Cancer Decedents' Hospital End-of-Life Care Documentation: A Retrospective Review of Patient Records.

Objective: International standards of end-of-life care (EOLC) intend to guide the delivery of safe and high-quality EOLC. Adequately documented care is conducive to higher quality of care, but the extent to which EOLC standards are documented in hospital medical records is unknown. Assessing which EOLC standards are documented in patients' medical records can help identify areas that are performed well and areas where improvements are needed. This study assessed cancer decedents' EOLC documentation in hospital settings. Methods: Medical records of 240 cancer decedents were retrospectively evaluated. Data were collected across six Australian hospitals between 1/01/2019 and 31/12/2019. EOLC documentation related to Advance Care Planning (ACP), resuscitation planning, care of the dying person, and grief and bereavement care was reviewed. Chi-square tests assessed associations between EOLC documentation and patient characteristics, and hospital settings (specialist palliative care unit, sub-acute/rehabilitation care settings, acute care wards, and intensive care units). Results: Decedents' mean age was 75.3 years (SD 11.8), 52.0% (n = 125) were female, and 73.7% lived with other adults or carers. All patients (n = 240; 100%) had documentation for resuscitation planning, 97.6% (n = 235) for Care for the Dying Person, 40.0% for grief and bereavement care (n = 96), and 30.4% (n = 73) for ACP. Patients living with other adults or carers were less likely to have a documented ACP than those living alone or with dependents (OR 0.48; 95% CI 0.26-0.89). EOLC documentation was significantly greater in specialist palliative care settings than that in other hospital settings (P < .001). Conclusion: The process of dying is well documented among inpatients diagnosed with cancer. ACP and grief and bereavement support are not documented enough. Organizational endorsement of a clear practice framework and increased training could improve documentation of these aspects of EOLC.

Magnetic properties of γ-Fe2O3 nanoparticles in a porous SiO2 shell for drug delivery.

A method is presented for synthesizing core-shell nanoparticles with a magnetic core and a porous shell suitable for drug delivery and other medical applications. The core contains multiple γ-Fe2O3 nanoparticles (∼15 nm) enclosed in a SiO2 (∼100-200 nm) matrix using either methyl (denoted TMOS-γ-Fe2O3) or ethyl (TEOS-γ-Fe2O3) template groups. Low-temperature Mössbauer spectroscopy showed that the magnetic nanoparticles have the maghemite structure, γ-Fe2O3, with all the vacancies in the octahedral sites. Saturation magnetization measurements revealed that the density of γ-Fe2O3 was greater in the TMOS-γ-Fe2O3 nanoparticles than TEOS-γ-Fe2O3 nanoparticles, presumably because of the smaller methyl group. Magnetization measurements showed that the blocking temperature is around room temperature for the TMOS-γ-Fe2O3 and around 250 K for the TEOS-γ-Fe2O3. Three dimensional topography analysis shows clearly that the magnetic nanoparticles are not only at the surface but have penetrated deep in the silica to form the core-shell structure.

Size-dependent magnetic properties of γ-Fe2O3 nanocrystallites.

A route for synthesizing monodisperse magnetic nanocrystallites of maghemite, [Formula: see text]-Fe2O3, with various sizes has been revisited. A systematic investigation of three [Formula: see text]-Fe2O3 nanocrystalline samples by different techniques has been performed to characterize their size-dependent magnetic properties. Zero-field-cooled and field-cooled magnetization measurements reveal that the superparamagnetic blocking temperatures are around 230 K, 170 K, and 50 K for the 15.0 nm, 11.8 nm, and 6.1 nm nanocrystallites, respectively. Low-temperature Mössbauer spectra show that all three nanocrystallites have the maghemite structure with all the vacancies in the B-sites. Furthermore, detailed analysis shows that there are more vacancies on the B-sites for the 6.1 nm nanocrystallites compared to 0.33 for the bulk maghemite.

Mössbauer spectroscopy of europium-containing glasses: Optical activator study for x-ray image plates.

A fluorozirconate glass (ZBLAN) containing BaCl2 nanocrystals doped with divalent Eu is a promising material for x-ray image plates for medical diagnosis. Since it is known that Eu2+ readily oxidizes to Eu3+, which reduces fluorescence efficiency of the image plates, 151Eu Mössbauer spectroscopy was used in this work to monitor the Eu oxidation state of the samples during degradation over time in the presence of ambient humidity. In addition, Mössbauer spectroscopic experiments show that the oxidation state has already changed during the glass melt: The sample made from 5 mol% EuCl2 contained 78% EuCl2 + 22% EuCl3 deduced from the relative areas of the absorption lines. The sample made from 2.5 mol% EuCl2 + 2.5 mol% EuCl2 contained 37% EuCl2 + 63% EuCl3, i.e. 26% of the original EuCl2 was oxidized to EuCl3.

Appropriate use of CT perfusion following aneurysmal subarachnoid hemorrhage: a Bayesian analysis approach.

BACKGROUND AND PURPOSE: In recent years CTP has been used as a complementary diagnostic tool in the evaluation of delayed cerebral ischemia and vasospasm. Our aim was to determine the test characteristics of CTP for detecting delayed cerebral ischemia and vasospasm in SAH, and then to apply Bayesian analysis to identify subgroups for its appropriate use. MATERIALS AND METHODS: Our retrospective cohort comprised consecutive patients with SAH and CTP performed between days 6 and 8 following aneurysm rupture. Delayed cerebral ischemia was determined according to primary outcome measures of infarction and/or permanent neurologic deficits. Vasospasm was determined by using DSA. The test characteristics of CTP and its 95% CIs were calculated. Graphs of conditional probabilities were constructed by using Bayesian techniques. Local treatment thresholds (posttest probability of delayed cerebral ischemia needed to initiate induced hypertension, hypervolemia, and hemodilution or intra-arterial therapy) were determined via a survey of 6 independent neurologists. RESULTS: Ninety-seven patients with SAH were included in the study; 39% (38/97) developed delayed cerebral ischemia. Qualitative CTP deficits were seen in 49% (48/97), occurring in 84% (32/38) with delayed cerebral ischemia and 27% (16/59) without. The sensitivity, specificity, and positive and negative predictive values (95% CI) for CTP were 0.84 (0.73-0.96), 0.73 (0.62-0.84), 0.67 (0.51-0.79), and 0.88 (0.74-0.94), respectively. A subgroup of 57 patients underwent DSA; 63% (36/57) developed vasospasm. Qualitative CTP deficits were seen in 70% (40/57), occurring in 97% (35/36) with vasospasm and 23% (5/21) without. The sensitivity, specificity, and positive and negative predictive values (95% CI) for CTP were 0.97 (0.92-1.0), 0.76 (0.58-0.94), 0.88 (0.72-0.95), and 0.94 (0.69-0.99), respectively. Treatment thresholds were determined as 30% for induced hypertension, hypervolemia, and hemodilution and 70% for intra-arterial therapy. CONCLUSIONS: Positive CTP findings identify patients who should be carefully considered for induced hypertension, hypervolemia, and hemodilution and/or intra-arterial therapy while negative CTP findings are useful in guiding a no-treatment decision.

p53 and cell cycle independent dysregulation of autophagy in chronic lymphocytic leukaemia.

BACKGROUND: Activation of wild-type p53 with the small molecule sirtuin inhibitor Tenovin-6 (Tnv-6) induces p53-dependent apoptosis in many malignant cells. In contrast, Tnv-6 reduces chronic lymphocytic leukaemia (CLL) cell viability with dysregulation of autophagy, without increasing p53-pathway activity. METHODS: Here, we have investigated whether a quiescent phenotype (unique to CLL) determines the Tnv-6 response, by comparing the effects of Tnv-6 on activated and proliferating CLL. We further studied if these responses are p53-dependent. RESULTS: Unlike quiescent cells, cell death in activated cultures treated with Tnv-6 was consistently associated with p53 upregulation. However, p53 acetylation remained unchanged, without caspase-3 cleavage or apoptosis on electron microscopy. Instead, cellular ultrastructure and protein profiles indicated autophagy inhibition, with reduced ubiquitin-proteasome activity. In specimens with mutant TP53 cultured with Tnv-6, changes in the autophagy-associated protein LC3 occurred independently of p53. Cells treated with Tnv-6 analogues lacking sirtuin inhibitory activity had attenuated LC3 lipidation compared with Tnv-6 (P0.01), suggesting that autophagy dysregulation occurs predominantly through an effect on sirtuins. CONCLUSION: These cell cycle and p53-independent anti-leukaemic mechanisms potentially offer novel therapeutic approaches to target leukaemia-sustaining cells in CLL, including in disease with p53-pathway dysfunction. Whether targets in addition to sirtuins contribute to autophagy dysregulation by Tnv-6, requires further investigation.

Mössbauer spectroscopy of europium-doped fluorochlorozirconate glasses and glass ceramics: optimization of storage phosphors in computed radiography.

Eu(2+)-doped fluorochlorozirconate (FCZ) glasses and glass ceramics, which are being developed for medical and photovoltaic applications, have been analysed by Mössbauer spectroscopy. The oxidation state and chemical environment of the europium ions, which are important for the performance of these materials, were investigated. Routes for maximizing the divalent europium content were also investigated. By using EuCl2 instead of EuF2 in the starting material a fraction of about 90% of the europium was maintained in the Eu(2+) state as opposed to about 70% when using EuF2. The glass ceramics produced by subsequent thermal processing contain BaCl2 nanocrystals in which Eu(2+) is incorporated, as shown by the narrower linewidth in the Mössbauer spectrum. Debye temperatures of 147 K and 186 K for Eu(2+) and Eu(3+), respectively, were determined from temperature dependent Mössbauer measurements. The f-factors were used to obtain the Eu(2+)/Eu(3+) ratio from the area ratio of the corresponding absorption lines.

Evaluating CT perfusion using outcome measures of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: DCI is a serious complication following aneurysmal SAH and remains a leading cause of morbidity and mortality. Our aim was to evaluate CTP in aneurysmal SAH by using outcome measures of DCI. MATERIALS AND METHODS: This was a retrospective study of consecutive patients with SAH enrolled in a prospective institutional review board-approved clinical accuracy trial. Qualitative CTP deficits were determined by 2 neuroradiologists blinded to clinical and imaging data. Quantitative CTP was performed by using a standardized protocol with region-of-interest placement sampling of the cortex. Primary outcome measures were permanent neurologic deficits and infarction. The secondary outcome measure was DCI, defined as clinical deterioration. CTP test characteristics (95% CI) were determined for each outcome measure. Statistical significance was calculated by using the Fisher exact and Student t tests. ROC curves were generated to determine accuracy and threshold analysis. RESULTS: Ninety-six patients were included. Permanent neurologic deficits developed in 33% (32/96). CTP deficits were seen in 78% (25/32) of those who developed permanent neurologic deficits and 34% (22/64) of those without (P < .0001). CTP deficits had 78% (61%-89%) sensitivity, 66% (53%-76%) specificity, and 53% (39%-67%) positive and 86% (73%-93%) negative predictive values. Infarction occurred in 18% (17/96). CTP deficits were seen in 88% (15/17) of those who developed infarction and 41% (32/79) of those without (P = .0004). CTP deficits had an 88% (66%-97%) sensitivity, 59% (48%-70%) specificity, and 32% (20%-46%) positive and 96% (86%-99%) negative predictive values. DCI was diagnosed in 50% (48/96). CTP deficits were seen in 81% (39/48) of patients with DCI and in 17% (8/48) of those without (P < .0001). CTP deficits had 81% (68%-90%) sensitivity, 83% (70%-91%) specificity, and 83% (70%-91%) positive and 82% (69%-90%) negative predictive values. Quantitative CTP revealed significantly reduced CBF and prolonged MTT for DCI, permanent neurologic deficits, and infarction. ROC analysis showed that CBF and MTT had the highest accuracy. CONCLUSIONS: CTP may add prognostic information regarding DCI and poor outcomes in aneurysmal SAH.

The oxidation state of europium in halide glasses.

The luminescent properties of divalent europium ions can be exploited to produce storage phosphors for x-ray imaging applications. The relatively high cost and limited availability of divalent europium halides makes it desirable to synthesize them from the readily available trivalent salts. In this work, samples of pure EuCl(3) and fluoride glass melts doped with EuCl(3) were processed at 700-800 °C in an inert atmosphere furnace. The Eu oxidation state in the resulting materials was determined using fluorescence and Mössbauer spectroscopy. Heat treatment of pure EuCl(3) for 10 min at 710 °C resulted in a material comprising approximately equal amounts of Eu(2+) and Eu(3+). Glasses made using mixtures of EuCl(2) and EuCl(3) in the starting material contained both oxidation states. This paper describes the sample preparation and analysis and discusses the results in the context of chemical equilibria in the melts.

Using quantitative CT perfusion for evaluation of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: DCI is a serious complication following aneurysmal SAH leading to permanent neurologic deficits, infarction, and death. Our aim was to prospectively evaluate the diagnostic accuracy of CTP and to determine a quantitative threshold for DCI in aneurysmal SAH. MATERIALS AND METHODS: Patients with SAH were prospectively enrolled in a protocol approved by the institutional review board. CTP was performed during the typical time period for DCI, between days 6 and 8 following SAH. Quantitative CBF, CBV, and MTT values were obtained by using standard region-of-interest placement sampling of gray matter. The reference standard for DCI is controversial and consisted of clinical and imaging criteria in this study. In a subanalysis of vasospasm, DSA was used as the reference standard. ROC curves determined the diagnostic accuracy by using AUC. Optimal threshold values were calculated by using the patient population utility method. RESULTS: Ninety-seven patients were included; 41% (40/97) had DCI. Overall diagnostic accuracy was 93% for CBF, 88% for MTT, and 72% for CBV. Optimal threshold values were 35 mL/100 g/min (90% sensitivity, 68% specificity) for CBF and 5.5 seconds (73% sensitivity, 79% specificity) for MTT. In the subanalysis (n = 57), 63% (36/57) had vasospasm. Overall diagnostic accuracy was 94% for CBF, 85% for MTT, and 72% for CBV. Optimal threshold values were 36.5 mL/100 g/min (95% sensitivity, 70% specificity) for CBF and 5.4 seconds (78% sensitivity, 70% specificity) for MTT. CONCLUSIONS: CBF and MTT have the highest overall diagnostic accuracy. Threshold values of 35 mL/100 g/min for CBF and 5.5-second MTT are suggested for DCI on the basis of the patient population utility method. Absolute threshold values may not be generalizable due to differences in scanner equipment and postprocessing methods.

Diagnostic accuracy of CT angiography and CT perfusion for cerebral vasospasm: a meta-analysis.

BACKGROUND AND PURPOSE: In recent years, the role of CTA and CTP for vasospasm diagnosis in the setting of ASAH has been the subject of many research studies. The purpose of this study was to perform a meta-analysis of the diagnostic performance of CTA and CTP for vasospasm in patients with ASAH by using DSA as the criterion standard. MATERIALS AND METHODS: The search strategy for research studies was based on the Cochrane Handbook for Systematic Reviews, including literature data bases (PubMed, Embase, Cochrane Database of Systematic Reviews, and the Web of Science) and reference lists of manuscripts published from January 1996 to February 2009. The inclusion criteria were the following: 1) published manuscripts, 2) original research studies with prospective or retrospective data, 3) patients with ASAH, 4) CTA or CTP as the index test, and 5) DSA as the reference standard. Three reviewers independently assessed the quality of these research studies by using the QUADAS tool. Pooled estimates of sensitivity, specificity, LR+, LR-, DOR, and the SROC curve were determined. RESULTS: CTA and CTP searches yielded 505 and 214 manuscripts, respectively. Ten research studies met inclusion criteria for each CTA and CTP search. Six CTA and 3 CTP studies had sufficient data for statistical analysis. CTA pooled estimates had 79.6% sensitivity (95%CI, 74.9%-83.8%), 93.1%specificity (95%CI, 91.7%-94.3%), 18.1 LR+ (95%CI, 7.3-45.0), and 0.2 LR- (95%CI, 0.1-0.4); and CTP pooled estimates had 74.1% sensitivity (95%CI, 58.7%- 86.2%), 93.0% specificity (95% CI, 79.6%-98.7%), 9.3 LR+ (95%CI, 3.4-25.9), and 0.2 LR- (95%CI, 0.04-1.2). Overall DORs were 124.5 (95%CI, 28.4-546.4) for CTA and 43.0 (95%CI, 6.5-287.1) for CTP. Area under the SROC curve was 98 ± 2.0%for CTA and 97 ± 3.0% for CTP. CONCLUSIONS: The high diagnostic accuracy determined for both CTA and CTP in this meta-analysis suggests that they are potentially valuable techniques for vasospasm diagnosis in ASAH. Awareness of these results may impact patient care by providing supportive evidence for more effective use of CTA and CTP imaging in ASAH.

Features of programmed cell death in intact Xenopus oocytes and early embryos revealed by near-infrared fluorescence and real-time monitoring.

Factors influencing apoptosis of vertebrate eggs and early embryos have been studied in cell-free systems and in intact embryos by analyzing individual apoptotic regulators or caspase activation in static samples. A novel method for monitoring caspase activity in living Xenopus oocytes and early embryos is described here. The approach, using microinjection of a near-infrared caspase substrate that emits fluorescence only after its proteolytic cleavage by active effector caspases, has enabled the elucidation of otherwise cryptic aspects of apoptotic regulation. In particular, we show that brief caspase activity (10 min) is sufficient to cause apoptotic death in this system. We illustrate a cytochrome c dose threshold in the oocyte, which is lowered by Smac, a protein that binds thereby neutralizing the inhibitor of apoptosis proteins. We show that meiotic oocytes develop resistance to cytochrome c, and that the eventual death of oocytes arrested in meiosis is caspase-independent. Finally, data acquired through imaging caspase activity in the Xenopus embryo suggest that apoptosis in very early development is not cell-autonomous. These studies both validate this assay as a useful tool for apoptosis research and reveal subtleties in the cell death program during early development. Moreover, this method offers a potentially valuable screening modality for identifying novel apoptotic regulators.

Divergent regulation of hypothalamic neuropeptide Y and agouti-related protein by photoperiod in F344 rats with differential food intake and growth.

Hypothalamic genes involved in food intake and growth regulation were studied in F344 rats in response to photoperiod. Two sub-strains were identified: F344/NHsd (F344/N) and F344/NCrHsd (F344/NCr); sensitive and relatively insensitive to photoperiod respectively. In F344/N rats, marked, but opposite, changes in the genes for neuropeptide Y (NPY) (+97.5%) and agouti-related protein (AgRP) (-39.3%) expression in the arcuate nucleus were observed in response to short (8 : 16 h light/dark cycle, SD) relative to long (16 : 8 h light/dark cycle, LD) day photoperiods. Changes were associated with both reduced food intake and growth. Expression of the genes for cocaine and amphetamine-regulated transcript (CART) and pro-opiomelanocortin (POMC) in the arcuate nucleus was unchanged by photoperiod. POMC in the ependymal layer around the third ventricle was markedly inhibited by SD. Parallel decreases in the genes for growth hormone-releasing hormone (GHRH) and somatostatin (Somatostatin) mRNA in the arcuate nucleus and Somatostatin in the periventricular nucleus were observed in SD. Serum levels of insulin-like growth factor (IGF)-1 and insulin were lower in F344/N rats in SD, whereas neither leptin nor corticosterone levels were affected. By contrast, F344/NCr rats that show only minor food intake and growth rate changes showed minimal responses in these genes and hormones. Thus, NPY/AgRP neurones may be pivotal to the photoperiodic regulation of food intake and growth. Potentially, the SD increase in NPY expression may inhibit growth by decreasing GHRH and Somatostatin expression, whereas the decrease in AgRP expression probably leads to reduced food intake. The present study reveals an atypical and divergent regulation of NPY and AgRP, which may relate to their separate roles with respect to growth and food intake, respectively.

Influence of pressing method on juice stilbene content in muscadine and bunch grapes.

Juice stilbene contents of 2 muscadine (Vitis rotundifolia) cultivars, Noble and Carlos, and 2 bunch grape (Vitis labrusca) cultivars, Mid South and Miss Blanc were evaluated after crushing and pressing. Four commercial pressing methods were used to produce juice: (1) cold press of fresh berries (CP); (2) hot press of fresh berries (HP); (3) cold press of frozen and thawed berries (FCP); and (4) cold press of pectolytic enzyme treated berries (ECP). Free run juice (FRJ) from the crusher without pressing was also tested. An HPLC with a UV detector was used to verify the presence and quantity of resveratrol, piceid, and their isomers. For the muscadine juices, total stilbenes were greater for HP and FCP than for FRJ and CP treatments. Trans-resveratrol was only detected in HP juices of the muscadines at levels near the detection limits. The bunch grape cultivars behaved similar to the muscadines in the processing treatments. HP juice had the greatest total stilbene levels and was significantly greater than FRJ, CP, and FCP. Total stilbene levels in juices from the 2 bunch grape cultivars, were higher (up to 5 times greater depending on pressing method) than for the muscadine grape cultivars. Total stilbene levels in muscadine juices treated with pectinase before pressing (ECP) were similar to those of the FCP samples. Juice from FCP and ECP treated Noble muscadine had total stilbene levels greater than FRJ and CP but less than HP levels. Juices from HP-, ECP-, and FCP-treated Carlos muscadine had total stilbene levels greater than for FRJ and CP juices.

Cancer specialists' palliative care referral practices and perceptions: results of a national survey.

PURPOSE: Cancer specialists can facilitate timely and appropriate access to specialized palliative care (SPC) services. To better match patients' needs with access to SPC services, we must understand factors associated with referral. This study aimed to investigate cancer specialists' referral practices, perceptions of, barriers to and triggers for referral of people with advanced cancer to SPC services. METHOD: A self-report questionnaire was mailed to all oncologists, clinical haematologists, respiratory physicians and colorectal surgeons in Australia (N = 1713). RESULTS: Out of 699 specialists who participated, 48% reported referring >60% of patients to SPC services. Most frequent reasons for referral were: the future need for symptom control, the presence of a terminal illness or uncontrolled physical symptoms. Psychosocial issues rarely triggered referral. Main reasons reported for not referring included: ability to manage patients' symptoms; the absence of symptoms or rapid deterioration. Significant predictors of referral (P < 0.05) included: being female; >10 years of practice in the speciality; agreeing all people with advanced cancer need referral, referral for the purpose of multidisciplinary management and having SPC services available. CONCLUSIONS: Specialists mainly refer people with advanced cancer for symptom-related reasons. Measures are needed to encourage ongoing needs-based assessments, especially of emotional, cultural and spiritual issues.

COMPARATIVE ASSESSMENT OF TOTAL PHENOLIC CONTENT IN SELECTED MEDICINAL PLANTS.

This study was to compare the total phenolic (TP) content in extracts from eleven plant materials collected at different geographical locations in Kenya, Nigeria, and USA. These plants have been selected because the majority of them are highly pigmented, from yellow to purple, and would therefore have economic value in industries for producing antioxidants and surfactants. Two of them were collected from the industrial and domestic waste outlets. Each analysis was achieved using the Folin-Ciocalteau technique. The order of decreasing phenolic acid content as gallic acid concentration (mg/g dry weight) was Prunus africana (55.14) > Acacia tortilis (42.11) > Khaya grandifoliola (17.54) > Curcuma longa (17.23) > Vernonia amygdalina (14.9)> Russelia equisetiformis (14.03) > Calendula officinalis (7.96) >Phragmites australis (control) (7.09) > Rauwolfia vomitoria (6.69) > Phragmites australis (industrial) (6.21) > Cnidoscolus aconitifolius (5.6). The TP contents of Spartina alterniflora species were below the detection limit.

Paramagnetic hyperfine splitting in the Eu Mössbauer spectra of CaF(2):Eu.

(151)Eu Mössbauer spectra in zero magnetic field of highly dilute (0.1 mol%) Eu(2+) ions in CaF(2) showed an almost temperature-independent asymmetrically split pattern, arising from the paramagnetic hyperfine interaction AS. I in a cubic crystal field with slow electron spin relaxation; in a small external magnetic field B of 0.2 T such that gµ(B)B>A an almost symmetrical pattern was observed. Both the spectra with and without external field are well described using the spin Hamiltonian and previous electron paramagnetic resonance data. A more concentrated (2 mol% Eu(2+)) sample exhibited a strongly broadened symmetrical resonance line due to an increased Eu-Eu spin relaxation rate; in an external magnetic field of 0.2 T the Mössbauer spectra exhibited further broadening and additional magnetic structures due to the reduced relaxation rate. When a large field of 6 T was applied such that gµ(B)B is much larger than the crystal field splitting, a fully resolved hyperfine pattern was observed at 2.5 K, with an effective field at the Eu nuclei of -33.7 T; at higher temperatures superimposed patterns originating from excited electronic states were observed in the spectra. The present results on the highly dilute CaF(2) : 0.1%Eu(2+) sample deliver a straightforward explanation for previous observations of a seemingly large dependence of the Eu(2+) isomer shift on europium concentration.

Antimony-121 Mössbauer spectral study of the Eu14MnSb11 and Yb14MnSb11 Zintl compounds.

The antimony-121 Mössbauer spectra of the Yb14MnSb11 and Eu14MnSb11 Zintl compounds have been measured between 2 or 5 and 300 K. The resulting three-dimensional arrays of the spectral counts, velocity, and temperature have been simultaneously fit with a minimum number of free parameters. These fits yield a 0 Kelvin transferred hyperfine field of 2.9(2) T, a Curie temperature of 57(3) K, and a Mössbauer temperature of 182(2) K for Yb14MnSb11; in this case the transferred field arises solely from the ordering of Mn2+. Because Eu14MnSb11 has both Eu2+ and Mn2+ ions that are magnetically ordered, its antimony-121 Mössbauer spectra are more complex and reveal two magnetic transitions, the first at 92(1) K resulting from the ordering of the Mn2+ ions and the second at 9.5(1.0) K resulting from the ordering of the Eu2+ ions; the corresponding 0 Kelvin transferred hyperfine fields are 1.3(1) and 3.7(1) T. The antimony-121 isomer shifts yield electronic configurations of 5s1.745p4.28 and 5s1.745p4.19 for the average antimony anion in Yb14MnSb11 and Eu14MnSb11, respectively.

Antimony-121 Mössbauer spectral study of alpha-Zn4Sb3.

The Mössbauer spectra of alpha-Zn4Sb3, a compound that is best formulated as alpha-Zn13Sb10 or (Zn2+)13(Sb3-)6(Sb24-)2, have been measured between 5 and 120 K. The resulting six spectra have been simultaneously fit with two components in the ratio of 3:2 corresponding to the Sb3- and Sb2- ions identified in this valence semiconductor. The fits yield temperature independent isomer shifts of -8.17(2) and -9.73(2) mm/s and quadrupole interactions of -4.9(2) and 0 mm/s for the Sb3- and Sb2- ions, respectively; the corresponding Mössbauer temperatures are 197(5) and 207(5) K, temperatures that are lower than the Debye temperature of beta-Zn4Sb3. The isomer shifts correspond to electronic configurations between 5s25p6 and 5s1.755p4.01 for the Sb3- ions and between 5s25p5 and 5s1.805p3.38 for the Sb2- ions, configurations that are in good agreement with the expected configurations for this valence semiconductor and with the results of band structure calculations.

Using CT in the diagnosis and management of patients with cerebral vasospasm.

Cerebral vasospasm remains a serious complication of aneurysmal subarachnoid hemorrhage. Efforts in improving its clinical outcome have been focused on early diagnosis and applying effective treatment regimens. Standard diagnostic modalities currently used do not fully address this complex disease. The use of CT angiography and CT perfusion are discussed, with emphasis on its potential role in not only detecting vasospasm, but also in guiding management decisions and assessing clinical outcome.