Extreme ultraviolet transient gratings: A tool for nanoscale photoacoustics.

Collective lattice dynamics determine essential aspects of condensed matter, such as elastic and thermal properties. These exhibit strong dependence on the length-scale, reflecting the marked wavevector dependence of lattice excitations. The extreme ultraviolet transient grating (EUV TG) approach has demonstrated the potential of accessing a wavevector range corresponding to the 10s of nm length-scale, representing a spatial scale of the highest relevance for fundamental physics and forefront technology, previously inaccessible by optical TG and other inelastic scattering methods. In this manuscript we report on the capabilities of this technique in the context of probing thermoelastic properties of matter, both in the bulk and at the surface, as well as discussing future developments and practical considerations.

Nanoscale transient gratings excited and probed by extreme ultraviolet femtosecond pulses.

Advances in developing ultrafast coherent sources operating at extreme ultraviolet (EUV) and x-ray wavelengths allow the extension of nonlinear optical techniques to shorter wavelengths. Here, we describe EUV transient grating spectroscopy, in which two crossed femtosecond EUV pulses produce spatially periodic nanoscale excitations in the sample and their dynamics is probed via diffraction of a third time-delayed EUV pulse. The use of radiation with wavelengths down to 13.3 nm allowed us to produce transient gratings with periods as short as 28 nm and observe thermal and coherent phonon dynamics in crystalline silicon and amorphous silicon nitride. This approach allows measurements of thermal transport on the ~10-nm scale, where the two samples show different heat transport regimes, and can be applied to study other phenomena showing nontrivial behaviors at the nanoscale, such as structural relaxations in complex liquids and ultrafast magnetic dynamics.

Observation of second sound in graphite at temperatures above 100 K.

Wavelike thermal transport in solids, referred to as second sound, is an exotic phenomenon previously limited to a handful of materials at low temperatures. The rare occurrence of this effect restricted its scientific and practical importance. We directly observed second sound in graphite at temperatures above 100 kelvins by using time-resolved optical measurements of thermal transport on the micrometer-length scale. Our experimental results are in qualitative agreement with ab initio calculations that predict wavelike phonon hydrodynamics. We believe that these results potentially indicate an important role of second sound in microscale transient heat transport in two-dimensional and layered materials in a wide temperature range.

Four-wave-mixing experiments with seeded free electron lasers.

The development of free electron laser (FEL) sources has provided an unprecedented bridge between the scientific communities working with ultrafast lasers and extreme ultraviolet (XUV) and X-ray radiation. Indeed, in recent years an increasing number of FEL-based applications have exploited methods and concepts typical of advanced optical approaches. In this context, we recently used a seeded FEL to demonstrate a four-wave-mixing (FWM) process stimulated by coherent XUV radiation, namely the XUV transient grating (X-TG). We hereby report on X-TG measurements carried out on a sample of silicon nitride (Si3N4). The recorded data bears evidence for two distinct signal decay mechanisms: one occurring on a sub-ps timescale and one following slower dynamics extending throughout and beyond the probed timescale range (100 ps). The latter is compatible with a slower relaxation (time decay > ns), that may be interpreted as the signature of thermal diffusion modes. From the peak intensity of the X-TG signal we could estimate a value of the effective third-order susceptibility which is substantially larger than that found in SiO2, so far the only sample with available X-TG data. Furthermore, the intensity of the time-coincidence peak shows a linear dependence on the intensity of the three input beams, indicating that the measurements were performed in the weak field regime. However, the timescale of the ultrafast relaxation exhibits a dependence on the intensity of the XUV radiation. We interpreted the observed behaviour as the generation of a population grating of free-electrons and holes that, on the sub-ps timescale, relaxes to generate lattice excitations. The background free detection inherent to the X-TG approach allowed the determination of FEL-induced electron dynamics with a sensitivity largely exceeding that of transient reflectivity and transmissivity measurements, usually employed for this purpose.

Sedation practice in a Scottish teaching hospital emergency department.

OBJECTIVES: To conduct a prospective survey in a teaching hospital emergency department to evaluate performance according to safe sedation principles, to establish the demographics of those sedated, and to review the drugs used and doses given to patients in the department. Any adverse events were reviewed for identification of preventable causes. METHODS: Pre-sedation checklists, peri-procedural observations, and patient notes were reviewed for 101 cases from 4 December 2004 to 3 September 2005. There are departmental guidelines outlining the principles of safe sedation. RESULTS: Emergency department procedural sedation was performed for a variety of acute conditions in patients aged from 7 to 91 years old. A variety of sedation agents were administered, morphine and midazolam being used most frequently. Drug administration, maximum sedation level, and time to recovery and discharge were recorded. Four adverse events were reported, none of which were clinically significant. Departmental guidelines were followed. CONCLUSION: Emergency department sedation is a safe and effective procedure if appropriately trained practitioners follow the principles of safe sedation.

Contact burns from hair straighteners: a new hazard in the home.

This series highlights a previously unreported hazard for children within the home, hair straightening irons. Thermal injury is a common reason for presentation at the emergency department. Contact burns from domestic irons and hair curling tongs are well documented in the literature. We have become aware of this new hazard in the home, which has resulted in several presentations to our department with deep partial thickness or full thickness burns.

Cushing's syndrome presenting as disseminated cutaneous Mycobacterium chelonae infection.

Mycobacterium chelonae infection has not to our knowledge been reported as a complication of endogenous Cushing's syndrome. We describe a patient who presented with sporotrichoid M. chelonae infection and olecranon bursitis whose symptoms did not completely resolve until after bilateral adrenalectomy.

Response of lymphoepithelial parotid cysts to antiretroviral treatment in HIV-infected adults.

BACKGROUND: Surgical resection has been the usual therapy for HIV-infected patients with lymphoepithelial parotid cysts. OBJECTIVE: To study antiretroviral therapy for lymphoepithelial parotid cysts. DESIGN: Case series. SETTING: HIV outpatient clinics. PATIENTS: HIV-infected patients with lymphoepithelial parotid cysts. INTERVENTION: Antiretroviral therapy. MEASUREMENTS: Change in size of the parotid cyst, CD4 lymphocyte count, and HIV viral load. RESULTS: Nine HIV-infected adults presented with chronic, large parotid cysts, eight of which were bilateral. In at least seven patients, the cysts were the initial sign of HIV infection. In six patients, the cysts resolved completely with combination antiretroviral therapy. Four of these patients also received prednisone. Three patients who did not comply with antiretroviral therapy had partial responses followed by relapses. CONCLUSIONS: Parotid cysts are an unrecognized sign of early HIV infection. These cysts respond to combination antiretroviral therapy, with or without corticosteroids. Surgical resection should be reserved for patients in whom medical therapy has failed or those who refuse or are poorly compliant with medical therapy.

Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals.

Antimicrobial resistance results in increased morbidity, mortality, and costs of health care. Prevention of the emergence of resistance and the dissemination of resistant microorganisms will reduce these adverse effects and their attendant costs. Appropriate antimicrobial stewardship that includes optimal selection, dose, and duration of treatment, as well as control of antibiotic use, will prevent or slow the emergence of resistance among microorganisms. A comprehensively applied infection control program will interdict the dissemination of resistant strains.

Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals.

Antimicrobial resistance results in increased morbidity, mortality, and costs of health care. Prevention of the emergence of resistance and the dissemination of resistant microorganisms will reduce these adverse effects and their attendant costs. Appropriate antimicrobial stewardship that includes optimal selection, dose, and duration of treatment, as well as control of antibiotic use, will prevent or slow the emergence of resistance among microorganisms. A comprehensively applied infection control program will interdict the dissemination of resistant strains.

Controlling use of antimicrobial agents.

Physicians and hospitals must curtail the excessive use of antimicrobial agents to limit the emergence and spread of multiply resistant organisms. This article describes how to organize an antimicrobial control program and provides options for hospitals working with a range of resources.

Timing of hot spot--related volcanism and the breakup of madagascar and India.

Widespread basalts and rhyolites were erupted in Madagascar during the Late Cretaceous. These are considered to be related to the Marion hot spot and the breakup of Madagascar and Greater India. Seventeen argon-40/argon-39 age determinations reveal that volcanic rocks and dikes from the 1500-kilometer-long rifted eastern margin of Madagascar were emplaced rapidly (mean age = 87.6 +/- 0.6 million years ago) and that the entire duration of Cretaceous volcanism on the island was no more than 6 million years. The evidence suggests that the thick lava pile at Volcan de l'Androy in the south of the island marks the focal point of the Marion hot spot at approximately 88 million years ago and that this mantle plume was instrumental in causing continental breakup.

Selective decontamination of the digestive tract: risks outweigh benefits for intensive care unit patients.

Selective decontamination of the digestive tract (SDD) involves the administration of non-absorbable antibiotics (+/- a systemic antibiotic) to prevent colonization and infection in intensive care unit patients. The regimen is targeted at nosocomial gram-negative bacilli, some gram-positive bacteria and yeast. Although all studies of SDD have demonstrated reduced rates of bacterial colonization and most yielded lower respiratory tract infection, it is unclear if the major impact of SDD is on pneumonia or tracheobronchitis. SDD regimens utilizing a broad spectrum, systemic antibiotic appear to be more effective, suggesting that this constitutes early treatment rather than prophylaxis. To date, there is conflicting evidence that SDD significantly reduces length of stay, mortality, or hospital costs. Currently, there are concerns that SDD may result in increased colonization and infection with gram-positive organisms and multi-drug resistant pathogens, particularly in medical ICU patients or when used for extended periods of time.

Idiopathic CD4+ T-lymphocytopenia--four patients with opportunistic infections and no evidence of HIV infection.

BACKGROUND AND METHODS: We describe four patients without major risk factors for human immunodeficiency virus (HIV) infection, each of whom presented with severe opportunistic infections and was found to have idiopathic CD4+ T-lymphocytopenia. We performed assays to detect the presence of retroviruses and undertook immunophenotyping of subgroups of peripheral-blood lymphocytes. RESULTS: The opportunistic infections at presentation included Pneumocystis carinii pneumonia, cryptococcal meningitis (two patients, one with concurrent pulmonary tuberculosis), and histoplasma-induced brain abscess. During 10 to 68 months of observation, none of the four patients had evidence of infection with HIV type 1 or 2 or human T-cell lymphotropic virus type I or II on the basis of epidemiologic, serologic, or polymerase-chain-reaction studies or culture, nor was there any detectable reverse transcriptase activity. Although all the patients had severe, persistent CD4+ T-lymphocytopenia (range, 12 to 293 cells per cubic millimeter), the CD4+ cell count progressively declined in only one and was accompanied by multiple opportunistic infections. All four patients had significantly reduced numbers of circulating CD8+ T cells, natural killer cells, or B cells (or all three). CONCLUSIONS: These four patients had idiopathic CD4+ T-lymphocytopenia with opportunistic infections but no evidence of HIV infection. Instead of the progressive, selective depletion of CD4+ T cells characteristic of HIV infection, some patients with idiopathic immunodeficiency have stable CD4+ cell counts accompanied by reductions in the levels of several other lymphocyte subgroups.

A multistate outbreak of sporotrichosis associated with sphagnum moss.

In the spring of 1988, the largest documented US outbreak of cutaneous sporotrichosis to date occurred, with 84 cases among persons from 15 states who were exposed to Wisconsin-grown sphagnum moss used in packing evergreen tree seedlings. In New York State, 13 cases occurred among 109 forestry workers. All 13 cases occurred among 76 workers who had handled evergreen seedlings and moss (attack rate = 17%). For those exposed to evergreens and moss, the risk of infection increased as worktime exposure to moss increased (attack rates: less than 10 hours, 8%; 10-19 hours, 12%; greater than 19 hours, 33%). While environmental samples of moss from the Wisconsin supplier were negative, Sporothrix schenckii was cultured from multiple samples of the sphagnum moss obtained from one of six Pennsylvania tree nurseries, representing the nursery that was identified as the source for 79 (94%) of the moss-associated cases. Differences in tree-handling procedures at this nursery--including the use of 1- to 3-year-old moss to pack seedlings, use of a pond water source to wet the moss, use of an organic polymer gel on the seedling root system, and underground storage and longer storage of moss-packed seedlings before shipping--suggested possible explanations for the association. Efforts to prevent sporotrichosis among persons handling evergreen seedlings should include the use of alternate types of packing material (e.g., cedar wood chips or shredded paper) and protective clothing such as gloves and long-sleeved shirts.

Use of a mouse model to evaluate clinical and environmental isolates of Sporothrix spp. from the largest U.S. epidemic of sporotrichosis.

Five clinical and 69 environmental isolates from the largest U.S. epidemic of sporotrichosis were evaluated in NYLAR male mice following intravenous injection of 5 x 10(6) to 2 x 10(8) conidia per mouse. The clinical isolates and eight environmental isolates produced 100% mortality in groups of three mice each between 12 and 24 days after injection. These virulent isolates grew at 37 degrees C, were dematiaceous by virtue of melanin (melanized) on permissive media (e.g., potato dextrose agar), produced ovoid conidia borne sympodially on lateral conidiophores and pleurogenously about the main hyphal axis, and were identified as Sporothrix schenckii. Two melanized environmental isolates that grew at 35 degrees C but not at 37 degrees C were not virulent and had subtle morphological differences from S. schenckii. The remaining environmental isolates were not melanized, were not virulent, and were not S. schenckii; five were identified as Ophiostoma stenoceras and the remainder were identified as Sporothrix spp. Quantitative organ cultures revealed that clinical isolates grew exponentially in livers and testes, in contrast to an isolate of O. stenoceras that was eliminated from liver, lung, and spleen but that persisted in the testes throughout the 14-day sample period. This model helped to confirm the identification of S. schenckii isolates obtained from the environment.

Nosocomial pneumonia: epidemiology and infection control.

Elderly, debilitated, or critically ill patients are at high risk for hospital acquired or nosocomial respiratory tract infection. Gram-negative bacilli, Staphyloccoccus aureus, and anaerobes colonizing the oropharynx are the most frequent etiologic agents. Colonization of the oropharynx may be related to the patient's age, underlying disease, nutritional status, prior exposure to antibiotics, supine position, and gastric colonization. Nosocomial pathogens may also be acquired from the hands of hospital personnel, contaminated equipment or fluids. The absence of sensitive and specific methods for accurate diagnosis remain a concern. Despite treatment with appropriate antimicrobial therapy, there is a high mortality and morbidity. Measures for the prevention of nosocomial pneumonia should include compliance with infection control principles, appropriate use of antibiotics, proper patient position, and removal of potential sources of cross colonization.

Establishment of orchards with black polyethylene film mulching: effect on nematode and fungal pathogens, water conservation, and tree growth.

Placement of a 3-m-wide, black, polyethylene film mulch down rows of peach (Prunus persica 'Red Haven' on 'Lovell' rootstock) and almond (Prunus dulcis 'Nonpareil' on 'Lovell') trees in the San Joaquin Valley of California resulted in irrigation water conservation of 75%, higher soil temperature in the surface 30 cm, a tendency toward greater root mass, elimination of weeds, and a greater abundance of Meloidogyne incognita second-stage juveniles in soil but reduced root galling when compared to the nonmulched control. Population levels of Pratylenchus hexincisus, a nematode found within tree roots, were reduced by mulching, as were those of Tylenchulus semipenetrans, which survived on old grape roots remaining from a previously planted vineyard, and Paratrichodorus minor, which probably fed on roots of various weed species growing in the nonmulched soil. Populations of Pythium ultimum were not significantly changed, probably also due to the biological refuge of the old grape roots and moderate soil heating level. Trunk diameters of peach trees were increased by mulching, but those of almond trees were reduced by the treatment. Leaf petiole analysis indicated that concentrations of mineral nutrients were inconsistent, except for a significant increase in Ca in both tree species.

A mantle plume initiation model for the wrangellia flood basalt and other oceanic plateaus.

The vast Wrangellia terrane of Alaska and British Columbia is an accreted oceanic plateau with Triassic strata that contain a 3- to 6-kilometers thick flood basalt, bounded above and below by marine sedimentary rocks. This enormous outpouring of basalt was preceded by rapid uplift and was followed by gradual subsidence of the plateau. The uplift and basalt eruptions occurred in less than approximately 5 million years, and were not accompanied by significant extension or rifting of the lithosphere. This sequence of events is predicted by a mantle plume initiation, or plume head, model that has recently been developed to explain continental flood volcanism. Evidence suggests that other large oceanic basalt plateaus, such as the Ontong-Java, Kerguelen, and Caribbean, were formed as the initial outbursts of the Louisville Ridge, Kerguelen, and Galapagos hot spots, respectively. Such events may play an important role in the creation and development of both oceanic and continental crust.