Element abundance patterns in stars indicate fission of nuclei heavier than uranium.

The heaviest chemical elements are naturally produced by the rapid neutron-capture process (r-process) during neutron star mergers or supernovae. The r-process production of elements heavier than uranium (transuranic nuclei) is poorly understood and inaccessible to experiments so must be extrapolated by using nucleosynthesis models. We examined element abundances in a sample of stars that are enhanced in r-process elements. The abundances of elements ruthenium, rhodium, palladium, and silver (atomic numbers Z = 44 to 47; mass numbers A = 99 to 110) correlate with those of heavier elements (63 ≤ Z ≤ 78, A > 150). There is no correlation for neighboring elements (34 ≤ Z ≤ 42 and 48 ≤ Z ≤ 62). We interpret this as evidence that fission fragments of transuranic nuclei contribute to the abundances. Our results indicate that neutron-rich nuclei with mass numbers >260 are produced in r-process events.

Beyond patient delay, navigating structural health system barriers to timely care and treatment in a high burden TB setting in Papua New Guinea.

Tuberculosis (TB) is a major public health issue in Papua New Guinea, with incidence rates particularly high in the South Fly District of Western Province. We present three case studies, along with additional vignettes, that were derived from interviews and focus groups carried out between July 2019 and July 2020 of people living in rural areas of the remote South Fly District depicting their challenges accessing timely TB diagnosis and care; most services within the district are only offered offshore on Daru Island. The findings detail that rather than 'patient delay' attributed to poor health seeking behaviours and inadequate knowledge of TB symptoms, many people were actively trying to navigate structural barriers hindering access to and utilisation of limited local TB services. The findings highlight a fragile and fragmented health system, a lack of attention given to primary health services, and undue financial burdens placed on people living in rural and remote areas associated with costly transportation to access functioning health services. We conclude that a person-centred and effective decentralised model of TB care as outlined in health policies is imperative for equitable access to essential health care services in Papua New Guinea.

Exploring Tuberculosis Riskscapes in a Papua New Guinean 'Hotspot'.

This article explores socio-spatial dimensions of risk and how they can enhance understanding of a high burden tuberculosis (TB) context in the South Fly District of Papua New Guinea. We report on select findings from a qualitative study that included 128 semi-structured in-depth interviews and 10 focus group discussions with a wide range of South Fly District community members. Using the conceptual framework of 'riskscapes' to examine emic perspectives on risk, space and practice, we map key elements of TB riskscapes on Daru Island, South Fly District, along with solutions for navigating through these riskscapes. Overcrowding, lack of water, sanitation and hygiene, as well as food insecurity and undernutrition, were identified as common elements within participants' riskscapes, that compounded upon each other to create the perception of an assemblage of risk favourable to TB transmission.

Quantitative Atomic Spectroscopy, a Review of Progress in the Optical-UV Region and Future Opportunities†.

The development of tunable dye lasers and a simple atomic and ionic beam source for all elements were critical in establishing a reliable absolute scale for atomic transition probabilities in the optical to near UV regions. The laboratory astrophysics program at the University of Wisconsin - Madison (UW) concentrates on neutral and singly-ionized species transitions that are observable in astronomical spectra of cool stars, emphasizing the rare earth n(eutron)-capture elements and the Fe-group elements that are important inputs to early Galactic nucleosynthesis studies. The UW program is one of several productive efforts on atomic transition probabilities. These programs generally use time-resolved laser-induced-fluorescence (TR-LIF) to accurately measure total decay rates and data from high resolution Fourier transform spectrometers (FTSs) to determine emission branching fractions (BFs). The UW laboratory results almost always are directly linked to astronomical chemical composition efforts. There are good opportunities to extend similar research to other wavelength regions.

Improved myo-inositol detection through Carr-Purcell PRESS: a tool for more sensitive mild cognitive impairment diagnosis.

A 3-T study is presented, comparing the ability of two (1) H spectroscopy pulse sequences, Carr-Purcell point resolved spectroscopy (CPRESS; TE = 45 msec), and conventional PRESS (TE = 35 msec), to separate between groups of 20 normal control (NC) and 20 mild cognitive impairment (MCI) subjects. Both sequences showed higher myo-inositol (mI) and mI/N-acetyl-aspartate (NAA) levels in the posterior cingulate gyrus of the MCI subjects. The increased intrasubject repeatability of mI and mI/NAA CPRESS measurements (∼ 6% vs. 9% for PRESS) translated into decreased intraclass variability. A 22% intraclass mI PRESS variability was reduced to 16% for CPRESS, and an 18% intraclass mI/NAA PRESS variability was reduced to 12% for CPRESS for the group of NC subjects. Similar results were observed for the MCI subjects. Decreased intraclass variability led to improved separation between NC and MCI subjects (P = 0.017 for PRESS and P < 0.0001 for CPRESS mI/NAA, the best NC/MCI discriminant for each method). Seventy-five percent sensitivity at eighty percent specificity was demonstrated by mI/NAA CPRESS measurements in separating NC from MCI subjects. High correlations were also observed between subject performance on a number of neuropsychological tests (probing verbal memory, visuoconstruction performance, and visual motor integration) and the mI/NAA ratio; higher correlation coefficients (with stronger statistical significance) were consistently evident for CPRESS than for PRESS data.

Minimally invasive pedicle screw fixation utilizing O-arm fluoroscopy with computer-assisted navigation: Feasibility, technique, and preliminary results.

BACKGROUND: Pedicle screw misplacement is relatively common, with reported rates ranging up to 42%. Although computer-assisted image guidance (CaIG) has been shown to improve accuracy in open spinal surgery, its use in minimally invasive procedures has not been as well evaluated. We present our technique and review the results from a cohort of patients who underwent minimally invasive lumbar pedicle screw placement utilizing the O-arm imaging unit in conjunction with the StealthStation Treon System. METHODS: A retrospective review of patients who underwent minimally invasive pedicle screw fixation with CaIG was performed. Eleven consecutive patients were identified and all were included. Nine patients underwent a single-level transforaminal lumbar interbody fusion. Two patients underwent multi-level fusion. Inaccurate pedicle screw placement was determined by postoperative computed tomography (CT) and graded as 0-2, 2-4, 4-6, or 6-8 mm. RESULTS: A total of 52 screws were placed. Forty screws were inserted in eight patients who had postoperative CT, and a misplacement rate of 7.5% was noted including one lateral and two medial breaches. All breaches were graded as 0-2 mm and were asymptomatic. In the remaining three patients, post-instrumentation O-arm imaging did not demonstrate pedicle screw misplacement. CONCLUSION: Although this initial study evaluates a relatively small number of patients, minimally invasive pedicle screw fixation utilizing the O-arm and StealthStation for CaIG appears to be safe and accurate.

Back and neck pain and psychopathology in rural sub-Saharan Africa: evidence from the Gilgel Gibe Growth and Development Study, Ethiopia.

STUDY DESIGN: Community-based cross-sectional analysis of the relation between symptoms of psychopathology and back pain (BP) or neck pain (NP) in rural southwest Ethiopia. OBJECTIVE: Using data from a community-based sample, we assessed the prevalence and psychopathologic correlates of BP or NP in rural sub-Saharan Africa. SUMMARY OF BACKGROUND DATA: BP and NP are among the most prevalent pain conditions. Psychopathology has been shown to be associated with both BP and NP in developed and urban developing contexts. Little is known about the relation between psychopathology and BP or NP in the rural, developing context. METHODS: Data on self-reported BP and NP, symptoms of depression, anxiety, and post-traumatic stress (PTS), gender, age, and socioeconomic status were collected from a representative cohort sample (N = 900) in rural southwest Ethiopia. We calculated univariate statistics to assess the prevalence of BP and NP. We used bivariate χ2 tests and multivariate logistic regression models to assess the relation between psychopathology and BP and NP. RESULTS: The prevalence of BP was 16.7%; that of NP was 5.0%. In χ2 analyses, symptoms of depression, anxiety, and PTS were significantly associated with increased risk for each outcome. In models adjusted for age, household assets, and gender, depression symptomatology was associated with increased risk for BP (OR = 3.44, 95% CI: 2.37-5.00) and NP (OR = 4.92, 95% CI: 2.49-9.74). Anxiety symptomatology was also associated with increased risk for BP (OR = 2.88, 95% CI: 1.98-4.20) and NP (OR = 2.67, 95% CI: 1.41-5.09). PTS symptomatology was associated with increased risk for BP (OR = 2.89, 95% CI: 1.78-4.69). CONCLUSION: In the first known study about the relation between psychopathologic symptomatology and BP and NP in a rural context in a developing country, the prevalence of BP and NP were comparable to published data in developed and developing countries. Symptoms of depression and anxiety were correlates of BP and NP, and symptoms of PTS were a correlate of BP. Comparative studies about the relation between psychopathology and chronic pain conditions between rural and urban contexts in the global south are needed.

Household food insecurity and symptoms of neurologic disorder in Ethiopia: an observational analysis.

BACKGROUND: Food insecurity (FI) has been shown to be associated with poor health both in developing and developed countries. Little is known about the relation between FI and neurological disorder. We assessed the relation between FI and risk for neurologic symptoms in southwest Ethiopia. METHODS: Data about food security, gender, age, household assets, and self-reported neurologic symptoms were collected from a representative, community-based sample of adults (N = 900) in Jimma Zone, Ethiopia. We calculated univariate statistics and used bivariate chi-square tests and multivariate logistic regression models to assess the relation between FI and risk of neurologic symptoms including seizures, extremity weakness, extremity numbness, tremors/ataxia, aphasia, carpal tunnel syndrome, vision dysfunction, and spinal pain. RESULTS: In separate multivariate models by outcome and gender, adjusting for age and household socioeconomic status, severe FI was associated with higher odds of seizures, movement abnormalities, carpal tunnel, vision dysfunction, spinal pain, and comorbid disorders among women. Severe FI was associated with higher odds of seizures, extremity numbness, movement abnormalities, difficulty speaking, carpal tunnel, vision dysfunction, and comorbid disorders among men. CONCLUSION: We found that FI was associated with symptoms of neurologic disorder. Given the cross-sectional nature of our study, the directionality of these associations is unclear. Future research should assess causal mechanisms relating FI to neurologic symptoms in sub-Saharan Africa.

Firearms in major motion pictures, 1995-2004.

BACKGROUND: Firearms are a major cause of injury and death. We sought to determine (1) the prevalence of movie scenes that depicted firearms and verbal firearm safety messages; (2) the context and health outcomes in firearm scenes; and (3) the association between the Motion Picture Association of America ratings and firearm scene characteristics. METHODS: Ten top revenue-grossing motion pictures were selected for each year from 1995 to 2004 in descending order of gross revenues. Data on firearm scenes were collected by movie coders using dual-monitor computer workstations and real-time collection tools. RESULTS: Seventy of the 100 movies had scenes with firearms and the majority of movies with firearms were rated PG-13. Firearm scenes (N = 624) accounted for 17% of screen time in movies with firearms. Among firearm scenes, crime or illegal activity was involved in 45%, deaths occurred in 19%, and injuries occurred in 12%. A verbal reference to safety was made in 0.8%. CONCLUSIONS: Depictions of firearms in top revenue-grossing movies were common, but safety messages were exceedingly rare. Major motion pictures present an under-used opportunity for education about firearm safety.

Seatbelt and helmet depiction on the big screen blockbuster injury prevention messages?

BACKGROUND: Injuries from vehicle crashes are a major cause of death among American youth. Many of these injuries are worsened because of noncompliant safety practices. Messages delivered by mass media are omnipresent in young peoples' lives and influence their behavior patterns. In this investigation, we analyzed seat belt and helmet messages from a sample of top-grossing motion pictures with emphasis on scene context and character demographics. METHODS: Content analysis of 50 top-grossing motion pictures for years 2000 to 2004, with coding for seat belt and helmet usage by trained media coders. RESULTS: In 48 of 50 movies (53% PG-13; 33% R; 10% PG; 4% G) with vehicle scenes, 518 scenes (82% car/truck; 7% taxi/limo; 7% motorcycle; 4% bicycle/skateboard) were coded. Overall, seat belt and helmet usage rates were 15.4% and 33.3%, respectively, with verbal indications for seat belt or helmet use found in 1.0% of scenes. Safety compliance rates varied by character race (18.3% white; 6.5% black; p = 0.036). No differences in compliance rates were noted for high-speed or unsafe vehicle operation. The injury rate for noncompliant characters involved in crashes was 10.7%. A regression model demonstrated black character race and escape scenes most predictive of noncompliant safety behavior. CONCLUSIONS: Safety compliance messages and images are starkly absent in top-grossing motion pictures resulting in, at worst, a deleterious effect on vulnerable populations and public health initiatives, and, at minimum, a lost opportunity to prevent injury and death. Healthcare providers should call on the motion picture industry to improve safety compliance messages and images in their products delivered for mass consumption.

Informatics and the American College of Surgeons National Surgical Quality Improvement Program: automated processes could replace manual record review.

BACKGROUND: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) provides reliable, risk-adjusted outcomes data using standardized definitions and end points. Collection of the data is time consuming, and the surgical clinical nurse reviewers (SCNRs) can sample only a subset of all surgical cases. We sought to test the feasibility of using an informatics tool to automatically identify postoperative complications stored as free-text documents in our electronic medical record. STUDY DESIGN: We used a locally developed electronic medical record search engine (EMERSE) to build sets of terminology that could accurately identify postoperative complications of both myocardial infarction (MI) and pulmonary embolism (PE) as defined by the ACS-NSQIP. All complications had been previously identified by our SCNRs and these were considered the gold standard. We used 5,894 cases from 2001 to 2004 from our institution's ACS-NSQIP dataset for building the terminology and 4,898 cases from 2005 to 2006 for validation. False-positive cases were then further reviewed manually. RESULTS: We achieved sensitivities of 100.0% and 92.8% for identifying postoperative myocardial infarction and pulmonary embolism, respectively, with somewhat lower specificities of 93.0% and 95.9%, respectively. These results compared favorably with results from the SCNRs, especially because our manual review uncovered cases previously missed. CONCLUSIONS: Informatics has the potential to improve the efficiency and accuracy of chart abstraction by SCNRs for the ACS-NSQIP. Using such tools may eventually allow all cases at an institution to be reviewed rather than a small subset.

The optimum conditions to collect X-ray data from very small samples.

A previous paper [Nave & Hill (2005). J. Synchrotron Rad. 12, 299-303] examined the possibility of reduced radiation damage for small crystals (10 microm and below in size) under conditions where the photoelectrons could escape from the sample. The conclusion of this paper was that higher-energy radiation (e.g. 40 keV) could offer an advantage as the photoelectron path length was greater and less energy would be deposited in the crystal. This paper refines these calculations further by including the effects of energy deposited owing to Compton scattering and the energy difference between the incident photon and the emitted photoelectron. An estimate is given for the optimum wavelength for collecting data from a protein crystal of a given size and composition. Another way of reducing radiation damage from a protein crystal is to collect data with a very short pulsed X-ray source where a single image can be obtained before subsequent radiation damage occurs. A comparison of this approach compared with the use of shorter wavelengths is made.

Use of endovascular coil embolization and surgical clip occlusion for cerebral artery aneurysms.

OBJECT: In recent years, endovascular treatment of cerebral artery aneurysms (CAAs) has received greater attention. The authors evaluated patient demographics, endovascular and surgical approaches, and basic outcomes in the treatment of CAAs in a nationally representative administrative database. METHODS: Using the Nationwide Inpatient Sample from 1998 to 2003, diagnosed CAA coded as either an unruptured or ruptured lesion and treated with surgical clip occlusion, wrapping combined with endovascular repair, or endovascular repair alone was included in the present study. RESULTS: Treatment of CAAs significantly increased for unruptured (from 4036 to 8334 cases, p = 0.002) but not ruptured (from 9330 to 11,269 cases, p = 0.231) lesions. Endovascular treatment of CAAs in particular also increased in patients with unruptured (from 11 to 43%, p < 0.001) and ruptured (from 5 to 31%, p < 0.001) lesions. In 2003, the mortality rate associated with unruptured CAAs treated using clip occlusion (1.36%) or endovascular repair (1.41%) was similar, whereas rate differences were noted between these treatments for ruptured CAAs (12.7% for clip occlusion compared with 16.6% for endovascular repair; p = 0.05). Endovascular treatment of unruptured CAAs was associated with a shorter length of stay (LOS) and higher rate of discharge to home compared with those for clip occlusion. The LOS was also shorter in patients with endovascularly treated ruptured CAAs. Aneurysm type (odds ratio [OR] 10.1, ruptured lesion), patient age (OR 1.28, each 10 years), comorbid conditions (OR 1.08, each condition), and hospital case volume (OR 0.97, each additional case) were significant predictors of death in the regression model. CONCLUSIONS: Endovascular techniques for the treatment of CAAs are being used increasingly in the US, although the majority of patients with this pathological entity still undergo surgical clip occlusion. In cases of unruptured CAAs, endovascular treatment is associated with a shorter LOS and higher discharge-to-home rate. Aneurysm status, patient age, comorbid conditions, and hospital case volume are significant predictors of death. Finally, demographic differences exist between the populations presenting with unruptured or ruptured CAAs.

Epidemiology of aortic aneurysm repair in the United States from 1993 to 2003.

The epidemiology of abdominal aortic aneurysm (AAA) disease has been well described over the preceding 50 years. This disease primarily affects elderly males with smoking, hypertension, and a positive family history contributing to an increased risk of aneurysm formation. The aging population as well as increased screening in high-risk populations has led some to suggest that the incidence of AAAs is increasing. The National Inpatient Sample (1993-2003), a national representative database, was used in this study to determine trends in mortality following AAA repair in the United States. In addition, the impact of the introduction of less invasive endovascular AAA repair was assessed. Overall rates of treated unruptured and ruptured AAAs remained stable (unruptured 12 to 15/100,000; ruptured 1 to 3/100,000). In 2003, 42.7% of unruptured and 8.8% of ruptured AAAs were repaired through an endovascular approach. Inhospital mortality following unruptured AAA repair continues to decline for open repair (5.3% to 4.7%, P = 0.007). Mortality after elective endovascular AAA repair also has statistically decreased (2.1% to 1.0%, P = 0.024) and remains lower than open repair. Mortality rates for ruptured AAAs following repair remain high (open: 46.5% to 40.7%, P = 0.01; endovascular: 40.0% to 35.3%, P = 0.823). These data suggest that the numbers of patients undergoing elective AAA repair have remained relatively stable despite the introduction of less invasive technology. A shift in the treatment paradigm is occurring with a higher percentage of patients subjected to elective endovascular AAA repair compared to open repair. This shift, at least in the short term, appears justified as the mortality in patients undergoing elective endovascular AAA repair is significantly reduced compared to patients undergoing open AAA repair.

Palliative sedation in a southern Appalachian community.

Of 1200 palliative care patients, 28 received palliative sedation. They were more likely than patients without palliative sedation to have an Eastern Cooperative Oncology Group performance status of at least 3, a cancer diagnosis, an expected survival of weeks or less, to have been monitored by the palliative care team for at least 1 week, to have delirium as the cause of decreased communication, to have dyspnea as a non-pain symptom, and to be less able to communicate symptoms. Almost 90% received palliative sedation for at least 24 hours for a median of 3 days (range, 0 to 24 days). Home patients received palliative sedation longer. Symptoms were controlled in 82% and improved in the rest. Sedation developed in 79% but was not required for symptom control in 5. Patient survival from palliative care consultation was a median of 8 days (range, 0 to 32 days).

Safety belt use by law enforcement officers on reality television: a missed opportunity for injury prevention?

BACKGROUND: Although safety belt usage rates are increasing nationwide, motor vehicle crashes (MVCs) remain a leading cause of death for young people and are emerging as a leading cause for police officers specifically. A content analysis was performed on the television show, COPS, to determine on-air safety belt usage rates. METHODS: A sample of 63 unique episodes of the reality-based television series, COPS, was viewed during a 4-month period (September 1, 2005 to January 1, 2006). Episodes had original airing dates ranging from 1990 to 2004. Safety belt usage status was determined per police officer per driving scene (N = 250). A driving scene represented a continuous trip (start to finish) with a total on-camera time exceeding 5 seconds. Scenes with indeterminate safety belt status were excluded. High-speed driving, officer gender, and officer race were also recorded. RESULTS: Of the 203 scenes included, 77 (38%) demonstrated safety belt usage. High-speed driving scenes had higher safety belt usage rates compared with low-speed (48% versus 29%, p = 0.005). More contemporary episodes (1999 to 2004) had higher safety belt usage rates as well (51% versus 28%, p = 0.001). Officer gender and race revealed no significant differences in safety belt usage rates (p = 0.930 and p = 0.900, respectively). CONCLUSIONS: In this popular, reality-based television series, safety belt usage by police officers is extremely low. These findings suggest the need to increase safety belt usage by police officers, especially those filmed for television.