Observation of a multimode plasma response and its relationship to density pumpout and edge-localized mode suppression.

Density pumpout and edge-localized mode (ELM) suppression by applied n=2 magnetic fields in low-collisionality DIII-D plasmas are shown to be correlated with the magnitude of the plasma response driven on the high-field side (HFS) of the magnetic axis but not the low-field side (LFS) midplane. These distinct responses are a direct measurement of a multimodal magnetic plasma response, with each structure preferentially excited by a different n=2 applied spectrum and preferentially detected on the LFS or HFS. Ideal and resistive magneto-hydrodynamic (MHD) calculations find that the LFS measurement is primarily sensitive to the excitation of stable kink modes, while the HFS measurement is primarily sensitive to resonant currents (whether fully shielding or partially penetrated). The resonant currents are themselves strongly modified by kink excitation, with the optimal applied field pitch for pumpout and ELM suppression significantly differing from equilibrium field alignment.

Pedestal bifurcation and resonant field penetration at the threshold of edge-localized mode suppression in the DIII-D Tokamak.

Rapid bifurcations in the plasma response to slowly varying n=2 magnetic fields are observed as the plasma transitions into and out of edge-localized mode (ELM) suppression. The rapid transition to ELM suppression is characterized by an increase in the toroidal rotation and a reduction in the electron pressure gradient at the top of the pedestal that reduces the perpendicular electron flow there to near zero. These events occur simultaneously with an increase in the inner-wall magnetic response. These observations are consistent with strong resonant field penetration of n=2 fields at the onset of ELM suppression, based on extended MHD simulations using measured plasma profiles. Spontaneous transitions into (and out of) ELM suppression with a static applied n=2 field indicate competing mechanisms of screening and penetration of resonant fields near threshold conditions. Magnetic measurements reveal evidence for the unlocking and rotation of tearinglike structures as the plasma transitions out of ELM suppression.

Fixation of osteoporotic fractures in the upper limb with a locking compression plate.

Locking Compression Plate (LCP) has the advantageous feature that screws can be locked in the plate leaving an angular stable construct. There is no need to have contact between the plate and the bone to achieve stability resulting from friction of the plate-bone-construct. Therefore the plate does not need to be contoured exactly to the bone and the healing bone's periosteal blood supply is not affected. The LCP is used as a bridging plate to gain relative stability in multi-fragmentary, diaphyseal or metaphyseal fractures. Depending on the fracture, the combination hole can also allow the LCP to achieve absolute stability similar to conventional fixation techniques. Osteoporotic fractures have significant impact on morbidity and mortality. Proximal humeral and distal radius fractures are typical examples. These osteoporotic and often comminuted fractures are ideal settings/indications for LCP utilization in the upper extremity. However, the data quality is due to mostly small study populations not so powerful. Unquestionably there has been a clear and fashionable trend to choose operative treatment for these fractures, because the angular stability allows stable fixation and early functional mobilization.

Mapping, monitoring, and surveillance of neglected tropical diseases: towards a policy framework.

As national programmes respond to the new opportunities presented for scaling up preventive chemotherapy programmes for the coadministration of drugs to target lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminthiasis, and trachoma, possible synergies between existing disease-specific policies and protocols need to be examined. In this report we compare present policies for mapping, monitoring, and surveillance for these diseases, drawing attention to both the challenges and opportunities for integration. Although full integration of all elements of mapping, monitoring, and surveillance strategies might not be feasible for the diseases targeted through the preventive chemotherapy approach, there are opportunities for integration, and we present examples of integrated strategies. Finally, if advantage is to be taken of scaled up interventions to address neglected tropical diseases, efforts to develop rapid, inexpensive, and easy-to-use methods, whether disease-specific or integrated, should be increased. We present a framework for development of an integrated monitoring and evaluation system that combines both integrated and disease-specific strategies.

Evaluation of the prevalence of trachoma 12 years after baseline surveys in Kidal Region, Mali.

OBJECTIVE: After prevalence surveys in all eight regions, Mali started a national programme to control trachoma in 1998. In the sparsely populated desert region of Kidal, where active trachoma prevalence was 46.2% in children under 10, no interventions beyond routine eye-care services were implemented. We estimated the prevalence of trachoma in Kidal, 12 years after baseline mapping surveys, to determine whether interventions to control trachoma were warranted. METHODS: A total of 2165 individuals from 477 households were examined for clinical trachoma signs in a cluster survey using the WHO simplified grading system. Individual and household risk factors for trachoma were assessed. RESULTS: The prevalence of follicular trachomatous inflammation (TF) in children 1-9 years of age was 15.6% (95% CI 11.8-19.5%). Trachomatous trichiasis (TT) was observed in 4 persons for an overall prevalence in all ages of 0.16% (95% CI 0.0-0.35%). Estimated household latrine coverage in the region was 33.1% (95% CI 14.0-52.2%). Residents of 52.8% of surveyed households reported access to a water source outside geographical boundaries of their communities. CONCLUSIONS: In the absence of control interventions, the prevalence of clinical signs of trachoma among children was substantially lower than estimates 12 years earlier. The current prevalence of active trachoma remains above the threshold adopted by WHO, yet there is little evidence of chronic blinding trachoma.

Petroleum associated with polymetallic sulfide in sediment from gorda ridge.

A sediment sample, impregnated with asphaltic petroleum and polymetallic sulfide, was dredged from the southern end of Gorda Ridge (the Escanaba Trough) off northern California, within the offshore Exclusive Economic Zone of the United States. The molecular distributions of hydrocarbons in this petroleum show that it was probably derived from terrestrial organic matter in turbidite sediment filling the Escanaba Trough. Hydrothermal activity at the Gorda Ridge spreading center provided the heat for petroleum formation and was the source of fluids for sulfide mineralization.

Cue-based oral feeding clinical pathway results in earlier attainment of full oral feeding in premature infants.

OBJECTIVE: To study whether a cue-based clinical pathway for oral feeding initiation and advancement of premature infants would result in earlier achievement of full oral feeding. STUDY DESIGN: Age of achievement of full oral intake was compared for two groups of preterm infants; a prospective study group vs historic cohort controls. Study infants had oral feedings managed by nurses using a clinical pathway that relied on infant behavioral readiness signs to initiate and advance oral feedings. Controls had oral feedings managed by physician orders. RESULT: Fifty-one infants (n=28 study and n=23 control) were studied. Gender distribution, gestational age, birth weight and ventilator days were not different between groups. Study infants reached full oral feedings 6 days earlier than controls (36+/-1 3/7 weeks of postmenstrual age (PMA) vs 36 6/7+/-1 4/7 weeks of PMA, P=0.02). CONCLUSION: The cue-based clinical pathway for oral feeding initiation and advancement of premature infants resulted in earlier achievement of full oral feeding.

Spatial and temporal analysis of DIII-D 3D magnetic diagnostic data.

An extensive set of magnetic diagnostics in DIII-D is aimed at measuring non-axisymmetric "3D" features of tokamak plasmas, with typical amplitudes ∼10-3 to 10-5 of the total magnetic field. We describe hardware and software techniques used at DIII-D to condition the individual signals and analysis to estimate the spatial structure from an ensemble of discrete measurements. Applications of the analysis include detection of non-rotating MHD instabilities, plasma control, and validation of MHD stability and 3D equilibrium models.

Sensitivity to carbenicillin and ticarcillin, and the beta-lactamases of Pseudomonas aeruginosa in the UK in 1978-79.

A total of 438 strains of Pseudomonas aeruginosa supplied by 10 hospitals in the UK reporting an increase in resistance to carbenicillin was tested for sensitivity to carbenicillin and ticarcillin. It was found that 85% of the strains were inhibited by 125 microgram carbenicillin/ml and 87% by 50 microgram ticarcillin/ml, and that ticarcillin was from two- to four-fold more active than carbenicillin against the majority of these strains. Strains with a high level of resistance to carbenicillin (MIC greater than 1000 microgram/ml) possessed constitutive beta-lactamases, and five different types of enzyme were identified. There was good correlation between minimum inhibitory concentrations and the results of disc sensitivity tests in this study, 82% with the 100 microgram carbenicillin disc and 90( with the 75 microgram ticarcillin disc, but results reported in the hospital laboratory tests with the carbenicillin disc were less satisfactory (64% correlation). From a comparison with data reported in 1967 there does not appear to have been a significant increase in the incidence of carbenicillin-resistant strains of Ps aeruginosa in the UK.

Benign hemangiomyoma of the uterus.

A benign cavernous hemangiomyoma of the uterus in a 52-year-old woman is described. The tumor consisted of large venous channels within a stroma composed chiefly of smooth muscle and was confined to the corpus, without involvement of the endometrium or cervix. Considerable thrombosis had occurred within the vascular spaces. Hemangiomas of the uterus are very uncommon and the great majority are benign. A classification of uterine hemangiomas is presented, together with a discussion of their histogenesis and their relation to malformations.

Controlled study of the putative interaction between famotidine and theophylline in patients with chronic obstructive pulmonary disease.

The effects of famotidine (80 mg per day), cimetidine (1600 mg per day), and placebo on theophylline pharmacokinetic parameters in chronic obstructive pulmonary disease (COPD) patients were compared. This was an open-label, randomized, three-period cross-over study, in which each subject first underwent a seven-day theophylline washout period, and thereafter received three single intravenous doses of theophylline (5 mg/kg infused over 30 minutes) during the study. Each of the experimental treatments was administered orally every 12 hours for a total of 9.5 days (19 doses). Theophylline was infused after the 17th dose of each treatment. Fourteen serial blood samples were collected before the start of each infusion, and for 30 hours after the end of each infusion. Plasma samples were assayed for theophylline, pharmacokinetic parameters were estimated, and treatment effects on each parameter were compared. Fourteen COPD patients completed all three periods of the investigation. Famotidine treatment had virtually no effect on any of theophylline's pharmacokinetic parameters. In contrast, cimetidine treatment significantly altered every pharmacokinetic parameter of theophylline as follows: Cimetidine decreased theophylline geometric mean CL from 2.74 L/h to 2.07 L/h (P < .001), and prolonged theophylline harmonic mean half-life from 6.6 to 9.6 hours (P < .001) and mean residence time from 10.8 to 15.0 hours (P < .001). Cimetidine treatment slightly increased theophylline volume of distribution by approximately 10%, and that change also was statistically significant (P = .032). The authors conclude that the treatment effects of cimetidine on theophylline pharmacokinetic parameters were in accord with those reported by others, and that famotidine treatment had no effect on any of theophylline's pharmacokinetic parameters in COPD patients.

Method for the clinical evaluation of enamel polish.

Enamel polish of 600 children was scored. The method used is simple and comprises a visual comparison of the facial surfaces of incisors with a polish standard prepared by selectively polishing extracted teeth. Examiners with little experience can distinguish degrees of enamel polish. A high-polish dentifrice produced significantly greater enamel polish during the 27-month study. A "polish" with flour of pumice at the beginning of the study did not influence this enamel polish.

Nutrition management in women with gestational diabetes mellitus: a review by ADA's Diabetes Care and Education Dietetic Practice Group.

Gestational diabetes mellitus (GDM) is the most common medical disorder complicating pregnancy that requires the services of a registered dietitian. Despite three international workshops on GDM, many questions remain regarding its epidemiology, pathophysiology, screening, diagnosis, and management. Registered dietitians encounter these controversial issues when working with women referred for GDM education and counseling. Nutrition intervention remains the cornerstone of therapy. The purpose of this article is not to provide practice guidelines but to review the literature and current practices in research centers across the United States. Registered dietitians are in a position to individualize nutrition care to each woman's needs and to participate in the decision-making process of nutrition management.

Determination of the sedimentary microbial biomass by extractible lipid phosphate.

The measurement of lipid phosphate is proposed as an indicator of microbial biomass in marine and estuarine sediments. This relatively simple assay can be performed on fresh, frozen or frozen-lyophilized sediment samples with chloroform methanol extraction and subsequent phosphate determination. The sedimentary lipid phosphate recovery correlates with the extractible ATP and the rate of DNA synthesis. Pulse-chase experiments show active metabolism of the sedimentary phospholipids. The recovery of added 14C-labeled bacterial lipids from sediments is quantitative. Replicate analyses from a single sediment sample gave a standard deviation of 11%. The lipid extract can be fractionated by relatively simple procedures and the plasmalogen, diacyl phospholipid, phosphonolipid and non-hydrolyzable phospholipid content determined. The relative fatty acid composition can be readily determined by gas-liquid chromatography.The lipid composition can be used to define the microbial community structure. For example, the absence of polyenoic fatty acids indicates minimal contamination with benthic micro-eukaryotes. Therefore the high content of plasmalogen phospholipids in these sediments suggests that the anaerobic prokaryotic Clostridia are found in the aerobic sedimentary horizon. This would require anaerobic microhabitats in the aerated zones.

Results of lumbar hemivertebral excision for congenital scoliosis.

The purposes of this study were to determine the long-term correction achieved by excision of lumbar hemivertebrae and the risk attendant. Seven patients had a follow-up of 41.14 months for lumbar hemivertebral excisions. Six had two-stage anterior vertebral body excision and, 7-8 days later, posterior lamina and pedicle excision with fusion. One patient had a single-stage correction. After surgery, the patients were in pantaloon casts or braces for a minimum of 6 months (supine, first 6-12 weeks). Hemivertebrae were at L2 (N = 1), L3 (N = 1), L4-L5 (N = 1), and L5-S1 (N = 4). Preoperative curves or hemivertebral angles averaged 36.6 degrees (range, 30-52 degrees). Average age was 7.5 years (range, 22 months to 12.5 years). Mean follow-up was 41.14 months. Surgical correction of the seven cases averaged 28.0 degrees. Two-stage procedures yielded 29.7 degrees correction with no complications; single-stage yielded 18 degrees correction, and the only complication was an L5 nerve root paresis.

Routine use of magnetic resonance imaging in idiopathic scoliosis patients less than eleven years of age.

The purpose of this study was to determine the incidence of intraspinal pathology presenting as idiopathic scoliosis in children less than 11 years of age and otherwise neurologically normal. Twenty-six consecutive patients (5 boys, 21 girls) with idiopathic scoliosis measuring at least 15 degrees were studied with magnetic resonance imaging. Five children (19.2%) were diagnosed by magnetic resonance imaging to have Chiari-I malformations with hydromyelia (two patients), syringomelia (one patient), intramedullary tumor (one patient) and terminal lipoma (one patient). Only two of the five patients had left thoracic curves. Intramedullary spinal cord pathology can present as scoliosis without neurologic signs. Scoliosis can be the initial neurologic sign suggesting intraspinal pathology, and magnetic resonance imaging is indicated in routine evaluation of children less than 11 years of age.

TGF-alpha protein and receptor localization in laryngotracheal tissue.

Both normal cell turnover and healing of laryngeal and tracheal injuries involve cell migration and mitosis. The proteins that regulate normal cell turnover and wound healing in the larynx and trachea have not been established. It is possible that peptide growth factors, such as transforming growth factor-alpha (TGF alpha) acting through its receptor (EGF/TGF alpha-R), participate in the regulation of these processes. To investigate this hypothesis, we analyzed laryngotracheal cells for TGF alpha protein and receptor in normal and postwounding conditions. TGF alpha protein was detected by immunohistochemical analysis in normal ferret laryngeal and tracheal mucosa. Specific binding to the EGF/TGF alpha receptor in membrane homogenates of ferret larynx and trachea reached saturation after 60 minutes at 37 degrees C, and was effectively displaced by unlabeled epidermal growth factor (EGF) or TGF alpha, but not by unlabeled insulin, angiotensin II, or basic fibroblast growth factor. Scatchard analysis of the specific binding indicated the presence of high-affinity (Kd = 117 pmol) and low-affinity (Kd = 40 nmol) binding sites. The maximum number of available binding sites was 73 fmol/mg protein. Localization of the EGF/TGF alpha receptor by autoradiographic analysis of 125I-EGF binding to sections of normal ferret larynx and trachea revealed EGF/TGF alpha receptors throughout the epithelium, with the highest grain density in the basal layers. Quantitative analysis of autoradiographic grain density between normal, intubated, and extubated animals revealed no significant differences. The presence of TGF alpha protein and its receptor in normal and wounded larynx and trachea supports the hypothesis that these proteins are involved in regulating physiologic responses of laryngotracheal cells.

An upgrade of the magnetic diagnostic system of the DIII-D tokamak for non-axisymmetric measurements.

The DIII-D tokamak magnetic diagnostic system [E. J. Strait, Rev. Sci. Instrum. 77, 023502 (2006)] has been upgraded to significantly expand the measurement of the plasma response to intrinsic and applied non-axisymmetric "3D" fields. The placement and design of 101 additional sensors allow resolution of toroidal mode numbers 1 ≤ n ≤ 3, and poloidal wavelengths smaller than MARS-F, IPEC, and VMEC magnetohydrodynamic model predictions. Small 3D perturbations, relative to the equilibrium field (10(-5) < δB/B0 < 10(-4)), require sub-millimeter fabrication and installation tolerances. This high precision is achieved using electrical discharge machined components, and alignment techniques employing rotary laser levels and a coordinate measurement machine. A 16-bit data acquisition system is used in conjunction with analog signal-processing to recover non-axisymmetric perturbations. Co-located radial and poloidal field measurements allow up to 14.2 cm spatial resolution of poloidal structures (plasma poloidal circumference is ~500 cm). The function of the new system is verified by comparing the rotating tearing mode structure, measured by 14 BP fluctuation sensors, with that measured by the upgraded B(R) saddle loop sensors after the mode locks to the vessel wall. The result is a nearly identical 2/1 helical eigenstructure in both cases.

Magnetohydrodynamic interference with the edge pedestal motional Stark effect diagnostic on DIII-D.

Accurate measurement of internal magnetic field direction using motional Stark effect (MSE) polarimetry in the edge pedestal is desired for nearly all tokamak scenario work. A newly installed 500 kHz 32-channel digitizer on the MSE diagnostic of DIII-D allows full spectral information of the polarimeter signal to be recovered for the first time. Fourier analysis of this data has revealed magnetohydrodynamic (MHD) fluctuations in the plasma edge pedestal at ρ ≥ 0.92. By correlating edge localized mode fluctuations seen on lock-in amplifier outputs with MSE spectrograms, it has been shown that edge pedestal tearing mode fluctuations cause interference with MSE second harmonic instrument frequencies. This interference results in unrecoverable errors in the real-time polarization angle measurement that are more than an order of magnitude larger than typical polarimeter uncertainties. These errors can cause as much as a 38% difference in local q. By using a redundant measure of the linear polarization found at the fourth harmonic photo-elastic modulator (PEM) frequency, MHD interference can be avoided. However, because of poorer signal-to-noise the fourth harmonic signal computed polarization angle shows no improvement over the MHD polluted second harmonics. MHD interference could be avoided in future edge pedestal tokamak polarimeters by utilizing PEMs with higher fundamental frequencies and a greater separation between their frequencies.

Mapping trachoma in Nasarawa and Plateau States, central Nigeria.

OBJECTIVES: The World Health Organization has called upon member states to eliminate blinding trachoma by 2020 using the SAFE strategy. We aimed to determine the prevalence of trachoma and quantify intervention needs for each aspect of the SAFE (surgery, mass administration of antibiotics, promotion of facial cleanliness and environmental improvements) strategy in Nasarawa and Plateau States, Nigeria. METHODS: District-based, household cluster surveys were conducted in all 30 local government areas (LGAs) within the states. RESULTS: A total of 46 960 persons were examined from 7883 selected households. Prevalence estimates of trachomatous inflammation follicular among children 1-9 years of age ranged from 1.7 to 15.8% by LGA. Trichiasis prevalence among adults varied by LGA from 0 to 2.1% and was more common among women (OR = 1.99, 95% CI 1.3 to 3.1). Access to water within a 30 min round trip was reported by 82.3% of households. CONCLUSION: LGA-wide trachoma control interventions are warranted in seven LGAs targeting: 5409 persons for surgery to correct trichiasis, 778 698 persons to receive at least three rounds of mass antibiotic distribution, 855 villages in which to promote face-washing and sanitation, and 102 751 households for latrine construction. These mapping surveys demonstrate an example of evidence-based programme planning necessary for measuring progress towards achieving the GET 2020 objective and can be replicated in other areas yet to be mapped for trachoma.