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Hypothesis: In our clinical study, the stages of pregnancy were independent variables, and the measured change of sensitivity in selected skin areas was the dependent variable. The research hypothesis that the threshold electric skin sensitivity (TESS) fluctuates was based on our previously published research, where the null hypothesis was rejected in similar conditions. Methods: TESS was measured repeatedly in short intervals on the abdomen and right forearm of pregnant and not pregnant women. Results: A statistically very significant change of TESS fluctuation was found between not pregnant and pregnant women in different stages of pregnancy, labor, and postpartum. In the midline above the navel, the TESS fluctuates with similar frequency like intestinal peristalsis and that may reflect on the functional state of the bowels. In both lateral areas of the lower abdomen in not pregnant women and in early pregnancy, we found only minimal TESS fluctuations. They gradually increased until the beginning of labor and then decreased postpartum. In midline above the pubic symphysis, moderate TESS fluctuation in not pregnant women gradually increased during pregnancy, until the beginning of labor and decreased postpartum. TESS fluctuation during labor was not synchronous with recorded uterine contractions. Only minimal TESS fluctuation on the right forearm never changed significantly. Conclusion: TESS fluctuation in midline abdomen may be related to bowel peristaltic motility. In the lateral abdomen and above symphysis, it may be related to uterus activity. TESS measurement in referral pain skin area could be used for functional monitoring of internal organ in the corresponding viscerotome. The measurement of TESS in skin areas and recording fluctuations graphically as an electrosensitogram, could have diagnostic value. As a new noninvasive diagnostic method, electrosensitography could help us better understand the gastrointestinal organ function.

While the long-term evolution of disease behavior in Crohn's disease has been well described in the pre-anti-TNF era, our knowledge thereon remains scarce after the introduction of anti-TNF.Our investigation examined the long-term evolution of disease concerning Montreal classification's B-stages over time in patients enrolled into the Swiss IBD Cohort Study between 2006 and 2017.We analyzed prospectively collected SIBDCS data using a Markov model and multivariate testing for effects of treatment and other confounders on B-stage migration over time. The primary outcome was a transition in disease behavior from B1 to either B2 or pB3, or from B2 to pB3, respectively.The 10- and 15-year probability of remaining in B1 was 0.61 and 0.48, as opposed to a probability to migrate to B2 or B3 of 0.25 or 0.14, and 0.32 or 0.2, after 10 and 15 years, respectively. In multivariate testing, the hazard ratio for migrating from B1 to pB3 (HR 0.27) and from B2 to pB3 (HR 0.12) was lower in patients 40 years compared to patients 17 years. We found that immunosuppression (HR 0.38) and treatment with anti-TNF for 1 year (HR 0.30) were associated with a decreased likelihood of transitioning from stage B1 to pB3.While in the anti-TNF era most patients with Crohn's disease will eventually develop stricturing and/or penetrating complications, our data indicate that immunosuppressive and anti-TNF treatment for more than 1 year reduce the risk of transitioning from stage B1 to pB3 in the long-term run.

The article deals with the utilization of energy by-product (EBP) for further processing. The suitability of EBP for ground structures significantly depends on its production process. Its properties are influenced by brown coal flotation and by the usage of desulphurization methods. A comparison of physical-mechanical properties of different types of EBPs was performed. The main goal was to compile an apparent table of utilization and suitability of EBP for ground structures - road earth bodies, dams, and embankments according to the process of their formation.

We implemented a real-time report to distribute respiratory pathogen data for our 8-hospital system to anyone with an Internet connection and a web browser. Real-time access to accurate regional laboratory observation data during an epidemic influenza season can guide diagnostic and therapeutic strategies.

Background: The complement system activation and regulation have been linked to post-transplant pathologies including chronic antibody mediated rejection (cAMR) and the recurrence of IgA nephropathy (ReIgAN) but distinct mechanisms remain to be elucidated.Methods: In this retrospective single center study, the outcome of kidney transplantation was studied in 150 patients with late histological diagnosis to be either cAMR or ReIgAN, 14 stable kidney grafts at 3 months and finally 11 patients with native kidney IgAN nephropathy. To study a role of complement cascade and regulation in cAMR and ReIgAN, the RNA was extracted from available frozen kidney biopsy samples and using RT-qPCR transcripts of 11 target genes along with clinical data were determined and compared with stable grafts at 3 months protocol biopsies or IgAN native kidney nephropathy. Immunohistologically, CD46 (MCP), and C5 proteins were stained in biopsies.Results: Interestingly, there were no differences in kidney graft survival between cAMR and ReIgAN since transplantation. cAMR was associated with significantly higher intragraft transcripts of C3, CD59, and C1-INH as compared to ReIgAN (p < 0.05). When compared to normal stable grafts, cAMR grafts exhibited higher C3, CD55, CD59, CFH, CFI, and C1-INH (p < 0.01). Moreover, ReIgAN was associated with the increase of CD46, CD55, CD59 (p < 0.01), and CFI (p < 0.05) transcripts compared with native kidney IgAN. Rapid progression of cAMR (failure at 2 years after biopsy) was observed in patients with lower intrarenal CD55 expression (AUC 0.77, 78.6% sensitivity, and 72.7 specificity). There was highly significant association of several complement intrarenal transcripts and the degree of CKD regardless the diagnosis; C3, CD55, CFH, CFI, and C1-INH expressions positively correlated with eGFR (for all p < 0.001). Neither the low mRNA transcripts nor the high mRNA transcripts biopsies were associated with distinct trend in MCP or C5 proteins staining.Conclusions: The intrarenal complement system transcripts are upregulated in progressively deteriorated kidney allografts.

An intervention for Gram-negative bloodstream infections that integrated mass spectrometry technology for rapid diagnosis with antimicrobial stewardship oversight significantly improved patient outcomes and reduced hospital costs. As antibiotic resistance rates continue to grow at an alarming speed, the current study was undertaken to assess the impact of this intervention in a challenging patient population with bloodstream infections caused by antibiotic-resistant Gram-negative bacteria.A total of 153 patients with antibiotic-resistant Gram-negative bacteremia hospitalized prior to the study intervention were compared to 112 patients treated post-implementation. Outcomes assessed included time to optimal antibiotic therapy, time to active treatment when inactive, hospital and intensive care unit length of stay, all-cause 30-day mortality, and total hospital expenditures.Integrating rapid diagnostics with antimicrobial stewardship improved time to optimal antibiotic therapy (80.9 h in the pre-intervention period versus 23.2 h in the intervention period, P0.001) and effective antibiotic therapy (89.7 h versus 32 h, P0.001). Patients in the pre-intervention period had increased duration of hospitalization compared to those in the intervention period (23.3 days versus 15.3 days, P = 0.0001) and longer intensive care unit length of stay (16 days versus 10.7 days, P = 0.008). Mortality among patients during the intervention period was lower (21% versus 8.9%, P = 0.01) and our study intervention remained a significant predictor of survival (OR, 0.3; 95% confidence interval [CI], 0.12-0.79) after multivariate logistic regression. Mean hospital costs for each inpatient survivor were reduced $26,298 in the intervention cohort resulting in an estimated annual cost savings of $2.4 million (P = 0.002).Integration of rapid identification and susceptibility techniques with antimicrobial stewardship resulted in significant improvements in clinical and financial outcomes for patients with bloodstream infections caused by antibiotic-resistant Gram-negatives. The intervention decreased hospital and intensive care unit length of stay, total hospital costs, and reduced all-cause 30-day mortality.

Introduction Microbiology culture is the "gold standard" for diagnosis of fungal infections; however, culture has a lengthy turnaround time. A more timely assessment is possible with cytology and Gomori-methamine silver (GMS) staining. Materials and methods A total of 100 respiratory tract specimens with a positive fungal Gomori-methamine silver stain and corresponding culture were selected. The cytology slides were reviewed for factors contributing to discrepant results. Specimens were classified as 2 types of variances: interpretative and sampling. Concordant diagnoses were also evaluated. Results Eighty-two cases had fungal organisms that grew in culture. The remaining 18 cases were composed solely of fungal organisms that did not grow in culture (17 cases with Pneumocystis jirovecii ; 1 case with Pityrosporum ovale ). These 18 cases were excluded from the variance analysis. Thirty-three of 82 cases (40%) had concordant cytology and microbiology results, whereas 49 cases were discrepant. Variances were both sampling (41 cases) and interpretive (8 cases). Interpretive variances were predominantly Aspergillus species misinterpreted as Candida . Difficulty identifying true septate hyphae was the major contributing factor for misinterpretation. Conclusions Cytologic evaluation of respiratory specimens remains a useful preemptive diagnostic tool in the rapid diagnosis of fungal infection. Cytology samples significantly contribute to the diagnosis of respiratory fungi. However, interpretive variances between Aspergillus and Candida organisms are common. Awareness of the characteristic features that distinguish fungal organisms can further improve the diagnostic utility of cytology.

Background Current national guidelines suggest limiting metronidazole (MTZ) use due to increased treatment failures in patients with Clostridioides difficile infections (CDI). However, the reason for these increased failure rates is unclear. We hypothesized an increase in the minimum inhibitory concentration (MIC) of MTZ to C. difficile may contribute to these poor response rates. The objective of this study was to examine clinical response rates in patients with CDI who received MTZ monotherapy vs. other therapies stratified by MTZ susceptibility. Methods Stool samples that tested positive for C. difficile (2017–2018) were collected from two large academic hospital systems in Texas. C. difficile was isolated from stool and visually screened for growth on heme-containing agar plates with MTZ at 2 mg/L (defined as reduced susceptibility). Blinded investigators reviewed electronic medical records to identify the treatment received and determine clinical success or failure for each patient. Treatment failure rates were assessed in patients that received MTZ monotherapy vs. other therapies stratified by MTZ susceptibility. Results were analyzed using multivariate logistic regression analysis. Results A total of 172 C. difficile isolates were included of which 55.8% displayed reduced susceptibility to MTZ. Clinical success rates with MTZ varied based on disease severity (mild-moderate: 80.4%; severe/severe-complicated: 64%). Treatment success rates were higher in patients infected with MTZ susceptible isolates (88.4%) compared with those infected with isolates showing reduced MTZ susceptibility (60.5%; P = 0.004.) In multivariate logistic regression after controlling for disease severity, patients infected with strains displaying reduced MTZ susceptibility and treated with MTZ were more likely to experience treatment failure compared with patients with susceptible isolates (OR = 6.8; 95% CI:1.96–23.8; P = 0.003). In patients given non-MTZ-based therapies, reduced susceptibility to MTZ was not predictive of failure to other treatments. Conclusion This is the first report to demonstrate that increased clinical failure rates for MTZ monotherapy are associated with reduced susceptibility to MTZ. Disclosures K. Garey, Summit Therapeutics: Collaborator, Research support.

Infectious pericardial effusion with tamponade is an uncommon but life-threatening disease. We report an unusual case of spontaneous Ureaplasma pericardial effusion with tamponade associated with pneumonia, pleural effusion, and urinary tract infection. All published cases of clinically invasive Ureaplasma infections in the adult population are also reviewed.

Fungi are important etiologic agents of sinusitis. However, features of fungal sinusitis including the histologic spectrum, diagnostic mishaps, incidence, and fungal types have not been systematically studied. From 1996 through 2001, a total of 788 surgical pathology sinus specimens from 384 cases was retrieved. Fungal sinusitis was diagnosed in 58 specimens (7%) from 47 cases (12%). Four histologic categories of fungal sinusitis were identified: (1) allergic fungal sinusitis in 34 cases (copious mucin, abundant eosinophils, Charcot-Leyden crystals (so-called allergic mucin), with rare noninvasive fungal hyphae); (2) mycetoma/fungus ball in 11 cases (tightly packed fungal hyphae without allergic mucin or tissue invasion); (3) chronic invasive fungal sinusitis in 1 case (tissue granulomas with fungal hyphae); and (4) acute fulminant fungal sinusitis in 1 case (fungal vascular invasion). The diagnosis was initially missed in 16/34 (47%) cases of allergic fungal sinusitis despite typical features; incorrect classification was noted in 47% of cases. Sixty-seven percent of cases had positive fungal cultures, dematiaceous fungi being the most common. Allergic fungal sinusitis accounted for the majority of fungal sinusitis. Although misdiagnosis or incorrect classification is rather frequent for fungal sinusitis, awareness of the distinctive morphologic features of this entity may prevent these errors.

Pre-operative embolisation of metastatic spinal tumours has the potential to decrease intra-operative blood loss. Intra-operative blood loss is multifactorial and one factor may be the embolisation technique used. The purpose of this study was to retrospectively analyse the effect of three different pre-operative embolisation techniques on intra-operative blood loss, complication rate and tumour aetiology in patients treated with a corpectomy and dorsoventral stabilisation at our institution.We conducted a retrospective analysis of embolisation procedures for vertebral metastases performed from January 2002 to December 2011. Only pre-operatively embolised patients treated by a single-level hemicorpectomy or corpectomy procedure from T4-L5, including posterior spinal stabilisation using pedicle screws, were included. All patient charts and examinations were analysed regarding the embolisation technique, gender, age, primary tumour, time between the embolisation and surgery, intra-operative blood loss, intra-operative transfusions and complications related to embolisation.We identified a total of 46 patients, 25 male and 21 female patients. The mean age at the time of surgery was 66 years (range 39-84 years). The tumours treated were: 15 (33%) renal cell carcinomas, six (13%) breast carcinomas, five (11%) lung carcinomas, five (11%) urothelial carcinomas, four (9%) myelomas and 11 (24%) miscellaneous types including rectal carcinoma, thymoma and melanoma. Embolisation with coils was performed in 23 patients, particles were used in six and a combination of coils and particles in 18. The mean time between the embolisation and surgery was 23 hours (range 80-4,430 minutes). The median overall intra-operative estimated blood loss (EBL) was 2,300 ml (range 500-15,000 ml). In patients embolised with coils and particles, EBL was 2,200 ml compared to 1,450 ml in patients embolised with particles and 2,500 ml in the coil group. No statistically significant differences between the three groups could be detected. There were no complications related to the embolisation techniques.Pre-operative embolisation of spinal metastases using coils, particles or a combination of both is a safe and reproducible procedure. In our cohort we reported no complications during the three different embolisation techniques. No statistically significant difference regarding blood loss between the three embolisation techniques could be detected. Our data confirm existing studies concerning the control of intra-operative blood loss using different embolisation techniques. The benefit of embolisation with a combination of coils and particles compared to embolisation with particles only is questionable.

Context Timely processing of blood cultures with positive results, including Gram staining and notification of clinicians, is a critical function of the clinical microbiology laboratory. Analysis of processing time in our laboratory revealed opportunities to enhance workflow efficiency. We found that the average time from positive blood culture result to removal of the bottle for processing (positive-to-removal [PR] time) was inadequate for our rapid pathogen identification program. Objective To determine whether increased vigilance about PR time and prioritization of laboratory resources would decrease PR time and total processing time. Design We performed a retrospective analysis of blood culture PR time 7 months before and 7 months after an in-service meeting during which the importance of PR time was emphasized, and corrective measures were implemented. Results Before the in-service meeting, the average PR time for 5057 samples was 38 minutes, with an aggregate time of 192 251 minutes. Unexpectedly, we discovered that only 51.8% (2617 of 5057) of the positive blood cultures were removed in less than 10 minutes. After the in-service meeting, for 5293 samples, the average PR time improved to 8 minutes, the aggregate time improved to 44 630 minutes, and 84.5% (4470 of 5293) of the positive blood cultures were removed in less than 10 minutes. These improvements reduced the time to telephone notification of the Gram stain results to a caregiver by 46.7% (from 105 minutes to 56 minutes). Conclusions Increased awareness of barriers to rapid pathogen identification and interventions for improving performance time significantly enhanced care of patients with bloodstream infections.

The dematiaceous fungi appear to be an increasing cause of human disease. At The Methodist Hospital, in Houston, Texas, five cases of serious disease caused by these fungi occurred between 1987 and 1992. Cerebral abscesses with Xylohypha bantiana followed treatment for lymphoma. An infection of the lower extremity with Exophiala jeanselmei var. castellanii followed cardiac surgery. Peritoneal growth of Alternaria tenuissima was a complication of peritoneal dialysis. Cerebral abscesses with Dactylaria gallopava occurred in a liver transplantation patient. A traumatic ankle wound contaminated with dirt led to an infection with Phialophora repens. All patients except the last were immunocompromised at the time of the infection; diabetics and patients on steroids may be at particular risk.

Context.—Early diagnosis of gram-negative bloodstream infections, prompt identification of the infecting organism, and appropriate antibiotic therapy improve patient care outcomes and decrease health care expenditures. In an era of increasing antimicrobial resistance, methods to acquire and rapidly translate critical results into timely therapies for gram-negative bloodstream infections are needed. Objective.—To determine whether mass spectrometry technology coupled with antimicrobial stewardship provides a substantially improved alternative to conventional laboratory methods. Design.—An evidence-based intervention that integrated matrix-assisted laser desorption and ionization time-of-flight mass spectrometry, rapid antimicrobial susceptibility testing, and near–real-time antimicrobial stewardship practices was implemented. Outcomes in patients hospitalized prior to initiation of the study intervention were compared to those in patients treated after implementation. Differences in length of hospitalization and hospital costs were assessed in survivors. Results.—The mean hospital length of stay in the preintervention group survivors (n = 100) was 11.9 versus 9.3 days in the intervention group (n = 101; P = .01). After multivariate analysis, factors independently associated with decreased length of hospitalization included the intervention (hazard ratio, 1.38; 95% confidence interval, 1.01–1.88) and active therapy at 48 hours (hazard ratio, 2.9; confidence interval, 1.15–7.33). Mean hospital costs per patient were $45 709 in the preintervention group and $26 162 in the intervention group (P = .009). Conclusions.—Integration of rapid identification and susceptibility techniques with antimicrobial stewardship significantly improved time to optimal therapy, and it decreased hospital length of stay and total costs. This innovative strategy has ramifications for other areas of patient care.

The well's Advanced Collaborative Environment (ACE) Community of Practice (CoP) was formed in March 2009 at BP's senior management request, to share good practice and promote standardisation in this area. Its mandate was one of self help and leveraging scale, but working through influence and consensus, with management support rather than by direct authority. It was also required to adhere to company IT standards and technology strategy.At the time of the CoP's formation, collaborative environments had been commissioned in various company locations worldwide, including Aberdeen, Baku, Houston, Stavanger and Tangguh. In the absence of any unifying well's concept, each of these centres had been developed independently, strongly influenced by local ideas, needs and resources. The approach was typical of the innovation stage referred to in the conference programme, but it was evident that connectivity between the different locations and with other disciplines was lacking and that effort was duplicated.Today the CoP has over 30 members, spanning wells, subsurface, IT and wells technology from 12 locations worldwide. It meets virtually, involving the widest possible membership in the different time zones. It has been instrumental in progressing and communicating standards, supporting the introduction and use of common tools and technology, leveraging its knowledge and expertise and helping start-ups in new areas. Overall the CoP has been a great success. The paper describes the CoP's evolution, from its formation to the present day and critically examines its achievements, shortfalls and future goals.In a rapidly changing technical environment, achieving and maintaining alignment between the diverse stakeholders in a medium to large organisation can be challenging. The CoP has earned its credibility and has proved to be an effective means of sharing experience and making good use of scarce resources, both keys for adoption at scale.Field of the Future is a registered trademark of BP.

Description of the material Advanced Collaborative Environment (ACE) drives improvements to BP’s business performance by strengthening teamwork, encouraging mentoring and personal development, and enabling rapid response to dynamic situations, all supported by collaborative technology. Application ACE is a unique and proven holistic approach to delivering integrated operations in E&P, both in Drilling and Production Operations. ACE is a comprehensive, focused framework which intertwines local, global, and external methods and learnings, and over 35 assets have benefited. The ACE methodology continues accumulating and transferring the value delivered since 2003, and consistently stresses balanced emphasis on addressing People, Process, Technology, Organization and Physical Environment to accelerate the local adoption of collaboration in the field and office. This paper will provide some perspectives on the importance and learnings of each of these five elements. Both Drilling and Production Operations face non-technical challenges in their daily business: access to knowledge in locations remote from centers of expertise, the cost of travel, the drive to employ more national staff, the need to remove people from harms way, and to share knowledge amongst team members in building a sense of common purpose. How do we address these “softer” challenges, and ensure solutions are enduring? Results, Observations, and Conclusions Those assets which have embraced the holistic ACE solution have seen positive changes in culture and team interactions. Collaborative, synchronized working enables assets to plan better and react efficiently, and supports faster delivery of major initiatives. ACE enables a “one team” approach that significantly improves the decision making process and optimization of field operations. Assets’ integrated operations, including E&P Technology’s global support center, have been accelerated and assured by the comprehensive ACE method, including it’s business awareness, ability to conform to local needs, and central position in E&P. As ACE becomes an embedded part of BP’s Drilling and Production Operations, increasing numbers of anecdotes and benefits are attributable to this methodology. This paper will conclude with a summary of some of the key business benefits attained from the application of ACEs within BP’s Drilling and Production Operations. Significance of Subject Matter In the next decade the oil and gas industry may shed as much as three-quarters of its intellectual capital as experienced technologists and explorationists retire. In the 21st century, as we reach deeper and further to secure the world’s energy supply the leaders in global E&P will be those companies which can make the best use of scarce experienced human resource and can build expertise in areas where the workforce are well qualified but inexperienced. Collaboration and communication are the linchpins of this connected organization. Advances in technology have created an opportunity to address the future challenges of our businesses. The application of technology will allow BP to leverage data, knowledge, and expertise dispersed throughout the organization, to increase collaboration and ultimately, the efficiency and effectiveness of decision making. This, in turn, will deliver significant benefits in improved operational performance. Advanced Collaborative Environments will bring the right information, to the right people, at the right time, creating real time and multidiscipline decision environments supporting Drilling and Production Operations. ACE’s are more than just technology; they are about building our collaborative capability, allowing people to work collaboratively, regardless of distance, making better decisions, faster, thereby enabling enhanced productivity and delivering operational performance improvements.

Advanced Collaborative Environments (ACE) have been shown to generate improvements to BP's business performance. To deliver efficient collaborative practices, asset teams have altered their ways of working, their organisational structures and business environments. These ACEs are designed to ensure that offshore production facilities can have immediate access to shore-based specialist support teams via visual, audio and data connectivity to improve the quality of decision making and the problem-solving processes.BP has several ACE programmes in operation around the world, supporting application of the Field of the Future concept and driving better decisions faster. This paper describes the performance benefits (in terms of increased production, lower costs, improved safety and operational integrity) that the creation and usage of these ACEs have brought to the organisation, as well as highlighting the need to see collaborative environments not as purely process or technology driven initiatives, but more as a capability transformation programme. The authors explain the necessity of genuine engagement and ownership by the end-users so they can search for and leverage advantage themselves. ACE programmes require significant operating expenditure, and it has proved of vital importance to put efforts into maintaining the programme profile, sustaining senior management endorsement and encouragement of the programme, both in funding and leadership behaviour.This paper also describes the need to develop relationships centered on trust and respect between the onshore and offshore communities so that jointly made decisions can be consistently implemented with confidence.The personal characteristics and behavioural traits and etiquettes which individuals need to have to work effectively within these environments are also discussed. Offshore personnel need to know when to ask for advice and in turn onshore users can become "respected brokers" to either deal with the issue themselves or seek further input from specific functional teams.The similarities and differences between the Gulf of Mexico (GoM) and North Sea programmes illuminate the forces which are at work when shaping an ACE programme, and along with the successes, areas for further improvement and plans for the future of both programmes are analysed.

As the variable pressure scanning electron microscopes and the environmental scanning electron microscopes are capable to operate with pressures up to several thousand Pa in the specimen chamber, they are frequently utilized for observations and diagnostics of a wide scale of specimens without modifications, including wet and non-conducting ones, and a wide scale of experiments, such as changes of a structure and a composition of a specimen caused by changes of specimen temperature and ambient in the specimen chamber. For information acquisition about the specimens in these microscopes, detectors that takes advantages of the process of the impact ionization in the gas ambient in the specimen chamber are often utilized [1, 2, 3].

Objective: New medical discoveries regarding genetic susceptibility to common chronic diseases, and the decoding of the human genome have increased public attention to genetics. What information is understood and what attitudes exist towards genetics and genetic research have not been well examined in underserved, culturally diverse communities. Methods: To better understand attitudes and beliefs towards genetics and genetic testing in these groups, we conducted eight focus groups with 55 patients and health care workers in New York City and Westchester, N.Y., in English, Spanish, and Chinese. Results: Focus group participants had limited understanding about genetics or genetic testing. Newborn screening was the least-known genetic issue, even among health care workers. Regardless of their cultural group, most participants expressed a desire for more information about genetics and genetic tests. Latinos and Chinese participants generally expressed positive attitudes towards genetic studies and genetic testing, with the possibility of preventing diseases cited as the main advantage. Black Americans and Non-Hispanic Whites reported mixed feelings about genetic research and genetic testing. Concerns expressed included: anxiety before receiving test results or waiting for a disease to develop, fear of genetic discrimination by health and life insurance companies and employers, not having the financial means to deal with genetic diseases in themselves or a sick child, concern that children and adults are having too many tests. Black Americans expressed the most concern for possibly harmful use of genetic information. Conclusions: Minority populations of diverse cultures have limited knowledge about genetics and genetic testing, would like to have more information, and are not well reached by the current educational approaches. Participants knew the least about newborn screening, a test that is mandatory in the New York State. While genetic knowledge by minority populations was perhaps not different from the level of knowledge of consumers in general, minority populations are at particular risk of being left behind because of historically poor access to information and services.

The monitored drift tubes (MDTs) of the Atlas muon spectrometer have to sustain count rates up to 1500 Hz/cm and must be able to survive an accumulated charge of up to 0.6 C/cm during 10 years of operation. This paper presents results of aging studies carried out at the CERN Gamma Irradiation Facility GIF for the first time with a final Atlas muon chamber and a prototype of the gas recirculation system planned at LHC. A loss in pulse height was observed for MDTs under gas recirculation after an accumulated charge equivalent to only 1 year of LHC operation; the effect was traced to a silicone contamination from bad components in the gas recirculation system. Tubes operated with the classical one-pass, flushing mode did not show any evidence of aging, thus (re)validating the materials and components used in the MDT construction. Questions of long-term stability when recycling the major part of the operating gas could also be addressed by the measurements performed; results on this will also be discussed.

Traditionally, fecal leukocyte testing detects large bowel inflammation or disruption, conditions that allow leukocytes into the stool. However, test usefulness with inpatients is unclear. Two hundred five inpatients who had undergone one to three tests were identified, and their FLT results were compared to their gastrointestinal disease diagnoses at time of discharge. A specificity of 92% for detecting intact colonic mucosae in inpatients was found.

During a large community-wide outbreak of hepatitis A in two adjoining villages in Slovakia with a total of 5,000 inhabitants we administered to schoolchildren the first commercially available vaccine against hepatitis A (HAVRIX, Smith-Kline Beecham Biologicals, Rixensart, Belgium) in an attempt to control the progress of the epidemic. Soon after the start of the vaccination programme, an abrupt decrease in the occurrence of cases in the school was observed. In the village school with 624 schoolchildren, 404 had received a first dose of 360 enzyme-linked immunosorbent assay (ELISA) units (EL.U) and 373 a second dose 1 month later. Subsequent to the start of vaccination there were eight clinical cases of hepatitis A among the 157 children without a history of hepatitis A who remained unvaccinated and only 1 case in the vaccinated school children, giving attack rates of 5.1% and 0.25% in the two groups, respectively. Among the remaining 63 children, one was found seropositive when screened and 62 had a history of hepatitis A at the start of the vaccination programme. These 63 children were not offered vaccine. No cases occurred in that group. During the epidemic, three cases occurred an average of 20 days following its administration among 19 children who received immune globulin (IG). Cases in the whole population of the villages also ceased soon after the vaccination of the children had started. The vaccine was found more effective than postexposure IG in interrupting the epidemic in the whole community.

Twins were diagnosed by ultrasound in a 29-year-old woman. The cesarean delivery revealed at first a mature girl with a large benign sacrococcygeal teratoma and then a healthy boy. X-ray and CT examinations of the teratoma showed pelvic and lower limb bones. A mature teratoma-tridermoma (weight 475 g) containing the underdeveloped lower half of a human body was confirmed during surgery and verified morphologically. The fraternal twins, i.e., the girl operated upon and her brother, have been followed for 5 years and are without any complaints. They have normal neurological function.

A cyst of the choroid plexus of the left lateral ventricle with intermittent blockage of the foramen of Monro and initially with invagination of the III ventricle in a child is described. In a 6-week-old boy a ventriculoatrial shunt was implanted for correction of an active asymmetrical hydrocephalus of unknown origin. When he was 3 months of age a water-soluble contrast CT ventriculography revealed a noncolloid cyst localised predominantly in the upper portion of the III ventricle. At that time the ventricular catheter obstructed with choroid plexus was removed; new bilateral catheters in a parieto-occipital region were implanted. In the course of the next 4 years, first the atrial catheter had to be extracted and then the peritoneal catheter was changed, in both cases because of obstruction. Periods of normal life alternated with periods of transient and intermittent symptoms of increased intracranial pressure, papilloedema, and myoclonic jerks. Repeated computed tomography (CT) and magnetic resonance imaging (MRI) showed stabilised hydrocephalus with an enlarged left lateral ventricle. When the boy was 16 years old MRI revealed a choroid plexus cyst in the left lateral ventricle 2 cm in diameter, with a ball-valve type of obstruction of the foramen of Monro. CT stereoendoscopic resection of the wall of a large cyst filled with cerebrospinal fluid was performed, and two additional adnexal small cysts were coagulated using the bipolar coagulator, Diomed 25 laser and scissors; the symptoms then regressed, except for superior bilateral altitudinal anopsia. Light and electron microscopy of the cyst wall is reported. The cyst was composed of collagenic connective tissue lined with a basal lamina lacking in epithelial cells. The preoperative and postoperative MRI are presented. Choroid plexus cysts localised in the anterior part of lateral ventricles are very rare, and all reported cases have been in male patients. According to the literature our case is only the third ever described in a child.

Rhinocerebral mucormycosis is a well-described fulminant fungal infection that typically presents acutely in patients with diabetic ketoacidosis or immunosuppression. Chronic presentations of rhinocerebral mucormycosis have also been described. In the chronic infection, the disease course is indolent and slowly progressive, often occurring over weeks to months. The authors report 2 cases of chronic rhinocerebral mucormycosis (CRM) treated at their institution and review 16 other cases reported in the English-language literature. In these cases, the median time from symptom onset to diagnosis was 7 months. The most common presenting features of CRM are ophthalmologic and include ptosis, proptosis, visual loss, and ophthalmoplegia. CRM occurs predominantly in patients with diabetes and ketoacidosis. The incidence of internal carotid artery and cavernous sinus thrombosis is higher in CRM patients than in those with the acute disease, although the overall survival rate for CRM patients is 83%. CRM is clinically distinct from chronic Entomophthorales infection.

We report a case of striking and disfiguring facial mycosis due to an organism belonging to the Pleurophoma complex of Coelomycetes. This condition was likely acquired through repeated contact with infected soil and exacerbated by prolonged applications of topical corticosteroid preparations. Antifungal drug susceptibility testing was used to direct a therapeutic choice in this unusual infection.

Thermal-structural errors are inherently present during AXAF metrology. These include gravity release, random alignment, thermal, and vibro acoustic errors. The impact of each of these sources on AXAF metrology is presentedin this paper.

The precision metrology mount is the structural "backbone" that supports all AXAF metrology at Hughes Danbury Optical Systems. This mount is currently designed to support P1 and Hi optics, the two outermost elements of the High Resolution Mirror Assembly (HRMA)1 . The mount must offload the mirror deterministically in a one-g field with tolerances established on the gram level. The intent of this paper is to quantify the requirements placed on the metrology mount and then to describe the design philosophy used to meet these demanding performance requirements. Finally and most importantly, the paper describes how each of the metrology mount's specifications were addressed and met from a design vantage point.© (1990) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

A methodology is described which minimizes optics distortion in the fabrication, metrology, and launch configuration phases. The significance of finite element modeling and breadboard testing is described with respect to performance analyses of support structures and material effects in NASA's AXAF X-ray optics. The paper outlines the requirements for AXAF performance, optical fabrication, metrology, and glass support fixtures, as well as the specifications for mirror sensitivity and the high-resolution mirror assembly. Analytical modeling of the tools is shown to coincide with grinding and polishing experiments, and is useful for designing large-area polishing and grinding tools. Metrological subcomponents that have undergone initial testing show evidence of meeting force requirements.

Fifty-five patients with Mycobacterium kansasii isolates (47 pulmonary and eight disseminated) were identified at a large Texas hospital from 1975 to 1985. The mean age of patients was 60 years, and there was a slight male predominance. Isolation of M. kansasii usually represented disease. The great majority of patients with pulmonary infection due to M. kansasii had underlying pulmonary diseases, and 70% had nonpulmonary predisposing factors. M. kansasii pulmonary disease clinically and radiographically resembled pulmonary tuberculosis. Disseminated M. kansasii infection occurred in severely immunocompromised patients, who frequently had pulmonary predispositions as well. Disseminated infection most of ten involved the lung, reticuloendothelial system, bone, joint, and skin and presented with signs and symptoms related to these organs. Despite only moderate in vitro susceptibility of M. kansasii to routine antituberculous drugs, most patients responded to rifampin-containing regimens. The prognosis of patients with M. kansasii disease was determined primarily by their underlying diseases.

To evaluate the acute and chronic effects of diuretic monotherapy with 3 mg piretanide bid, 46 patients (pts) with congestive heart failure (NYHA II-III) secondary to coronary artery disease were studied. Within 3 weeks of therapy, the patients lost 1.6 kg body weight. Forty-four patients reported a subjective feeling of improvement. Echocardiographically, a highly significant (p less than 0.001) reduction of diastolic and systolic diameters was found, as well as an increase of fraction shortening. Chest x-ray indicated a reduction of heart volume from 1012 +/- 263 ml to 936 +/- 233 ml (p less than 0.001). The serum potassium level remained unchanged. A subgroup of 26 pts underwent invasive hemodynamic examinations. IV injection of 6 mg piretanide resulted in an acute reduction of pulmonary wedge pressure (pc) from 20.2 +/- 5.3 mmHg to 11.9 +/- 5.0 mmHg (p less than 0.001); simultaneously a slight decrease of cardiac index from 3.2 +/- 0.6 l/min/m2 to 3.0 +/- 0.4 l/min/m2 was observed. Invasive control after 3 weeks of oral therapy showed no decline of the piretanide effect. The exercise tolerance increased clearly from 135 +/- 161 Wmin to 249 +/- 268 Wmin (p less than 0.05). A control group of further 14 pts was treated with placebo only and did not show any significant changes of pc (20.0 +/- 6.4 mmHg vs. 22.8 +/- 19.2 mmHg), exercise tolerance, or other clinical parameters. Thus, the diuretic monotherapy of congestive heart failure with piretanide is highly effective and shows a significant improvement in all clinical and hemodynamic parameters in the absence of any remarkable side effects.

To the Editor.— Among the nontuberculous species of Mycobacterium isolated from cutaneous lesions, Mycobacterium haemophilum has received the least attention. Since first described in 1978, 1 fewer than 20 cases have been reported worldwide. Clinical disease is usually associated with an underlying condition resulting in immunosuppression, and is characterized by cutaneous nodules or plaques on the extremities. The unique features that separate M haemophilum from other Mycobacterium are the requirement of hemin for growth, and an unusual antimicrobial susceptibility pattern. We report a case in a nonimmunosuppressed host where the organism was isolated on routine bacteriologic medium and the patient was successfully treated with ciprofloxacin. Report of a Case.— In August 1988, a 65-year-old white woman was evaluated for a scaly erythematous papular eruption on her right forearm (Fig 1) that developed postoperatively following coronary artery bypass surgery. The rash had been present for 4 months and was unresponsive to

The basis of olfactory signatures mediating human kin recognition was investigated in two experiments. The odors of mothers and offspring were correctly matched (by subjects unfamiliar with the stimulus individuals) at a greater than chance frequency. In contrast, subjects were not able reliably to match the odors of husbands and wives. These data support the hypotheses that characteristic individuals odors are genetically mediated and that kin recognition should be facilitated by the similarity of such familiar odors among close relatives.

A series of experiments investigated the salience of newborn infants' facial-visual features for recognition and sex identification. Within 33 hours post-partum, mothers recognized photographs of their own offspring when presented with those of unrelated neonates. Furthermore, adult subjects were able to match photographs of unfamiliar mothers and their infants, and determine the sex of neonates, at a greater than chance level of accuracy. Although recognizable facial features are presumably genetically determined, maternal recognition of offspring probably results from brief exposure and familiarization as well as physical resemblance between the infant and other familiar family members, including the mother herself.

The epidemiology of genital white piedra was investigated in 166 young men with a variety of genital complaints. Trichosporon beigelii was isolated from sixty-six (40%) of the cultured scrotal hairs. Infection was more common among black patients--54% of those examined, compared to 16% of white patients and 30% of "others" (p less than 0.001). There was no relationship between infection and foreign travel. White piedra was also found in young women, but less frequently than in young men (14% vs 40%, respectively). Transmission rarely occurred from person to person. Occasionally multiple body sites were simultaneously infected. A relationship may exist between T. beigelii and Corynebacterium concurrently infecting genital hair shafts. Eradication of infection was extremely difficult, despite in vitro sensitivity to antifungal agents. Spontaneous remissions occurred, however, in some patients.

A melanotic neuroectodermal neurocranial tumor of infancy of extra-intra-subdural right temporal location, examined by CT and successfully operated in a 33-month-old boy is reported in context with the literature. Out of 30 cases (including our case) of melanotic neuroectodermal neurocranial and intracranial tumors (MNNIT) 18 were located in the neurocranium (MNNT) and 12 intracranially, i.e. in the brain and cerebellum (MNIT). 23 tumors were located medially (11 at the anterior fontanel, one at the posterior fontanel, one in the 3rd ventricle, one in the sella turcica, one in the pineal region, 8 in the cerebellar vermis) and 7 laterally (five involved the temporal bone, one of which with intracranial propagation (our case), one in the temporal lobe of the brain, one in the skull posterior to the mastoid process). Twenty-eight cases were children (16 boys, 8 girls, four not stated), two adults. The location is important in respect to biology and surgery: MNNIT can be grouped as to its relation to the arachnoid barrier layer into malignant and benign. MNIT localised medially subarachnoidally are malignant. MNNT of small dimensions localised medially and laterally extraarachnoidally are benign. MNNT of extreme dimensions localised medially extra-intradurally are also benign, but difficult to treat. In the MNNT when diagnosed early and operated radically, the mortality can be lowered. Our case, presented on CT (1978) as first case of combined extra-intra-subdural location, represents the 173rd MNT and the 18th related to neurocranium.

A two-dimensional elasto-plastic finite element analysis is developed herein which has the capability of analyzing structural members which are subjected to cyclic thermal-mechanical loadings. This analysis, therefore, is of great value in gas turbine applications. The analysis, which is based on an effective stress-strain formulation, employs a tangent modulus approach in its execution. Both principal and conventional stresses are computed in the body. Unloading procedures are established and subsequently employed in cyclic loading problems. Several examples are presented. A turbine blade shroud, which has been mechanically loaded due to interference with its adjacent member, is analyzed. Cyclic behavior is shown for a uniaxial tension specimen and then generalized to a multiaxial stress state. A “predictor-corrector” procedure, which calculates the most efficient loading increment, is developed. Analyses of stress concentration factors and thermal stress applications are also presented.

The authors report on 13 cases of dermoid cysts over the anterior fontanelle in Czechoslovak children. These children were 2-19 months of age; with a male-to-female ratio of 2:1. The cyst sizes ranged from 10 to 30 mm. Hence, the number of cases published in the world so far in children has increased to 174. Simultaneously, the number of European cases has increased to 30 (17.2%). Nevertheless, the dominance of the reported cases is still 74 in America (42.5%) and 45 in Africa (25.9%).

Oesophagoscopic and X-ray examinations were performed in 30 patients with Sjogren's syndrome. Mucosal atrophy was found throughout the entire length of the oesophagus in all patients examined. On X-ray examination no malignant changes were observed. In four of the patients a characteristic incisure was found located by contrast filling in the anterior wall of the pharynx close below Killian's sphincter.We also found that dysphagia during the ingestion of solid food in these patients is not due to pathological oesophageal membranes, but, in the first place, to lack of saliva and dryness of the mucosa which make the passage of solid food difficult.We believe that mucosal atrophy of the oesophagus in patients with Sjogren's syndrome should be included among the major features on which the diagnosis of Sjogren's syndrome is based.