US-guided core breast biopsy: use and cost-effectiveness

OBJECTIVES: We sought to determine, using serial echocardiography, the hydrodynamic mechanisms involved in the occurrence of hemolysis after mitral valve repair. BACKGROUND: Recently, fluid dynamic simulation models have identified distinct patterns of mitral regurgitant flow disturbances in patients with mitral prosthetic hemolysis that were associated with high shear stress and may therefore produce clinical hemolysis. Rapid acceleration, fragmentation, and collision jets were associated with high shear stress and hemolysis whereas slow deceleration and free jets were not. METHODS: We reviewed serial echocardiographic studies of 13 consecutive patients with hemolytic anemia after mitral valve repair who were referred for mitral reoperation between January 1985 and December 1996 (group 1). Thirteen patients undergoing reoperation for mitral regurgitation after mitral valve repair but without hemolysis served as controls (group 2). RESULTS: The mitral regurgitant jet was central in origin in 12 group 1 patients and 9 group 2 patients (Fisher exact test, p= 0.3). The other patients had para-ring regurgitation. Group 1 patients had collision (n=11), rapid acceleration (n=2) or fragmentation (n=1) jets whereas group 2 patients had slow deceleration (n=11) or free jets (n=2) (Fisher exact test, p < 0.0001). One patient with hemolysis had both collision and rapid acceleration jets. The "culprit" jet could be identified on the postbypass transesophageal echocardiography (TEE) study in only 1 patient at the time of initial mitral repair. Twelve group 1 patients underwent reoperation, with subsequent resolution of hemolysis in all patients. At reoperation, the initial repair was found to be intact in 8 (67%) patients. CONCLUSION: Distinct patterns of flow disturbance associated with high shear stress were identified by color Doppler imaging in patients with hemolysis after mitral valve repair. The majority (92%) of these color flow disturbances were not present during intraoperative postbypass TEE study after initial mitral repair and subsequently developed in the early postoperative period.     

Pediatric pain management in an adult critical care unit

Many children every year will be treated in "adult" critical care units because of the limited pediatric trauma centers currently available. Assessment is an integral part of all pain management. Ideally, self-report is the gold standard for assessing pain; however, some children may not have the ability to use these tools. Nonverbal children may be assessed with behavioral tools such as the CHEOPS or FLACC. In children as young as 3 years old, the self-report tool called an OUCHER can be administered to assess their pain. Easy to apply nonpharmacological approaches are discussed with recommendations for nurses to incorporate into their daily care.     

Endogenous Neighborhood Selection and the Attainment of Cooperation in a Spatial Prisoner’s Dilemma Game

There is a large literature in economics and elsewhere on the emergence and evolution of cooperation in the repeated Prisoner’s Dilemma. Recently this literature has expanded to include games in a setting where agents play only with local neighbors in a specified geography. In this paper we explore how the ability of agents to move and choose new locations and new neighbors influences the emergence of cooperation. First, we explore the dynamics of cooperation by investigating agent strategies that yield Markov transition probabilities. We show how different agent strategies yield different Markov chains which generate different asymptotic behaviors in regard to the attainment of cooperation. Second, we investigate how agent movement affects the attainment of cooperation in various networks using agent-based simulations. We show how network structure and density can affect cooperation with and without agent movement.     

A quantum chemical study of the mechanism of action of Vitamin K epoxide reductase (VKOR) II. Transition states

A reaction path including transition states is generated for the Silverman mechanism [R.B. Silverman, Chemical model studies for the mechanism of Vitamin K epoxide reductase, J. Am. Chem. Soc. 103 (1981) 5939-5941] of action for Vitamin K epoxide reductase (VKOR) using quantum mechanical methods (B3LYP/6-311G**). VKOR, an essential enzyme in mammalian systems, acts to convert Vitamin K epoxide, formed by Vitamin K carboxylase, to its (initial) quinone form for cellular reuse. This study elaborates on a prior work that focused on the thermodynamics of VKOR [D.W. Deerfield II, C.H. Davis, T. Wymore, D.W. Stafford, L.G. Pedersen, Int. J. Quant. Chem. 106 (2006) 2944-2952]. The geometries of proposed model intermediates and transition states in the mechanism are energy optimized. We find that once a key disulfide bond is broken, the reaction proceeds largely downhill. An important step in the conversion of the epoxide back to the quinone form involves initial protonation of the epoxide oxygen. We find that the source of this proton is likely a free mercapto group rather than a water molecule. The results are consistent with the current view that the widely used drug Warfarin likely acts by blocking binding of Vitamin K at the VKOR active site and thereby effectively blocking the initiating step. These results will be useful for designing more complete QM/MM studies of the enzymatic pathway once three-dimensional structural data is determined and available for VKOR.     

Kosha: A Peer-to-Peer Enhancement for the Network File System

The storage needs of modern scientific applications are growing exponentially, and designing economical storage solutions for such applications – especially in Grid environments – is an important research topic. This work presents Kosha, a system that aims to harvest redundant storage space on cluster nodes and user desktops to provide a reliable, shared file system that acts as a large distributed storage. Kosha utilizes peer-to-peer (p2p) mechanisms to enhance the widely-used Network File System (NFS). P2P storage systems provide location transparency, mobility transparency, load balancing, and file replication – features that are not available in NFS. On the other hand, NFS provides hierarchical file organization, directory listings, and file permissions, which are missing from p2p storage systems. By blending the strengths of NFS and p2p storage systems, Kosha provides a low overhead storage solution. Our experiments show that compared to unmodified NFS, Kosha introduces a 3.3% fixed overhead and 4.5% additional overhead as nodes are increased from two to sixteen. For larger number of nodes, the additional overhead increases slowly. Kosha achieves load balancing in distributed directories, and guarantees or better file availability.*This work was supported in part by an NSF CAREER award (ACI-0238379).Troy A. Johnson was supported by a U.S. Department of Education GAANN doctoral fellowship.     

Cytochemical localization of acetylcholine receptors at the neuromuscular junction by means of horseradish peroxidase-labeled alpha-bungarotoxin

The cytochemical localization of acetylcholine (ACh) receptors at the neuromuscular junction was investigated with a procedure utilizing alpha-bungarotoxin (alpha-BtX) labeled directly with horseradish peroxidase (HRP). Following incubation of tissues in the conjugate and reaction for peroxidase, activity was observed on the junctional folds of the motor endplate. A uniform layer of reaction product approximately 15 nm thick occurred over the apical portions of the junctional folds. Membranes at the bases of the synaptic cleft showed only small amounts of reaction product. Non-junctional regions of the muscle fiber were unreactive. Activity was also observed in the membrane of the axon facing the muscle surface, often including the axolemma overlying the "active zones" of the nerve terminal. Such presynaptic activity was still evident on nerve terminals disjuncted from the synapse by enzymatic treatment prior to incubation in the conjugate. This localization indicates the possible presence of presynaptic ACh receptors within the axolemma. In muscle denervated for 7-12 days, motor endplates were reactive and parajunctional sarcolemma showed slight activity, but most extrajunctional regions contained no obvious accumulations of reaction product. Activity at all sites was prevented by preincubation of tissues in native alpha-BTX prior to incubation in the conjugate and reaction for HRP. This procedure represents a simple and convenient method for the high resolution localization of ACh receptors.     

Spark Plasma Sintering of Nanostructured Aluminum: Influence of Tooling Material on Microstructure

The influence of tooling material, i.e., graphite and WC-Co, on the microstructure of a spark plasma sintering (SPS) consolidated, nanostructured aluminum alloy is studied in this paper. The results show that tooling selection influences microstructure evolution, independent of process parameters. The influence of tooling on microstructure is rationalized on the basis of the following factors: heating rate, electrical current density, localized heating, and imposed pressure. A theoretic framework, based on the physical properties of graphite and WC-Co, is formulated to explain the observed behavior.     

Dynamic Micro-Strain Analysis of Ultrafine-Grained Aluminum Magnesium Alloy Using Digital Image Correlation

Tensile tests were performed in situ on an ultrafine-grained (UFG) Al-Mg alloy using a micro-tensile module in a scanning electron microscope. The micro-strain evolution was tracked and measured using digital image correlation (DIC). A fine random speckle pattern was required to achieve high resolution and accuracy of strain measurement using DIC. To produce the speckle pattern, a patterning method was developed using electron beam lithography to deposit a gold speckle pattern. The nanoscale feature size of this gold pattern (45 nm) was useful for identifying the micro-strain among individual grains of the UFG Al-Mg alloy. Microstructural aspects of the UFG Al-Mg alloy were revealed by analysis of electron backscattered diffraction (EBSD) patterns. Finally, the effect of the UFG Al-Mg alloy microstructure on the nanoscale deformation mechanism was investigated by combining EBSD and DIC data in a contour map. This combined technique provides a method for direct measurement of micro-strain and is potentially useful for deformation studies of a wide range of nanostructured materials.     

Seaweed Allelopathy Against Coral: Surface Distribution of a Seaweed Secondary Metabolite by Imaging Mass Spectrometry

Coral reefs are in global decline, with seaweeds increasing as corals decrease. Although seaweeds inhibit coral growth, recruitment, and survivorship, the mechanism of these interactions is poorly understood. Here, we used field experiments to show that contact with four common seaweeds induces bleaching on natural colonies of Porites rus. Controls in contact with inert, plastic mimics of seaweeds did not bleach, suggesting seaweed effects resulted from allelopathy rather than shading, abrasion, or physical contact. Bioassay-guided fractionation of the hydrophobic extract from the red alga Phacelocarpus neurymenioides revealed a previously characterized antibacterial metabolite, neurymenolide A, as the main allelopathic agent. For allelopathy of lipid-soluble metabolites to be effective, the compounds would need to be deployed on algal surfaces where they could transfer to corals on contact. We used desorption electrospray ionization mass spectrometry (DESI-MS) to visualize and quantify neurymenolide A on the surface of P. neurymenioides, and we found the molecule on all surfaces analyzed, with highest concentrations on basal portions of blades.     

Evaluating the role of ivy (Hedera helix) in moderating wall surface microclimates and contributing to the bioprotection of historic buildings

The role of ivy (Hedera helix L.) on building walls is much debated, with arguments being put forward for it playing a biodeteriorative role (for example through ivy rootlets exploiting cracks and holes) as well as suggestions that it might provide some bioprotection (for example by the ivy canopy protecting the walls from other agents of deterioration such as frost). We have carried out a year-long study of the influence that ivy canopies play on wall surface microclimates at five sites across a range of climatic settings within England, using iButtons to monitor temperature and relative humidity fluctuations at the wall surface on ivy-covered and exposed walls. Hourly data illustrates a general mediating effect of ivy canopies on both temperature and relative humidity regimes. The ivy reduces extremes of temperature and relative humidity, with the most clearcut differences for temperature. Across all five sites the average daily maximum temperature was 36% higher and the average daily minimum temperature 15% lower on exposed vs ivy-covered surfaces. Differences in the exposure level of studied walls (i.e. whether they are shaded or not by trees or other walls) influenced the degree of microclimatic alteration provided by the ivy canopy. Other important factors influencing the strength of the ivy impact on microclimate were found to be thickness of the canopy and aspect of the wall. A detailed analysis of one site, Byland in North Yorkshire, illustrates the seasonal differences in impact of ivy on microclimates, with insulation against freezing being the dominant effect in January, and the removal of high temperature ‘spikes’ the dominant effect in July. The observed moderating role of ivy canopies on wall surface microclimates will reduce the likelihood of frost and salt deterioration to the building materials, thus contributing to their conservation. Further research needs to be done on other potentially deteriorative roles of ivy before an overall bioprotective role can be assumed, but the significant impact of ivy on wall surface microclimates across England is clear.