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Cultural competence, and Indigenous cultural competence in particular, is recognised as a priority in Australian higher education (Universities Australia, 2011). There is a need to develop the knowledge, skills and attitudes required to engage respectively and effectively in Aboriginal and Torres Strait Islander contexts in tertiary education settings across the country (Universities Australia, 2011). This chapter details a study conducted by the National Centre for Cultural Competence (NCCC), in its journey to embed cultural competence across a large higher education workforce. The study documents the creation and delivery of in-person workshops to determine the effectiveness of this approach in building understandings of, and commitment to, cultural competence among staff.

As globalization continues to make cross-cultural interactions more of a reality, the need to develop the cultural competence of students and staff is imperative. The University of Sydney has included cultural competence in its 2016-20 strategic plan, necessitating the embedding of cultural competence across all functions of the University. The National Centre for Cultural Competence (NCCC) at The University of Sydney was created to lead the thinking on cultural competence, which includes creating teaching and learning resources to guide University students and staff on their cultural competence journey. In this paper, we discuss a cultural competence seminar developed and delivered by the NCCC to students participating in a broader program designed to educate and prepare them to be global citizens. We will examine the efficacy of our approach to cultural competence training with this particular cohort of students.

Ice cloud bulk scattering models are derived for 445 discrete wavelengths between 0.2 µm and 100 µm. The methodology for deriving these optical models is based on microphysical data from 11 field campaigns using a variety of in situ probes, and incorporates a correction to mitigate the impact of ice particles that shatter at the probe inlets. The models are also based on a new library of ice habit single scattering properties developed for plates, droxtals, hollow and solid columns, hollow and solid bullet rosettes, an aggregate of solid columns, and a small/large aggregate of plates. Three sets of models are developed that assume the use of solid columns only, the aggregate of solid columns only, and a general habit mixture that incorporates all the habits. The consistency of the resulting models is explored. While the general habit mixture provides consistency with in situ microphysical measurements and the closest agreement with polarized reflectivities observed by the POLDER instrument on the PARASOL satellite, the aggregate of severely roughened solid columns provides the closest agreement between solar and infrared optical thicknesses. Finally, spectral results are presented for the shortwave and longwave models.

Background: Three-dimensional echocardiography (3DE) is a promising method for strain determination; however, there are temporal resolution concerns. This study aims to evaluate the feasibility and accuracy of 3DE on longitudinal and circumferential strain (LS, CS) determination and infarction detection under variable frame rates (FR) and “heart rates” (stroke rates [SR]) conditions. Methods: Latex balloons were sewn into the left ventricle (LV) of 20 freshly harvested pig hearts which were then passively driven by a pulsatile pump apparatus at stroke volumes (SV) 30–70 mL. The hearts were pumped at 2 normal limits of human heart rate. Full-volume data were acquired before and after a simulated myocardial infarction (MI) at the 2 most commonly used FRs. LS and CS values were evaluated against sonomicrometry. Results: Longitudinal strain and CS derived from high FR acquisitions showed statistically superior correlations with sonomicrometry data (LS: R 2 = 0.85, CS: R 2 = 0.84) than strain values from low FR (LS: R 2 = 0.78, CS: R 2 = 0.76) (all P < 0.01). After MI induction, LS and CS at different FRs were significantly decreased while maintaining excellent correlations with sonomicrometry data (all P < 0.001). There is no statistical difference of strain values between different SR acquisitions. Conclusion: Three-dimensional wall-motion tracking has the ability to accurately determine regional myocardial deformation and detect MI. Different heart rates within a physiologically relevant range have no effect on 3D strain accuracy. Strain values calculated from higher frame rate acquisitions were found to have a slightly better accuracy. (Echocardiography 2014;00:1–10)

A data library is developed containing the scattering, absorption, and polarization properties of ice particles in the spectral range from 0.2 to 100 μm. The properties are computed based on a combination of the Amsterdam discrete dipole approximation (ADDA), the T-matrix method, and the improved geometric optics method (IGOM). The electromagnetic edge effect is incorporated into the extinction and absorption efficiencies computed from the IGOM. A full set of single-scattering properties is provided by considering three-dimensional random orientations for 11 ice crystal habits: droxtals, prolate spheroids, oblate spheroids, solid and hollow columns, compact aggregates composed of eight solid columns, hexagonal plates, small spatial aggregates composed of 5 plates, large spatial aggregates composed of 10 plates, and solid and hollow bullet rosettes. The maximum dimension of each habit ranges from 2 to 10 000 μm in 189 discrete sizes. For each ice crystal habit, three surface roughness conditions (i.e., smooth, moderately roughened, and severely roughened) are considered to account for the surface texture of large particles in the IGOM applicable domain. The data library contains the extinction efficiency, single-scattering albedo, asymmetry parameter, six independent nonzero elements of the phase matrix (P11, P12, P22, P33, P43, and P44), particle projected area, and particle volume to provide the basic single-scattering properties for remote sensing applications and radiative transfer simulations involving ice clouds. Furthermore, a comparison of satellite observations and theoretical simulations for the polarization characteristics of ice clouds demonstrates that ice cloud optical models assuming severely roughened ice crystals significantly outperform their counterparts assuming smooth ice crystals.

Knowing enough information about pain and its management to adequately care for people in pain may seem challenging, especially for primary care providers who provide the bulk of pain management services in the United States. Few, if any, primary care providers received training beyond the names of a few analgesics and the rudiments of pain assessments. Fortunately, many national and international societies provide health care practitioners with pain-related education, resources, and tools. Education may be tied to pain certification or specialization, or provided solely for the benefit of practitioners. Due in large part to the World Wide Web, much information about pain is readily available online.

The occurrence of diabetic peripheral neuropathy (DPN) is linked to poor glycemic control over time. While most people never develop diabetic peripheral neuropathic pain (DPNP) as a consequence of DPN, enough of them do that we must have effective options for the management of this disabling condition. Two years ago there were no formally approved medications for the treatment of DPNP, and now there are two medications with Food and Drug Administration approval for DPNP. One of these medications, duloxetine has been established to significantly improve pain and to address depression by its reuptake inhibition of norepinephrine and serotonin. This article examines the epidemiology of DPNP, its underlying pathogenesis, necessary evaluation methods, and treatment options available with a focus on the role of duloxetine.

Opioid analgesics are given to people with pain. These medications are highly effective for relieving pain and are generally considered to have little or no end-organ toxi-cities. Although they are generally feared because of their potential for abuse, diversion, and psychological dependence, little attention is given to their neuroendocrine consequences. They are known to have central nervous systems effects and are now understood to impact the regulation of gonadotropic hormones. Providing meaningful informed consent requires disclosure about the risks associated with lowered gonadotropic hormone levels.

Despite the number of patients affected by diabetic peripheral neuropathic pain (DPNP), little consensus exists about the pathophysiology, best diagnostic tools, and primary treatment choices. Theories about the causes of DPNP are inextricably linked with the causes of diabetic neuropathies, yet most patients with such neuropathies do not experience pain. The factors that differentiate patients with pain from those without remain unknown and are the subject of much research. When choosing treatment for patients with DPNP, physicians are confronted with a myriad of choices, none of which has been shown to be effective for all patients. This article reviews the evidence for these treatments and attempts to guide physicians in choosing those treatments based on evidence from well-designed clinical trials to support their use. Two agents, duloxetine and pregabalin, are formally approved by the Food and Drug Administration for the treatment of DPNP. In addition, several other agents, including the tricyclic class of antidepressants, have been effective in clinical trials. Ultimately, treatment choice must also include consideration of adverse effects, individual patient factors such as comorbidities, and often cost.

A method for designing and manufacturing wavelength-specific laser-activated reflection switches for use at THz frequencies is described. A key figure of merit for such switches is the contrast ratio, the ratio of power reflected after activation to that reflected before activation. The new switches improve the pulse contrast ratio by utilizing interference to suppress reflections prior to laser activation. Measurements using the University of California, Santa Barbara Free Electron Laser indicate that contrast ratios can be improved from approximately 60 to as large as 4.5×104 using the new switches. The switches improve contrast ratio by an average factor of 400, with peak improvement by a factor as large as 740. Such switches can be used in the generation of short THz pulses from narrow bandwidth sources and may also find applications in the extraction of single pulses from longer pulse trains.

Involvement by psychiatrists in the care of patients who are terminally ill has been limited historically; however, psychiatrists increasingly are participating in the care of these people who are facing the most challenging times of their lives. Pain management is considered to be an area of subspecialization for psychiatrists beyond their traditional role of being psychopharmacologists and psychotherapists. Biologically focused psychiatrists are able to address neuropsychiatric disorders, including pain and depression in the medically ill, and actively improve the quality of life for dying patients and their family members. This article provides a review of the recent literature that has addressed the involvement of psychiatrists in end-of-life care. Beginning with an example of the scientific aspects of cancer-related treatment from a patient's perspective, and into the major treatment considerations, this article addresses pain, its recognition, and management challenges when the end of life approaches. The prompt recognition of frequently overlooked and underestimated concomitant depressions, delirium, dementia, and other mental disorders is important for mental health specialists. The importance of psychiatric care for patients who are terminally ill and the role of psychiatrists in the phase of care also are discussed.

Objective Quantitative left ventricular mass (LVM) as well as regional strain values may be obtained from full-volume real time 3D echocardiography data via semi-automated feature tracking and represent indices of heart function, both in health and disease. Methods Fresh adult porcine and ovine hearts were passively pumped to simulate normal cardiac motion at stroke volumes (SVs) varying from 30 to 70 mL. A 3V-D Matrix probe, interfaced with a GE Vivid E9 ultrasound system, was used to image each heart at baseline conditions and after simulated myocardial infarction (MI). The 4D LV quantification function of EchoPAC PC was used to quantify the LVM and longitudinal and circumferential strain (LS & CS) of LV segments at each SV prior and subsequent to simulated MI. LVM was validated by volumetric displacement, while LS and CS values were compared to sonomicrometry-based strain. Results Linear regression analyses show excellent correlations in LVM, LS, and CS between the 4D echo and volumetric/sonomicrometric displacement with R2 values of 0.99, 0.88, and 0.67, respectively. Bland–Altman analyses for all variables validate the compatibility of both methods. It was also determined that EchoPAC PC was able to detect a decrease in LS and CS in the relevant segments between pre- and post-MI at all SVs (P

Osteochondral allograft transplantation is a surgical technique that relies on obtaining tissue from cadaveric “living” donors. Th e objective is to procure healthy articular cartilage from a donor and transfer it to the damaged area of the recipient’s knee. Using cadaveric tissue eliminates the donor site morbidity associated with osteochondral autografting and allows for the treatment of larger and more aggressive lesions in virtually any joint. Th e technique also allows for the ability to implant fully formed articular cartilage without specific limitation with respect to defect size, and it can be completed as a singlestage procedure. Issues regarding cost, graft availability, cell viability, immunogenicity, and risk of disease transmission are some of the factors that may limit the use of this technique.

The relation between quantified emphysema and measured lung content of coal and silica was investigated in the lungs of 264 deceased underground coalworkers who had been exposed to mixed coal and silica dust. Lung specimens obtained at postmortem and inflated and fixed under standard conditions were used to quantify the extent of emphysema and then to measure the amount of coal and silica present in the lungs at the time of death. These data were combined with clinical and other pathological information from the subjects. Multiple regression analysis showed that the extent of emphysema (E score) had a strong positive quantitative relation with coal content of the lungs (p < 0.0003), age (p < 0.0001), and smoking (p < 0.0001). There was a significant negative interaction of uncertain biological importance between coal content of the lungs and smoking (p < 0.004; E score = -1.79 + 0.62 coal + 0.06 age + 0.21 smoking -0.17 coal x smoking; adjusted R2 = 0.25). In lifelong non-smokers emphysema was particularly strongly related to coal content and age (coal: p < 0.001; age: p < 0.002; E score = -1.56 + 0.78 coal + 0.06 age; adjusted R2 = 0.66). The relation was basically unchanged by adding a lung silica content term. Emphysema score was highly negatively correlated with forced expiratory volume in one second (FEV1; % predicted, obtained within five years of death) (r = -0.44, p < 0.0001). Degree of lung fibrosis was highly positively associated with lung silica content (chi 2(1) = 12.9, p < 0.0003). These results provide strong evidence that emphysema in coalworkers is actually related to lung coal content. The role silica in development of emphysema, however remains unclear.

The US population is aging with those 65 years or older reaching 70 million (20% of the population) by the year 2030. Chronic conditions such as osteoarthritis, atherosclerosis, cancer, and diabetes prevalent in older Americans will contribute to the increasing costs of health care. Despite the frequency of pain and the suffering that occurs, it is often underreported and undertreated in older people. The incidence of undertreated pain ranges from 25 to 50% in adult communities, from 45 to 80% in nursing homes, and as high as 85% in long-term care facilities. Since cures for many of the chronic conditions manifesting in older patients are not always readily available, there must be a focus on the management of the pain associated with these conditions. There are multiple treatment modalities which have been shown to be effective for older people. The choice of pharmacologic treatment for an individual patient will depend upon multiple factors, including the source and pathophysiology of the pain, and the presence of comorbid conditions. Combining pharmacologic and nonpharmacologic options helps keep the drug effects lower. The growing number and types of analgesics available permit an individualized pharmacologic regimen that targets chronic pain while addressing the issues associated with treating older patients. The goal of this chapter is to explore the topic of pain in the older persons including neurophysiology, measurement of pain in the cognitively intact and nonintact patients, and psychosocial issues associated with pain. Complementary and alternative modalities and pain at the end of life will also be discussed. Suggestions will be made about the future research in the field of pain and aging.

Articular cartilage provides for a smooth low-friction articulation, joint lubrication, and proper stress distribution in order to minimize peak force on the subchondral bone. Acute or repetitive impact can result in articular cartilage lesions, but fortunately in most cases these are asymptomatic. However, when symptomatic, these lesions cause pain, swelling, joint dysfunction, and instability. Multiple non-surgical and surgical therapeutic options are available to treat such chondral injuries. Non-surgical options include oral medications, injections, bracing, and physical therapy. Surgical interventions range from a simple arthroscopic debridement and lavage to allograft transplantation. To determine the proper treatment approach, it is crucial for the operating surgeon to consider the patient’s age, symptom intensity, clinical history, post-operative expectations, and lesion characteristics. This chapter provides an overview of the etiology, diagnosis, and management of articular cartilage lesions.

Picosecond to nanosecond-wide terahertz pulses are used to study the fast photoresponse of a gallium-doped germanium (Ge:Ga) photoconductor operating at 4.2 K. A recombination time of about 2 ns is observed in the time-resolved photoresponse. Laser-activated semiconductor reflection switches are used to “slice” the variable-width terahertz pulses from the quasicontinuous-wave output of a free-electron laser.

Pain and disability associated with diabetic neuropathy have economic, social, and emotional consequences. Because these complications impact patients during the prime of their lives, physicians should screen and manage patients at risk. Improvement in glycemic and lipid management, glycemic variability, and lifestyle interventions such as smoking cessation should limit disease progression. Patients who have symptomatic disease should be treated, targeting a 50% improvement in pain within 4 weeks. Physicians should also strive to improve function and comorbidities such as sleep disorders, depression, and anxiety. Patient education is critical for treatment adherence and prevention of serious complications. Consequences associated with diabetic neuropathy include nontraumatic amputations and silent ischemia; thus proper foot care and education regarding "warning signs" of silent ischemia are necessary.

It is not often that a book related to the field of pain comes along that requires me to stop and think. I am accustomed to looking at books that explain aspects of painful conditions, address means to immediately modify the pain experience, and help me better utilize medications. Instead, Pain: new essays on its nature and the methodology of its study investigates pain as a philosophical construct and provides over 400 pages of information in a manner that provides no specific clinical answers yet triggers fascinating questions within the reader. Therein lies the paradox of the book and its subject matter. What is pain? What does pain mean to the sufferer? How is a set of bodily phenomena experienced as pain? Why is pain so vexing to manage? This is a book about pain written primarily by philosophers, psychologists, and neuroscientists. It is not a book intended for clinicians to use to resolve clinical concerns for their patients in pain. It is a book that is best read when having long blocks of time to read, reread, and contemplate. It reviews historical facts, offers first-person interpretation of the significance of those facts, and provides peer commentaries on the writings of other authors. Several chapters provide much insight about the nature of pain by defining it through the first-person experience of the sufferer, addressing the difficulties clinicians have understanding pain in others and what pain means in a multidimensional construct involving sensory input, response to sensation, interpretation, and motivation. This is not an easy book to read, and yet it is written much the way university professors teach imponderable concepts, through a series of logical steps leading to inescapable conclusions. Bit by bit, arguments are put forth in the book, with lines of reasoning playing out until the reader “gets it,” thereby provoking for the reader a desire to question basic assumptions, rules, and strategies about pain. I believe that the purpose of this book is to challenge the reader to set aside all existing beliefs and conceptions about pain and to explore the outward contradictions that make understanding pain so difficult. Working from subjective interpretations of perceptual experience, the authors weave their own feelings, ideas, and thoughts into the essays and commentaries. The authors create definitions for the terms and concepts they use, then employ rules of debate to weave their arguments first around everyday occurrences (quite literally work environments and office furniture) and later around people, bodily changes, and pain itself. This style of argument will frustrate some readers by not just giving them simple answers, while fascinating and stimulating others to think through the experience and meaning of pain. The book certainly achieves its goal of forcing readers to critically think about the very nature of pain, what we experience as painful, and what it means to live a life in pain. It does not prepare readers to be better clinical diagnosticians as much as it develops their skills of critical reasoning. The book does not help practitioners select the proper medication for a specific type of pain. Rather, it encourages clinicians to look past the chief complaint and consider what pain means to people who live and suffer with it. The book provides many lessons that shift the thinking of “left-brain” practitioners focusing only on underlying disease states or treatments needed without exploring the disruptions pain brings beyond the expected disruptions in activities of daily living. Interventionists, those pain practitioners who routinely use procedural and surgical skills to manage pain, may have the most difficult time understanding what is written in this book. Behavioral health practitioners who delve into intrapersonal experiences of people in pain may find it challenging if read too quickly. Read more slowly, with time taken for reflection, the book opens doors into a world few ever consider. I highly recommend this book to academicians, clinicians, and sufferers of pain who are prepared to go beyond the experience of pain and want to begin to master it. I do not recommend it for busy clinicians who need immediate strategies for managing pain. Those in training will be well served by reading it within the context of a seminar or discussion group with a veteran clinician suggesting practical application of the material. Through the use of this book, even the most technical clinician would begin to connect with the humanistic aspects of caring for those in pain. Used as a guide, reading this book may challenge clinicians to better understand the nature of pain and become more interested in the use of behavioral health options. Beyond pills and procedures, the introduction of practical behavioral considerations into operating rooms, surgical centers, departments of radiology, and other highly technical and intimidating healthcare environments will do much to ease pain. This book has great promise for opening the minds of its readers while sparking debates and discussions among clinicians. Importantly, like courses on professional ethics, it will cause readers to examine their own practices.

Three case reports in this article illustrate the diagnostic methods used and the treatment course encountered for many patients with diabetic peripheral neuropathic pain (DPNP). Each case addresses an aspect of DPNP: pain that appears to be refractory to initial therapy, DPNP occurring with other medical conditions, and nondiabetlc neuropathy occurring in patients with diabetes mellitus. Together, these cases bring clarity to the confusing clinical experience for patients who have decreased sensation in combination with burning pain, and they apply the consensus guidelines for DPNP. Recently approved medications by the Food and Drug Administration for the treatment of DPNP offer hope for many patients whose pain was thought to be refractory to treatment.

Diabetic peripheral neuropathy (DPN) is estimated to be present in 50% of people living with diabetes mellitus (DM). Comorbidities of DM, such as macrovascular and microvascular changes, also interact with DPN and affect its course. In patients with DM, DPN is the leading cause of foot ulcers, which in turn are a major cause of amputation in the United States. Although most patients with DPN do not have pain, approximately 11% of patients with DPN have chronic, painful symptoms that diminish quality of life, disrupt sleep, and can lead to depression. Despite the number of patients affected by DPN pain, little consensus exists about the pathophysiology, best diagnostic tools, and primary treatment choices. This article reviews the current knowledge about and presents recommendations for diagnostic assessment of DPN pain based on a review of the literature.

General practitioner Norwich (b China 1940; q Middlesex Hospital 1964; DRCOG), died from a cerebral glioma on 10 November 2003. Peter's parents ran a leper hospital in China during invasion and civil war and were evacuated with 5 year old Peter on the last plane out. He rarely spoke of what he saw at that time, but it undoubtedly informed his approach to medicine and to life. After retirement and voluntary service in Cameroon, he did as much locum work as he could find time for. His chief love outside medicine was sailing, at which he competed nationally. He leaves a wife, Sue; three children; and two grandchildren.

We report the first use of high temperature superconductors for multilayer interconnection of bare semiconductor die to form multichip modules. Ten die with a total of 160 pads were interconnected on a 3.4 cm2 substrate. The interconnections were a combination of YBa2Cu3O7−δ lines and vias on two wiring levels separated by an epitaxial insulating layer. Connection between the two YBa2Cu3O7−δ wiring layers was accomplished by the use of superconducting vias through the insulator. Two similar multilayer multichip module designs, with 30‐ and 10‐μm‐wide YBa2Cu3Oδ−7 lines, were constructed.

We have deposited YBa2Cu3O(7-delta) (YBCO) films with low microwave surface resistance (Rs) on 5-cm-diam, oxide-buffered sapphire substrates by planar magnetron sputtering. MgO buffer layers are used on M-plane (1 0 -1 0) sapphire, and R-plane (1 -1 0 2) sapphire is buffered by CeO2. Rs values of 450-620 microhms at 77 K and 10 GHz were measured across an entire 5-cm diam YBCO film on M-plane sapphire. For YBCO on R-plane sapphire, Rs values at 77 K and 10 GHz were 950 microohms for a 5-cm-diam wafer and 700 microohms for 1 x 1 sq cm samples.

We compared the effectiveness of antibiotics alone and in combination with arthroscopy, arthroscopy with debridement, arthrotomy, or needle aspiration for the treatment of septic arthritis. Each modality has its proponents, but, to our knowledge, no comparative studies have been conducted in animals. We used biochemical and histological analysis to compare these methods of treatment in an experimental model. The right hind knee of thirty goats was injected with 1 x 10(5) Staphylococcus aureus bacilli. The left hind knee was not inoculated and served as the normal control. Seventy-two hours after inoculation, a two-week course of treatment with intramuscular administration of cefuroxime sodium, either alone or in combination with another mode of treatment, was initiated in each of five groups. The cartilage was evaluated histologically with biochemical, enzymatic, and interleukin-1 analyses. Despite the early therapeutic intervention, on the average, there was a 25 per cent loss of uronic acid (t test, p < 0.001) and a 43 per cent increase in neutral protease activity (signed-rank test, p = 0.003) in the treatment groups. There were no significant intergroup differences with regard to the histochemical-histological rating or the levels of uronic acid, neutral protease, or interleukin-1.

The photoresponse of zero-dimensional states in double barrier resonant tunneling diodes has been observed using high intensity THz radiation (photon frequencies ranging from 4 to 10 THz) from a free-electron laser. The double barrier resonant tunneling diodes have silicon donors in the quantum well which act as individual localized tunneling channels. The high frequency response of these diodes shows additional features due to the presence of these extra channels. The temperature dependence allows us to identify the contribution of the zero-dimensional states. The absence of wavelength dependence in the observed photoresponse indicates that photoassisted tunneling does not occur under these measurement conditions. (C) 1995 American Institute of Physics.

The success of any tunnelling contract must rely upon a unique combination of technical and management skills.

Necrosis in lymph nodes shown on CT in many patients with nodal metastases may indicate that the primary tumor is aggressive and has a high degree of malignancy. However, the significance of nodal necrosis in patients with mediastinal Hodgkin disease remains uncertain. We studied the thoracic CT scans of 76 patients who had newly diagnosed Hodgkin disease with mediastinal involvement with respect to the presence of necrosis (low attenuation, complex, fluidlike areas), the size and volume of the mass, the sites involved, extension ("E" disease), and the patients' clinical response to treatment. CT scans showed necrotic nodes in 16 patients (21%). The difference between these patients and those without necrotic nodes was not statistically significant with respect to sex, age, stage, distribution of disease, presence of E disease, cell type, mass diameter, or the presence of bulk disease (mass diameter/maximal thoracic diameter greater than or equal to 0.33). The mass volume as measured by CT was not significantly (p = .08) larger (1274 cm3) than the group without necrotic nodes (876 cm3). An analysis of the various mediastinal sites involved showed no difference between patients with and without necrotic nodes. Lastly, the presence of necrotic nodes had no significant impact on patients' clinical response to treatment or survival. The presence of mediastinal necrotic nodes appears to have little radiologic or prognostic significance in patients with newly diagnosed Hodgkin disease.

Autosomal recessive polycystic kidney disease (ARPKD) is a specific disease of the kidneys and liver, characterized by renal collecting tubule ectasia and invariably accompanied by biliary dysgenesis and portal fibrosis. In the past the disease has been called “infantile” polycystic kidney disease because of the predominant presentation in infancy. In recent years, however, presentation at later ages and survival into adulthood have become obvious. This chapter will describe the evolution of our knowledge of ARPKD, the diagnosis and management of the condition, and a summary of what is known about pathogenetic mechanisms.

15527 Background: ACC is a rare malignancy with a very poor prognosis. Surgery is the only potential curative option. Gefitinib is an oral EGFR inhibitor that may have activity in solid tumors that express EGFR. ACC over expresses EGFR in a high proportion of cases. Methods: From April 2004 through December 2006, the ACC Working Group conducted a phase II trial of Gefitinib as second line, monotherapy in patients with pathologically confirmed unresectable ACC who had progressed on mitotane or chemotherapy. All prior systemic therapy was discontinued 28 days prior to starting gefitinib. Patients were ineligible if: had received prior therapy with any EGFR inhibitor, pregnant or breast feeding, had other co-existing malignancies (other than basal cell carcinoma or cervical cancer in situ), had an ECOG PS > 2, absolute neutrophil counts < 1,500, or platelets < 20,000. Patients were not allowed concomitant use of phenytoin, carbamazepine, rifampicin, barbiturates, or St John’s Wort. Patients took gefitinib 250 mg orally once a day. Each cycle was 21 days with radiological assessment every 6 weeks.Response rate as determined by RECIST criteria was the primary endpoint. Results: 19 patients accrued to the study (18 with measurable disease and 1 without). Pt Characteristics: Female 79% (15/19); Median age 48 (range 26–74); 84% (12 female and 4 male =15/19) of the patients had steroid secreting tumors. Grade 3 toxicity was noted in 2 patients and included, hypertension and lower extremity edema and elevated liver transaminases. No grade 4 toxicities occurred. Of 19 patients evaluable, there were no complete responders, partial responders or patients with stable disease (0% response rate; 95% CI: 0%-18%). Conclusions: Gefitinib demonstrated no activity in patients with unresectable ACC. This study is now closed. This study demonstrated the ability to successfully accrue to a trial of novel agents in rare tumors in a multicenter setting. [Table: see text]

A continuous-wave all-optoelectronic terahertz imaging system based on diode lasers is presented. The coherent detection scheme is phase sensitive and operates at room temperature. This low-cost, compact system has image capture rates comparable with those from state-of-the-art pulsed THz systems.

An angle resolved photoelectron spectrometer has been constructed and coupled to the high throughout 2 m normal incidence monochromator now in operation at SURF-II. The electron analyzer whose design has been previously reported [2] scans the angular distribution of the ejected photoelectrons in a plane perpendicular to the partially polarized exit beam from the monochromator. The intensity of the photon beam from the monochromator is monitored by measuring the photocurrent from a screen in front of a three mirror polarization analyzer which is used to determine the degree of polarization of the photon beam. The function of the spectrometer is under computer control which is also acquires and processes the data output from the apparatus. Two novel features are employed to make the system highly effective: one is a capillary which channels the monochromatized output photon beam to the gas-photon-interaction zone and isolates the 10−4 vacuum int the spectrometer chamber from the 10−9 vacuum in the monochromator; the second feature is a high speed cryopump which permits a high density gas jet to interact with the photon beam while maintaining a high enough vacuum to minimize electron scattering and permit operation of the channeltron electron detector. These features combined with output fluxes of 5 × 1010 photons/s−1 A−1 permit vibrationally resolved photoelectron spectra of N2 and CO to be obtained in about 15 min.

The high intrinsic brightness of the circulating electron beam at SURF-II is used as the entrance slit for a two-meter normal incidence monochromator. A typical beam size for the electron beam is 100 μ high by 2 mm wide yielding an observed resolution of 0.4 A with a 200 μm exit slit and a 2400 lines/mm grating. The instrument accepts a beam with a 65 mrad horizontal divergence and a 10 mrad vertical divergence. A plane pre-mirror used near normal incidence reflects the incoming radiation onto the 2 m grating; this combination provides a horizontal exit beam, and enables the experiment to be located three meters from the orbit tangent point. With magnesium fluoride coated aluminum optics a flux of 2×10″ photons/s·A at 1200 A is observed with a 10 mA circulating current. A flux of 5×10 10 photons/sdA at 600 A is observed with an osmium coated grating and a 10 mA circulating current. Sample spectra of the angle-resolved photoelectron spectrum of CO are presented.

Diamond turned aluminium mirrors are being used more often in forward looking infrared (FLIR) imaging systems (operating in the 8–12 μm region) because they provide high optical performance at low cost. The original high reflectivity of these surfaces must be maintained through military standard humidity/temperature cycling tests. We have developed ion beam sputtered Y2O3 as a protective coating that meets all optical and environmental requirements. Data are presented that show that ion beam sputtered optical coatings are much less permeable to water than electron‐beam coatings while retaining many of the desirable features of e‐beam coatings. The deposition process and the properties of the coatings will be presented. Thin protective coatings of Y2O3 that exhibit very little angular dependence in reflectivity on aluminum have been prepared by ion beam sputtering.