Kidney transplant donor glomerular filtration rate by iohexol clearance during computerized tomographic angiography of the kidneys.

BACKGROUND: Pre-transplantation living-donor kidney function determines remaining donor kidney function and significantly affects post-transplantation allograft function in the recipient. Few transplantation centers perform donor kidney function measurement owing to patient burden. A simplified method of glomerular filtration rate (GFR) measurement after angiographic procedures may facilitate more precise measurement of donor kidney function. METHODS: We evaluated the agreement between a simplified method of GFR measurement after renal computerized tomographic (CT) angiography (index GFR, 100 mL iohexol [350 mg/mL iodine]) and the reference GFR measurement with the use of iodinated radiocontrast media (5 mL bolus of iohexol [300 mg/mL iodine]) among 19 potential living kidney transplant donors. The 24-hour creatinine clearance and GFR estimation equations were additionally examined. Kidney lengths and total and segmented cortical kidney volumes were also measured. RESULTS: The index CT angiography GFR performed best with respect to the reference GFR with minimal bias (mean difference, -4 mL/min/1.73 m(2)), good precision (SD of the difference, 9.8 mL/min/1.73 m(2)), coefficient of determination (R(2)) of 0.74, narrow mean coefficient of variation (5% [range 1%-15%]), and high accuracy, with 100% of the values for the index test within 30% of the reference test. The 24-hour urine creatinine clearance values performed poorly. Kidney volumes and length did not significantly correlate with measured GFR. CONCLUSIONS: The CT angiographic GFR measurement could be a useful and more convenient method of donor kidney function evaluation and maintains minimal bias, high precision, and accuracy compared with the reference GFR measurement.

Lessons learned for collaborative clinical content development.

BACKGROUND: Site-specific content configuration of vendor-based Electronic Health Records (EHRs) is a vital step in the development of standardized and interoperable content that can be used for clinical decision-support, reporting, care coordination, and information exchange. The multi-site, multi-stakeholder Acute Care Documentation (ACD) project at Partners Healthcare Systems (PHS) aimed to develop highly structured clinical content with adequate breadth and depth to meet the needs of all types of acute care clinicians at two academic medical centers. The Knowledge Management (KM) team at PHS led the informatics and knowledge management effort for the project. OBJECTIVES: We aimed to evaluate the role, governance, and project management processes and resources for the KM team's effort as part of the standardized clinical content creation. METHODS: We employed the Center for Disease Control's six step Program Evaluation Framework to guide our evaluation steps. We administered a forty-four question, open-ended, semi-structured voluntary survey to gather focused, credible evidence from members of the KM team. Qualitative open-coding was performed to identify themes for lessons learned and concluding recommendations. RESULTS: Six surveys were completed. Qualitative data analysis informed five lessons learned and thirty specific recommendations associated with the lessons learned. The five lessons learned are: 1) Assess and meet knowledge needs and set expectations at the start of the project; 2) Define an accountable decision-making process; 3) Increase team meeting moderation skills; 4) Ensure adequate resources and competency training with online asynchronous collaboration tools; 5) Develop focused, goal-oriented teams and supportive, consultative service based teams. CONCLUSIONS: Knowledge management requirements for the development of standardized clinical content within a vendor-based EHR among multi-stakeholder teams and sites include: 1) assessing and meeting informatics knowledge needs, 2) setting expectations and standardizing the process for decision-making, and 3) ensuring the availability of adequate resources and competency training.

Clinician preferences for verbal communication compared to EHR documentation in the ICU.

BACKGROUND: Effective communication is essential to safe and efficient patient care. Additionally, many health information technology (HIT) developments, innovations, and standards aim to implement processes to improve data quality and integrity of electronic health records (EHR) for the purpose of clinical information exchange and communication. OBJECTIVE: We aimed to understand the current patterns and perceptions of communication of common goals in the ICU using the distributed cognition and clinical communication space theoretical frameworks. METHODS: We conducted a focus group and 5 interviews with ICU clinicians and observed 59.5 hours of interdisciplinary ICU morning rounds. RESULTS: Clinicians used an EHR system, which included electronic documentation and computerized provider order entry (CPOE), and paper artifacts for documentation; yet, preferred the verbal communication space as a method of information exchange because they perceived that the documentation was often not updated or efficient for information retrieval. These perceptions that the EHR is a "shift behind" may lead to a further reliance on verbal information exchange, which is a valuable clinical communication activity, yet, is subject to information loss. CONCLUSIONS: Electronic documentation tools that, in real time, capture information that is currently verbally communicated may increase the effectiveness of communication.

Immunodepression reduces learning performance in male laboratory mice (Mus musculus).

Several theoretical and empirical studies have suggested that immunocompetence may act as a constraint on learning, due to a trade-off in investment in the two processes. Here we tested whether experimentally depressing immune responsiveness of male BKW mice using antithymocyte serum (ATS) would lead to reduced learning performance in a radial maze task. Correct choices in the maze were indicated by the presence of familiar odours, incorrect choices by unfamiliar odours. We showed that temporarily depressing cellular immunity led to a reduction in performance in terms of a reduced proportion of correct choices. We also found a positive relationship between the proportion of correct entries over the period of testing and haemagglutination titre, indicating that mice showing greater immune responsiveness performed better in the maze. We conclude that depressing the immune system reduces learning performance in a combined odour/spatial learning task, and that some individuals are better able to compensate for the experimental immunodepression. In contrast to previous studies, there was no evidence that the effect of ATS was mediated by associated changes in corticosterone or testosterone secretion. There were no significant effects of the presence of female odour on learning performance, and therefore no evidence that the down regulation of learning in relation to immune depression was influenced by apparent reproductive opportunity.

Odour learning and immunity costs in mice.

There is accumulating evidence that learning is metabolically costly. One way in which this may manifest itself is in trade-offs between learning effort and immune function, with learning increasing susceptibility to infection. We tested this idea in the context of odour learning using outbred (BKW) male laboratory mice. Mice were exposed to three experimental treatments in which they were required to learn different numbers of urinary odours. While treatment affected the extent to which mice habituated to test odours during training, differences were not a simple function of the number of odours. The fact that there was also no significant effect of treatment on the degree of preference for novel over familiar odours in subsequent tests suggests mice retained learned odour profiles equally well regardless of the number of odours. That subsequent infection with Babesia microti increased with the number of odours mice had to learn is then consistent with an increased cost to learning effort when more odours were presented. Analysis within treatments, and relationships with the change in corticosterone concentration over the period of the experiment, suggested that it was a failure to learn, rather than maintaining learning performance, in more difficult learning tasks that led to greater infection. As in a previous study of maze learning in the strain, there was no direct relationship between infection and measures of peripheral antibody (total IgG) titre. The results are discussed in relation to studies in other learning contexts and reported relationships between glucocorticoid hormones and learning outcomes.

Glagov remodeling of the atherosclerotic aorta demonstrated by cardiovascular magnetic resonance: the CORDA asymptomatic subject plaque assessment research (CASPAR) project.

BACKGROUND: Aortic atherosclerosis and coronary artery disease (CAD) are closely linked. Early detection of aortic atherosclerosis with the adoption of appropriate preventive measures may therefore help to reduce mortality and morbidity related to CAD. Arterial remodeling, by which the wall adapts to physiological or pathological insults by a change in vessel size, is being increasingly recognized as an important aspect of atherosclerosis. In this prospective longitudinal study we used cardiovascular magnetic resonance (CMR) to detect aortic plaque and to study aortic wall remodeling in asymptomatic subjects. METHODS: We recruited 175 healthy volunteers (49 years, 110 men) and documented their cardiovascular risk profile. Each subject underwent echocardiogram (ECG)-gated T1-weighted spin-echo imaging of the infrarenal abdominal aorta at baseline and after 2 years. FINDINGS: Of the 175 subjects who volunteered at baseline, CMR was successful in 174 (99%), with one (0.6%) failure due to claustrophobia. At 2 years, follow-up scanning was performed in 169 subjects (97%). Infrarenal aortic plaque was identified at baseline in nine (5.2%) subjects. This was reconfirmed in all nine (100%) cases at 2-year follow-up. No new cases of infrarenal plaque were identified at follow-up. The signal characteristics of the plaque on the subtracted images of the Dixon method indicate that all plaques were fibrous. In the nine subjects with infrarenal plaque, the total plaque burden increased as assessed by the total wall volume (561 to 677 mm3, p = 0.0063). The total vessel volume also increased (1737 to 1835 mm3, p = 0.031) but there was no change in the total luminal volume (1175 to 1157 mm3, p = 0.29). CONCLUSIONS: Cardiovascular magnetic resonance detects subclinical aortic atherosclerosis, can follow plaque burden over time, and confirms the presence of Glagov remodeling with preservation of the lumen despite progression of plaque. Cardiovascular magnetic resonance is well suited for the longitudinal follow-up of the general population with atherosclerosis, may help in the understanding of the natural history of atherosclerosis, and in particular may help determine factors to retard disease progression at an early stage.

Design of delay elements in a binary optical true-time-delay device that uses a White cell.

A White-cell-based binary optical true-time-delay device has two parts: the controller, or switching engine, and the delay elements. Here we discuss in detail the design of both glass blocks and lens trains as delay elements. Glass blocks can be used in our design for delays ranging from one to a few hundred picoseconds. Lens trains are suitable for longer delays. We also analyze the loss associated with each design and give design limits.

Artificially increasing scent mark rate increases urogenital gland size in mice Mus musculus.

Male mice produce scent marks by depositing urine throughout their territory. The scent marks contain a number of pheromones and contain major urinary proteins (MUPs). Up to 1 g of these MUPs may be produced everyday. It is therefore likely that scent marking is costly and as such will impact on male fitness. In order to investigate the costs of scent marking, we conducted an experiment where scent marking rate was increased artificially, without changing the social environment (which may have an independent and different effect on both scent marking and physiology), or changing travelling time (such as would occur in a larger territory). Novel objects were introduced every other day (Replace); objects were introduced on day 1 and moved on alternate days (Move); or the mice were left undisturbed (Control). Introducing new objects daily caused a significant increase in scent marking rate, and an increase in the size of both the coagulating gland and the testes compared to the other two conditions. This is likely to be due to increased hormonal activity, which is known to affect these gland sizes. Interestingly, the preputial gland, which produces a number of pheromones, did not differ between the three conditions. There were no differences in male weight, growth rate or condition, indicating that the effect of an increase in scent marking of this magnitude does not have measurable fitness effects.

Cardiovascular disease morbidity in an Iowa law enforcement cohort, compared with the general Iowa population.

It remains uncertain if law enforcement officers experience an elevated cardiovascular disease morbidity and, if so, whether their profession contributes to this incidence. Consequently, the self-reported incidence of cardiovascular disease (CVD) (coronary heart disease, myocardial infarction, stroke, coronary artery bypass graft surgery, angioplasty) and CVD risk factors (age, diabetes, elevated body mass index (> or = 27.8 kg.m-2), hypercholesterolemia, hypertension, tobacco use) in 232 male retirees, > or = 55 years of age, from the Iowa Department of Public Safety were compared with 817 male Iowans of similar age. CVD incidence was higher in the law enforcement officers than the general population (31.5% vs 18.4%, P < 0.001). Using multiple logistic regression, factors found to be associated with CVD included the law enforcement profession (odds ratio [OR] = 2.34; 95% confidence interval [95% CI] = 1.5-3.6), hypercholesterolemia (OR = 2.37; 95% CI = 1.7-3.3); diabetes (OR = 2.22; 95% CI = 1.4-3.6), hypertension (OR = 1.79; 95% CI = 1.3-2.5), tobacco use (OR = 1.67; 95% CI = 1.07-2.6), and age (OR = 1.06; 95% CI = 1.03-1.08). These results suggest that employment as a law enforcement officer is associated with an increased cardiovascular disease morbidity and this relationship persists after considering several conventional risk factors.

Landed XRD/XRF analysis of prime targets in the search for past or present Martian life.

Mars landers seeking evidence for past or present life will be guided by information from orbital mapping and from previous surface exploration. Several target options have been proposed, including sites that may harbor extant life and sites most likely to preserve evidence of past life These sites have specific mineralogic characteristics. Extant life might be gathered around the sinters and associated mineral deposits of rare active fumaroles, or held within brine pockets and inclusions in a few evaporite-mineral deposits. Possibilities for fossilization include deltaic and lake-bottom sediments of once-flooded craters, sinters formed by ancient hot-spring deposits, and the carbonate deposits associated with some evaporite systems. However, the highly varied mineralogy of fossil occurrences on Earth leads to the inference that Mars, an equally complex planet, could host a broad variety of potential fossilizing deposits. The abundance of volcanic systems on Mars and evidence for close associations between volcanism and water release suggest possibilities of organism entrapment and mineralization in volcaniclastic deposits, as found in some instances on Earth. Thus the targets being considered for exploration include a wide variety of unique deposits that would be characterized by silica or various nonsilicate minerals. Beyond these "special" deposits and in the most general case, an ability to distinguish mineralized from uncemented volcanic detritus may be the key to success in finding possible fossil-bearing authigenic mineralogies. A prototype miniaturized X ray diffraction/X ray fluorescence (XRD/XRF) instrument has been evaluated with silica, carbonate, and sulfate minerals and with a basalt, to examine the capabilities of this tool in mineralogic and petrologic exploration for exobiological goals. This instrument. CHEMIN (chemical and mineralogical analyzer), is based on an innovative low-power X ray tube, transmission geometry, and CCD collection and discrimination of diffracted and fluoresced X rays. The ability to accumulate and integrate the entire circumference of each complete Debye diffraction ring compensates for poor powder preparations, as might be produced by robotic sampling systems. With CHEMIN, a wide range of minerals can be uniquely identified. Using Rietveld analysis of the XRD results, mineral quantification is also possible. Expanded capabilities in phase analysis and constrained data solutions using quantitative XRD and XRF are within reach.

Optically produced true-time delays for phased antenna arrays.

A device is described for generating true-time delays optically for microwave signals used in beam steering and beam shaping in phased-array antennas. The device can be adapted to provide delays from picoseconds to nanoseconds. A single, compact unit should provide parallel delays for more than 64 independent antenna elements with a greater than 6-bit resolution. The time delays are produced by multiple reflections in a mirror configuration with continuous refocusing. A single spatial light modulator selects independent optical path lengths for each of the parallel antenna elements. Amplitude control for beam shaping can be integrated into the device. The unit can be made rugged for harsh environments by use of solid-block construction. The operation of the true-time delay device is described, along with the overall system configuration. Preliminary experimental data are given.

A randomized, double-blind, placebo-controlled study of luteal phase dydrogesterone (Duphaston) in women with minimal to mild endometriosis.

OBJECTIVE: To compare dydrogesterone with placebos in the treatment of minimal to mild endometriosis. DESIGN: Prospective, double-blind, randomized study. SETTING: Three Obstetrics and Gynaecology Departments in the United Kingdom. PATIENTS: Sixty-two premenopausal women with complaints of pain (n = 12) and infertility with or without pain (n = 50) with minimal to mild endometriosis diagnosed at laparoscopy. Thirty-nine women had a laparoscopy after treatment and 56 women were followed up 12 months after treatment. INTERVENTIONS: Two high doses of dydrogesterone (either 40 or 60 mg) or a placebo, which was given for 12 days, beginning 2 days after the LH surge for a treatment period of 6 months. MAIN OUTCOME MEASURES: Change between before and after treatment endometriosis scores, pregnancy rates (PRs), and pain. RESULTS: Treatment with dydrogesterone did not alter the natural history of endometriosis or PRs when compared with placebo. Pain was reduced significantly during treatment with 60 mg dydrogesterone and this improvement still was evident at 12-month follow-up. CONCLUSION: Luteal phase dydrogesterone reduces pain associated with endometriosis.

Chronic tissue expansion.

BACKGROUND: Chronic tissue expansion is an extremely useful addition to the dermatologic surgeon's skills. OBJECTIVE: To review chronic tissue expansion. METHODS: The relevant literature is summarized. Two case histories are presented as examples of the utility of chronic tissue expansion. RESULTS: The history of tissue expansion is briefly reviewed. Indications pertinent to the practice of dermatologic surgery are discussed. The devices themselves are described, as well as new experimental advances. The general procedure for utilizing tissue expanders is outlined, as well as relevant histologic changes that occur in expanded skin. Both common and rare complications are covered, with attention to prevention. CONCLUSION: Chronic tissue expansion provides an excellent means for obtaining extra tissue for cosmetic and reconstructive surgery.

Fluvoxamine: an open pilot study in moderately obese female patients suffering from atypical eating disorders and episodes of bingeing.

The results of a small pilot study using Fluvoxamine (Faverin) in the treatment of non-vomiting bingeing female patients and women with bulimia nervosa is presented. Ten non-vomiting subjects and six with bulimia nervosa were treated on an open basis with Fluvoxamine 100-200 mg daily. Assessment was made using established questionnaires for severity of eating disorder and abnormality of mood. Five non-vomiting patients and three with bulimia nervosa completed the study. Non-vomiters showed a significant weight loss; a significant reduction in number of binges; a significant reduction in the scores on the BITE and the EAT; and a significant reduction in anxiety. Those with bulimia nervosa had a significant reduction in hunger and a reduction in depression which tended towards significance. Firm conclusions cannot be drawn from this study as it is an open pilot study of a small number of women. However, the results indicate that Fluvoxamine may have a role in the treatment of eating disorders where bingeing is a prominent symptom and that further research would be valuable. Comments are also made on the usefulness of various questionnaires designed to assess eating disorders.

Optical implementation and applications of closest-vector selection in neural networks.

Closest-vector selection is a process that underlies one technique for sending compressed-signal sets over noisy communication channels. Recently it has had application in radar target identification, speech and image analysis, pattern classification, and neural-net training. Various applications of closest-vector selection are discussed, and the design of an all-optical system that performs closest-vector selection is presented.

A first study to compare two dosages of dydrogesterone in opposing the 50 mg oestradiol implant.

Thirty post-menopausal, non-hysterectomised women received a 50 mg oestradiol implant subcutaneously and either 10 mg or 20 mg dydrogesterone daily for 14 days every 28 days for 6 months. Endometrial biopsies were taken during the initial oestrogen-only phase and again during the final progestogen phase. Of the ten initial samples which were adequate for histological diagnosis, nine showed proliferative and one non-secretory endometrium. Of the 28 samples obtained at the end of the study during the progestogen phase, all except one showed satisfactory conversion, irrespective of dose. Acceptable bleeding patterns were seen in both dosage groups. Tolerance was good and no patient discontinued treatment. This study has shown that both 10 mg and 20 mg dydrogesterone for 14 days are potent enough to oppose the proliferative effects of the 50 mg oestradiol implant. In view of the wide inter-patient variation in endometrial response to progestogens, it appears appropriate to choose the dosage of dydrogesterone on the basis of cycle control and tolerability, whilst being able to maintain confidence in endometrial protection.

Voyager 2 at neptune: imaging science results.

Voyager 2 images of Neptune reveal a windy planet characterized by bright clouds of methane ice suspended in an exceptionally clear atmosphere above a lower deck of hydrogen sulfide or ammonia ices. Neptune's atmosphere is dominated by a large anticyclonic storm system that has been named the Great Dark Spot (GDS). About the same size as Earth in extent, the GDS bears both many similarities and some differences to the Great Red Spot of Jupiter. Neptune's zonal wind profile is remarkably similar to that of Uranus. Neptune has three major rings at radii of 42,000, 53,000, and 63,000 kilometers. The outer ring contains three higher density arc-like segments that were apparently responsible for most of the ground-based occultation events observed during the current decade. Like the rings of Uranus, the Neptune rings are composed of very dark material; unlike that of Uranus, the Neptune system is very dusty. Six new regular satellites were found, with dark surfaces and radii ranging from 200 to 25 kilometers. All lie inside the orbit of Triton and the inner four are located within the ring system. Triton is seen to be a differentiated body, with a radius of 1350 kilometers and a density of 2.1 grams per cubic centimeter; it exhibits clear evidence of early episodes of surface melting. A now rigid crust of what is probably water ice is overlain with a brilliant coating of nitrogen frost, slightly darkened and reddened with organic polymer material. Streaks of organic polymer suggest seasonal winds strong enough to move particles of micrometer size or larger, once they become airborne. At least two active plumes were seen, carrying dark material 8 kilometers above the surface before being transported downstream by high level winds. The plumes may be driven by solar heating and the subsequent violent vaporization of subsurface nitrogen.

The epidermal nevus syndrome: case report and review.

A 33-year-old woman had multiple basal cell epitheliomas complicating a large, unilateral nevus sebaceus. Other unilateral epidermal nevi and a contralateral pigmentary nevoid disorder were noted on cutaneous examination. There were signs of skeletal, neurologic, and vascular involvement. This patient illustrates the unpredictable features of the epidermal nevus syndrome and the importance of close follow-up to manage attendant complications.

Phosphorylation of the alpha-subunit of (Na+ + K+)-ATPase by carbachol in tissue slices and the role of phosphoproteins in stimulus-secretion coupling.

This study examined the changes in protein phosphorylation in response to cholinergic (muscarinic) stimulation of salivary secretion in the rat submandibular gland. Carbachol stimulation was associated with phosphorylation in a number of protein bands as detected by sodium dodecyl sulfate (SDS) polyacrylamide gel electrophoresis and autoradiography. The molecular masses (Mr) of two proteins, in which the amount of phosphorylation more than doubled in response to carbachol, were 22,000 and 96,000. The Mr 96,000 protein precipitated at 120,000 X g while most of the Mr 22,000 protein remained in the supernatant at this speed. The effect of carbachol on the phosphorylation of the Mr 22,000 and 96,000 proteins was blocked by atropine, indicating that the cholinergic receptor involved is muscarinic. The time course of phosphorylation of the Mr 22,000 protein consisted of a rapid increase in phosphorylation within the first min of carbachol stimulation. This increased phosphorylation persisted for less than 1 min. The increased phosphorylation of the Mr 96,000 protein also occurred within the first min but it persisted for at least 10 min. However, removal of the muscarinic agonist, carbachol, resulted in the rapid dephosphorylation of this protein. When the plasma membranes were purified, the Mr 96,000 protein was phosphorylated by ATP in the presence of Na+ and Mg2+. It was dephosphorylated by K+. This proves that the Mr 96,000 dalton protein is the alpha-subunit of the (Na+ + K+)-ATPase.

Implementation of a fast digital optical matrix-vector multiplier using a holographic look-up table and residue arithmetic.

The design and implementation of a digital (numerical) optical matrix-vector multiplier are presented. A Hughes liquid crystal light valve, the residue arithmetic representation, and a holographic optical memory are used to construct position coded optical look-up tables. All operations are performed in effectively one light valve response time with a potential for a high information density.