Is laser space propulsion practical?: review.

In this paper, we review practical limitations to laser space propulsion that have been discussed in the literature. These are as follows: (1) thermal coupling to the propelled payload, which might melt it; (2) a decrease in mechanical coupling with number of pulses, which has been observed in some cases; and (3) destruction of solar panels in debris removal proposals that might create more debris rather than less. Previously, lack of data prevented definite assessments. Now, new data on multipulse vacuum laser impulse coupling coefficient Cm on several materials at 1064 nm, at 1030 nm, and at 532 nm are available. We are now able to compare the results for single and multiple pulses on materials that have been considered for laser ablation space propulsion (LASP), or that are likely space debris constituents, and decide whether LASP is a practical idea. Laser space propulsion and debris removal concepts depend on thousands or hundreds of thousands of repetitive pulses. Repetitive pulse mechanical coupling as well as thermal coupling (which can melt the target rather than propel it) are both important considerations. Materials studied were 6061T6 aluminum, carbon-doped polyoxymethylene (POM), undoped POM, a yellow POM copolymer, and a mixture of Al and POM microparticles combined and pressed, containing a 50%/50% mixture of the two materials by mass. We address 6 and 70 ps pulses because of the availability of data at these pulse durations. We also briefly consider continuous wave (CW) laser propulsion. Finally, we consider a recent paper concerning solar panel destruction from a positive perspective.

Acute physiological effects following Bacillus subtilis DE111 oral ingestion - a randomised, double blinded, placebo-controlled study.

Previous studies using ileostomy samples from study participants demonstrated that the spore-forming probiotic Bacillus subtilis DE111® can germinate in the small intestine as early as 4 hours after ingestion. Metabolomics, proteomics and sequencing technologies, enabled further analysis of these samples for the presence of hypoglycaemic, hypolipidemic, antioxidant, anti-inflammatory and antihypertensive molecules. In the DE111 treatment group, the polyphenols trigonelline and 2,5-dihydroxybenzoic acid, orotic acid, the non-essential amino acid cystine and the lipokine 12,13-diHome were increased. DE111 also reduced acetylcholine levels in the ileostomy samples, and increased the expression of leucocyte recruiting proteins, antimicrobial peptides and intestinal alkaline phosphatases of the brush border in the small intestine. The combination of B. subtilis DE111 and the diet administered during the study increased the expression of the proteins phosphodiesterase ENPP7, ceramidase ASAH2 and the adipokine Zn-alpha-2-glycoprotein that are involved in fatty acid and lipid metabolism. Acute B. subtilis DE111 ingestion had limited detectable effect on the microbiome, with the main change being its increased presence. These findings support previous data suggesting a beneficial role of DE111 in digestion, metabolism, and immune health that appears to begin within hours of consumption.

Evaluation of Bacillus clausii CSI08, Bacillus megaterium MIT411 and a Bacillus cocktail on gastrointestinal health: a randomised, double-blind, placebo-controlled pilot study.

In the present study, the safety, tolerance and impact of 1×109 cfu Bacillus clausii CSI08, 1×109 cfu Bacillus megaterium MIT411 and a probiotic cocktail containing Bacillus subtilis DE111®, Bacillus megaterium MIT411, Bacillus coagulans CGI314, and Bacillus clausii CSI08 with a total count of 2.0×109 cfu administered daily were assessed as compared with a maltodextrin containing placebo control. A total of 98 study participants received daily doses for 45 days, followed by a washout period of 2 weeks. A questionnaire to capture the incidence and duration of upper respiratory tract, urinary tract and/or gastrointestinal complaints and a diary to capture stool regularity and consistency was kept daily to record compliance throughout the 45 days. Faecal and blood samples were collected for microbiological and haematological analysis at the start and end of the treatment period. The probiotic cocktail significantly decreased the incidence of loose stools throughout the entire study. The recorded respiratory, urinary and gastrointestinal symptoms, defecation frequency and other stool consistency were not influenced. No clinically relevant changes in blood parameters, such as liver and kidney function and no serious adverse events appeared during and after administration. There were no changes in symptoms including sadness, irritability, energy, appetite, tension, stress, sleep, cardiovascular events, aches and pains, and dizziness as determined by a mood questionnaire administered to participants at baseline and at the end of the treatment period. Similarly, the measured inflammatory cytokines, antioxidant levels, cholesterol, triglycerides, free amino acids or minerals remained unaffected. There were no negative changes in alpha or beta diversity of the microbiota with any of the treatment groups. These promising data suggest that these treatments were safe and well tolerated, and further work with larger cohorts are justified to determine the efficacy of these potential probiotics in select demographic groups. Trial registration number with clinicaltrials.gov at NCT04758845.

Early relapse post autologous transplant is a stronger predictor of survival compared with pretreatment patient factors in the novel agent era: analysis of the Singapore Multiple Myeloma Working Group.

The clinical outcome of multiple myeloma is heterogeneous. Both the depth of response to induction and transplant as well as early relapse within a year are correlated with survival, but it is unclear which factor is most relevant in Southeast Asian patients with multiple myeloma. We retrospectively analyzed outcomes of 215 patients who were treated with upfront autologous transplant in Singapore between 2000 and 2014. In patients who received novel agent (NA)-based induction, achieving only partial response (PR) post-induction was associated with poorer OS (HR 1.95, P=0.047) and PFS (HR 2.9, P<0.001), while achieving only PR post-transplant was strongly correlated with both OS (HR 3.3, P=0.001) and PFS (HR 7.6, P<0.001), compared with patients who achieved very good partial response (VGPR) or better. Early relapse was detected in 18% of all patients, although nearly half had initially achieved VGPR or better post-transplant. Early relapse after NA-based induction led to significantly shorter OS (median 22 months vs not reached, P<0.001), and was strongly associated with OS (HR 13.7, P<0.001). The impact of suboptimal post-transplant response and early relapse on survival may be more important than pretransplant factors, such as International Staging System or cytogenetics, and should be considered in risk stratification systems to rationalize therapy.

Utilization of stored autologous PBSCs to support second autologous transplantation in multiple myeloma patients in the era of novel agent therapy.

Outcomes in multiple myeloma (MM) have improved significantly with novel agent therapy and autologous stem cell transplantation (ASCT). ASCTs are typically planned as either tandem or a single transplant with additional stored PBSCs available for a second salvage transplant. To accommodate these strategies, many centers routinely collect and store adequate PBSCs for two ASCTs. We analyzed the cost associated with this practice by determining the expenses of PBSC collection, cryopreservation and storage, and the ultimate use of additional cryopreserved PBSCs in patients who had undergone at least one ASCT. There were 889 MM patients transplanted between 1993 and 2011 at our center. Most (N=726) had residual PBSCs in storage after their first ASCT (ASCT1). Only 135 patients underwent a second ASCT within a median of 14 months after ASCT1. The percentage of patients receiving a second ASCT declined over time. The resources required to collect and store unused PBSCs added up to 336 extra patient days of apheresis and 41 587 extra patient months of cryopreservation, translating into an average extra cost per patient of US$4981.12. A reconsideration of conventional PBSC collection and storage practices would save significant cost for the majority of MM patients who never undergo a second ASCT.

Choosing sample volume to achieve maximum detection sensitivity and resolution with high-performance liquid chromatography columns of 1.0, 2.1 and 4.6 mm I.D.

The relationship between sample volume and the chromatographic performance factors of detection sensitivity and resolution were explored for high-performance liquid chromatography (HPLC) columns of 1.0, 2.1 and 4.6 mm I.D. Performance was evaluated for isocratic and gradient elution in systems having low, intermediate and high extracolumn dispersion. Sample volumes ranged from 0.4 microliter to 2 ml. This paper provides guideline for selecting sample injection parameters so that the performance of microbore columns is not needlessly sacrificed by using too small or too large a sample volume. The guidelines are extracted from the works of others and are modified by our own experimental results. Comments are also made on the relative merits of various injection techniques.

Gastroesophageal reflux contributing to chronic sinus disease in children: a prospective analysis.

OBJECTIVE: To explore the possible role of gastroesophageal reflux (GER) in children with chronic sinus disease (CSD). DESIGN: A descriptive prevalence study of the frequency of GER and nasopharyngeal reflux in children with CSD. SETTING: Pediatric otolaryngology and gastroenterology outpatient clinics of a regional medical center. PATIENTS AND OTHER PARTICIPANTS: Consecutive children aged 2 to 18 years referred for evaluation of CSD from December 1, 1996, through April 30, 1998. INTERVENTIONS: Participants underwent 24-hour monitoring with dual pH probes, and participants (or their parents) completed questionnaires before treatment and at specific intervals after treatment. MAIN OUTCOME MEASURES: Prevalence of GER and nasopharyngeal reflux in children with CSD, and the response of sinusitis to treatment in those diagnosed with GER. RESULTS: Nineteen (63%) of 30 patients demonstrated esophageal reflux, which is well above the expected prevalence of GER in the healthy general population. Six (32%) of these 19 patients demonstrated nasopharyngeal reflux. Fifteen (79%) of 19 patients improved after treatment for GER. CONCLUSIONS: The children in this population had a prevalence of GER that was significantly higher than expected. Furthermore, most children with GER demonstrated improvement of sinus disease after treatment of GER. We recommend that children with CSD refractory to aggressive medical management be evaluated for GER and, if GER is present, be treated accordingly, before sinus surgery is considered.

Gunshot wounds to the mandible and midface: evaluation, treatment, and avoidance of complications.

As American society becomes progressively violent, an ever-increasing number of gunshot wounds are being seen across the United States. Particularly challenging are injuries that involve the mandible and midface, not only because of problems with reconstructing bone and soft-tissue defects but also because of emergent problems with airway obstruction and neurovascular compromise. We present 40 cases of gunshot wounds to the mouth, mandible, and maxilla treated at Wake Forest University Medical Center during the past 7 years. The focus of this retrospective analysis is on emergency evaluation and treatment, complications encountered, and operative techniques used for reconstruction. Special emphasis is placed on recognizing and avoiding the complications of these injuries.

Combined use of alcohol and nicotine gum.

This study evaluated the effects of chewing nicotine gum immediately before and just after drinking a moderate amount of alcohol. Four research questions were addressed. First, does chewing nicotine gum prior to drinking alcohol attenuate the increased craving to smoke that is typically associated with alcohol use? Second, does drinking prior to chewing reduce the gum's effectiveness? Third, are significant side effects observed with nicotine gum, and is their severity affected by alcohol use? Finally, can we identify subjects who are more likely to respond well to the gum on the basis of smoking history or pattern or other descriptive-demographic, psychologic, or historical variables? Smokers who had abstained for at least 12 h were studied in a fully crossrandomized experimental design that contrasted nicotine gum (before or after drinking) versus sugarless gum, and alcohol versus a no-alcohol comparison condition. Nicotine gum use was associated with significantly greater immediate reduction in craving to smoke, regardless of whether it preceded or followed alcohol, but the effects were weak and short-lived in either case. Moderate use of alcohol after chewing the gum eliminated virtually all of its beneficial effects. Mild side effects were common with nicotine gum, but equally so regardless of alcohol use. A small battery of demographic and historical variables failed to identify those subjects who responded well to nicotine gum.

Is the hospital setting the place for teaching breast self-examination?

The purpose of this study was to investigate the effects of an instructional program for nurses educating them to teach breast self-examination (BSE) to hospitalized patients. Nurses' knowledge, attitudes, self-practice, and practice of teaching breast self-examination to patients were measured in a group who attended such a program and compared with those of a control group who did not attend. The researchers found that the instructional program increased nurses' teaching of BSE to their patients, but did not affect their own self-practice. Nurses' attitudes to teaching BSE were less favorable than for self-practice. Issues related to environments for teaching BSE are discussed.

Infantile subglottic hemangioma: a review and presentation of two cases of surgical excision.

Subglottic hemangioma in infants is a well-defined entity with which otolaryngologists should be familiar. Although benign lesions with a natural history of regression, they may demand the attention of an otolaryngologist to maintain a secure airway. Throughout the years, multiple treatment options have been proposed and utilized for subglottic hemangioma. As of yet, however, there is no consensus as to the best treatment. Surgical excision is one treatment option available to the otolaryngologist which has previously received less attention. We review treatment options and report two cases of surgical excision of infantile subglottic hemangioma. Both patients were extubated by postoperative day number three and have remained symptom free. We support surgical excision as a valuable treatment option.

Positron emission tomography findings in patients with lymphoma-associated haemophagocytic syndrome.

Lymphomas that manifest initially with haemophagocytic syndrome (HPS) often pose a diagnostic challenge, as the majority of cases have no significant lymphadenopathy for early histological diagnosis. There is paucity of data on specific features of fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography with integrated computed tomography (PET/CT) in patients with lymphoma-associated HPS (LHPS). We describe three cases of LHPS and their characteristic PET imaging features. These three patients had pyrexia and pancytopenia. Their PET/CT images showed extensive and diffuse FDG uptakes in the bone marrow of the axial skeleton, with little involvement in the lymph nodes. They also faced a common initial diagnostic difficulty; the lack of nodal involvement on clinical examination or CT contributed to the delay in the diagnosis of lymphoma. The PET/CT images, however, revealed extensive and distinctive FDG uptakes in the axial skeletal marrow compartment, thus leading to a greater appreciation of the full extent of the disease.

Effectiveness of the clinical nurse specialist in preadmission testing.

Prospective payment has led health care providers to shorten hospital stays wherever possible. Cutting costs by shortening stays has particularly affected the care surgical patients receive. Formerly, patients were admitted one or more days before a planned surgery for medical workup, laboratory testing and patient teaching. Today, hospitals nationwide admit patients scheduled for many types of surgery on the day surgery is performed. Preoperative testing programs have been established in hospitals across the country to replace the inpatient preoperative testing and assessment period (Anderson and Zimbra 1986; Connaway and Blackledge 1986; Worley 1986). These programs provide the necessary medical workup, but most fail to include the elements of preoperative care performed by nurses (Kemaghan 1985). Comprehensive preoperative nursing assessment, patient education, and discharge planning, essential components of quality surgical nursing care, have been jeopardized in this process. Clearly, payor policies encouraging providers to control costs were not meant to result in poor quality care. In the case of elective surgical patients, however, that possibility currently exists when preoperative nursing care is compressed into a very brief period just prior to the surgery itself. In order to enhance the efficiency and effectiveness of the care provided, appropriate nursing care must be available in preadmission programs. By this reallocation of nursing manpower, nurses can plan and establish priorities for management of patient care in a low-cost environment and can initiate appropriate interventions for the inpatient period and for discharge planning.(ABSTRACT TRUNCATED AT 250 WORDS)

Saturation behavior of p-type germanium at CO(2) laser wavelengths.

Observed bleaching of single-crystal p-type germanium in the 10-microm region obeys an inhomogeneous broadening model for input intensities up to 100 times the saturation intensity I(s). Bleaching measurements show that I(s) varies from about 3.2 MW cm(-2) at 10.59 microm to about 6.8 MW cm(-2) at 9.27 microm. No significant variation of I(s) with crystal orientation is seen. Applications to CO(2) laser system isolation are discussed.