Winner Winner Turkey Dinner! An Empirical Approach to Measuring Palatability and Satisfaction with Emergency Department Turkey Sandwiches.

Introduction: Despite their popularity in many EDs, little is known regarding perceptions of turkey sandwiches among patients. Given the importance of turkey sandwiches as a form of nutrition provided in EDs, we sought to quantify the composition and taste of ED turkey sandwiches through a quantitative assessment of turkey sandwiches by ED staff. Methods: This was a blinded observational study performed at a tertiary, urban academic medical center in Boston, MA. We collected ED turkey sandwiches up to 48 hours prior to study days from 4 emergency departments in the Boston area (2 community hospitals and 2 academic medical centers). We enrolled ED physicians, nurses, physician assistants, and staff who were exposed to four sandwiches in a random fashion. Participants were asked to assess sandwiches on a Likert scale of 1 to 5 on a variety of factors including, nutritional value "goodness", smell "olfactory", texture "bite", ingredient distribution "balance", appearance "look", and flavor "edibility" to produce a composite score for sandwich quality (GOBBLE score). Next, participants were asked standardized questions surrounding suitability for consumption and nutrition on a 10 point Likert scale. We calculated mean scores and measured differences using t-tests. Results: We enrolled 22 participants over the study period. Twenty-one participants completed all measures. GOBBLE scores were calculated and averaged for sandwiches. A One-way ANOVA test was performed to measure statistically significant differences between mean GOBBLE scores (p<0.05) with a post hoc Tukey HSD procedure used to assess for statistically significant difference for pairwise comparison. A significant difference (p=0.009) was noted between the 4 sandwiches being compared, with a single site outperforming the others. Aggregating for academic and community sites demonstrated no statistically significant difference (p=0.08). Sandwiches in general were not considered healthy or palatable by study subjects. Conclusion: Despite out-performance by a single ED, there is no significant difference in the quality of sandwiches provided to patients in EDs between academic and community hospitals. ED turkey sandwiches do not appear to be food items that are viewed as healthy or recommended to patients by ED staff who participated in this study.

Wartime toxicology: the spectre of chemical and radiological warfare in Ukraine.

The unprovoked invasion of Ukraine by the Russian Federation has resulted in the largest humanitarian crisis in Europe since World War II. As fighting intensifies throughout Ukraine, there is an increasing concern that the Russian Federation may consider the direct use of chemical or radiological weapons against military personnel and civilians in Ukraine. Despite prohibition of chemical weapons from the Chemical Weapons Convention of 1997, recent evidence has demonstrated that state actors will continue to use these agents as weapons of war and terror, despite publicly denying their use. We review chemical weapons produced and used by the Russian Federation (or its allies) to identify plausible risks in the Russian war in Ukraine. We also provide rapid assessment and treatment guidelines to recognize and manage these acute exposures.

Severe colchicine poisoning treated successfully with kidney replacement therapy and plasmapheresis: a case report.

Colchicine is commonly prescribed for treatment of inflammatory conditions but has a narrow therapeutic window and dangerous toxicity profile. Here we describe a case of survival after massive unintentional colchicine overdose treated with plasmapheresis and renal replacement therapy. A 37 year old male with history of pericarditis presented to the Emergency Department with a chief complaint of nausea, vomiting, and diarrhea after unintentionally ingesting 36 mg of colchicine 17 h prior to arrival. An initial colchicine concentration resulted at 5.1 ng/mL (30 h post-ingestion) and peaked at 12 ng/mL (40 h post-ingestion). He was treated with continuous kidney replacement therapy (CKRT) beginning on his first day of hospitalization and with plasmapheresis on hospital days two through four. The patient's course was complicated by multiorgan failure including coagulopathy, respiratory failure, neuropathy, renal failure, pancytopenia, and heart failure. He was discharged to inpatient rehabilitation on hospital day 24. On clinical follow up four months after discharge the patient was found to have no significant persistent morbidity related to colchicine overdose.

Satellite imaging reveals increased proportion of population exposed to floods.

Flooding affects more people than any other environmental hazard and hinders sustainable development1,2. Investing in flood adaptation strategies may reduce the loss of life and livelihood caused by floods3. Where and how floods occur and who is exposed are changing as a result of rapid urbanization4, flood mitigation infrastructure5 and increasing settlements in floodplains6. Previous estimates of the global flood-exposed population have been limited by a lack of observational data, relying instead on models, which have high uncertainty3,7-11. Here we use daily satellite imagery at 250-metre resolution to estimate flood extent and population exposure for 913 large flood events from 2000 to 2018. We determine a total inundation area of 2.23 million square kilometres, with 255-290 million people directly affected by floods. We estimate that the total population in locations with satellite-observed inundation grew by 58-86 million from 2000 to 2015. This represents an increase of 20 to 24 per cent in the proportion of the global population exposed to floods, ten times higher than previous estimates7. Climate change projections for 2030 indicate that the proportion of the population exposed to floods will increase further. The high spatial and temporal resolution of the satellite observations will improve our understanding of where floods are changing and how best to adapt. The global flood database generated from these observations will help to improve vulnerability assessments, the accuracy of global and local flood models, the efficacy of adaptation interventions and our understanding of the interactions between landcover change, climate and floods.

Traumatic pedestrian and bicyclist injuries associated with intoxication.

BACKGROUND: Drug and alcohol use are risk factors for trauma among operators of motor vehicles and contribute to trauma in pedestrians and bicyclists. We describe the prevalence of drug and alcohol use and clinical consequences in a cohort of pedestrians and bicyclists with trauma. METHODS: We analyzed a 25-month data set of 916 trauma team activations from January 2017-January 2019 at an urban, level I trauma center. Blood ethanol levels and urine toxicology screens were obtained in 94 pedestrian and bicyclist trauma activations. We compared pedestrians or bicyclists with a positive urine or blood screen (n = 69) to those with negative screens (n = 25). We conducted a retrospective chart review to determine mechanism of injury, injury pattern, and disposition from the emergency department (ED). RESULTS: Overall, 38 (55%) of injured patients with positive screen were pedestrians and 31 (45%) were bicyclists. Fentanyl was the most commonly detected drug (n = 38; 40%), followed by opiates (n = 27; 29%), and tetrahydrocannabiol (THC) (n = 23; 25%). Twenty-one patients were positive for ethanol. Pedestrians and bicyclists with positive toxicology screens were significantly more likely to sustain fractures (p < .01), require an operative procedure (p < .05), or intensive care unit admission (p < .05). CONCLUSION: Our study builds on previous literature which suggests that intoxicated bicyclists and pedestrians suffer frequent and more severe injury than their sober counterparts. Public health campaigns should educate bicyclists and pedestrians about the risks of cycling or walking in areas of road traffic while under the influence of alcohol or illicit drugs.

Intentional Hydroxychloroquine Overdose Treated with High-Dose Diazepam: an Increasing Concern in the COVID-19 Pandemic.

INTRODUCTION: Recent attention on the possible use of hydroxychloroquine and chloroquine to treat COVID-19 disease has potentially triggered a number of overdoses from hydroxychloroquine. Toxicity from hydroxychloroquine manifests with cardiac conduction abnormalities, seizure activity, and muscle weakness. Recognizing this toxidrome and unique management of this toxicity is important in the COVID-19 pandemic. CASE REPORT: A 27-year-old man with a history of rheumatoid arthritis presented to the emergency department 7 hours after an intentional overdose of hydroxychloroquine. Initial presentation demonstrated proximal muscle weakness. The patient was found to have a QRS complex of 134 ms and QTc of 710 ms. He was treated with early orotracheal intubation and intravenous diazepam boluses. Due to difficulties formulating continuous diazepam infusions, we opted to utilize an intermitted intravenous bolus strategy that achieved similar effects that a continuous infusion would. The patient recovered without residual side effects. DISCUSSION: Hydroxychloroquine toxicity is rare but projected to increase in frequency given its selection as a potential modality to treat COVID-19 disease. It is important for clinicians to recognize the unique effects of hydroxychloroquine poisoning and initiate appropriate emergency maneuvers to improve the outcomes in these patients.

Chloroquine, hydroxychloroquine and COVID-19.

The media have featured the antimalarials chloroquine (CQ) and hydroxychloroquine (HCQ) to treat coronavirus (COVID-19). Political leaders have touted their use and recommended availability to the public. These anti-inflammatory agents have substantial human toxicity with a narrow therapeutic window. CQ and HCQ poisoning cause myocardial depression and profound hypotension due to vasodilation. Bradycardia and ventricular escape rhythms arise from impaired myocardial automaticity and conductivity due to sodium and potassium channel blockade. With cardiotoxicity, ECGs may show widened QRS, atrioventricular heart block and QT interval prolongation. CQ may also cause seizures, often refractory to standard treatment. Of concern is pediatric poisoning, where 1-2 pills of CQ or HCQ can cause serious and potentially fatal toxicity in a toddler. The treatment of CQ/HCQ poisoning includes high-dose intravenous diazepam postulated to have positive ionotropic and antidysrhythmic properties that may antagonize the cardiotoxic effects of CQ. Infusions of epinephrine titrated to treat unstable hypotension, as well as potassium for severe hypokalemia may be required. Current scientific evidence does not support treatment or prophylactic use of these agents for COVID-19 disease. Regulatory and public health authorities recognize that CQ/HCQ may offer little clinical benefit and only add risk requiring further investigation before wider public distribution.

Garnet, the archetypal cubic mineral, grows tetragonal.

Garnet is the archetypal cubic mineral, occurring in a wide variety of rock types in Earth's crust and upper mantle. Owing to its prevalence, durability and compositional diversity, garnet is used to investigate a broad range of geological processes. Although birefringence is a characteristic feature of rare Ca-Fe3+ garnet and Ca-rich hydrous garnet, the optical anisotropy that has occasionally been documented in common (that is, anhydrous Ca-Fe2+-Mg-Mn) garnet is generally attributed to internal strain of the cubic structure. Here we show that common garnet with a non-cubic (tetragonal) crystal structure is much more widespread than previously thought, occurring in low-temperature, high-pressure metamorphosed basalts (blueschists) from subduction zones and in low-grade metamorphosed mudstones (phyllites and schists) from orogenic belts. Indeed, a non-cubic symmetry appears to be typical of common garnet that forms at low temperatures (<450 °C), where it has a characteristic Fe-Ca-rich composition with very low Mg contents. We propose that, in most cases, garnet does not initially grow cubic. Our discovery indicates that the crystal chemistry and thermodynamic properties of garnet at low-temperature need to be re-assessed, with potential consequences for the application of garnet as an investigative tool in a broad range of geological environments.

Seed germination and dormancy traits of forbs and shrubs important for restoration of North American dryland ecosystems.

In degraded dryland systems, native plant community re-establishment following disturbance is almost exclusively carried out using seeds, but these efforts commonly fail. Much of this failure can be attributed to the limited understanding of seed dormancy and germination traits. We undertook a systematic classification of seed dormancy of 26 species of annual and perennial forbs and shrubs that represent key, dominant genera used in restoration of the Great Basin ecosystem in the western United States. We examined germination across a wide thermal profile to depict species-specific characteristics and assessed the potential of gibberellic acid (GA3 ) and karrikinolide (KAR1 ) to expand the thermal germination envelope of fresh seeds. Of the tested species, 81% produce seeds that are dormant at maturity. The largest proportion (62%) exhibited physiological (PD), followed by physical (PY, 8%), combinational (PY + PD, 8%) and morphophysiological (MPD, 4%) dormancy classes. The effects of chemical stimulants were temperature- and species-mediated. In general, mean germination across the thermal profile was improved by GA3 and KAR1 for 11 and five species, respectively. We detected a strong germination response to temperature in freshly collected seeds of 20 species. Temperatures below 10 °C limited the germination of all except Agoseris heterophylla, suggesting that in their dormant state, the majority of these species are thermally restricted. Our findings demonstrate the utility of dormancy classification as a foundation for understanding the critical regenerative traits in these ecologically important species and highlight its importance in restoration planning.

Cyanobacteria inoculation enhances carbon sequestration in soil substrates used in dryland restoration.

Despite significant efforts to restore dryland ecosystems worldwide, the rate of success of restoration is extremely low in these areas. The role of cyanobacteria from soil biocrusts in reestablishing soil functions of degraded land has been highlighted in recent years. These organisms are capable of improving soil structure and promoting soil N and C fixation. Nevertheless, their application to restore functions of reconstructed soils in dryland restoration programs is yet to be harnessed. In this study, we used microcosms under laboratory conditions to analyse the effects of inoculating soil substrates used in post-mine restoration with a mixture of N-fixing cyanobacteria isolated from soil biocrust (Nostoc commune, Tolypothrix distorta and Scytonema hyalinum) on i) the recovery of the biocrust, and ii) the carbon sequestration and mineralisation rates of these substrates. Soils were collected from an active mine site in the mining-intensive biodiverse Pilbara region (north-west Western Australia) and consisted of previously stockpiled topsoil, overburden waste material, a mixture of both substrates, and a natural soil from an undisturbed area. Our results showed that cyanobacteria rapidly colonised the mine substrates, with biocrust coverage ranging from 23.8 to 52.2% and chlorophyll a concentrations of up to 12.2 µg g-1 three months after inoculation. Notably, soil organic C contents increased 3-fold (P < 0.001) in the mine waste substrate (from 0.6 g kg-1 to 1.9 g kg-1) during this period of time. Overall, our results showed that cyanobacteria inoculation can rapidly modify properties of reconstructed soil substrates, underpinning the potential key role of these organisms as bio-tools to initiate recovery of soil functions in infertile, reconstructed soil substrates.

Impact of hospital transfer on surgical outcomes of intestinal atresia.

BACKGROUND: Examine effects of hospital transfer into a quaternary care center on surgical outcomes of intestinal atresia. METHODS: Children <1 yo principally diagnosed with intestinal atresia were identified using the Kids' Inpatient Database (2012). Exposure variable was patient transfer status. Outcomes measured were inpatient mortality, hospital length of stay (LOS) and discharge status. Linearized standard errors, design-based F tests, and multivariable logistic regression were performed. RESULTS: 1672 weighted discharges represented a national cohort. The highest income group and those with private insurance had significantly lower odds of transfer (OR:0.53 and 0.74, p < 0.05). Rural patients had significantly higher transfer rates (OR: 2.73, p < 0.05). Multivariate analysis revealed no difference in mortality (OR:0.71, p = 0.464) or non-home discharge (OR: 0.79, p = 0.166), but showed prolonged LOS (OR:1.79, p < 0.05) amongst transferred patients. CONCLUSIONS: Significant differences in hospital LOS and treatment access reveal a potential healthcare gap. Post-acute care resources should be improved for transferred patients.

Health behaviours associated with indoor tanning based on the 2012/13 Manitoba Youth Health Survey. / Comportements en matière de santé associés au bronzage artificiel d'après l'Enquête sur la santé des jeunes du Manitoba de 2012-2013.

INTRODUCTION: Although indoor tanning causes cancer, it remains relatively common among adolescents. Little is known about indoor tanning prevalence and habits in Canada, and even less about associated behaviours. This study explores the prevalence of adolescent indoor tanning in Manitoba and its association with other demographic characteristics and health behaviours. METHODS: We conducted secondary analyses of the 2012/13 Manitoba Youth Health Survey data collected from Grade 7 to 12 students (n = 64 174) and examined associations between indoor tanning (whether participants had ever used artificial tanning equipment) and 25 variables. Variables with statistically significant associations to indoor tanning were tested for collinearity and grouped based on strong associations. For each group of highly associated variables, the variable with the greatest effect upon indoor tanning was placed into the final logistic regression model. Separate analyses were conducted for males and females to better understand sex-based differences, and analyses were adjusted for age. RESULTS: Overall, 4% of male and 9% of female students reported indoor tanning, and prevalence increased with age. Relationships between indoor tanning and other variables were similar for male and female students. Binary logistic regression models indicated that several variables significantly predicted indoor tanning, including having part-time work, being physically active, engaging in various risk behaviours such as driving after drinking for males and unplanned sex after alcohol/drugs for females, experiencing someone say something bad about one's body shape/size/appearance, identifying as trans or with another gender, consuming creatine/other supplements and, for females only, never/rarely using sun protection. CONCLUSION: Indoor tanning among adolescents was associated with age, part-time work, physical activity and many consumption behaviours and lifestyle risk factors. Though legislation prohibiting adolescent indoor tanning is critical, health promotion to discourage indoor tanning may be most beneficial if it also addresses these associated factors.

INTRODUCTION: Bien que le bronzage artificiel cause le cancer, il demeure relativement courant chez les adolescents. Nous en savons peu sur les habitudes en matière de bronzage artificiel ainsi que sur la prévalence de ce dernier au Canada, et nous en savons encore moins sur les comportements associés. Cette étude se penche sur la prévalence du bronzage artificiel chez les adolescents du Manitoba ainsi que sur son association avec d'autres caractéristiques individuelles et comportements en matière de santé. MÉTHODOLOGIE: Nous avons effectué des analyses secondaires des données recueillies dans le cadre de l'Enquête sur la santé des jeunes du Manitoba (2012-2013) auprès d'élèves de la 7e à la 12e année (n = 64 174) et nous avons examiné les associations entre le bronzage artificiel (selon si les répondants avaient déjà utilisé des appareils de bronzage artificiel) et 25 variables. Les variables présentant un lien statistiquement significatif avec le bronzage artificiel ont fait l'objet de tests pour déterminer toute colinéarité potentielle et elles ont été regroupées en fonction de la force de leurs associations. Pour chaque groupe de variables dont l'association avait une signification statistique, la variable ayant l'effet de plus grande ampleur sur le bronzage artificiel a été intégrée au modèle final de régression logistique. Des analyses séparées ont été réalisées pour les garçons et les filles afin de mieux comprendre les différences fondées sur le sexe, et les analyses ont été ajustées en fonction de l'âge. RÉSULTATS: Globalement, 4 % des garçons et 9 % des filles ont indiqué avoir eu recours au bronzage artificiel, et la prévalence augmentait avec l'âge. Les associations entre le bronzage artificiel et les autres variables étaient similaires chez les garçons et les filles. Les modèles de régression logistique binaire ont révélé que plusieurs variables prédisaient de façon significative le recours au bronzage artificiel, notamment l'occupation d'un emploi à temps partiel, l'activité physique, l'adoption de divers comportements à risque comme conduire un véhicule sous l'emprise de l'alcool (chez les garçons) et le fait d'avoir des relations sexuelles non planifiées après avoir consommé de l'alcool ou de la drogue (chez les filles), être victime de commentaires négatifs sur sa silhouette, sa taille ou son apparence, se déclarer comme transgenre ou d'un autre genre, consommer de la créatine ou autres suppléments et, pour les filles, utiliser rarement ou ne jamais utiliser de protection solaire. CONCLUSION: Le bronzage artificiel chez les adolescents a été associé à l'âge, au travail à temps partiel, à l'activité physique et à de nombreux comportements de consommation et de facteurs de risque liés au mode de vie. Même si la législation interdisant l'accès des adolescents aux salons de bronzage est essentielle, les activités de promotion de la santé visant à décourager le bronzage artificiel pourraient porter davantage fruit si elles s'attaquaient aussi à ces facteurs connexes.

Cell type-specific transcriptomic analysis by thiouracil tagging in zebrafish.

Transcriptomic studies are important tools for understanding the development and function of the different cell types that make up complex tissues. Zebrafish (Danio rerio) is a valuable organism for modeling key aspects of vertebrate development, cell biology, and human disease. However, the small size of individual larvae and relative scarcity of certain cell types in zebrafish can hamper efforts to collect enough pure material for cell type-specific transcriptomic studies. Thus, there is a need in the zebrafish field for spatially and temporally resolved gene expression assays. This chapter will discuss the general principles behind the TU-tagging method to isolate cell type-specific RNAs and provide guidance in designing and executing TU-tagging experiments in zebrafish.

The effects of acidification on human milk's cellular and nutritional content.

OBJECTIVE: Fortification of human milk for preterm infants is necessary and a common newborn intensive care practice. Currently, acidified human milk as part of a human milk fortifier is being fed to preterm infants. However, there are little data on the acidification effects on mother's milk. The aim of this study is to determine the effects of acidification on human milk's cellular and nutritional composition. STUDY DESIGN: One hundred milk samples were collected from eight mothers who had infants in the neonatal intensive care unit. All milk samples were frozen at 4 °C. The frozen samples were thawed and divided into two equal aliquots, control and acidified. The control milk sample had its pH determined while the other sample was acidified to pH 4.5. Each milk sample was examined for pH, white cells, total protein, creamatocrit, lipase activity and free fatty acids. RESULT: Mean pH of the human milk control was 6.8 ± 0.1 (M ± s.d.) with the acidified milk at 4.5 ± 0.1. Acidification caused a 76% decrease in white cells, a 56% decrease in lipase activity and a 14% decrease in the total protein but a 36% increase in the creamatocrit. CONCLUSION: Acidification of human milk causes significant changes of the milk's cellular and nutritional components that may not be beneficial to preterm infants.

The impact of a rural emergency department rotation on applicant ranking of a US emergency medicine residency program.

INTRODUCTION: Few US emergency medicine (EM) residency programs have been located in rural states due to program requirements for emergency department (ED) patient volume. Recent revision to the program requirements now permits 'educationally justifiable exceptions' to the patient population requirement, 'such as clinical sites in a rural setting', and some EM residency programs now plan to offer rural ED clinical experiences as a required curricular component. The impact of a required rural EM rotation on the ranking decisions of applicants is important to residency programs seeking to attract the most desirable applicants. OBJECTIVE: To assess the impact of a required rural ED rotation on applicant ranking of an EM residency program in the US National Resident Matching Program (NMRP). METHODS: All applicants to the study's EM residency program completing the interview portion of the application process received a mailed and emailed survey following the release of the 2004 NMRP results. The survey included questions addressing the rural/non-rural classification of the location of the applicants' childhood home, medical school, and anticipated future practice. RESULTS: Of 46 eligible subjects, 32 (69.6%) completed the survey. Of subjects with a rural childhood, 73.3% reported a positive impact on rank order (95% CI 50.9-95.7%) and 26.7% reported no impact (CI 4.3-49.1%); 81.3% of subjects with non-rural backgrounds reported no impact (CI 62.2-100%), 12.5% higher rank (CI 0-28.7%), and 6.3% lower (CI 0-18.2%). If planning a future practice in a rural community, 83.3% reported positive impact (CI 62.2-100%) and 16.7% no impact (CI 0-37.8%); 78.9% of subjects anticipating future practice in non-rural communities reported no impact (CI 60.6-97.3%), 15.8% higher rank (CI 0-32.2%), and 5.3% lower (CI 0-15.4). Of the subjects attending medical school in rural states, 52.2% reported a positive impact (CI 31.8-72.6%) and 47.8% no impact (CI 27.4-68.2%), while 75% of graduates of medical schools in non-rural states reported no impact (CI 32.6-100%) and 25% (CI 0-67.4%) a negative impact. CONCLUSION: The presence of a rural ED rotation did not adversely impact EM residency applicants' ranking of the program.

Male microchimerism in women with systemic sclerosis and healthy women who have never given birth to a son.

BACKGROUND: Male DNA or cells are often used to measure microchimerism in a woman. In studies of autoimmune diseases male microchimerism is most often attributed to the previous birth of a son. OBJECTIVE: To determine the frequency of male microchimerism in healthy women or women with systemic sclerosis who had never given birth to a son. METHODS: Real time quantitative polymerase chain reaction targeting the Y chromosome specific sequence DYS14 was employed to test DNA extracted from peripheral blood mononuclear cells of 26 women with systemic sclerosis and 23 healthy women who had never given birth to a son. RESULTS: are expressed as the genome equivalent number of male cells per million host cells (gEq/mil).Results: Male DNA was found in 15% of women with systemic sclerosis (range 0 to 23.7 gEq/mil) and in 13% of healthy women (range 0 to 5.1 gEq/mil). Although two women with male DNA had an induced abortion, most had no history of spontaneous or induced abortion (either systemic sclerosis or healthy). CONCLUSIONS: Microchimerism with male DNA can be found in the circulation of women who have never given birth to a son. Thus sources other than a male birth must be considered when male DNA is used to measure microchimerism. Although other studies are needed, there was no apparent difference in women with systemic sclerosis and healthy women. Possible sources of male DNA include unrecognised male pregnancy or unrecognised male twin, an older male sibling with transfer through the maternal circulation, or sexual intercourse alone.

Selection of an ultraviolet disinfection system for a municipal wastewater treatment plant.

As part of an expansion to an average flow of 45.9 million gallons per day (174 mld), the Ypsilanti Community Utilities Authority wastewater treatment plant in the State of Michigan, USA, elected to install ultraviolet disinfection as a replacement for the existing chlorination process. This paper presents a unique methodology used in selecting the best system based on not only the life cycle costs, and O & M considerations but also the participation of the stakeholders. The Team members consisted of representatives of all departments at the Authority, and these Team members made the decision. The Team evaluated all criteria in the office, which was followed by verification at selected sites with similar types of equipment. The selected equipment then was pilot tested for validation of the dose-kill relationship under normal operation and also under reduced irradiation conditions. A low-pressure, high intensity system was selected, based on life-cycle cost, reliability, safety, and ease of operation. This paper describes the unique methodologies used in making that decision. The full-scale system is scheduled for start-up in Spring 2003.

Knowledge communities: online environments for supporting knowledge management and its social context

It takes a strongly social approach to the issue of how to support the re-use of knowledge, arguing that knowledge (and expertise) is created, used, and disseminated in ways that are inextricably entwined with the social milieu. Document in pdf format; Acrobat Reader required.

Multiple virulence factors of Cryptococcus neoformans are dependent on VPH1.

Acidification of vesicular compartments plays an important role in a number of cellular transport processes, including protein secretion, metal cofactor insertion, glycosylation and pH stability. In the present study, we identify and characterize a component of the vesicular proton pump, Vph1p, to determine its role in the virulence of the AIDS-related fungal pathogen Cryptococcus neoformans. Insertional mutagenesis and plasmid rescue were used to identify the VPH1 gene by screening for mutants defective in laccase activity. Disruption of VPH1 resulted in defects in three virulence factors (capsule production, laccase and urease expression), as well as a growth defect at 37 degrees C, but only a small growth reduction at 30 degrees C. These effects were duplicated by the vacuolar (H+)-ATPase inhibitor bafilomycin A1. Furthermore, the vph1 insertional mutant was also avirulent in a mouse meningo-encephalitis model. Complementation of the insertional mutant with wild-type VPH1 resulted in a recovery of virulence factor expression, normal growth at 37 degrees C and restoration of full virulence. These studies establish the importance of the VPH1 gene and vesicular acidification in the virulence of C. neoformans.