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Purpose: Pretreating the kidney with 100 low-energy shock waves (SWs) with a time pause before delivering a clinical dose of SWs (Dornier HM-3, 2000 SWs, 24 kV, and 120 SWs/min) has been shown to significantly reduce the size of the hemorrhagic lesion produced in that treated kidney, compared to a protocol without pretreatment. It has been assumed that a similar reduction in injury will occur with lithotripters other than the HM-3, but experiments to confirm this assumption are lacking. In this study, we sought to verify that the lesion protection phenomenon also occurs in a lithotripter using an electromagnetic shock source and dry-head coupling. Materials and Methods: Eleven female pigs were placed in a Dornier Compact S lithotripter where the left kidney of each animal was targeted for lithotripsy treatment. Some kidneys received 2500 SWs at power level (PL) = 5 (120 SWs/min) while some kidneys were pretreated with 100 SWs at PL = 1, with a 3-minute time pause, followed immediately by 2500 SWs at PL = 5 (120 SWs/min). Lesion size analysis was performed to assess the volume of hemorrhagic tissue injury created by each treatment regimen (% functional renal volume). Results: Lesion size fell by 85% (p = 0.01) in the 100 SW pretreatment group compared to the injury produced by a regimen without pretreatment. Conclusions: The results suggest that the treatment pause protection phenomenon occurs with a Dornier Compact S, a machine distinctly different from the Dornier HM-3. This result also suggests that this phenomenon may be observed generally in SW lithotripters.

Kidney stones frequently develop as an overgrowth on Randall's plaque (RP) which is formed in the papillary interstitium. The organic composition of RP is distinct from stone matrix in that RP contains fibrillar collagen; RP in tissue has also been shown to have two proteins that are also found in stones, but otherwise the molecular constituents of RP are unstudied. We hypothesized that RP contains unique organic molecules that can be differentiated from the stone overgrowth by fluorescence. To test this, we used micro-CT-guided polishing to expose the interior of kidney stones for multimodal imaging with multiphoton, confocal and infrared microscopy. We detected a blue autofluorescence signature unique to RP, the specificity of which was also confirmed in papillary tissue from patients with stone disease. High-resolution mineral mapping of the stone also showed a transition from the apatite within RP to the calcium oxalate in the overgrowth, demonstrating the molecular and spatial transition from the tissue to the urine. This work provides a systematic and practical approach to uncover specific fluorescence signatures which correlate with mineral type, verifies previous observations regarding mineral overgrowth onto RP and identifies a novel autofluorescence signature of RP demonstrating RP's unique molecular composition.

Burst Wave Lithotripsy (BWL) is a new stone treatment that utilizes ultrasound to fracture renal calculi. However, it is not known if BWL alters renal function, so we tested if a clinical dose of BWL impacts glomerular filtration rate (GFR) or kidney blood flow. Treatment consisted of placing each pig (32–42 kg) on its side, locating the lower pole of the right kidney, and treating that kidney with a BWL dose of 18,000 ultrasound pulses at 10Hz, 20 cycles/pulse and a peak negative pressure of −7 MPa (n = 6). Six additional pigs were used as sham controls. Inulin and para-aminohippuric acid (PAH) were infused into the pigs with blood and urine samples being collected both before and 1-h after BWL treatment. The concentrations of inulin and PAH were determined in the samples and used to calculate GFR and effective renal plasma flow (eRPF). For the BWL treated group, GFR and eRPF did not change after BWL exposure (−6.7 ± 7.2% for GFR, −10.9 ± 5.5% for eRPF), and this response was like the sham control group ( P = 0.23 for GFR, P = 0.08 for eRPF). A typical clinical dose of BWL caused no change in renal function. [Work supported by NIH, Grant P01 DK43881.]

This article explores different ways in which time structures and signatures can be figured both as a means of analysis and as a strategy for creation of performance work. It extends Anne Bogart's description of time signatures as understood within her system of Viewpoints training, specifically how different modalities of time combine in ways that uniquely identify each performance “in a similar way that the palm of every hand has a unique pattern of lines and creases”. Anne Ubersfeld's general observation regarding the lack of critical tools available for semiotic analysis of time compared with space is also discussed. How such time structures and schemas are actually signified to audiences then becomes the central question: each may involve varying levels of framing, foregrounding and bringing into view, with audiences sometimes consciously engaged with the playing out of these as a central thematic concern. The temporal devices and strategies that drive the generation of material may also be identifie...

Probability of guilt is not the criterion on which a verdict in a criminal trial should be based, says Tony Gardner-Medwin. The courts, quite sensibly, do not even allow access to some of the background evidence on which a proper assessment of this probability should be made. He argues that a more satisfactory criterion is the probability, or degree of belief, that the evidence could have arisen without guilt.

This chapter champions the elicitation and use of probabilistic measures of uncertainty. It compares two different views (roughly corresponding, respectively, to the Bayesian and frequentist approaches to statistical inference) as to how probabilities should be used as evidence. It argues that, while the former may be a logical ideal, the latter may be more appropriate in the special circumstances of the courtroom.