Highly multimodal structure of high topological charge extreme ultraviolet vortex beams.

Optical beams carrying orbital angular momentum are a very active field of research for their prospective applications, especially at short wavelengths. We consider here such beams produced through high-harmonic generation (HHG) in a rare gas and analyze the characterization of their high-charge vortex structure by an extreme ultraviolet Hartmann wavefront sensor. We show that such HHG beams are generally composed of a set of numerous vortex modes. The sensitivity of the intensity and phase of the HHG beam to the infrared laser aberrations is investigated using a deformable mirror.

Hartmann wavefront sensor characterization of a high charge vortex beam in the extreme ultraviolet spectral range.

We demonstrate for the first time, to the best of our knowledge, the ability of extreme ultraviolet (XUV) Hartmann wavefront sensors to characterize high charge vortex beams produced by high-order harmonic generation up to the order of 25. We also show that phase matched absorption limited high harmonic generation is able to maintain the high charge vortex structure of the XUV beam even in a rather long (1 cm) generation medium.

Gain dynamics in quickly ionized plasma for seeded operated soft x-ray lasers.

Harmonic seeded operation of a neon-like titanium plasma-based soft x-ray laser is described. The plasma amplifier is pumped with a variation of the grazing incidence technique involving a fast and localized ionization step. We discuss its effect on gain dynamics by measuring the amplifying factor as a function of the delay between pump pulse and harmonic seed. Two different regimes are pointed out, following the pumping scheme used. For one of them, a delay in the gain generation compared with the pumping laser pulse is observed.

Low energy prepulse for 10 Hz operation of a soft-x-ray laser.

The influence on Nickel-like Molybdenum soft-x-ray laser performance and stability of a low energy laser prepulse arriving prior to the main laser pumping pulses is experimentally investigated. A promising regime for 10 Hz operation has been observed. A four times increase in soft-x-ray laser operation time with a same target surface is demonstrated. This soft-x-ray laser operation mode corresponds to an optimum delay between the prepulse and the main pulses and to a prepulse energy greater than 20 mJ. We also show that this regime is not associated with a weaker degradation of the target or any reduced ablation rate. Therefore the role of preplasma density gradient in this effect is discussed.

Fulminant Neisseria meningitidis septicaemia with purpura fulminans requiring limb amputation.

Despite the isolation of Neisseria meningitidis over 200 years ago, meningococcal disease remains a feared cause of bacterial sepsis, with significant morbidity and mortality, despite prompt antibiotic use and modern critical care support. Neisseria meningitides is a Gram-negative encapsulated diplococcus, which exists only in the human host (Kvalsvig and Unsworth, 2003). The bacterium can cause life-threatening septic shock and coagulopathy, which may rapidly manifest within a matter of hours from preceding mild symptoms (Kvalsvig and Unsworth, 2003). Whilst N. meningitidis is recognised as a common commensal organism in the nasopharynx, associated with asymptomatic carriage in up to 10 %, manifestation of life-threatening disease is rare (Rappuoli and Pizza, 2015). We report the case of 31-year-old male presenting with devastating meningococcal septicaemia with disseminated intravascular coagulopathy (DIC) and purpura fulminans, requiring surgical debridement and a right above-knee amputation for sepsis-driven skin necrosis. The patient suffered extensive tissue loss secondary to a type 3 immune hypersensitivity reaction involving immune-complex mediated inflammation and tissue necrosis. Due to a strong immune component driving the patient's failure to convalesce pulsed intravenous methylprednisolone was used alongside antimicrobial therapy. The use of steroids was associated with fever subsidence and significant clinical improvement, highlighting the benefit of corticosteroid use in immune-complex mediated pathology.

International regulations and standards for avian influenza, including the vaccine standards of the World Organisation for Animal Health.

For avian influenza the World Organisation for Animal Health (OIE) has laid down international standards on notification, trade, diagnosis, surveillance and the production and use of vaccine. These standards are science- and risk-based to ensure safe trade in poultry and poultry products without unjustified barriers. The European Union, with its 27 Member States, has in place harmonised legislation in line with OIE standards. Early detection, rapid diagnosis, notification and high quality Veterinary Services are crucial for ensuring a rapid response to avian influenza outbreaks and for swiftly reducing the risk of virus spread via trade. Depending on the situation, vaccination may also be a very important tool for disease control. The use of high quality vaccines and postvaccination monitoring are essential for the successful implementation of vaccination. Compliance with international standards is of paramount importance for protecting animal and human health in the global crisis of the highly pathogenic avian influenza of the H5N1 subtype.

EFSA scientific risk assessment on animal health and welfare aspects of avian influenza (EFSA-Q-2004-075).

Outbreaks of highly pathogenic avian influenza (HPAI) (2000-2003) resulted in 50 million EU birds culled or dead. The circulation of H5N1 in Asia could represent the origin of a human pandemic. Questions have been raised to combat the ongoing AI crisis. HPAI H5N1 has spilled over to resident and migratory wild bird populations which could represent a means of the virus reaching the EU, but lack of data make any forecast imprudent. Poultry holdings located close to migratory bird breeding and resting sites are considered at greater risk of exposure and methods to prevent exposure should be implemented. Legal safeguards for importation of poultry commodities currently only apply to HPAI and rely on detection of clinical signs that may not be observable during incubation period. Illegal imports represent an additional risk. Insufficient data on the effectiveness of commodity processing are available and few indications can be deducted. Biosecurity is the primary tool to prevent AI introduction and secondary spread. Massive spread was observed in densely populated poultry areas resulting in vaccination programs. Vaccination should be used to support eradication together with enhanced biosecurity and restriction measures, which shall also be implemented in case of prophylactic vaccination. Animal welfare aspects of AI include use of appropriate culling methods, correct vaccine application, and availability of trained staff. EFSA has recently set up a new scientific work group to further assess the risk of HPAI introduction and spread posed in particular by wild, migratory birds, as well as further follow-up of recent AI developments.

Experiences in control of avian influenza in Europe, the Russian Federation and the Middle East.

An unprecedented global epidemic of highly pathogenic avian influenza virus H5N1 has and continues to present enormous challenges to the international community for control in the animal reservoir. Enhanced biosecurity, good surveillance, both passive and active, supplemented by strong veterinary services, can reduce the risk for incursion and subsequent spread in free countries. Surveillance of mortality and laboratory testing among wild birds are useful early indicators of incursion of the virus into areas in which domestic poultry are not infected. Conventional control methods used widely in Europe and the Middle Eastern region involve stamping-out, zoning, quarantine, movement restrictions, enhanced surveillance and disinfection. Use of preventive vaccination is increasing in the region. In the Russian Federation, all backyard poultry considered to be at high risk for infection have been vaccinated since 2006. Several countries in the Middle East permit the use of vaccine, although rarely as part of a formal statutory programme. In the European Union, conventional approaches for control have proved effective, but both emergency and preventive vaccination could be used. Application of such programmes would have to be preceded by an evaluation of the risks for introduction and spread and might be restricted.

Mitral and aortic valve orifice area in normal subjects and in patients with congestive cardiomyopathy: determination by two dimensional echocardiography.

Previous determinations of normal valve orifice areas have been mainly from postmortem studies. In this study mitral and aortic valve orifice area were determined from two dimensional echocardiograms in 20 normal subjects and 20 patients with congestive cardiomyopathy. Mitral valve orifice area was larger than quoted in standard textbooks. Both mitral and aortic valve orifice area were reduced in patients with cardiomyopathy. Valve opening was assessed relative to left ventricular and aortic root size. The ratio of mitral valve orifice area to left ventricular cross-sectional area was markedly reduced in patients with cardiomyopathy compared with normal subjects. The ratio of aortic valve orifice area to aortic root size also was reduced in patients with cardiomyopathy. Anterior mitral leaflet E point-septal separation was similar to that in previous reports contrasting normal subjects with patients with myopathy. Among patients with cardiomyopathy, mitral E point-septal separation was primarily a function of left ventricular size and was not significantly correlated with fractional shortening or ejection fraction within this group having uniformly poor systolic function.

Primum non nocere: a pharmacologically inert pertussis toxoid alone should be the next pertussis vaccine.

The objective of a vaccine for pertussis is to prevent the paroxysmal cough with its complications. Prevention of the paroxysmal cough should prevent transmission of B. pertussis. Clinical studies indicate that a critical level of antitoxin confers protection against pertussis and that the long-lived protective immunity that follows pertussis is best explained by the presence of antitoxin. Vaccine-induced protective immunity can be mediated by a critical level of antitoxin alone. In addition to preventing pertussis with vaccines, we predict this level of antitoxin will also exert epidemiologic control (herd immunity) by inhibition of colonization with B. pertussis and by prevention of the paroxysmal cough which will reduce transmission of this pathogen. Lastly, a pertussis toxoid need not have detectable pharmacologic activity to exert its protective actions: residual activity could exert a deleterious effect on glucose metabolism and exert immunomodulating effects. Accordingly the new pertussis vaccine should contain inactivated pertussis toxoid alone and there is no need to include other components. Several candidates could serve as a satisfactory pertussis toxoid. The admonition to physicians given by Hippocrates, Primum non nocere (first of all do no harm), should be heeded by those responsible for the development and use of the new pertussis vaccine.

Neurotoxicity of Bordetella pertussis.

Pertussis is a unique disease in which the harmful effects are mediated by an exotoxin that effects stimulation of the adrenergic system which is neuronally controlled. The interdependence of the growth of bacteria and toxin production, and the local colonization of the bacteria that precedes the clinical symptom of the disease reflect the nature of the disease. Pertussis toxin enzymatically alters the function of numerous regulatory cells that is demonstrable, after an interval of time, by a specific stimulus. The toxin also may act rapidly and effect action at a target tissue. The latter appears to be associated with the rapid adverse events after vaccination whereas both may occur in the disease. The pathophysiologic responses associated with specific clinical symptoms have not been clearly defined. Responses to be evaluated relative to encephalopathy are increased vascular permeability, hypoglycemia and enhanced activity of neuronal glutamate and aspartate. The intensity of responses is related to the amount of pertussis toxin available, genetic susceptibility, ethnic and allotype, and external factors. The reason for the non-linear dose response shown by the critical level between the sublethal and the lethal infection in mice is unclear. Bacterial adenylate cyclase may be a candidate. Much remains to be elucidated about the enzymatic pathways that effect the many disparate events, the identity of the neurons that effect the clinical symptoms and their CNS location, the identity of the neuronal transmitters and the pathoneuronal pharmacodynamics.

The healthy communities movement and the coalition for healthier cities and communities.

Part One of this article describes the principles and origins of the Healthy Communities movement. Part Two describes the Coalition for Healthier Cities and Communities, a national network of partnerships and organizations. The authors argue (a) that to sustain community initiatives, practitioners must move from projects that address symptoms of social problems to changing the underlying community cultures, incentives, and settings that give rise to these symptoms, and (b) that the Coalition's continued relevance depends on its ability to help leaders make that transition.

Atheroembolism presenting as selective muscle embolisation.

Two cases of occult aneurysmal disease presenting with select muscle embolisation are described. Both cases were characterised by symptomatology suggestive of occlusive disease but in the presence of normal pulses. It is concluded that the clinical features allow early diagnosis of this uncommon presentation of aneurysmal disease.

An exploration of content on legal aspects of practice in nursing programs.

The paucity of literature on legal content in nursing curricula was used to frame the research question that guided this study. In what ways and to what extent are nursing educators addressing the subject of legal aspects of nursing practice? This study was designed to explore the area of legal aspects of nursing practice in nursing programs curricula. The researchers gathered information on numerous areas, including course content, methods of delivery, topics covered, and time devoted to legal content. The results revealed that content on legal aspects of nursing practice is commonly a component of nursing programs curricula and provided information on many areas; however, the results also revealed other areas that need to be researched.

Haptic-visual form identification in children aged 4 through 13.

Children 4 through 13 yr. of age performed on a haptic-to-visual form-identification task. The obtained curves showed that for both sexes, rate of improvement slowed down at approximately 9 yr. of age.

Workplace violence in healthcare environments.

Violence in the workplace is making headlines across the United States. Healthcare workers are not immune to violent encounters. Many healthcare workers will experience workplace violence at least once during their professional careers. Nurses are in a unique position to develop and provide assistance to implement prevention programs that can decrease the incidence and prevalence of violence in healthcare environments. This article reviews the definition of violence and its elements, and outlines a plan to reduce violence in healthcare environments.

Voices of reform. The AHA: policy, advocacy and the tools for reform.

In three thoughtful essays, with an introduction by president Dick Davidson, executives at the AHA discuss the policy and political aspects of the reform process, and the organization's reform vision, including the development of tools for its membership.

CEO summit. Building the new health care delivery alliance, Part III. Roundtable discussion.

In cooperation with McManis Associates, Hospitals & Health Networks recently convened a CEO summit on physician/hospital integration activities. In the third report of a three-part series on the summit, leading health care executives discuss investor capital needs, strategic information management needs, and the management competencies required for capitated managed care success.

CEO Summit. Building the new health care delivery alliance, Part II. Roundtable discussion.

In cooperation with McManis Associates, Hospitals & Health Networks recently convened a CEO summit on physician/hospital integration activities. The summit was designed and facilitated by the senior staff of McManis Associates. Part I, which appeared in the May 5 issue, focused on the lessons being learned by those providers on the front lines of integration. This report focuses on aligning incentives and achieving cost-effectiveness.

Primary aortoenteric fistula following disseminated bacillus Calmette-Guérin infection: a case report.

The aim of this paper is to illustrate a rare case of primary aortoenteric fistula in the presence of disseminated infection and review the critical decision-making process. A clinical case was reviewed for its initial presentation, planning of treatment strategy and outcome. A secondary literature search for discussion on current accepted recommendations for primary aortoenteric fistula was then completed. Aortoenteric fistulas are rare pathologies with highly morbid potential. Their diagnosis requires a high index of suspicion and prompt intervention is critical to patient survival. In conclusion, aortoenteric fistula most commonly arises from large atherosclerotic aneurysms but can be caused by systemic infection. In the case of the latter, extra-anatomic repair appears to be the treatment of choice.