (p 0.001).A multiple method approach with collaboration of key community partners led to successful recruitment of hard to reach populations at high risk for unintended pregnancy and STI.

In this study, the contact resistance (CR) and electrochemical properties of TiN, CrN and TiAlN electron beam physical vapor deposition (EBPVD) coatings and their stainless steel 316L (SS316L) substrate were investigated in a simulated proton exchange membrane (PEM) fuel cell environment. The potentiodynamic polarization corrosion tests were conducted at 70 °C in 1 M H 2 SO 4 purged with either O 2 or H 2 , and the potentiostatic corrosion tests were performed under both simulated cathodic (+0.6 V vs. Ag/AgCl reference electrode purged with O 2 ) and anodic conditions (−0.1 V vs. Ag/AgCl reference electrode purged with H 2 ) for a long period (4 h). SEM was used to observe the surface morphologies of the samples after corrosion testing. All the TiN-, TiAlN- and CrN-coated SS316L showed a lower CR than the uncoated SS316L. While the corrosion performance of the coatings was dependent on the cathodic and anodic conditions, the CrN coating exhibited a higher (in the anodic environment) or similar (in the cathodic environment) corrosion resistance to the uncoated SS316L. Thus, the CrN-coated SS316L could potentially be used as a bipolar plate material in the PEM fuel cell environment. Although the EBPVD process greatly reduced number of pinholes in the coatings compared to other plasma enhanced reactive evaporations, future research efforts should be directed to eliminate the pinholes in the coatings for long-term durability in fuel cell applications.

This paper reports on tribological properties of magnetron-sputtered WC–C and chemical vapour-deposited diamond-like carbon films coated onto hard-metal surfaces when sliding on aluminium foil (0.2 mm nominal thickness) at different temperatures. The study addresses the evolution of the coefficient of friction at the interfaces of the coated hard metal and the aluminium foil under dry-lubrication conditions, in a ball-on-disc configuration. The wear mechanisms of the aluminium foil and the damage produced on the coated surfaces due to the sticking of aluminium were evaluated as a function of the deposited coating and the temperature at their interfaces. Aluminium-transfer to WC–C coated hard-metal surfaces during the sliding operation seemed to be a non-continuous process, which appeared after a certain number of sliding cycles. Temperatures above 70°C accelerated the transfer of aluminium to the WC–C tool surfaces. Chemical vapour-deposited diamond-like carbon films hindered the transfer of aluminium to the hard metal even at temperatures of around 125°C. At greater temperatures, an aluminium–aluminium tribosurface is formed at the interface, which increases the wear rate of the foils and rapidly degrades the quality of coatings of the hard-metal surfaces.

In this research, CrAlN and TiN coatings were deposited on AISI M2 tool steel substrate test coupons and on industrial punch tools by electron beam plasma-assisted physical vapour deposition (EB-PAPVD). The microstructure and morphology of the coatings were investigated by XRD, XPS, TEM, and SEM with EDX. Pin-on-disc tribotests were conducted on the coatings against AISI 52100 steel counterface material in order to investigate their wear performance, with particular emphasis on the material transfer phenomena during the sliding tests. After industrial trials on piercing high strength steels, the worn uncoated as well as CrAlN- and TiN-coated punches were also studied. The results showed that the nanostructured CrAlN coating exhibited less material transfer and thus better adhesive wear protection than the TiN coating under both laboratory pin-on-disc tribotests and industrial trial conditions. It was also found that the coating morphologies replicated the surface finish of the punch substrates, and that local coating spallation appeared to be initiated at machining grooves on the punches, which were detrimental to the coating lifetime.

An attempt to improve the load support for hard PVD coatings on soft Cu alloys has been made by using a medium phosphorous content electroless Ni–P coating prior to PVD deposition, envisaging the application of these coating/substrate systems in plastic injection moulding. Several PVD coatings, including TiN, CrN, CrAlN, multilayered CrAlN, WC–C, multilayered CrAlN/WC–C were deposited onto an Ampcoloy 940 Cu alloy in two conditions: ‘standard’ and electroless Ni–P plated. The effect of the electroless Ni–P coating on the coating/substrate performance was evaluated by pin-on-disc wear and impact tests. Ultra-microhardness and surface roughness measurements were also used to characterise the resulting coating/substrate systems. The electroless Ni–P coating reduced the wear rates of the PVD-coated Cu alloys and increased the impact wear resistance. Among the PVD coatings trialled, CrN, CrAlN and multilayered CrAlN coatings on electroless Ni–P provided the lowest wear rates.

Diamond-like carbon (DLC) coatings have found great applicability in the automotive industry because of their low friction coefficient and high wear resistance. Nevertheless, their tribological performance can be greatly reduced on soft substrates such as titanium alloys. The hard DLC coating cannot usually follow elastic and plastic deformation of the substrate without failing. In order to overcome this property mismatch between hard coating and soft substrate, triode plasma nitriding was applied as a pre-treatment to improve the mechanical properties of the Ti6Al4V alloy and further enhance the load support for the DLC coating. DLC and multilayered TiN/DLC, CrN/DLC CrAlN/DLC coatings were deposited onto “standard” and plasma nitrided Ti6Al4V substrates. Triode plasma nitriding increased the load-bearing capacity of the coating/substrate system, as higher critical adhesion loads were recorded for DLC coatings on plasma nitrided Ti6Al4V substrates. This treatment also reduced the wear rate of the DLC coating/substrate. Further load support and lower wear rates were achieved by using TiN, CrN and CrAlN as intermediate layers on plasma nitrided Ti6Al4V substrates.

This paper reports an investigation on the tribological properties of Al thin foils (0.2 mm nominal thickness) in sliding contact with PVD-coated carbide forming-tools, with reference to the applications in the manufacture of miniature/micro-products, particularly through micro-forming. The study addresses the evolution of the friction coefficient between both surfaces under dry lubrication conditions, its influence on the surface quality of the processed material and the damage produced on the tool due to sticking phenomena. Uncoated, CrN-coated and WC-C-coated tools were tested, using a pin-on-disc configuration to monitor the evolution of the relative friction coefficients under different contact pressures. It was shown that the contact sliding of Al foils on the untreated carbide tool produced a significant transfer of Al to the tool, leading to a rapid degradation of both tool and foil surfaces, even faster than that produced on bulk aluminium. Conversely, the sticking of Al was retarded using low friction magnetron sputtered WC-C-coated carbides. Other PVD coatings such as CrN failed under similar operation conditions. Aluminium transfer to the WC-C-coated tool surfaces during sliding seemed to be a non-continuous process, which appeared after certain sliding distances. Temperature accelerated the Al transfer to the WC-C tool surfaces, probably due to the increase of the thermoplastic behaviour of Al above 100 °C, which led to an increase of the adhesive interaction with the WC-C coating.

Objective The objective of this study was to estimate the association between time from uterine incision to delivery and hypoxic neonatal outcomes in nonanomalous term infants. Methods All women undergoing in-labor term cesarean deliveries (CDs) in the first 2 years of an ongoing prospective cohort study were included. The primary exposure was time in seconds from uterine incision to delivery. The primary outcome was a composite of hypoxia-associated neonatal outcomes, defined as at least one of: seizures, hypoxic ischemic encephalopathy, need for hypothermia treatment, and death within 7 days. Results Of 812 patients who underwent in-labor CD, the composite hypoxia outcome occurred in 18 (2.2%) neonates. There was no significant difference in the rate of hypoxic morbidity with increasing increments of 60 seconds from uterine incision to delivery (p = 0.35). There was a significantly increased risk of hypoxic morbidity in those delivered in the highest quintile (>240 seconds) compared with those in the lowest quintile (≤60 seconds) in cesareans performed for an indication other than nonreassuring fetal status (relative risk, 5.58; 95% confidence interval, 1.30–23.91). Conclusion Overall, duration from uterine incision to delivery for in-labor cesareans of nonanomalous term infants was not associated with an increase in risk of hypoxia-associated morbidities.

There is an increasing number of applications for hard coatings in engineering where both high oxidation resistance and hot hardness are required. One way to address this problem is to use hard ceramic coatings which are a combination of more than one metal so that the coating performance will benefit from the combined mechanical properties of the metals present. In this study, chromium aluminium nitride (Cr–Al–N), titanium nitride (Ti–N), titanium aluminium nitride (Ti–Al–N) and chromium nitride (Cr–N) coatings were deposited on 6.35 mm HSS drills and on hardened and polished AISI M2 steel test discs by means of electron beam plasma-assisted physical vapour deposition. For all depositions, the coating temperature was below 500 °C. Laboratory tests were performed to characterise the mechanical and tribological properties of the coatings. Along with the laboratory tests, accelerated drilling tests and actual industrial applications (punching and gear-shaping) were also used to evaluate the performance of the coatings. The results from the laboratory characterisation, drill tests and industrial applications all showed that Cr–Al–N performs exceptionally well compared to the industry “standards” of Ti–N, Ti–Al–N and titanium carbo-nitride (Ti–C–N). The exceptional performance of Cr–Al–N compared to the other coatings is considered with reference to the coatings’ characteristics.

Plasma nitriding of different substrates such as Ti6Al4V and AISI M2 steel was achieved by means of D.C. glow discharges assisted by thermionic emission (triode configuration). The higher ionisation levels achieved using a D.C. triode configuration reduced the treatment time and nitriding temperature required to obtain hard and reasonably deep nitrided cases in the Ti6Al4V alloy. For this alloy, surface hardness values of 560–600 HV 0.05 and nitrided layer depths of 30–40 μm were achieved at 700 °C. Up to this nitriding temperature, hardening seemed to be mainly accomplished by incorporation of nitrogen in the α-Ti phase, as the formation of a titanium nitride layer on the surface could not be detected by SEM. For the AISI M2 steel, hard (1379–1524 HV 0.05 ) nitrided layers of 100–150 μm were obtained at 480–500 °C for 240 min, depending on total pressure, gas composition and substrate bias. For the highest nitrogen concentration and lowest bias voltage, no compound layer was formed. The triode plasma nitriding process allowed a significant reduction in processing time for both M2 steel and Ti6Al4V alloy in comparison to conventional D.C. diode plasma nitriding.

This paper is focussed on the characterisation of electron beam evaporation plasma-assisted physical vapour deposition Cr–N coatings deposited on AISI M2 steel and hardmetal (K10) substrates in two different conditions: Pristine (i.e., coated) and Recoated (i.e., stripped and recoated). Analytical methods, including X-ray diffraction (XRD), scanning electron microscopy, scratch adhesion and pin-on-disc tests were used to evaluate several coating properties. XRD analyses indicated that both Pristine and Recoated coatings consisted of a mixture of hexagonal Cr2N and cubic CrN, regardless of substrate type. For the M2 steel substrate, only small differences were found in terms of coating phases, microstructure, adhesion, friction and wear coefficients between Pristine and Recoated. Recoated on WC–Co (K10) exhibited a less dense microstructure and significant inferior adhesion compared to Pristine on WC–Co (K10). The wear coefficient of Recoated on WC–Co was 100 times higher than those exhibited by all other specimens. The results obtained confirm that the stripping process did not adversely affect the Cr–N properties when this coating was deposited onto M2 steel substrates, but it is clear from the unsatisfactory tribological performance of Recoated on WC–Co that the stripping process is unsuitable for hardmetal substrates.

Cr–N benefits from good oxidation and corrosion resistance, which has, until recently, caused difficulties in removing the coating without damage to substrates. Consequently, the industrial use of Cr–N coatings, particularly on expensive tools, has been limited. As a new commercially viable wet-stripping process has been developed that causes little or negligible damage to steel substrates, it is appropriate to investigate the effect of coating thickness and structure on the stripping rate of different Cr–N films. In this work, Cr–N coatings deposited by magnetron sputtering, arc and electron beam evaporation, having different thicknesses, was wet-stripped. The stripping rate was evaluated by statistical analyses for each deposition method and thickness. The stripping rate for the various deposition methods was correlated to the coating phases, structure, morphology, and surface roughness, which varied depending on the deposition process. For all deposition methods, the stripping rate was constant at a given as-deposited coating thickness. Regardless of the deposition method, the stripping rate for all different as-deposited thicknesses was statistically similar within the same deposition process, indicating that the stripping rate was independent of the coating thickness. Moreover, the stripping rate was not influenced by changes in the coating structure with increased thickness, which occurred in arc and electron beam Cr–N coatings. For coatings having similar as-deposited thicknesses, the highest stripping rate was obtained in magnetron sputtered Cr–N (∼ 4.4 μm h − 1 ), followed by electron beam and arc Cr–N coatings, which displayed similar stripping rates (∼ 3.3 μm h − 1 ). The highest stripping rate recorded for magnetron Cr–N coatings could not be explained by changes in coating structure/morphology and surface roughness. The differences in the stripping were attributed to the amount of CrN phase present in the coatings.

Recent breakthroughs in wet-stripping Physical Vapour Deposited (PVD) CrN coatings on standard high speed and stainless steels and on hard metal substrates are reported in this work. Validation of the stripping processes was evaluated in terms of substrate damage after exposure to the chemical agents and also in terms of the tribological properties of the PVD CrN layers before (Pristine) and after stripping and re-coating (Recoated). The investigation was focussed on the influence of the stripping process on the hardness, roughness, adherence and wear resistance of the Recoated CrN coatings deposited by electron beam PVD (e-beam) after stripping. Analysis of the chemically stripped and Recoated steel substrates showed that: (a) hardness and elastic modulus of the Recoated e-beam CrN did not change significantly compared to Pristine e-beam CrN, and (b) surface roughness of the Recoated e-beam CrN layers was greater by a factor of 50–60% than the initial. For hard-metal substrates, the surface damage and its effect on the re-deposited coating performance in terms of the chemical reactions during the stripping process were discussed. It was observed that wet-stripping in a basic solution led to depletion of tungsten and carbon at the surface of the stripped WC-Co specimens. D 2004 Elsevier B.V. All rights reserved.

Objective The purpose of this study was to identify ante- and intrapartum risk factors for serious morbidity in term nonanomalous neonates. Study Design We analyzed the first 5000 subjects within an ongoing prospective cohort study of consecutive term births from 2010-2012. The primary outcome was a composite of serious neonatal morbidity defined as ≥1 cases of hypoxic ischemic encephalopathy, meconium aspiration with pulmonary hypertension, requirement of hypothermia therapy, respiratory distress syndrome, seizures, sepsis or suspected sepsis, or death. We calculated odds ratios for the composite morbidity that is associated with ante- and intrapartum factors. Multivariable logistic regression was used to estimate adjusted odds ratios. Results Of 5000 term nonanomalous births, 393 had the composite morbidity. Significant risk factors for morbidity were nulliparity, presence of meconium, first stage of labor >95th percentile, second stage of labor >95th percentile, pregestational diabetes mellitus, chronic hypertension, obesity, maternal intrapartum fever, and cesarean delivery. In contrast, induction of labor and gestational age ≥41 weeks were not associated with significant morbidity. Conclusion We identified several significant risk factors for serious morbidity in term nonanomalous neonates. Clinicians may use these risk factors to help anticipate the potential need for additional neonatal support at delivery.

We sought to examine neonatal morbidity associated with different maneuvers used among term patients who experience a shoulder dystocia.We conducted a retrospective cohort study of all women who experienced a clinically diagnosed shoulder dystocia at term requiring obstetric maneuvers at a single tertiary care hospital from 2005 through 2008. We excluded women with major fetal anomaly, intrauterine death, multiple gestation, and preterm. Women exposed to Rubin maneuver, Wood's screw maneuver, or delivery of the posterior arm were compared to women delivered by McRoberts/suprapubic pressure only, which served as the reference group. The primary outcome was a composite morbidity of neonatal injury (defined as clavicular or humeral fracture or brachial plexus injury) and neonatal depression (defined as Apgar7 at 5 minutes, arterial cord pH7.1, continuous positive airway pressure use, intubation, or respiratory distress). Logistic regression was used to adjust for nulliparity and duration of shoulder dystocia, defined as time from delivery of fetal head to delivery of shoulders.Among the 231 women who met inclusion criteria, 135 were delivered by McRoberts/suprapubic pressure alone (57.9%), 83 women were exposed to Rubin maneuver, 53 women were exposed to Wood's screw, and 36 women were exposed to delivery of posterior arm. Individual maneuvers were not associated with composite morbidity, neonatal injury, or neonatal depression after adjusting for nulliparity and duration of shoulder dystocia.We found no association between shoulder dystocia maneuvers and neonatal morbidity after adjusting for duration, a surrogate for severity. Our results demonstrate that clinicians should utilize the maneuver most likely to result in successful delivery.

To compare first-stage labor patterns in women in preterm labor to those in labor at term.We performed a retrospective cohort study of consecutive women admitted from 2004 to 2008 with viable (≥ 24 weeks) vertex singleton gestations who reached the second stage of labor. Labor curves for preterm and term labor were created using a repeated-measures analysis with polynomial modeling. Interval-censored regression was used to estimate and compare median time of progression of labor. Multivariable analyses were performed to adjust for smoking, obesity (body mass index ≥ 30), induction, and nulliparity. The adjusted model was stratified by parity and induction of labor.Of 5,612 consecutive births, 224 were preterm (37 weeks) and 5,388 were term (≥ 37 weeks). Preterm first-stage labor progressed significantly faster than term labor (median time 4 to 10 cm: 3.3 hours versus 4.5 hours, p 0.01). When stratified by parity, preterm labor progressed significantly more rapidly than term labor in both nulliparous and multiparous women (median time 4 to 10 cm: 3.7 hours versus 4.9 hours [p = 0.04] in nulliparous women and 2.5 hours versus 4.3 hours [p = 0.01] in multiparous women).Women in preterm labor progress more rapidly through the first stage of labor than women at term.

Few studies have compared self-report and clinician-administered measures of youth psychopathic features in juvenile-justice settings in terms of antisocial behavior and treatment indices. In a sample of 85 adjudicated delinquents, the predictive validities of the Antisocial Process Screening Device (APSD), the modified Childhood Psychopathy Scale (mCPS), and the Hare Psychopathy Checklist: Youth Version (PCL:YV) were tested. Three indices of institutional antisocial behavior (physical aggression; verbal aggression; administrative infractions) and two indices of treatment progress (time to treatment level promotion; whether treatment levels were dropped) were used as external correlates. The self-report measures (mCPS more so than APSD) were more consistently and strongly related to antisocial behavior and to the days required to progress in treatment than the PCL:YV. The following issues are discussed: (i) implications of the potential impact of measurement format on the understanding and predictive validity of youth psychopathy features and measures; (ii) the differential predictive validity of self-report versus clinician-administered measures; and (iii) the potential practical utility of measures of psychopathic features in youth. Copyright © 2004 John Wiley & Sons, Ltd.

Purpose: Create an internet based multi‐institutional stereotactic radiosurgery patient registry for the purposes of: 1) tracking patient outcomes, 2) assisting with patient follow‐up, 3) comparison of utilization and outcomes data with national averages, 4) reviewing in‐house utilization; professional and technical, and 5) tracking patient treatment parameters. Method and Materials: A multidisciplinary advisory board was created that included physicians, physicists, nurses, therapists and administrators. Over a period of one year this group was responsible for defining the data to be collected, the structure of the data, the collection and storage methods, the electronic interface to the registry, and ultimately presentation of the data in multiple reports. Particular emphasis was placed on what data to collect; only data with clinical or utilization value was defined. Patient privacy was also paramount in the registry design. After creating data definitions, requirements were given to a commercial vendor for the database creation. The initial database and interface was evaluated by the board and recommendations for its improvement were made. These recommendations were incorporated into the current design of the registry. Site participation in the registry is voluntary, but IRB approval is required. Results: An internet based patient registry was created. Patient privacy is guaranteed by adhering to HIPAA regulations. Individual site privacy is also maintained. Sites only have access to their data, or national data in aggregate format. Patient data has been entered from multiple centers. Conclusion: The patient registry functions as designed and continues to be evaluated for possible improvements. Multiple centers are participating and data continues to accrue. Data abstraction by Cancer Registry personnel at author's center takes approximately 30 minutes. It is our hope that meticulous data collection as described will benefit our patients, increase interest in research and development, and serve as a comprehensive data source for evidence based treatment disciplines.

SUMMARYThe proportion of salmonella carriers among town-nesting herring gulls increased significantly from 2·1% in 1975–6 to 8·4% in 1979. The range of serotypes carried by herring gulls was similar to that causing infection in man, and it is likely that the gulls ingest these serotypes when feeding at untreated sewage outfalls on the coast. This is supported by the proportion of salmonella carriers being higher among first-year birds (9·7%) than among older birds (2·0%), as it is known that higher proportions of immature herring gulls feed on the coast. Herring gulls carrying salmonellas appeared healthy at the time of capture and at a later date it was assumed that they were not themselves infected. However, their habit of congregating in large numbers on reservoirs and rubbish tips and also at resting sites on farmland often far from feeding and roosting areas, multiplies thejpollution problem and increases the potential health hazard for both man and farm stock. Herring gulls feed at a variety of sites and fly many miles from food source to food source and from feeding areas to the roost. Thus, even within the same day, there is the possibility of the transfer of salmonellas over a much wider area than previously considered.

Two samples of patients suffering from senile dementia were administered the Kew tests for parietal lobe function and aphasia. No evidence emerged of any clinical heterogeneity; parietal lobe test performance was found to be more a function of degree of impairment rather than of age.

SUMMARYIn 1988 there were two outbreaks of infection with Salmonella enteritidis phage type 4 in adjacent local authorities. The first affected 18 of 75 helpers and guests who attended a private function. Investigations revealed that home-made vanilla ice-cream containing uncooked eggs was the vehicle of infection and the causative organism was identified at the premises of the egg producer. The second affected 84 of 422 delegates attending a conference dinner, and 12 of 50 hotel staff at risk. A dessert made with lightly-cooked egg yolk and raw egg white was associated with infection, and the epidemic strain was cultured from the shell of an egg and an environmental sample from the producer's farm. It is of interest that one outbreak involved free-range and one battery-produced eggs, and that in one the vehicle was prepared at home and in the other in commercial premises. In neither incident was any deficiency in standards of egg production or catering practice discovered.