Use of diamond sensors for a high-flux, high-rate X-ray pass-through diagnostic.

X-ray free-electron lasers (XFELs) deliver pulses of coherent X-rays on the femtosecond time scale, with potentially high repetition rates. While XFELs provide high peak intensities, both the intensity and the centroid of the beam fluctuate strongly on a pulse-to-pulse basis, motivating high-rate beam diagnostics that operate over a large dynamic range. The fast drift velocity, low X-ray absorption and high radiation tolerance properties of chemical vapour deposition diamonds make these crystals a promising candidate material for developing a fast (multi-GHz) pass-through diagnostic for the next generation of XFELs. A new approach to the design of a diamond sensor signal path is presented, along with associated characterization studies performed in the XPP endstation of the LINAC Coherent Light Source (LCLS) at SLAC. Qualitative charge collection profiles (collected charge versus time) are presented and compared with those from a commercially available detector. Quantitative results on the charge collection efficiency and signal collection times are presented over a range of approximately four orders of magnitude in the generated electron-hole plasma density.

Learning Disability Liaison Nursing Services in south-east Scotland: a mixed-methods impact and outcome study.

BACKGROUND: There have been significant concerns about the care and treatment of people with intellectual disabilities (ID) when attending general hospitals, which have led to inquiries that highlight service and systems failures. One response has been the development of Learning Disability Liaison Nursing (LDLN) Services across the UK that aim to ensure that additional, specialist support is available for patients, their carers and general healthcare professionals. METHODS: A mixed-methods study to investigate the impact of LDLN Services across four Scottish NHS boards was undertaken. In total, 323 referrals made over 18 months were analysed along with qualitative data drawn from interviews and focus groups with a sample of 85 participants including patients with ID (n = 5), carers (n = 16), primary care healthcare professionals (n = 39) and general hospital professionals (n = 19) and learning disability liaison nurses (n = 6). RESULTS: The referral patterns to the four liaison nursing services closely matched the known health needs of adults with ID, with common admissions being due to neurological, respiratory and gastrointestinal issues. The LDLN role was seen to be complex and impacted on three key areas: (i) clinical patient care; (ii) education and practice development; and (iii) strategic organisational developments. Specific patient outcomes were linked to issues relating to capacity and consent to treatment, fostering person-centred adjustments to care, augmenting communication and the liaison nurses acting as positive role models and ambassadors for people with ID. CONCLUSIONS: The LDLN Services were valued by stakeholders by achieving person-centred outcomes. With their expert knowledge and skills, the liaison nurses had an important role in developing effective systems and processes within general hospital settings. The outcomes highlight the importance of supporting and promoting LDLN Services and the challenges in delivering the multifaceted elements of the role. There is a need to take account of the complex and multidimensional nature of the LDLN role and the possible tensions between achieving clinical outcomes, education and practice developments and organisational strategic initiatives.

Author Correction: 3D-printed vascular networks direct therapeutic angiogenesis in ischaemia.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

3D-printed vascular networks direct therapeutic angiogenesis in ischaemia.

Arterial bypass grafts remain the gold standard for the treatment of end-stage ischaemic disease. Yet patients unable to tolerate the cardiovascular stress of arterial surgery or those with unreconstructable disease would benefit from grafts that are able to induce therapeutic angiogenesis. Here, we introduce an approach whereby implantation of 3D-printed grafts containing endothelial-cell-lined lumens induces spontaneous, geometrically guided generation of collateral circulation in ischaemic settings. In rodent models of hind-limb ischaemia and myocardial infarction, we demonstrate that the vascular patches rescue perfusion of distal tissues, preventing capillary loss, muscle atrophy and loss of function. Inhibiting anastomoses between the construct and the host's local capillary beds, or implanting constructs with unpatterned endothelial cells, abrogates reperfusion. Our 3D-printed grafts constitute an efficient and scalable approach to engineer vascular patches able to guide rapid therapeutic angiogenesis and perfusion for the treatment of ischaemic diseases.

Professional issues associated with the role of the research nurse.

This article presents the findings of two studies undertaken during 2002 and 2003 that aimed to explore a range of professional issues facing research nurses. The results indicated that the position of research nurses is often complex because of a combination of contractual and accountability arrangements. This position can be intensified by feelings of isolation, a lack of professional support and limited specific educational opportunities. Experienced research nurses are often highly skilled in terms of their specialist clinical knowledge, and have a comprehensive understanding of all aspects of the research process, including methodological, ethical and practical issues.

Circular dichroism measurements at an x-ray free-electron laser with polarization control.

A non-destructive diagnostic method for the characterization of circularly polarized, ultraintense, short wavelength free-electron laser (FEL) light is presented. The recently installed Delta undulator at the LCLS (Linac Coherent Light Source) at SLAC National Accelerator Laboratory (USA) was used as showcase for this diagnostic scheme. By applying a combined two-color, multi-photon experiment with polarization control, the degree of circular polarization of the Delta undulator has been determined. Towards this goal, an oriented electronic state in the continuum was created by non-resonant ionization of the O2 1s core shell with circularly polarized FEL pulses at hν ≃ 700 eV. An also circularly polarized, highly intense UV laser pulse with hν ≃ 3.1 eV was temporally and spatially overlapped, causing the photoelectrons to redistribute into so-called sidebands that are energetically separated by the photon energy of the UV laser. By determining the circular dichroism of these redistributed electrons using angle resolving electron spectroscopy and modeling the results with the strong-field approximation, this scheme allows to unambiguously determine the absolute degree of circular polarization of any pulsed, ultraintense XUV or X-ray laser source.

Is routine preoperative hemodynamic evaluation of nonagenarians necessary?

An Incidence of co-morbid cardiac disease in the elderly surgical patient as high as 66% has been previously reported. Even in the absence of clinically significant cardiac disease, advanced age alone is often considered sufficient indication for Swan-Ganz placement, hemodynamic evaluation, adjustment of fluid states, and inotropic support. Yet data clearly documenting the need for this evaluation and therapy are difficult to obtain. All major general surgical and orthopedic operations in non-agenarians were reviewed in our institution from July 1, 1987 through December 31, 1988. Fifty-one procedures were performed on 46 patients. None of these patients had preoperative Swan-Ganz catheterization or hemodynamic evaluation. Eighteen general surgical, 30 orthopedic, 2 neurosurgical, and 1 gynecological procedures were performed. Forty-three were performed under general anesthesia, 7 under spinal anesthesia, and 1 with local anesthesia. Seven out of 51 patients (14%) experienced major complications, and 16 out of 51 (31%) experienced minor complications. Thirty-day mortality was 0%, and 6-month survival was 92%. Only one complication occurred within 48 hours of surgery that might possibly have been prevented with hemodynamic evaluation, adjustment of fluid status, inotropic support, and intensive care unit monitoring.

A simple effective technique for performing intraoperative cholangiography.

This simple, effective technique for performing intraoperative cholangiography uses a smooth-tipped side port cannula that is easily threaded into the cystic duct. Performance of intraoperative cholangiography is expedited by this method and artifacts commonly produced during cholangiography are avoided.

Efficacy of mefloquine and sulfadoxine-pyrimethamine for the treatment of uncomplicated Plasmodium falciparum infection in Machinga District, Malawi, 1998.

In response to the spread of chloroquine-resistant Plasmodium falciparum, Malawi changed its first-line antimalarial drug in 1993 from chloroquine to sulfadoxine-pyrimethamine (SP). Surveillance data has suggested that resistance to SP may be increasing. We compared the efficacy of SP with a potential successor, mefloquine (MQ). By use of a modified World Health Organization in vivo protocol, children infected with P. falciparum were randomized to receive SP (sulfadoxine 25 mg/kg) or MQ (15 mg/kg). We observed combined RII and RIII parasitologic failures of 20.0 and 22.0% in the SP and MQ arms, respectively. Among those in the MQ arm, the relative hazard of failing with a Day 2 drug level < 500 ng/mL was 10.6 times higher than those with levels > or = 500 ng/mL. Given the decreased efficacy of the first-line antimalarial drug and the high failure rates of MQ at this lower dosage, Malawi should consider assessing the efficacy and feasibility of alternative drugs to treat uncomplicated falciparum malaria.

The effect of misdiagnosis and delay in diagnosis on clinical outcome in melanomas of the foot.

BACKGROUND: Melanoma of the foot is often discussed as an uncommon tumor which, when it occurs, presents in nonwhite races. STUDY DESIGN: The tumor registry of a 650 bed community teaching hospital and the Connecticut Tumor Registry were retrospectively reviewed for the nine-year period from July 1980 to July 1989. Patient age, race, sex, incidence of misdiagnosis, and delay until definitive therapy were recorded. Tumor location, size, staging, follow-up, recurrence, and disease-free survival rates were also recorded and correlated with initial disease, stage, and misdiagnosis or delay. RESULTS: Twenty-six cases were identified at Bridgeport Hospital, and 140 cases were identified in the Connecticut Tumor Registry. Significant delay in diagnosis occurred in 68 percent of the cases from the hospital and at least 16 percent of the cases in the state tumor registry. Regardless of stage, melanoma of the foot had a worse prognosis than melanoma of the thigh and lower leg. Delays in diagnosis had no demonstrable effect on clinical outcome. CONCLUSIONS: Melanoma of the foot is not as rare as commonly suspected, and constituted 3 percent of the 4,562 melanomas reported in the state tumor registry for the nine-year period. The majority were in fair-skinned individuals, and misdiagnosis was common. It is the inherent aggressiveness of the tumor rather than the delay in diagnosis that accounts for the poor clinical outcome.

Specific but limited role of new imaging techniques in decision-making about intraabdominal abscesses.

Despite the very high accuracy rate of imaging studies (ultrasound, computed tomography, liver-lung-spleen scans and gallium-67 scans) in detecting intraabdominal abscesses, our experience with 80 recent cases indicate that these techniques have not significantly altered traditional methods of decision-making about when and where to drain such abscesses. In only 12.5 percent of cases were such decisions based on special imaging techniques alone, and most of these cases subphrenic abscesses were diagnosed late after surgery. In the remainder, physical examination and routine radiologic studies sufficed, with special imaging techniques primarily corroborating clinical evidence based on these methods. We conclude that the use of special imaging techniques alone in a search for the cause of fever early after abdominal surgery does not provide evidence upon which clinical decisions can be based unless there are already physical signs of an abscess.

Hypothermia and acidosis worsen coagulopathy in the patient requiring massive transfusion.

Massive transfusion may cause abnormalities of electrolytes, clotting factors, pH, and temperature and may occur in a scenario of refractory coagulopathy and irreversible shock. Identification of correctable variables to improve survival is complicated by the interplay of this pathophysiology. Temperature may be an under-appreciated problem in the genesis of coagulopathy. In vitro studies have demonstrated that platelet function and vascular response are critically temperature-dependent. We reviewed the records of 45 trauma patients without head injury or co-morbid medical illness who required massive transfusions. The mean Injury Severity Score was 55 +/- 6, a mean of 22.5 +/- 5 units of blood was transfused, and mortality was 33%. Nonsurvivors were more likely to have had penetrating injury (88% versus 55%), received more transfusions (26.5 +/- 9 versus 18.6 +/- 1, p less than 0.05), had lower pH (pH 7.04 +/- 0.06 versus 7.18 +/- 0.02, p less than 0.05), had lower core temperature (31 +/- 1 degree C versus 34 +/- 1 degree C, p less than 0.01), and had a higher incidence of clinical coagulopathy (73% versus 23%). Severe hypothermia (temperature less than 34 degrees C) occurred in 80% of the nonsurvivors and in 36% of survivors. Patients who were hypothermic and acidotic developed clinically significant bleeding despite adequate blood, plasma, and platelet replacement. Avoidance or correction of hypothermia may be critical in preventing or correcting coagulopathy in the patient receiving massive transfusion.

Yersiniosis in a breeding unit of Macaca fascicularis (cynomolgus monkeys).

2 outbreaks of acute fatal enteric disease involving 20 animals in a breeding unit of approximately 200 cynomolgus monkeys were diagnosed as yersiniosis; Yersinia pseudotuberculosis was isolated from 50% of the clinically affected animals. Post-mortem findings included enlarged mesenteric lymph nodes with some enterocolitis and necrotic foci in liver and spleen. Approximately 7% of clinically healthy monkeys were found to be excreting Y. pseudotuberculosis and a further 5% Y. enterocolitica. Rectal swabs, though less convenient, were better than faecal samples for the detection of Yersinia spp. in 'healthy' monkeys. Efficiency of the cold saline technique and direct plating for isolating Yersinia spp. were compared. It is thought likely that the infection was introduced into the unit by asymptomatic infected monkeys.

Control of oxyurids in mice using thiabendazole.

Mice with a natural infection of Syphacia obvelata and Aspiculuris tetraptera were continuously medicated with 0.1% thiabendazole in the diet. No oxyurids were found in test animals after 24 days of treatment though control animals remained infected. Growth rates in treated animals increased. 2 generations of mice were studied and, although overall production fell by 1.45%, the use of this drug in total eradication of the worms is suggested.

Establishment of small breeding colony of rhesus monkeys.

A breeding colony of 22 female and 4 male rhesus monkeys (Macaca mulatta) was established in a controlled-environment building with an outdoor run. The animals were quarantined for 2 years prior to their release into the unit. The housing, release and management of the colony are described. During the first year 19 young were born of which 17 have survived to 6 months of age. The cost of production and maintenance of the colony when compared with the cost of importing rhesus monkeys would appear to be acceptable.

The effect of measles vaccination in rhesus monkeys (Macaca mulatta).

30 rhesus monkeys (Macaca mulatta), born into a breeding colony, received measles vaccination when aged between 3 and 26 months; 28 of them were re-vaccinated 5 to 7 months later. Measles virus antibody was measured by haemagglutination-inhibition at the time of each vaccination and again 3 to 6 weeks later. Only 2 out of 9 animals aged less than 6 months responded to vaccination, whereas 10 out of 14 older animals showed 4-fold or greater rises. Re-vaccination of the younger group when aged 8 to 10 months resulted in a marked rise in antibody.

Transmission of B virus infection between monkeys especially in relation to breeding colonies.

Studies of B virus (Herpesvirus simiae) antibody in several species of macaque lead to the following generalizations. Newborn monkeys are not infected with B virus, even when born of seropositive mothers. Young monkeys remain uninfected until they become adults. The majority of adults develop B virus antibody unless their physical contact with seropositive adults is restricted. These observations are consistent with sexual transmission of B virus and classification of the disease in monkeys as venereal. However, infection at oral and dermal sites also occurs and may play a part in monkey-to-monkey transmission. Epizootics of B virus occurred during early attempts to start B virus-free breeding colonies. They appeared to originate from reactivated latent B virus in adult monkeys which had only low titres of antibody. The stress produced when groups of adult strangers were assembled to form breeding colonies was the most effective known inducer of latent B virus. Total exclusion of animals with any trace of antibody has enabled the establishment of new breeding colonies which are free from B virus.

Anterior cervical osteophytes: a rare cause of dysphagia.

Anterior cervical osteophyte is a rare cause of dysphagia usually occurring in the elderly. We report two cases in which the anterior cervical osteophytes impinged upon the esophagus, and we describe their surgical management. Initial investigation of a case of dysphagia should be directed to the common causes; however, in the elderly and in those with disorders of the cervical spine an anterior cervical osteophyte may be the cause of dysphagia.

X-ray power and yield measurements at the refurbished Z machine.

Advancements have been made in the diagnostic techniques to measure accurately the total radiated x-ray yield and power from z-pinch implosion experiments at the Z machine with high accuracy. The Z machine is capable of outputting 2 MJ and 330 TW of x-ray yield and power, and accurately measuring these quantities is imperative. We will describe work over the past several years which include the development of new diagnostics, improvements to existing diagnostics, and implementation of automated data analysis routines. A set of experiments on the Z machine were conducted in which the load and machine configuration were held constant. During this shot series, it was observed that the total z-pinch x-ray emission power determined from the two common techniques for inferring the x-ray power, a Kimfol filtered x-ray diode diagnostic and the total power and energy diagnostic, gave 449 TW and 323 TW, respectively. Our analysis shows the latter to be the more accurate interpretation. More broadly, the comparison demonstrates the necessity to consider spectral response and field of view when inferring x-ray powers from z-pinch sources.

MEG-SIM: a web portal for testing MEG analysis methods using realistic simulated and empirical data.

MEG and EEG measure electrophysiological activity in the brain with exquisite temporal resolution. Because of this unique strength relative to noninvasive hemodynamic-based measures (fMRI, PET), the complementary nature of hemodynamic and electrophysiological techniques is becoming more widely recognized (e.g., Human Connectome Project). However, the available analysis methods for solving the inverse problem for MEG and EEG have not been compared and standardized to the extent that they have for fMRI/PET. A number of factors, including the non-uniqueness of the solution to the inverse problem for MEG/EEG, have led to multiple analysis techniques which have not been tested on consistent datasets, making direct comparisons of techniques challenging (or impossible). Since each of the methods is known to have their own set of strengths and weaknesses, it would be beneficial to quantify them. Toward this end, we are announcing the establishment of a website containing an extensive series of realistic simulated data for testing purposes ( http://cobre.mrn.org/megsim/ ). Here, we present: 1) a brief overview of the basic types of inverse procedures; 2) the rationale and description of the testbed created; and 3) cases emphasizing functional connectivity (e.g., oscillatory activity) suitable for a wide assortment of analyses including independent component analysis (ICA), Granger Causality/Directed transfer function, and single-trial analysis.