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.

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.

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.

Temperature and Thermal Emissivity of the Surface of Neptune's Satellite Triton.

Analysis of the preliminary results from the Voyager mission to the Neptune system has provided the scientific community with several methods by which the temperature of Neptune's satellite Triton may be determined. If the 37.5 K surface temperature reported by several Voyager investigations is correct, then the photometry reported by the imaging experiment on Voyager requires that Triton's surface have a remarkably low emissivity. Such a low emissivity is not required in order to explain the photometry from the photopolarimeter experiment on Voyager. A low emissivity would be inconsistent with Triton having a rough surface at the approximately 100-microm scale as might be expected given the active renewal processes which appear to dominate Triton's surface.

Photometry from voyager 2: initial results from the uranian atmosphere, satellites, and rings.

The Voyager 2 photopolarimeter successfully completed the Uranus encounter, acquiring new data on the planet's atmosphere, its principal satellites, and its ring system. Spatially resolved photometry of the atmosphere at 0.27 micrometer shows no enhancement in absorption toward the pole, unlike the case for Jupiter and Saturn. Stellar occultation measurements indicate the temperature at the 1-millibar level over the north pole is near 90 kelvins. The geometric albedos of the five large satellites of Uranus were measured at 0.27 and 0.75 micrometer and indicate the presence of low albedo, spetrally flat absorbing material. Titania seems to have a fluffy surface, as indicated by its phase curve. The nine ground-based rings were detected, and their internal structure, optical depths, and positions were determined. The sharp edges of the in ring made it possible to measure its edge thickness (less than 150 meters) and particle sizes (less than 30 meters); little or no dust was detcted. New narrow rings and partial rings (arcs) were measured, and the narrow component of the eta ring was found to be discontinuous.

Photometry from voyager 2: initial results from the neptunian atmosphere, satellites, and rings.

The Voyager photopolarimeter successfully accomplished its objectives for the Neptune encounter, performing measurements on the planet, several of its satellites, and its ring system. A photometric map of Neptune at 0.26 micrometer (microm) shows the planet to be bland, with no obvious contrast features. No polar haze was observed. At 0.75 microm, contrast features are observed, with the Great Dark Spot appearing as a low-albedo region and the bright companion as being substantially brighter than its surroundings, implying it to be at a higher altitude than the Great Dark Spot. Triton's linear phase coefficients of 0.011 magnitudes per degree at 0.26 microm and 0.013 magnitudes per degree at 0.75 microm are consistent with a solid-surface object possessing high reflectivity. Preliminary geometric albedos for Triton, Nereid, and 1989N2 were obtained at 0.26 and 0.75 microm. Triton's rotational phase curve shows evidence of two major compositional units on its surface. A single stellar occultation of the Neptune ring system elucidated an internal structure in 1989N1R, in the approximately 50-kilometer region of modest optical depth. 1989N2R may have been detected. The deficiency of material in the Neptune ring system, when compared to Uranus', may imply the lack of a "recent" moon-shattering event.

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.

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.

False-positive rates of cervical zygapophysial joint blocks.

OBJECTIVE: To determine the false-positive rate of anesthetic blocks of the medial branches of the cervical dorsal rami in the diagnosis of cervical zygapophysial joint pain. DESIGN: Comparison between single diagnostic blocks, and a criterion standard of double-blind, controlled, differential anesthetic blocks. SETTING: Tertiary referral center. PATIENTS: The first 55 consecutive patients with neck pain for > 3 months after and attributable to a motor vehicle accident, and who had completed a second diagnostic block after an initial positive response. A total of 60 joints was studied, with five patients providing two joints each. The mean age was 41 years; 61% were female. METHODS: Each patient had been investigated with radiologically controlled blocks of the medial branches of the cervical dorsal rami to anesthetize the target cervical zygapophysial joint. The initial block was performed using either 0.5% bupivacaine or 2% lignocaine, randomly selected. The duration of pain relief was assessed in a double-blind fashion. The procedure was repeated with the complementary anesthetic. Only patients experiencing a longer period of pain relief from bupivacaine were considered to have true-positive responses. RESULTS: The second block failed to relieve pain in two of the tested joints. In a further 14 joints, the control blocks relieved pain, but the patient failed to correctly discriminate the longer acting anesthetic. The remaining 44 joints met the criteria for true-positive responses. The false-positive rate of single blocks was 16 of 60 or 27% (95% confidence interval 15%, 38%). CONCLUSIONS: Uncontrolled diagnostic blocks are compromised by a significant false-positive rate that seriously detracts from the specificity of the test.

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.

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.

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.

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.

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.

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.

Learning decision-making in clinical medicine: a card game dealing with acute emergencies for undergraduate use.

A card game concerning the assessment and management of patients involved in medical emergencies was constructed for use by medical students who were beginning Year 3 of a 5-year curriculum. Particular emphasis was place on the identification by the student of priorities for action and the justification for decisions made on the basis of underlying mechanisms. Our aim was to help the student sharpen his problem-solving skills in situations where decisions may have to be made and interventions undertaken before information gathering is complete. The game is simple in construct and may be played by individuals or groups. It has a major advantage over other forms of problem presentation in that the student can select and document his own decision-making pathway with minimal cueing and he may compare his pathway with that of the experts at the end of the game. Students and tutors found this approach enjoyable and realistic and considered the game a useful tool in our problem solving curriculum.