First Direct Measurement of an Astrophysical p-Process Reaction Cross Section Using a Radioactive Ion Beam.

We have performed the first direct measurement of the ^{83}Rb(p,γ) radiative capture reaction cross section in inverse kinematics using a radioactive beam of ^{83}Rb at incident energies of 2.4 and 2.7A MeV. The measured cross section at an effective relative kinetic energy of E_{cm}=2.393 MeV, which lies within the relevant energy window for core collapse supernovae, is smaller than the prediction of statistical model calculations. This leads to the abundance of ^{84}Sr produced in the astrophysical p process being higher than previously calculated. Moreover, the discrepancy of the present data with theoretical predictions indicates that further experimental investigation of p-process reactions involving unstable projectiles is clearly warranted.

Regional anaesthesia to improve pain outcomes in paediatric surgical patients: a qualitative systematic review of randomized controlled trials.

Summary The development of analgesic interventions in paediatric surgical patients is often limited by the inherent difficulties of conducting large randomized clinical trials to test interventions in those patients. Regional anaesthesia is a valid strategy to improve postoperative pain in the adult surgical population, but the effects of regional anaesthesia on postoperative pain outcomes in paediatric patients are currently not well defined. The main objective of the current review was to systematically evaluate the use of regional anaesthesia techniques to minimize postoperative pain in paediatric patients. A systematic search was performed to identify randomized controlled trials that evaluated the effects of the regional anaesthesia techniques on postoperative pain outcomes in paediatric surgical patients' procedures. Seventy-three studies on 5125 paediatric patients were evaluated. Only few surgical procedures had more than one small randomized controlled trial favouring the use of regional anaesthesia to minimize postoperative pain (ophthalmological surgery, cleft lip repair, inguinal hernia, and urological procedures). Additional evidence is required to support the use of specific regional anaesthesia techniques to improve postoperative pain for several surgical procedures (craniectomy, adenotonsillectomy, appendectomy, cardiac surgery, umbilical hernia repair, upper and lower extremity) in paediatric patients. Currently, only a very limited number of regional anaesthesia techniques have demonstrated significant improvement on postoperative pain outcomes for a restricted number of surgical procedures. More studies are needed in order to establish regional anaesthesia as a valid strategy to improve analgesia in the paediatric surgical population.

Elective use of supraglottic airway devices for primary airway management in children with difficult airways.

BACKGROUND: Supraglottic airways (SGAs) have an established role in airway management of difficult airways in both adults and children. However, there are limited data regarding the use of SGAs for primary airway management in children. The aim of this study is to assess the success rates and adverse events related to the use of SGAs for primary airway management during anaesthesia in children with difficult airways. METHODS: A retrospective analysis of SGA use for primary airway management in the difficult airway population in a single centre over a 4-yr period was performed. Difficult airway was defined as either a history of difficult direct laryngoscopy (a documented Cormack and Lehane Grade 3 or greater and the need for an alternate device to direct laryngoscopy for successful tracheal intubation), a history of difficult mask ventilation, or both. The difficult airway condition, patient characteristic data, type and length of procedure, type and size of SGA placed, number of attempts for successful device placement, success/failure associated with the device during anaesthetic maintenance, and complications were recorded. RESULTS: A total of 77,272 children received general anaesthesia in a free-standing paediatric institution. Four hundred and fifty-nine patients were reported to have a difficult airway. Of those, 109 received general anaesthesia and an SGA for primary management, meeting the inclusion criteria for this study during a 4-yr period. An SGA was successfully used in 96% of these patients. In four patients, an alternative airway was needed. CONCLUSIONS: SGAs can be effectively utilized for airway maintenance in the paediatric difficult airway population.

Stereotyped behaviour in children with autism and intellectual disability: an examination of the executive dysfunction hypothesis.

BACKGROUND: Increasing attention has been paid to the executive dysfunction hypothesis argued to underpin stereotyped behaviour in autism. The aim of this study is to investigate one component of this model, that stereotyped behaviours are related to impaired generativity and compromised behavioural inhibition, by examining whether episodes of these behaviours terminate naturally without external intervention. METHODS: Using a naturalistic observational methodology the stereotyped behaviours of six participants with autism were recorded in real time over periods ranging from 3.59 to 9.20 h. Data were also recorded for teaching staff interactions with participants and environmental settings (one-to-one, group and freetime). RESULTS: In comparison with one-to-one settings stereotyped behaviours were more frequent when participants were in freetime settings with the exception of one participant. For the termination of stereotyped behaviours these behaviours stopped with no ongoing physical or verbal adult contact being evident for a median of 73.25% of the time. Additionally, for a median of 89.40% of the time stereotyped behaviour stopped without the initiation of adult contact. DISCUSSION: The termination of bouts of stereotyped behaviour was frequently not associated with any adult contact and thus this form of external intervention. This finding warrants explanation by extending the hypothesis that compromised impaired generativity and behavioural inhibition offers a complete explanation of stereotyped behaviours.

Water vapour jets inside the plume of gas leaving Enceladus.

A plume of water vapour escapes from fissures crossing the south polar region of the Saturnian moon Enceladus. Tidal deformation of a thin surface crust above an internal ocean could result in tensile and compressive stresses that would affect the width of the fissures; therefore, the quantity of water vapour released at different locations in Enceladus' eccentric orbit is a crucial measurement of tidal control of venting. Here we report observations of an occultation of a star by the plume on 24 October 2007 that revealed four high-density gas jets superimposed on the background plume. The gas jet positions coincide with those of dust jets reported elsewhere inside the plume. The maximum water column density in the plume is about twice the density reported earlier. The density ratio does not agree with predictions-we should have seen less water than was observed in 2005. The ratio of the jets' bulk vertical velocities to their thermal velocities is 1.5 +/- 0.2, which supports the hypothesis that the source of the plume is liquid water, with gas accelerated to supersonic velocity in nozzle-like channels.

Identification of a unique epigenetic sub-microenvironment in prostate cancer.

The glutathione S-transferase P1 (GSTP1) gene promoter is methylated in tumour cells in more than 90% of prostate carcinomas. Recently, GSTP1 promoter methylation was identified in tumour-associated stromal cells in addition to the tumour epithelium. To define the extent and location of stromal methylation, epigenetic mapping using pyrosequencing quantification of GSTP1 promoter methylation and an anatomical three-dimensional reconstruction of an entire human prostate specimen with cancer were performed. Normal epithelium and stroma, tumour epithelium, and tumour-associated stromal cells were laser capture-microdissected from multiple locations throughout the gland. As expected, the GSTP1 promoter in both normal epithelium and normal stromal cells distant from the tumour was not methylated and the tumour epithelium showed consistently high levels of promoter methylation throughout. However, tumour-associated stromal cells were found to be methylated only in a localized and distinct anatomical sub-field of the tumour, revealing the presence of an epigenetically unique microenvironment within the cancer. Morphologically, the sub-field consisted of typical, non-reactive stroma, representing a genomic alteration in cells that appeared otherwise histologically normal. Similar epigenetic anatomical mapping of a control prostate gland without cancer showed low background methylation levels in all cell types throughout the specimen. These data suggest that stromal cell methylation can occur in a distinct sub-region of prostate cancer and may have implications for understanding tumour biology and clinical intervention.

Temperatures, winds, and composition in the saturnian system.

Stratospheric temperatures on Saturn imply a strong decay of the equatorial winds with altitude. If the decrease in winds reported from recent Hubble Space Telescope images is not a temporal change, then the features tracked must have been at least 130 kilometers higher than in earlier studies. Saturn's south polar stratosphere is warmer than predicted from simple radiative models. The C/H ratio on Saturn is seven times solar, twice Jupiter's. Saturn's ring temperatures have radial variations down to the smallest scale resolved (100 kilometers). Diurnal surface temperature variations on Phoebe suggest a more porous regolith than on the jovian satellites.

Injury and frequency of use of playground equipment in public schools and parks in Brisbane, Australia.

OBJECTIVE: The purpose of this study was to determine the frequency of use of play equipment in public schools and parks in Brisbane, Australia, and to estimate an annual rate of injury per use of equipment, overall and for particular types of equipment. METHODS: Injury data on all children injured from playground equipment and seeking medical attention at the emergency department of either of the two children's hospitals in the City of Brisbane were obtained for the years 1996 and 1997. Children were observed at play on five different pieces of play equipment in a random sample of 16 parks and 16 schools in the City of Brisbane. Children injured in the 16 parks and schools were counted, and rates of injury and use were calculated. RESULTS: The ranked order for equipment use in the 16 schools was climbing equipment (3762 uses), horizontal ladders (2309 uses), and slides (856 uses). Each horizontal ladder was used 2.6 times more often than each piece of climbing equipment. Each horizontal ladder was used 7.8 times more than each piece of climbing equipment in the sample of public parks. Slides were used 4.6 times more than climbing equipment in parks and 1.2 times more in public schools. The annual injury rate for the 16 schools and 16 parks under observation was 0.59/100 000 and 0.26/100 000 uses of equipment, respectively. CONCLUSIONS: This study shows that annual number of injuries per standardized number of uses could be used to determine the relative risk of particular pieces of playground equipment. The low overall rate of injuries/100 000 uses of equipment in this study suggests that the benefit of further reduction of injury in this community may be marginal and outweigh the economic costs in addition to reducing challenging play opportunities.

Action research: a suitable method for promoting change in nurse education.

This paper arose from a research study and its follow-up in four schools of nursing and midwifery. The study was concerned with evaluating the extent to which a philosophy of health had been integrated into the educational curricula of nurses, midwives and health visitors. The purpose of the follow-up was to disseminate and implement the study findings in the four centres. The findings showed that the interpretation and implementation of a philosophy of health in nursing had been variable. Health was operationalized as both health education and health promotion ranging from individualized information giving and disease prevention. Action research was chosen as the appropriate methodology for the follow-up because of its emphasis on participation and partnership. As the follow-up study progressed a number of issues emerged which were indicative of the changes taking place in nurse education as its institutional base shifted into higher education. Other issues were associated with the gap between the rhetoric and reality of action research and the expectations and needs of the key partners. The authors conclude that the follow-up study presented both challenges and opportunities to nurse educators in their endeavour to undertaken research and implement educational change.

The psychological profiles of patients with whiplash-associated headache.

Headache often compounds chronic neck pain following whiplash injury. To better understand post-traumatic headache, the SCL-90-R symptom checklist was used to determine the psychological profiles of patients with whiplash-associated headache and of patients with whiplash-associated neck pain without headache. The psychological profiles of these patients were compared with previously published SCL-90-R profiles of patients with post-traumatic and nontraumatic headache, and of the normal population. Patients with whiplash-associated headache were not significantly different from those with other forms of post-traumatic headache or with whiplash-associated neck pain without headache. However, when patients with whiplash-associated headache and patients with nontraumatic headache were compared to normal data, significant differences emerged. Patients with nontraumatic headache exhibited higher scores on all subscales, whereas patients with whiplash-associated headache differed from the normal sample only on somatization, obsessive-compulsive, depression and hostility subscales, and the global severity index. These differences imply that patients with whiplash-associated headache suffer psychological distress secondary to chronic pain and not from tension headache and generalized psychological distress.

Resolution of psychological distress of whiplash patients following treatment by radiofrequency neurotomy: a randomised, double-blind, placebo-controlled trial.

It is well recognised that patients with chronic pain, in particular, chronic whiplash-associated neck pain, exhibit psychological distress. However, debate continues as to whether the psychological distress precedes and causes the chronic pain or, conversely, the psychological distress is a consequence of chronic pain. Using cervical zygapophysial joint pain as a model for chronic pain, the effect of a definitive neurosurgical treatment on the associated psychological distress was studied. Seventeen patients with a single painful cervical zygapophysial joint participated in a randomised, double-blind, placebo-controlled trial of percutaneous radiofrequency neurotomy. Their pain and psychological status were evaluated pre-operatively and 3 months post-operatively by medical interview and examination, a visual analogue pain scale, the McGill Pain Questionnaire, and the SCL-90-R psychological questionnaire. All patients who obtained complete pain relief exhibited resolution of their pre-operative psychological distress. In contrast, all but one of the patients whose pain remained unrelieved continued to suffer psychological distress. Because psychological distress resolved following a neurosurgical treatment which completely relieved pain, without psychological co-therapy, it is concluded that the psychological distress exhibited by these patients was a consequence of the chronic somatic pain.

Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain.

BACKGROUND: Chronic pain in the cervical zygapohyseal joints is a common problem after whiplash injury, but treatment is difficult. Percutaneous radiofrequency neurotomy can relieve the pain by denaturing the nerves innervating the painful joint, but the efficacy of this treatment has not been established. METHODS: In a randomized, double-blind trial, we compared percutaneous radio-frequency neurotomy in which multiple lesions were made and the temperature of the electrode making the lesions was raised to 80 degrees C with a control treatment using an identical procedure except that the radio-frequency current was not turned on. We studied 24 patients (9 men and 15 women; mean age, 43 years) who had pain in one or more cervical zygapophyseal joints after an automobile accident (median duration of pain, 34 months). The source of their pain had been identified with the use of double-blind, placebo-controlled local anesthesia. Twelve patients received each treatment. The patients were followed by telephone interviews and clinic visits until they reported that their pain had returned to 50 percent of the preoperative level. RESULTS: The median time that elapsed before the pain returned to at least 50 percent of the preoperative level was 263 days in the active-treatment group and 8 days in the control group (P=0.04). At 27 weeks, seven patients in the active-treatment group and one patient in the control group were free of pain. Five patients in the active-treatment group had numbness in the territory of the treated nerves, but none considered it troubling. CONCLUSIONS: In patients with chronic cervical zygapophyseal-joint pain confirmed with double-blind, placebo-controlled local anesthesia, percutaneous radio-frequency neurotomy with multiple lesions of target nerves can provide lasting relief.

Feed us nutrition: final year medical students' perceptions of nutrition medical education.

BACKGROUND: Nutrition is recognised as an integral aspect of Australian medical education. Since medical students will learn more of a subject they consider important, there is a need for their perceptions of nutrition to be investigated. AIMS: To identify final year medical students' perceptions about nutrition and its inclusion in their medical course, and to compare priority nutrition topics identified with those previously identified by Faculty and General Practitioners (GPs) who teach in the undergraduate curriculum. METHODS: A cross-sectional survey of all final year medical students attending the University of Newcastle was conducted, using a distributed questionnaire, comprising three sections: demographics, perceptions about nutrition and its inclusion in the medical course, and a listing of 38 major nutrition topics. Main outcome measures were: interest in nutrition, and whether it should be included in the undergraduate medical curriculum; rated importance of listed nutrition topics; comparison between students and Faculty and GPs. Frequency distributions and Chi square analyses were used to compare group responses. RESULTS: Seventy-one per cent of the students were interested in nutrition and 94% believed it should be included in the medical curriculum. More than 60% of the students nominated 21 of the 38 topics, essential or important. Thirteen of these topics were also highly rated by Faculty and GPs, although Faculty and GPs rated more topics as essential or important. CONCLUSIONS: Newcastle medical students are interested in nutrition and believe it should be included in their medical curriculum. This may be due to their clinical exposure and the educational milieu of the University of Newcastle Medical School. Exposure to nutrition in their undergraduate education appears to be an important determinant for priority designated nutrition topics.

Chronic cervical zygapophysial joint pain after whiplash. A placebo-controlled prevalence study.

STUDY DESIGN: The authors developed a diagnostic double-blindfolded survey using placebo-controlled local anesthetic blocks. OBJECTIVE: To determine the prevalence of cervical zygapophysial joint pain among patients with chronic neck pain (more than 3 months' duration) after whiplash injury. SUMMARY OF BACKGROUND DATA: The prevalence of cervical zygapophysial joint pain after whiplash has been studied by means of comparative local anesthetic blocks. The concern is that such blocks may be compromised by placebo responses and that prevalence estimates based on such blocks may exaggerate the importance of this condition. METHODS: Sixty-eight consecutive patients referred for chronic neck pain after whiplash were studied. Patients with dominant headache were first screened with the use of comparative blocks of the C2-C3 zygapophysial joint. Patients who had positive responses concluded investigations. Those who did not experience pain relief together with the patients with dominant neck pain proceeded to undergo placebo-controlled local anesthetic blocks. Two different local anesthetics and a placebo injection of normal saline were administered in random order and under double-blindfolded conditions. A positive diagnosis was made if the patient's pain was completely and reproducibly relieved by each local anesthetic but not by the placebo injection. RESULTS: Among patients with dominant headache, comparative blocks revealed that the prevalence of C2-C3 zygapophysial joint pain was 50%. Among those without C2-C3 zygapophysial joint pain, placebo-controlled blocks revealed the prevalence of lower cervical zygapophysial joint pain to be 49%. Overall, the prevalence of cervical zygapophysial joint pain (C2-C3 or below) was 60% (95% confidence interval, 46%, 73%). CONCLUSION: Cervical zygapophysial joint pain is common among patients with chronic neck pain after whiplash. This nosologic entity has survived challenge with placebo-controlled, diagnostic investigations and has proven to be of major clinical importance.

Faking a profile: can naive subjects simulate whiplash responses?

The psychological symptom checklist, the SCL-90-R (Derogatis 1983), has been used to assess patients with a number of chronic pain syndromes. For whiplash injury, a characteristic profile has been found (Wallis et al. 1995). However, there is still a belief that patients with neck pain following whiplash injury may be malingering, and therefore the utility of the SCL-90-R as a screen for possible malingering is assessed here. Forty pain-free university students were asked to simulate chronic pain 6 months after a motor vehicle accident in order to ensure compensation. The SCL-90-R, McGill Pain Questionnaire and a visual analogue pain scale were used. Students' scores were compared with those of a group of 132 whiplash patients (Wallis et al. 1995). Differences between the two groups were striking; the students scored significantly higher than patients on all subscales of the SCL-90-R and on the visual analogue pain scale (Mann-Whitney P-values all less than 0.001). However, pain scores for both groups on the McGill Pain Questionnaire were similar. The conclusion was that it is very difficult for an ingenuine individual to fake a psychological profile typical of a whiplash patient.

Pain and psychologic symptoms of Australian patients with whiplash.

STUDY DESIGN: A survey of pain intensity and psychological symptoms in patients with chronic neck pain after whiplash injury. OBJECTIVES: To describe the pain and psychological profiles of patients with chronic whiplash. SUMMARY OF BACKGROUND DATA: Reports in the literature mention a constellation of symptoms associated with chronic whiplash injury but no systematic survey using objective patient report measures has been reported. METHODS: One hundred forty consecutive referred patients with chronic neck pain after a motor vehicle accident were studied using the SCL-90-R psychological profile and the McGill Pain Questionnaire. RESULTS: Psychological profiles and pain intensity ratings, similar to profiles obtained from patients suffering from rheumatoid arthritis and low back pain of organic origin, were obtained. CONCLUSIONS: The SCL-90-R is a convenient instrument to administer to patients with whiplash. It yielded a characteristic profile of pain and appears to be more expedient than other psychometric tests for these patients.

Nutrition in Medical Education: Does a problem based, community oriented medical faculty value it more than a traditional medical faculty?

OBJECTIVE: To identify nutrition topics considered important for inclusion in Newcastle undergraduate medical education, and compare them to those from a traditional medical school. DESIGN: A survey, using a mailed questionnaire, listing 38 major nutrition topics. Respondents were instructed to rank topics as essential, important, desirable, does not belong or don't know. Responses were identified by participant group only. PARTICIPANTS: All members of the University of Newcastle medical faculty, general practitioners (GPs) available for final year teaching and dietitians working in the region of the medical school. MAIN OUTCOME MEASURES: Rated importance of listed nutrition topics; comparison between participant groups and previous survey. RESULTS: More than 60% of the Newcastle respondents overall nominated 30 of the 38 topics essential or important. For 31 of the 38 topics, a higher percentage of respondents in the Newcastle survey ranked the topic as essential or important. Newcastle medical faculty considered nutrition education significantly more essential (p=0.03) than their peers from a traditional medical faculty. CONCLUSIONS: Both Newcastle Medical Faculty and GPs have a strong commitment to nutrition in medical education. Differences between the level of interest in Nutrition education in problem based and traditional courses are postulated to be due to beliefs regarding the importance of nutrition in the practice of medicine, the structure of the course and the extent of integration within the curriculum.

The prevalence of chronic cervical zygapophysial joint pain after whiplash.

STUDY DESIGN: A survey of the prevalence of cervical zygapophysial joint pain was conducted. OBJECTIVES: To determine the prevalence of cervical zygapophysial joint pain in patients with chronic neck pain after whiplash. SUMMARY OF BACKGROUND DATA: In a significant proportion of patients with whiplash, chronic, refractory neck pain develops. Provisional data suggest many of these patients have zygapophysial joint pain, but the diagnosis has been established by single, uncontrolled diagnostic blocks. METHODS: Fifty consecutive, referred patients with chronic neck pain after whiplash injury were studied using double-blind, controlled, diagnostic blocks of the cervical zygapophysial joints. On separate occasions, the joint was blocked with either lignocaine or bupivacaine in random order. RESULTS: A positive diagnosis was made only if both blocks relieved the patient's pain and bupivacaine provided longer relief. Painful joints were identified in 54% of the patients (95% confidence interval, 40% to 68%). CONCLUSION: In this population, cervical zygapophysial joint pain was the most common source of chronic neck pain after whiplash.

Third occipital nerve headache: a prevalence study.

A consecutive series of 100 patients was studied to determine the prevalence of third occipital nerve headache in patients with chronic neck pain (> three months in duration) after whiplash. Seventy one patients complained of headache associated with their neck pain. Headache was the dominant complaint of 40 patients, but was only a secondary problem for the other 31. Each patient with headache underwent double blind, controlled diagnostic blocks of the third occipital nerve. On two separate occasions the nerve was blocked with either lignocaine or bupivacaine, in random order. The diagnosis of third occipital nerve headache was made only if both blocks completely relieved the patient's upper neck pain and headache and the relief lasted longer with bupivacaine. The prevalence of third occipital nerve headache among all 100 whiplash patients was 27% (95% confidence interval (95% CI) 18-36%) and among those with dominant headache the prevalence was as high as 53% (95% CI 37-68%). There were no distinguishing features on history or examination that enabled a definitive diagnosis to be made before the nerve blocks. Those patients with a positive diagnosis, however, were significantly more likely to be tender over the C2-3 zygapophysial joint (p = 0.01). Third occipital nerve headache is a common condition in patients with chronic neck pain and headache after whiplash. Third occipital nerve blocks are essential to make this diagnosis.