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This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited., The Nadir and Occultation for MArs Discovery (NOMAD) instrument suite aboard ExoMars/Trace Gas Orbiter spacecraft is mainly conceived for the study of minor atmospheric species, but it also offers the opportunity to investigate surface composition and aerosols properties. We investigate the information content of the Limb, Nadir, and Occultation (LNO) infrared channel of NOMAD and demonstrate how spectral orders 169, 189, and 190 can be exploited to detect surface CO2 ice. We study the strong CO2 ice absorption band at 2.7 μm and the shallower band at 2.35 μm taking advantage of observations across Martian Years 34 and 35 (March 2018 to February 2020), straddling a global dust storm. We obtain latitudinal-seasonal maps for CO2 ice in both polar regions, in overall agreement with predictions by a general climate model and with the Mars Express/OMEGA spectrometer Martian Years 27 and 28 observations. We find that the narrow 2.35 μm absorption band, spectrally well covered by LNO order 189, offers the most promising potential for the retrieval of CO2 ice microphysical properties. Occurrences of CO2 ice spectra are also detected at low latitudes and we discuss about their interpretation as daytime high altitude CO2 ice clouds as opposed to surface frost. We find that the clouds hypothesis is preferable on the basis of surface temperature, local time and grain size considerations, resulting in the first detection of CO2 ice clouds through the study of this spectral range. Through radiative transfer considerations on these detections we find that the 2.35 μm absorption feature of CO2 ice clouds is possibly sensitive to nm-sized ice grains. © 2022. The Authors., ExoMars is a space mission of the European Space Agency (ESA) and Roscosmos. The NOMAD experiment is led by the Royal Belgian Institute for Space Aeronomy (IASB-BIRA), assisted by Co-PI teams from Spain (IAA-CSIC), Italy (INAF-IAPS), and the United Kingdom (The Open University). This project acknowledges funding by the Belgian Science Policy Office (BELSPO), with the financial and contractual coordination by the ESA Prodex Office (PEA 4000103401, 4000121493), by Spanish Ministry of Science and Innovation (MCIU) and by European funds under grants PGC2018-101836-BI00 and ESP2017-87143-R (MINECO/FEDER), as well as by UK Space Agency through grants ST/V002295/1, ST/V005332/1, and ST/S00145X/1 and Italian Space Agency through Grant 2018-2-HH.0. This work was supported by the Belgian Fonds de la Recherche Scientifique—FNRS under Grant No. 30442502 (ET_HOME). The IAA/CSIC team acknowledges financial support from the State Agency for Research of the Spanish MCIU through the “Center of Excellence Severo Ochoa” award for the Instituto de Astrofísica de Andalucía (SEV-2017-0709). US investigators were supported by the National Aeronautics and Space Administration. Canadian investigators were supported by the Canadian Space Agency. SR thanks BELSPO for the FED-tWIN funding (Prf-2019-077—RT-MOLEXO). Open Access Funding provided by Istituto nazionale di astrofisica within the CRUI-CARE Agreement.

The Jovian InfraRed Auroral Mapper (JIRAM) onboard the NASA Juno mission monitored the evolution of Jupiter’s polar cyclones since their first observation ever in February 2017. Data acquired by JIRAM have revealed cloudy cyclones organized in a complex, yet stable geometrical pattern at both poles. Several studies have investigated the dynamics and the structure of these cyclones, to understand the physical mechanisms behind their formation and evolution. In this work, we present vorticity maps deduced from the wind fields for the region poleward of ∼−80°, which has been extensively covered over the last four years of observations. The cyclonic features related to the stable polar cyclones are embedded in a slightly, but diffused anticyclonic circulation, in which short-living anticyclones emerge with respect to the surroundings. Although the general stability of both the cyclones and the whole system is strongly confirmed by this work, variations in the shape of the vortices, as well as changes in the local structures, have been observed.

The regular polygons of circumpolar cyclones, discovered by Juno in 2017, are one of the most puzzling features of Jupiter. Here we show new recent global pictures of the North polar cyclones' structure. These are the first simultaneous images of the whole structure since 2017, and we find that it remained almost unperturbed, just like the South one. The observation of these long-lasting structures poses questions regarding the formation mechanism of cyclones, and on their vertical structure. Data by Juno/JIRAM infrared camera collected over the last 5 years show that cyclones migrate around what may seem like equilibrium positions, with timescales of a few months but, aside from that, the cyclones systems are very stable. Our analysis of the observations shows that the motion of cyclones around their equilibrium position is uncorrelated with their position if a barotropic approximation (β-drift) is assumed. Thus, a different dynamical explanation than the barotropic β-drift is needed to explain the stability of the observed features. Each cyclone has a peculiar morphology, which differs from the others and is stable over the observed lapse of time in most cases.

The Ma_MISS spectrometer is integrated within the drilling system of the Rosalind Franklin ExoMars rover. This paper reports the on-ground calibration campaign performed on the spectrometer. Here, we focus on the spectral calibration of the instrument. The experimental setup used to carry out calibration is described, and the methods used for data processing and key parameters retrieval are explained. In particular, the spectral parameters such as (i) pixel central wavelengths, (ii) spectral response function, (iii) spectral resolution, (iv) sampling, and (v) range are determined. In a follow-up paper, the linearity and radiometric calibrations are described, while in De Sanctis et al. [Planet. Sci. J. 3, 142 (2022)], the validation of spectral measurements performed on synthetic and natural rock targets is presented.

The Nadir and Occultation for MArs Discovery (NOMAD) instrument suite aboard ExoMars/Trace Gas Orbiter spacecraft is mainly conceived for the study of minor atmospheric species, but it also offers the opportunity to investigate surface composition and aerosols properties. We investigate the information content of the Limb, Nadir, and Occultation (LNO) infrared channel of NOMAD and demonstrate how spectral orders 169, 189, and 190 can be exploited to detect surface CO

An essential part of the Exomars 2022 payload is the Mars Multispectral Imager for Subsurface Studies (Ma_MISS) experiment hosted by the drill system. Ma_MISS is a visible and near-infrared (0.4–2.3 μm) miniaturized spectrometer with an optical head inside the drill tip capable of observing the drill borehole with a spatial resolution of 120 μm. Here we report on how the Ma_MISS hyperspectral information provides in situ investigation of the subsurface at very fine resolution, prior to the collection of the samples that will be manipulated and crushed for further analysis by the analytical laboratory on the rover. Ma_MISS is the instrument that will closely investigate the subsurface mineralogical characteristics in its original geologic context at depths never reached before in Mars exploration. Ma_MISS recognizes all the major spectral features of the clays, basaltic, and minor phases expected at the ExoMars landing site, Oxia Planum. The high spatial resolution on the borehole wall is such that single grains of about 100 μm can be distinguishable in the assemblage of minerals observed by Ma_MISS. The spatial distribution of the mineralogies within the borehole walls is associated with the rocks and the processes that put these materials in place and possibly altered them with time, characterizing the habitats found in the stratigraphic record, indicating which ones are the most suitable to have held or to be holding nowadays traces of life.

Return of samples from the surface of Mars has been a goal of the international Mars science community for many years. Affirmation by NASA and ESA of the importance of Mars exploration led the agencies to establish the international MSR Objectives and Samples Team (iMOST). The purpose of the team is to re-evaluate and update the sample-related science and engineering objectives of a Mars Sample Return (MSR) campaign. The iMOST team has also undertaken to define the measurements and the types of samples that can best address the objectives. Seven objectives have been defined for MSR, traceable through two decades of previously published international priorities. The first two objectives are further divided into sub-objectives. Within the main part of the report, the importance to science and/or engineering of each objective is described, critical measurements that would address the objectives are specified, and the kinds of samples that would be most likely to carry key information are identified. These seven objectives provide a framework for demonstrating how the first set of returned Martian samples would impact future Martian science and exploration. They also have implications for how analogous investigations might be conducted for samples returned by future missions from other solar system bodies, especially those that may harbor biologically relevant or sensitive material, such as Ocean Worlds (Europa, Enceladus, Titan) and others. Summary of Objectives and Sub-Objectives for MSR Identified by iMOST: Objective 1 Interpret the primary geologic processes and history that formed the Martian geologic record, with an emphasis on the role of water. Intent To investigate the geologic environment(s) represented at the Mars 2020 landing site, provide definitive geologic context for collected samples, and detail any characteristics that might relate to past biologic processesThis objective is divided into five sub-objectives that would apply at different landing sites. 1.1 Characterize the essential stratigraphic, sedimentologic, and facies variations of a sequence of Martian sedimentary rocks. Intent To understand the preserved Martian sedimentary record. Samples A suite of sedimentary rocks that span the range of variation. Importance Basic inputs into the history of water, climate change, and the possibility of life 1.2 Understand an ancient Martian hydrothermal system through study of its mineralization products and morphological expression. Intent To evaluate at least one potentially life-bearing “habitable” environment Samples A suite of rocks formed and/or altered by hydrothermal fluids. Importance Identification of a potentially habitable geochemical environment with high preservation potential. 1.3 Understand the rocks and minerals representative of a deep subsurface groundwater environment. Intent To evaluate definitively the role of water in the subsurface. Samples Suites of rocks/veins representing water/rock interaction in the subsurface. Importance May constitute the longest-lived habitable environments and a key to the hydrologic cycle. 1.4 Understand water/rock/atmosphere interactions at the Martian surface and how they have changed with time. Intent To constrain time-variable factors necessary to preserve records of microbial life. Samples Regolith, paleosols, and evaporites. Importance Subaerial near-surface processes could support and preserve microbial life. 1.5 Determine the petrogenesis of Martian igneous rocks in time and space. Intent To provide definitive characterization of igneous rocks on Mars. Samples Diverse suites of ancient igneous rocks. Importance Thermochemical record of the planet and nature of the interior. Objective 2 Assess and interpret the potential biological history of Mars, including assaying returned samples for the evidence of life. Intent To investigate the nature and extent of Martian habitability, the conditions and processes that supported or challenged life, how different environments might have influenced the preservation of biosignatures and created nonbiological “mimics,” and to look for biosignatures of past or present life.This objective has three sub-objectives: 2.1 Assess and characterize carbon, including possible organic and pre-biotic chemistry. Samples All samples collected as part of Objective 1. Importance Any biologic molecular scaffolding on Mars would likely be carbon-based. 2.2 Assay for the presence of biosignatures of past life at sites that hosted habitable environments and could have preserved any biosignatures. Samples All samples collected as part of Objective 1. Importance Provides the means of discovering ancient life. 2.3 Assess the possibility that any life forms detected are alive, or were recently alive. Samples All samples collected as part of Objective 1. Importance Planetary protection, and arguably the most important scientific discovery possible. Objective 3 Quantitatively determine the evolutionary timeline of Mars. Intent To provide a radioisotope-based time scale for major events, including magmatic, tectonic, fluvial, and impact events, and the formation of major sedimentary deposits and geomorphological features. Samples Ancient igneous rocks that bound critical stratigraphic intervals or correlate with crater-dated surfaces. Importance Quantification of Martian geologic history. Objective 4 Constrain the inventory of Martian volatiles as a function of geologic time and determine the ways in which these volatiles have interacted with Mars as a geologic system. Intent To recognize and quantify the major roles that volatiles (in the atmosphere and in the hydrosphere) play in Martian geologic and possibly biologic evolution. Samples Current atmospheric gas, ancient atmospheric gas trapped in older rocks, and minerals that equilibrated with the ancient atmosphere. Importance Key to understanding climate and environmental evolution. Objective 5 Reconstruct the processes that have affected the origin and modification of the interior, including the crust, mantle, core and the evolution of the Martian dynamo. Intent To quantify processes that have shaped the planet's crust and underlying structure, including planetary differentiation, core segregation and state of the magnetic dynamo, and cratering. Samples Igneous, potentially magnetized rocks (both igneous and sedimentary) and impact-generated samples. Importance Elucidate fundamental processes for comparative planetology. Objective 6 Understand and quantify the potential Martian environmental hazards to future human exploration and the terrestrial biosphere. Intent To define and mitigate an array of health risks related to the Martian environment associated with the potential future human exploration of Mars. Samples Fine-grained dust and regolith samples. Importance Key input to planetary protection planning and astronaut health. Objective 7 Evaluate the type and distribution of in-situ resources to support potential future Mars exploration. Intent To quantify the potential for obtaining Martian resources, including use of Martian materials as a source of water for human consumption, fuel production, building fabrication, and agriculture. Samples Regolith. Importance Production of simulants that will facilitate long-term human presence on Mars. Summary of iMOST Findings: Several specific findings were identified during the iMOST study. While they are not explicit recommendations, we suggest that they should serve as guidelines for future decision making regarding planning of potential future MSR missions. The samples to be collected by the Mars 2020 (M-2020) rover will be of sufficient size and quality to address and solve a wide variety of scientific questions. Samples, by definition, are a statistical representation of a larger entity. Our ability to interpret the source geologic units and processes by studying sample sub sets is highly dependent on the quality of the sample context. In the case of the M-2020 samples, the context is expected to be excellent, and at multiple scales. (A) Regional and planetary context will be established by the on-going work of the multi-agency fleet of Mars orbiters. (B) Local context will be established at field area- to outcrop- to hand sample- to hand lens scale using the instruments carried by M-2020. A significant fraction of the value of the MSR sample collection would come from its organization into sample suites, which are small groupings of samples designed to represent key aspects of geologic or geochemical variation. If the Mars 2020 rover acquires a scientifically well-chosen set of samples, with sufficient geological diversity, and if those samples were returned to Earth, then major progress can be expected on all seven of the objectives proposed in this study, regardless of the final choice of landing site. The specifics of which parts of Objective 1 could be achieved would be different at each of the final three candidate landing sites, but some combination of critically important progress could be made at any of them. An aspect of the search for evidence of life is that we do not know in advance how evidence for Martian life would be preserved in the geologic record. In order for the returned samples to be most useful for both understanding geologic processes (Objective 1) and the search for life (Objective 2), the sample collection should contain BOTH typical and unusual samples from the rock units explored. This consideration should be incorporated into sample selection and the design of the suites. The retrieval missions of a MSR campaign should (1) minimize stray magnetic fields to which the samples would be exposed and carry a magnetic witness plate to record exposure, (2) collect and return atmospheric gas sample(s), and (3) collect additional dust and/or regolith sample mass if possible.

The Jupiter InfraRed Auroral Mapper (JIRAM) aboard Juno observed the Jovian South Pole aurora during the first orbit of the mission. H 3+ (trihydrogen cation) and CH 4 (methane) emissions have been identified and measured. The observations have been carried out in nadir and slant viewing both by a L-filtered imager and a 2–5 μm spectrometer. Results from the spectral analysis of the all observations taken over the South Pole by the instrument are reported. The coverage of the southern aurora during these measurements has been partial, but sufficient to determine different regions of temperature and abundance of the H 3+ ion from its emission lines in the 3–4 μm wavelength range. Finally, the results from the southern aurora are also compared with those from the northern ones from the data taken during the same perijove pass and reported by Dinelli et al. (2017).

Throughout the first orbit of the NASA Juno mission around Jupiter, the Jupiter InfraRed Auroral Mapper (JIRAM) targeted the northern and southern polar regions several times. The analyses of the acquired images and spectra confirmed a significant presence of methane (CH4) near both poles through its 3.3 μm emission overlapping the H3+ auroral feature at 3.31 μm. Neither acetylene (C2H2) nor ethane (C2H6) have been observed so far. The analysis method, developed for the retrieval of H3+ temperature and abundances and applied to the JIRAM-measured spectra, has enabled an estimate of the effective temperature for methane peak emission and the distribution of its spectral contribution in the polar regions. The enhanced methane inside the auroral oval regions in the two hemispheres at different longitude suggests an excitation mechanism driven by energized particle precipitation from the magnetosphere.

During the first orbit around Jupiter of the NASA/Juno mission, the Jovian Auroral Infrared Mapper (JIRAM) instrument observed the auroral regions with a large number of measurements. The measured spectra show both the emission of the H3+ ion and of methane in the 3-4 μm spectral region. In this paper we describe the analysis method developed to retrieve temperature and column density (CD) of the H3+ ion from JIRAM spectra in the northern auroral region. The high spatial resolution of JIRAM shows an asymmetric aurora, with CD and temperature ovals not superimposed and not exactly located where models and previous observations suggested. On the main oval averaged H3+ CDs span between 1.8 × 1012 cm-2 and 2.8 × 1012 cm-2, while the retrieved temperatures show values between 800 and 950 K. JIRAM indicates a complex relationship among H3+ CDs and temperatures on the Jupiter northern aurora.

Throughout the first orbit of the NASA Juno mission around Jupiter, the Jupiter InfraRed Auroral Mapper (JIRAM) targeted the northern and southern polar regions several times. The analyses of the acquired images and spectra confirmed a significant presence of methane (CH 4 ) near both poles through its 3.3 μm emission overlapping the H 3+ auroral feature at 3.31 μm. Neither acetylene (C 2 H 2 ) nor ethane (C 2 H 6 ) have been observed so far. The analysis method, developed for the retrieval of H 3+ temperature and abundances and applied to the JIRAM-measured spectra, has enabled an estimate of the effective temperature for methane peak emission and the distribution of its spectral contribution in the polar regions. The enhanced methane inside the auroral oval regions in the two hemispheres at different longitude suggests an excitation mechanism driven by energized particle precipitation from the magnetosphere.

The Jovian Infrared Auroral Mapper (JIRAM) is an imager/spectrometer on board NASA/Juno mission for the study of the Jovian aurorae. The first results of JIRAM's imager channel observations of the H 3+ infrared emission, collected around the first Juno perijove, provide excellent spatial and temporal distribution of the Jovian aurorae, and show the morphology of the main ovals, the polar regions, and the footprints of Io, Europa and Ganymede. The extended Io “tail” persists for ~3 hours after the passage of the satellite flux tube. Multi- arc structures of varied spatial extent appear in both main auroral ovals. Inside the main ovals, intense, localized emissions are observed. In the southern aurora, an evident circular region of strong depletion of H 3+ emissions is partially surrounded by an intense emission arc. The southern aurora is brighter than the north one in these observations. Similar, probably conjugate emission patterns are distinguishable in both polar regions.

JIRAM is the imaging spectrometer on board the NASA Juno mission. Data collected since August 2016 on both Jupiter Northern and Southern aurora have an unprecedent spatial resolution. Moreover, JIRAM scanning mirror allows observations of the same area at serveral adiacent time frames. In this work we focus on the spatial and temporal variability of the Southern aurora. JIRAM data of the L imager channel have been averaged in bins of 2.5°LAT × 2°LON and variations of the signal have been investigated for 17h50m < time < 19h45m, 27 August 2016. Time frames have been carefully selected in order to avoid possibile instrumental residuals in the signal (Mura et al., 2017). We find that on the South Pole, for -87.5°

During the first perijove passage of the Juno mission, the Jovian InfraRed Auroral Mapper (JIRAM) observed a line of closely spaced oval features in Jupiter's southern hemisphere, between 30° and 45°S (Fig. 1), as well as other persistent vortices. In this work, we focused on the longitudinal region covering the three ovals having higher contrast at 5 micron, i.e. between 120° W and 60° W in System III coordinates. We used the JIRAM's full spectral capability in the range 2.4-3 micron together with a Bayesian data inversion approach to retrieve maps of column densities and altitudes for an NH3 cloud and a N2H4 haze. The deep (under the saturation level) volume mixing ratio and the relative humidity for gaseous ammonia were also retrieved. Our results suggest different vortex activity for the three ovals. Updraft and downdraft together with considerations about the ammonia condensation could explain our maps providing evidences of cyclonic and anticyclonic structures.

The NASA Juno mission has been investigating Jupiter's atmosphere since August 2016, providing unprecedented insight on the atmosphere of the planet. The Jupiter Infrared Auroral Mapper (JIRAM) experiment, on board Juno, performed spectroscopic observations of the H3+ emissions both in the auroral regions (Dinelli et al., 2017; Adriani et al.,2017; Mura et al., 2017) and at mid latitudes. In the present work, we concentrate on the observations acquired by the JIRAM spectrometer during the first Jupiter passage on 26-27 August 2016, when the spacecraft was at about 500,000-1,200,000 km from the planet. During a portion of the observations, the slit of the spectrometer was sampling Jupiter's limb in the latitude range from 30 to 60 deg for both hemispheres. In the 3-4 ?m spectral region, the limb spectra show the typical features of the H3+ emission, usually used to retrieve concentration and temperature of this species in the auroral region. In this work we exploit this spectral region to provide new insight on the H3+ vertical distribution and, more generally, on thecomposition of the atmosphere of Jupiter. The spatial resolution of the limb observations of Jupiter, ranging between 50 and 130 km, is favourable for investigating the vertical distribution of H3+. The vertical profiles of the integrated H3+ intensity will be presented along with the preliminary results of the retrieval of the H3+ vertical volume mixing ratio (VMR) distribution and compared with predictions from available atmospheric models of the planet (Achilleos et al. 1998). Possible variability of the altitude distribution of the peak emission with respect to latitude and longitude will also be discussed.

The recent identification of large deposits of sulphates by remote sensing and in situ observations has been considered evidence of the past presence of liquid water on Mars. Here we report the unambiguous detection of diverse phyllosilicates, a family of aqueous alteration products, on the basis of observations by the OMEGA imaging spectrometer on board the Mars Express spacecraft. These minerals are mainly associated with Noachian outcrops, which is consistent with an early active hydrological system, sustaining the long-term contact of igneous minerals with liquid water. We infer that the two main families of hydrated alteration products detected-phyllosilicates and sulphates--result from different formation processes. These occurred during two distinct climatic episodes: an early Noachian Mars, resulting in the formation of hydrated silicates, followed by a more acidic environment, in which sulphates formed.

Point of care testing (POCT) is an area of medical technology that has been growing rapidly over the past decade. As new devices and equipment become available, new questions of regulation and quality assurance are generated. In this report, we attempt to relate to some of the history in the development of POCT technology, show how this technology has been incorporated into our medical practice, and discuss how we think it will be incorporated in the future. We will describe some of the current devices used in POCT and discuss at least some of the points that are debated by physicians on the necessity of POCT. Finally, the broad-based description of the governmental regulation of POCT, as it is set forth in the 1998 Clinical Laboratory Improvement Amendments, are discussed. The future trends and direction of POCT are also discussed.

Urinary tract infections (UTIs) are common in children, however, they are "sneaky and sly" because they frequently do not manifest as dysuria, as is common in adults. 30,2 The diagnosis of UTI should be considered in all infants and children who present to the emergency department (ED) with classic symptoms of UTI, as well as in those with nonspecific symptoms, including fever, vomiting, abdominal, or flank pain. The goal of early diagnosis and treatment of UTIs in the pediatric population is the prevention of the complications of bacteremia and renal scarring. Although the most severe complication of pyelonephritis, renal scarring with progression to end stage renal disease is rare, aggressive treatment and work-up of pediatric urinary tract infection is preventive. UTI is a nonspecific phrase used to define an inflammatory response to bacterial invasion anywhere within the renal system. Bacteria is present within the urine, as well as other signs of infection (nitrates, pyuria), and the patient may have local (dysuria, frequency, urgency) or systemic symptoms (fever, myalgias, rigors, nausea, vomiting, abdominal, or flank pain). Asymptomatic bacteriuria is defined as bacterial growth in the urine without signs or symptoms of infection. UTIs are divided into two overlapping categories—uncomplicated lower tract infection of cystitis and urethritis and upper tract infections of ureteritis, pyelitis (upper collecting system), and pyelonephritis (renal parenchyma). In general, the presence of fever, systemic symptoms, or back pain with infected urine indicates the presence of upper tract infection. Reliance upon the presence of fever alone to indicate the presence of an upper tract infection is problematic because renal scanning fails to show that fever is a reliable marker for pyelonephritis. 36 As well, studies that have analyzed fever as a marker for upper tract infection have shown a wide range of sensitivities (53%–84%) and specificities (44%–92%). 9 Also complicating the diagnosis of upper tract infection is the fact that there is no "gold standard" test for pyelonephritis. In the past, antibody-coated bacteria, and more recently, renal nuclear scanning have been used as indicators of pyelonephritis. However, the utility of these tests is still limited. This chapter will discuss the spectrum of infections that fall under the heading of UTI. The diagnostic approach and management of the pediatric patient will be addressed. Infection in adults is addressed elsewhere.

Objectives:Follow-up compliance is critical in febrile children because they may harbor unrecognized life-threatening illnesses. This study compares follow-up rates between 2 systems: Wilford Hall Medical Center (WHMC), with preset appointments after ED release, and free medical care; and Fairfax Hospital (FFX), where parents must arrange follow-up appointments after ED release, and are responsible for payment for their follow-up visits. The study also investigated factors associated with follow-up compliance. Methods:This was a prospective, observational study of febrile children seen in 2 EDs with different systems for patient follow-up. From ED records and parental phone calls, diagnosis, follow-up compliance, and demographics were collected. Data were analyzed using logistic regression and χ2. Results:423 children met entrance criteria, and 330 parents were successfully contacted after the child's ED release (146 from WHMC; 184 from FFX). The WHMC children were more likely to comply with follow-up than were the children in the FFX system (92% vs 67% follow-up, odds ratio 2.5, 95% CI 1.1–5.3). Other factors associated with noncompliance with recommended follow-up were: Hispanic ethnicity, non-English-speaking parents, and follow-up suggested for

The abuse of children may be physical, sexual, or emotional or may take the form of neglect. Primary care physicians are in an excellent position to recognize abuse and to respond with the proper intervention. In order to act appropriately, physicians must have a high degree of suspicion and a working knowledge of the governmental agencies in their area that may be utilized to intervene in abuse cases. Physicians should also be attuned to the family dynamics that may predispose to incidents of child abuse. Language: en

Local anesthetic infiltration is painful and frightening for children. We prospectively compared a topical alternative, TAC solution (tetracaine 0.5%, adrenaline 1:2,000, cocaine 11.8%), with 1% lidocaine infiltration for use in laceration repair in 467 children. Adequate anesthesia of facial and scalp wounds was achieved for 81% of TAC-treated wounds versus 87% of lidocaine-treated wounds (P = .005). TAC was less effective on extremity wounds; 43% had effective anesthesia compared with 89% of lidocaine-treated extremity wounds (P less than .0001). No systemic toxicity was observed. The incidence of wound infection was 2.2% for both TAC and lidocaine. Wound dehiscence occurred in seven TAC- and two lidocaine-treated facial or scalp wounds (4.5% vs 1.8%, NS) and in five TAC- and four lidocaine-treated extremity wounds (20% vs 17.4%, NS). The unusually high rate of dehiscence was due partially to recurrent trauma or coincident infection. TAC was well accepted by patients and parents. We encourage the careful use of TAC as a less painful alternative to lidocaine infiltration for selected scalp and facial lacerations in children.

A productive angiogenic response must couple to the survival machinery of endothelial cells to preserve the integrity of newly formed vessels. Angiopoietin-1 (Ang-1) is an endothelium-specific ligand essential for embryonic vascular stabilization, branching morphogenesis, and post-natal angiogenesis, but its contribution to endothelial cell survival has not been completely elucidated. Here we show that Ang-1 acting via the Tie 2 receptor induces phosphorylation of the survival serine-threonine kinase, Akt (or protein kinase B). This is associated with up-regulation of the apoptosis inhibitor, survivin, in endothelial cells and protection of endothelium from death-inducing stimuli. Moreover, dominant negative survivin negates the ability of Ang-1 to protect cells from undergoing apoptosis. The activation of anti-apoptotic pathways mediated by Akt and survivin in endothelial cells may contribute to Ang-1 stabilization of vascular structures during angiogenesis, in vivo.

Jointly developed by members of the American Society for Artificial Internal Organs and the Society of Thoracic Surgeons along with staff from the Food and Drug Administration, the National Heart, Lung and Blood Institute and other experts, this recommendation describes the reliability considerations and goals for Investigational Device Exemption and Premarket Approval submissions for long-term, mechanical circulatory support systems. The recommendation includes a definition of system failure, a discussion of an appropriate reliability model, a suggested in vitro reliability test plan, reliability considerations for animal implantation tests, in vitro and animal in vivo performance goals, the qualification of design changes during the Investigational Device Exemption clinical trial, the development of a Failure Modes Effects and Criticality Analysis, and the reliability information for surgeons and patient candidates. The document will be periodically reviewed to assess its timeliness and appropriateness within five years.

The combination of tetracaine, adrenalin, and cocaine (TAC) has become increasingly popular as a topical anesthetic for the suturing of simple skin lacerations. The purpose of this study was to determine the effects of TAC on a urine drug test for cocaine. On the morning after the use of TAC, 14 of 18 patients (78%) studied had positive screening tests for benzoylecgonine (cocaine metabolite) by the enzyme multiple immunoassay test (EMIT ® ) method. All specimens also were analyzed by gas chromatography and mass spectrometry, the references standard for analysis of drugs of abuse in urine, and 15 of the specimens (83%) were positive. Four of 18 positive specimens (22%) still had positive EMIT ® drug screens on the morning of the next day, an average of 36 hours after use of TAC. We recommend that physicians who use TAC solutions as a local anesthetic caution their patients that they may fail a urine drug screen for cocaine if they are tested within 36 to 48 hours of the administration of the use of TAC.