Observation and diagnostic application of Kr K-shell emission in magnetized liner inertial fusion experiments at Z.

In a series of Magnetized Liner Inertial Fusion (MagLIF) experiments performed at the Z pulsed power accelerator of Sandia National Laboratories, beryllium liners filled with deuterium gas pressures in the 4-8 atm range and a tracer amount of krypton were imploded. At the collapse of the cylindrical implosion, temperatures in the 1-3 keV range and atom number densities of ∼1023 cm-3 were expected. The plasma was magnetized with a 10 T axial magnetic field. Krypton was added to the fuel for diagnosing implosion plasma conditions. Krypton K-shell line emission was recorded with the CRITR time-integrated transmission crystal x-ray spectrometer. The observation shows n = 2 to n = 1 line emissions in B-, Be-, Li-, and He-like Kr ions and is characteristic of the highest electron temperatures achieved in the thermonuclear plasma. Detailed modeling of the krypton atomic kinetics and radiation physics permits us to interpret the composite spectral feature, and it demonstrates that the spectrum is temperature sensitive. We discuss temperatures extracted from the krypton data analysis for experiments performed with several filling pressures.

Shared decision-making in peri-operative medicine: a narrative review.

This review on shared decision-making comes at a time when international healthcare policy, domestic law and patient expectation demand a bringing-together of the patient's values and preferences with the physician's expertise to determine the best bespoke care package for the individual. Despite robust guidance in terms of consent, the anaesthetic community have lagged behind in terms of embracing the patient-focused rather than doctor-focused aspects of shared decision-making. For many, confusion has arisen due to a conflation of informed consent, risk assessment, decision aids and shared decision-making. Although they may well be linked, they are discrete entities. The obstacles to delivering shared decision-making are many. Lack of time is the most widely cited barrier from the perspective of physicians across specialties, with little time available to the anaesthetist at the day-of-surgery pre-operative visit. A more natural place to start the process may be the pre-operative assessment clinic, especially for the 'high-risk' patient. Yet shared decision-making is for all, even the 'low-risk' patient. Another barrier is the flow and the focus of the typical anaesthetic consultation; the truncated format presents the danger of a cursory, 'time-efficient' and mechanical process as the anaesthetist assesses risk and determines the safest anaesthetic. As patients have already decided to proceed with therapy or investigation and may be more concerned about the surgery than the anaesthesia, it is often assumed they will accept whatever anaesthetic is offered and defer to the clinician's expertise - without discussion. Furthermore, shared decision-making does not stop at time of anaesthesia for the peri-operative physician. It continues until discharge and requires the anaesthetist to engage in shared decision-making for prescribing and deprescribing peri-operative medicines.

Carbon deposition and phase transformations in red mud on exposure to methane.

A characterization study detailing the phase transformations and microstructural nature of the carbon deposited during methane decomposition over red mud has been undertaken. In situ XRD was carried out to study the phase transformation sequences of red mud during the reaction. Scanning electron microscopy, high resolution transmission electron microscopy, thermogravimetric analysis, BET surface area determination and CHN analysis were carried out to investigate the properties of the post-reaction samples. Exposure to methane with increasing temperature caused a stepwise reduction of iron oxides in red mud and promoted methane cracking leading to carbon deposition. The presence of carbon nanostructures was confirmed by HRTEM observations. The carbon formed was graphitic in nature and the spent red mud, rich in Fe and Fe(3)C formed as a result of the reduction of the iron oxide, was magnetic in nature. The surface area of the material was enhanced upon reaction. In addition, reactivity comparisons between goethite and red mud were carried out to study the formation of carbon oxides during reaction.

Diversity leadership: the Rush University Medical Center experience.

Meeting the challenges of diversity is crucial, and within healthcare organizations a particularly strong case exists for a diversity strategy. Rush University Medical Center in 2006 was at an important juncture. Since its founding, the organization had made notable progress toward advancing diversity and inclusiveness. On the other hand, many diversity-related problems continued. Rush convened a committee to review the work of the institution in this area. The committee's report called for changes, and a Diversity Leadership Group (DLG) model was established. This article documents the progress made since 2006 through implementation of the DLG model. The changes prescribed for Rush are presented as recommendations and challenges that other healthcare organizations may find applicable to their own institutions.

Overcoming barriers to developing seamless ST-segment elevation myocardial infarction care systems in the United States: recommendations from a comprehensive Prehospital 12-lead Electrocardiogram Working Group.

BACKGROUND: Reducing time to reperfusion treatment for patients with ST-segment elevation myocardial infarction (STEMI) improves patient outcomes. Few medical systems consistently meet current benchmarks regarding timely access to treatment. Studies have widely demonstrated that prehospital 12-lead electrocardiography can facilitate early catheterization laboratory activation and is the most effective means of decreasing patients' time to treatment. METHODS: We gathered experts to examine the barriers to implementation of prehospital 12-lead electrocardiographic monitoring and transmission to in-hospital cardiologists in creating seamless STEMI care systems (STEMI-CS) and propose multidisciplinary approaches to overcoming these barriers. RESULTS AND CONCLUSIONS: Physicians, hospital systems, and emergency medical services often lack coordination of care delivery and receive fragmented funding and oversight. Clinical and regulatory guidelines do not emphasize local solutions to achieving clinical benchmarks, do not target incentives at all components of the STEMI-CS, and underemphasize risk-based approaches to protecting patient health. Integration of the multiple complex components involved in STEMI-CS is essential to improving care delivery.

Uterine blood flow during supine rest and exercise after 28 weeks of gestation.

OBJECTIVE: To test the null hypothesis that, after 28 weeks of gestation, uterine blood flow during supine rest and supine exercise is no different than uterine blood flow at left-lateral rest. DESIGN: In vivo experimental study in pregnant women. SETTING: Department of Obstetrics, MetroHealth Medical Center, Cleveland, OH, USA. POPULATION: Fourteen, physically active, late-pregnant women who continued supine exercise throughout gestation. METHODS: Studies were carried out between 29 and 38 weeks of gestation. Maternal blood pressure, maternal heart rate, and ultrasound estimates of volume blood flow in the right ascending branch of the uterine artery were obtained serially at rest in the left-lateral position, at rest in the supine position, during and immediately after 10 minutes of supine exercise, and again at rest in the left-lateral position. Exercise sessions included alternating 60- to 90-second periods of abdominal crunches and leg exercise at moderate/high intensity (Borg's rating of perceived exertion 14 +/- 1). MAIN OUTCOME MEASURES: Blood pressure, heart rate, and uterine artery volume flow. RESULTS: Data are presented as the mean +/- SD. Maternal heart rate and blood pressure were unchanged at supine rest but increased during supine exercise (heart rate increased from 76 +/- 9 to 98 +/- 12 beats per minute, mean arterial pressure increased from 81 +/- 6 to 102 +/- 12 mmHg). Volume flow fell from 410 +/- 93 to 267 +/- 73 cc/minute after 5 minutes of supine rest and then, during supine exercise, increased to 355 +/- 125 cc/minute. Uterine artery luminal diameter and blood flow correlated directly with tissue weights at birth (r(2) values between 0.32 and 0.59). CONCLUSIONS: In physically active women, uterine blood flow decreases during both supine rest and supine exercise but the decrease in the former is twice that seen in the latter.

Drunk in public, drunk in private: the relationship between college students, drinking environments and alcohol consumption.

This study examines environmental differences in public (bars) and private (parties) drinking settings among of-age (21 and up years of age) and underage (18-20 years of age) college students attending college near the US/Mexico border. A random telephone survey of graduate and undergraduate students attending two large public universities in the southwestern United States was conducted during the 2000-2003 academic years. A university-based social science research laboratory conducted the telephone interviews with respondents who reported an occasion in the past 28 days where alcohol was being consumed (N = 4,964). The data were analyzed using ordinary least squares multiple regression. The results suggests that drinking settings contributed to the amount of alcohol consumed by respondents. Additionally, environmental factors contributing to drinking vary by setting. In general, having many people intoxicated at an event, BYOB parties, playing drinking games, and having illicit drugs available contribute to heavier drinking.

Influence of endurance exercise and diet on human placental development and fetal growth.

The delivery of oxygen and substrate to the maternal-fetal interphase is the major maternal environmental stimulus which either up- or down-regulates feto-placental growth. During pregnancy, sustained exercise sessions cause an intermittent reduction in oxygen and substrate delivery to the interphase that may exceed 50% during the exercise but, it is probable that regular bouts of sustained exercise or exercise training may improve oxygen and substrate delivery at rest. The type of maternal carbohydrate intake (low- versus high-glycemic sources) and food intake frequency also influence substrate availability through their effects on maternal blood glucose levels and insulin sensitivity. As a result, different exercise regimens and/or different types of carbohydrate intake modify feto-placental growth. The magnitude and direction of the effect is determined by their average 24-h effect on oxygen and substrate availability at different time-points in pregnancy. In general, exercise in early and mid pregnancy stimulates placental growth while the relative amount of exercise in late pregnancy determines its effect on late fetal growth. Low-glycemic food sources in the diet decrease growth rate and size at birth while high-glycemic food sources increase it. Thus, it may be possible to improve pregnancy outcomes in both healthy, low-risk women and a variety of high-risk populaces by simply modifying maternal physical activity and dietary carbohydrate intake during pregnancy.

Running throughout pregnancy: effect on placental villous vascular volume and cell proliferation.

Many studies have documented that placental development is altered by a variety of environmental factors which alter placental bed blood flow and/or oxygen delivery. One of these is sustained weight-bearing exercise. The purpose of this investigation was to examine the effects of running throughout pregnancy on villous vascular development and cell proliferation by testing the null hypothesis that continuing a regular running regimen throughout pregnancy has no effect on villous vascular volume or cell proliferation at term. Accordingly, placentae of 11 healthy runners with uncomplicated pregnancies were matched by placental weight, maternal diet and birth weight with those of 11 healthy controls and examined using systematic random sampling and point counting of placental tissues stained immunohistochemically with either an endothelial (CD 31, PECAM-1, endoCam) or a proliferative (Ki-67, MIB-1) marker. The placentae of the runners had greater villous vascular volumes in both absolute (77 +/- 20 cm(3) versus 47 +/- 18 cm(3), p < 0.02) and relative (% of total villous volume: 29 +/- 5% versus 20 +/- 6%, p < 0.003) terms. Likewise, they had a greater proliferation index (45 +/- 14 mitoses/1000 nuclei versus 29 +/- 10 mitoses/1000 nuclei, p < 0.008). We conclude that continuing to run regularly throughout pregnancy increases both absolute and relative villous vascular volume and cell proliferation at term. We also speculate that this exercise effect may have clinical value in cases at risk for anomalous feto-placental growth as increased villous vascular volume should improve feto-placental growth by enhancing placental transfer of oxygen and diffusible substrate.

Beer and bongs: differential problems experienced by older adolescents using alcohol only compared to combined alcohol and marijuana use.

Alcohol and other drug problems experienced by adolescents who use only alcohol compared to those who use both alcohol and marijuana (A + M) is studied. Using the national longitudinal survey of youth 1994 data, forward multiple regression analyses revealed that impulsivity, A + M use (compared to alcohol-only use), age, sex, religiosity, frequency of substance use were associated with a higher number of behavioral problems. Youth with more alcohol problems were found to be binge drinkers, impulsive, more frequent alcohol users, and nonHispanic. Implications and future research needs are discussed.

Fetal cerebellum: US appearance with advancing gestational age.

PURPOSE: To evaluate the change in ultrasonographic (US) appearance of the fetal cerebellum with advancing gestation. MATERIALS AND METHODS: A total of 291 normal fetuses of uncomplicated pregnancies were evaluated at gestational ages (GAs) between 15 and 41 weeks with a 3.75-MHz transabdominal curvilinear probe. After the transcerebellar view was obtained, the transverse cerebellar diameter (TCD) was measured and the images were stored. On hard-copy US images, cerebella were assigned three grades of appearance. These grades were analyzed in relation to GA and TCD. Inter- and intraobserver variations were assessed in 91 randomly selected cases. RESULTS: Cerebella in 137 (47.1%), 71 (24.4%), and 83 (28.5%) of 291 subjects were classified as grade I (hypoechoic, "eyeglass" shape), grade II (intermediate echogenicity, "dumbbell" outline), and grade III (hyperechoic, "fan" shape), respectively. With advancing gestation, the dominant grade changed from I to III gradually and progressively. The median GA and TCD, respectively, were 22 weeks and 22 mm for grade I, 29 weeks and 35 mm for grade II, and 36 weeks and 46 mm for grade III. These differences were statistically significant (P <.001). The agreements within inter- and intraobserver estimations were 96% (87 of 91) and 95% (86 of 91), respectively. CONCLUSION: A gradual change in US appearance of the fetal cerebellum is seen with advancing gestation.

PCR-SSCP comparison of 16S rDNA sequence diversity in soil DNA obtained using different isolation and purification methods.

This study compared different methods of direct DNA extraction and purification from a silt loam soil and investigated the relationship between DNA quantity and sequence diversity. Five extraction methods and four purification techniques were investigated. Quantities of DNA extracted were between 3.4+/-0.55 and 54.3+/-8.18 &mgr;g g(-1) (dry wt) of soil with OD(260)/OD(230) purity ratios between 0.80 and 1.15. Analysis of sequence diversity in all extracts was conducted using PCR-single strand conformation polymorphism (SSCP). Profiles generated using universal 16S rDNA primers (Com1/Com2) were found to be identical when used to amplify 16S rDNA extracted directly from soil. The genus Pseudomonas was targeted in order to reduce profile complexity, which was apparent when using universal 16S rDNA primers, and which hindered direct comparison of sequence diversity. A Pseudomonas culture library and non-cultured Pseudomonas 16S rDNA genes were used to provide a background count of Pseudomonas operational taxonomic units present in the soil. Cloning and sequencing of amplicons generated using a Pseudomonas-specific (Ps-for) and a universal 16S rDNA (Com2) primer, coupled with nested amplification (Com1/Com2 amplification from Ps-for/Ps-rev amplicons), used in conjunction with SSCP, revealed that environmental contaminants co-extracted with DNA, such as humic acid, significantly reduced primer specificity. SSCP was sensitive enough to reveal template bias in different primer sets. PCR-restriction fragment length-SSCP of Pseudomonas 16S rDNA amplified from soil-extracted DNA revealed distinct differences in sequence representation between extraction methods and showed that greater DNA yield is not synonymous with higher sequence diversity. We, therefore, suggest that DNA extractions from soil should be evaluated not only in terms of quantity and purity, but also in terms of the sequence diversity present. SSCP proved to be a valuable tool for the assessment of the methodologies commonly used in PCR-mediated microbial ecology studies.

Substance use problems reported by college students: combined marijuana and alcohol use versus alcohol-only use.

This study examines the relationships among selected demographic characteristics, alcohol use only, alcohol plus marijuana use and substance-use related problems. Data are from 409 randomly selected undergraduate college students attending a large urban university. Poly-substance users were more likely than alcohol only users to be younger and experience all substance-use related problems studied. The relationship between poly-substance use and increased substance use-associated problems was also identified when controlling for other common predictors of substance use problems.

Environmental predictors of heavy episodic drinking.

This study examined the relationship between environmental characteristics and heavy episodic drinking by examining college students' last drinking events. For this study, 409 undergraduate students attending a large public university were randomly selected. Students were asked to report on their last drinking event within the 30-day period prior to being surveyed. There were 274 drinking events analyzed. Bivariate analyses and multiple logistic regression analysis were used to identify contextual factors predictive of heavy episodic drinking in specific drinking events. Drinking with friends, drinking beer and hard liquor, and having many people intoxicated at an event were predictive of heavy episodic drinking events. Dating events were protective of heavy episodic drinking. Implications for future research and prevention are discussed.

Ribotyping of rhizobia nodulating Acacia mangium and Paraserianthes falcataria from different geographical areas in Indonesia using PCR-RFLP-SSCP (PRS) and sequencing.

Acacia mangium and Paraserianthes falcataria are leguminous tree species widely grown for timber in Indonesia and other tropical countries, yet little is known about the identity of their rhizobial symbionts. Polymerase chain reaction-restriction fragment length polymorphism-single-strand conformational polymorphism (PRS) analysis of the 16S rRNA gene was used along with sequencing to assess the diversity of 57 rhizobia isolated from nodules of A. mangium and P. falctaria in Indonesia. In total, 26 rhizobia isolated from A. mangium were analysed by PRS and sequencing. The PRS patterns indicated that 12 (46%) clustered with Bradyrhizobium elkanii, 13 (50%) with B. lianoningense/japonicum and one (4%) with Mesorhizobium loti. Thirty-one isolates were analysed from P. falcataria: five (16%) clustered with B. elkanii and 26 (84%) with B. lianoningense/japonicum. These results were confirmed by phylogenetic analysis of sequences. Intraspecific diversity of the 16S rRNA genes from rhizobia nodulating A. mangium and P. falcataria revealed by PRS was low, only one genotype was found within the isolates that clustered with B. elkanii and two within the B. liaoningense/japonicum group. These Bradyrhizobium species are apparently ubiquitous throughout the Indonesian archipelago and it is clear why the two tree species are able to successfully establish outside their native range without the need for inoculation with indigenous rhizobia.

Inter- and intra-isolate rRNA large subunit variation in Glomus coronatum spores.

• High levels of variation are reported in the large subunit (LSU) rRNA gene, D2 region of Glomus coronatum, a well characterized species of arbuscular mycorrhizal fungus (AMF). • Clones (435) containing the D2 regions from 7 isolates of G. coronatum were investigated for intra- and inter-isolate sequence variation using PCR-single-strand conformational polymorphism (PCR-SSCP) as a prescreen before sequencing. Isolates of G. mosseae, G. constrictum and G. geosporum, three species of AMF with similar spore ontogeny and morphology, were also analysed. • Analysis of 138 representative sequences indicated that most were unique; this variation could not be attributed to DNA polymerase or cloning artefacts. Only 13 sequences were found in more than one isolate. Neighbour-joining analysis showed that most sequences from G. coronatum formed a main group although several sequences from G. mosseae and G. constrictum clustered with G. coronatum. • There was greater than expected variation in the LSU D2 region sequences from G. coronatum. The four Glomus species, closely related by spore morphology, might represent part of a genetic continuum. Implications for the concept of species in AMF, the use of rRNA sequences to estimate biodiversity and in situ detection in field ecology are discussed.

The large subunit ribosomal RNA genes of Entrophospora infrequens comprise sequences related to two different glomalean families.

• The D2 region of the large subunit (LSU) ribosomal RNA gene of isolates of Entrophospora infrequens from trap cultures, the type fungus for the genus Entrophospora, was investigated for sequence variation. • LSU rRNA genes were amplified using PCR from multiple (50 spores) and six single spore DNA extractions. Recombinant clones (261) from these amplifications were analysed for sequence differences using a combination of PCR-single strand conformational polymorphism (PCR-SSCP) and sequencing. • Single spores of glomalean fungi have been previously shown to contain high levels of ribosomal RNA gene sequence diversity. From single and multiple spore extractions, 64 glomalean sequences were obtained, of which 61 were unique. These were related to two glomalean families: the Glomaceae (41/61) and the Gigasporaceae (20/61). No evidence of Acaulosporaceae-like sequences was found. • Sequences related to both families were found within three single spores. Sequences related only to the Gigasporaceae were found in two single spores. The remaining spore only contained sequences related to the Glomaceae. The multiple spore PCR contained sequences related to both families. • The implications of these results for the current taxonomy of this unculturable species are discussed.

Turning your practice around.

The techniques of managing a medical practice are no different from those required to manage any other business. Planning is the first step, and establishing a realistic budget is essential to creating a successful plan. Knowing your patients and the sources of your revenue are next. Understanding the weaknesses within your practice and developing courses of action to correct them is essential. This includes developing ways to increase revenue as well as control expenses. Once a plan has been developed a basis for monitoring that plan is required. We suggest tracking financial performance monthly. If these basic management techniques are put into place, the actions discussed above will become both easier and more effective.