The blood acid base and gastrointestinal response to three different forms of sodium citrate encapsulation.

Enterically coated (ENT) or delayed-release (DEL) capsules may lessen gastrointestinal symptoms (GIS) following acute sodium citrate (SC) ingestion, although the effects on blood acid-base balance are undetermined. Fourteen active males ingested 0.4 g.kg-1 body mass (BM) SC, within gelatine (GEL), DEL and ENT capsules or 0.07 g.kg-1 BM sodium chloride control (CON). Blood acid-base balance and GIS were measured for 4 h. Ingestion form had no significant effect on total GIS experienced (GEL: 2 ± 7; DEL: 1 ± 8; ENT: 1 ± 4 AU). Most (7/14) participants experienced zero symptoms throughout. Peak GIS typically emerged ≤100 min post-ingestion, with a similar time to reach peak GIS between ingestion form (GEL: 36 ± 70; DEL: 13 ± 28; ENT: 15 ± 33 AU). Blood [HCO3-] was significantly higher with ENT versus GEL (ENT: 29.0 ± 0.8; GEL: 28.5 ± 1.1 mmol.L-1, P = 0.037). Acute ingestion of a reduced SC dose elicited minimal GIS, producing significant changes in blood [HCO3-] from rest, irrespective of ingestion form (GEL: 6.0 ± 0.9; DEL: 5.1 ± 1.0; ENT: 6.2 ± 0.8 mmol.L-1). The necessity of individualized ingestion strategies is also challenged, with sustained increases in blood [HCO3-] of ≥4 mmol.L-1 for up to 153 min highlighted. If commencing exercise at peak alkalosis augments subsequent performance above starting at a standardized time point where HCO3- is still elevated remains unclear.

Spatio-temporal distribution and agroecological factors associated with canine leptospirosis in Great Britain.

Leptospirosis is an important global zoonotic disease that affects a wide range of mammalian species. Canine leptospirosis outbreaks have been reported after metereological events such as flooding (eg. in Brazil and the United States of America) suggesting an environmental association, but there has been no such study in Great Britain (GB). The distribution of cases across GB is also unreported. Objectives of this study were to: (1) assess the spatio-temporal variation of leptospirosis test submissions (2) explore associations between agroecological risk factors and distribution of different canine leptospirosis serogroups in GB, and (3) generate probability of presence maps for the different serogroups. Data analysed comprised laboratory submissions (n = 3986) to IDEXX laboratories between 1st January 2009 and 31st December 2018 for PCR or MAT leptospirosis testing. Spatial and seasonal scan statistics were used to investigate spatial and temporal clustering of positive tests, logistic regression was used to identify significant agroecological risk factors for positive tests, and the Maxent algorithm was used to model the environmental niche of four serogroups. There was an increased risk of a positive test result in the West Midlands of England (relative risk = 2.16) and between October and January (relative risk = 1.54). Logistic regression identified season and region to be significantly associated with a positive diagnosis,with higher odds of a positive test in Autumn (OR = 1.86 95 %CI 1.29-2.69) and Winter (OR = 1.51, 95 %CI 1.02-2.23) and in the East (OR = 2.20, 95 %CI = 1.31-3.71) and West Midlands (OR = 2.32, 95 %CI 1.45-3.71). The increased test-positive proportion in Autumn together with the increased odds of a positive diagnosis in Autumn suggests there may be a seasonal pattern to the canine leptospirosis in GB. The most important variable associated with higher leptospirosis presence in all ecological niche models was higher average annual temperature. The importance and retention of other variables differed between serogroups. Overall, a higher probability of leptospirosis presence was predicted in southern England and a low probability in Scotland and northern England. Although leptospirosis vaccine usage provides protection against the majority of serogroups identified here, one is not represented in the currently licensed vaccine formulations and therefore leptospirosis should remain a differential diagnosis in vaccinated dogs demonstrating consistent clinical signs of the disease.

Graphene oxide nanocapsules within silanized hydrogels suitable for electrochemical pseudocapacitors.

Soft biocompatible gels comprised of rolled up graphene oxide nanocapsules within the pores of silanized hydrogels may be used as electrochemical pseudocapacitors with physiological glucose or KOH as a reducing agent, affording a material suitable for devices requiring pulses with characteristic time less than a second.

Development and evaluation of a new simulation model for interactive training of the medical response to major incidents and disasters.

BACKGROUND AND AIMS: The need for and benefit of simulation models for interactive training of the response to major incidents and disasters has been increasingly recognized during recent years. One of the advantages with such models is that all components of the chain of response can be trained simultaneously. This includes the important communication/coordination between different units, which has been reported as the most common cause of failure. Very few of the presently available simulation models have been suitable for the simultaneous training of decision-making on all levels of the response. In this study, a new simulation model, originally developed for the scientific evaluation of methodology, was adapted to and developed for the postgraduate courses in Medical Response to Major Incidents (MRMI) organized under the auspices of the European Society for Trauma and Emergency Surgery (ESTES). The aim of the present study was to describe this development process, the model it resulted in, and the evaluation of this model. METHODS: The simulation model was based on casualty cards giving all information normally available for the triage and primary management of traumatized patients. The condition of the patients could be changed by the instructor according to the time passed since the time of injury and treatments performed. Priority of the casualties as well as given treatments could be indicated on the cards by movable markers, which also gave the time required for every treatment. The exercises were run with real consumption of time and resources for all measures performed. The magnetized cards were moved by the trainees through the scene, through the transport lines, and through the hospitals where all functions were trained. For every patient was given the definitive diagnosis and the times within certain treatments had to be done to avoid preventable mortality and complications, which could be related to trauma-scores. RESULTS: The methodology was tested in nine MRMI courses with a total of 470 participants. Based on continuous evaluations and accumulated experience, the setup of the simulation was step-wise adjusted to the present model, including also collaborating agencies such as fire and rescue services as well as the police, both on-scene and on superior command levels. The accuracy of the simulation cards for this purpose was evaluated as "very good" by 63 % of the trainees and as "good" by 33 %, the highest two of the six given alternatives. The participants' ranking of the extent that the course increased their competencies related to the given objectives on a 1-5 scale for prehospital staff had an average value of 4.25 ± 0.77 and that for hospital staff had an average value of 4.25 ± 0.72. The accuracy of the course for the training of major incident response on a 1-5 scale by prehospital staff was evaluated as 4.35 ± 0.73 and that by hospital staff as 4.30 ± 0.74. CONCLUSIONS: The simulation system tested in this study could, with adjustments based on accumulated experience and evaluations, be developed into a tool for the training of major incident response meeting the specific demands on such training based on recent experiences from major incidents and disasters. Experienced trainees in several courses evaluated the methodology to be accurate for this training, markedly increasing their perceived knowledge and skills in fields of importance for a successful outcome of the response to a major incident.

Hard-x-ray lensless imaging of extended objects.

We demonstrate a hard-x-ray microscope that does not use a lens and is not limited to a small field of view or an object of finite size. The method does not suffer any of the physical constraints, convergence problems, or defocus ambiguities that often arise in conventional phase-retrieval diffractive imaging techniques. Calculation times are about a thousand times shorter than in current iterative algorithms. We need no a priori knowledge about the object, which can be a transmission function with both modulus and phase components. The technique has revolutionary implications for x-ray imaging of all classes of specimen.

A wide-aperture dynamically focusing sagittal monochromator for X-ray spectroscopy and diffraction.

A scanning dynamically focusing sagittal X-ray monochromator accepting 7 mrad of the fan from a 6 T wiggler is in routine use on beamline 16.5 (ultra-dilute spectroscopy) of the SRS at CCLRC Daresbury Laboratory, UK. The energy range covered is 7-27 keV, with a horizontal spot size of <1.1 mm FWHM. Measured monochromatic flux from a Si 220 crystal pair is 1 x 10(11) photons s(-1) (100 mA)(-1) at 9 keV. This level of flux, usually associated with an insertion device on a third-generation source, permits collection of EXAFS data on concentrations at or below 10 ppm.

Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury.

We prospectively studied the characteristics and early recovery of an unselected population of patients who had acute first-time lateral patellar dislocation. The recovery program used standardized rehabilitation, emphasizing range of motion, muscle strength, and return of function. Patients returned to stressful activities including sports as tolerated when they regained full passive range of motion, had no effusion, and when quadriceps muscle strength was at least 80% compared with the noninjured limb. Seventy-four patients met the enrollment criteria; 37 men and 37 women. The average age was 19.9 years, and preinjury sports participation was similar to that of ligament-injury patients. Four percent of patients (N = 3) had a history of birth complications, 3% (N = 2) had a history of lower extremity problems as an infant or child, and 9% (N = 7) had a family history of patellar dislocation. Radiographs revealed a 50% incidence (N = 37) of patella alta; all patients demonstrated lateral patellar overhang. Patients regained range of motion (mean, 0 degrees to 132 degrees) by 6 weeks. Sports participation remained significantly reduced throughout the first 6 months after injury, with the greatest limitations in kneeling and squatting. At 6 months, 58% of patients (N = 43) noted limitation in strenuous activities. The patients who had acute primary patellar dislocation were young and active. Most injuries occurred during sports, and few patients had abnormal physical features, contradicting any stereotype of an overweight, sedentary, adolescent girl whose patella dislocates with little or no trauma.

Iron in the basal ganglia in Parkinson's disease. An in vitro study using extended X-ray absorption fine structure and cryo-electron microscopy.

Iron is found in high concentration in some areas of the brain, and increased iron in the substantia nigra is a feature of Parkinson's disease. The purpose of this study was to investigate the physical environment of brain iron in post-mortem tissue to provide information on the possible role of iron in neurodegeneration in Parkinson's disease. Iron has also been implicated as the cause of signal loss in areas of high brain iron on T2-weighted MRI sequences. Knowledge of the physical environment of the brain iron is essential in interpreting the cause of signal change. Post-mortem tissue was obtained from six cases of Parkinson's disease and from six age-matched controls. Iron levels were measured using absorption spectrophotometry. Extended X-ray absorption fine structure was used to evaluate the atomic environment of iron within the substantia nigra and both segments of the globus pallidus. Cryo-electron transmission microscopy was used to probe the iron storage proteins in these areas. Iron levels were increased in the parkinsonian nigra and lateral portion of the globus pallidus. Spectra from the extended X-ray absorption fine structure experiments showed that ferritin was the only storage protein detectable in both control and parkinsonian tissue in all areas studied. Cryo-electron transmission microscopy studies showed that ferritin was more heavily loaded with iron in Parkinson's disease when compared with age-matched controls. In summary we have shown that iron levels are increased in two areas of the brain in Parkinson's disease including the substantia nigra, the site of maximal neurodegeneration. This produces increased loading of ferritin, which is the normal brain iron storage protein. It is possible that increased loading of ferritin may increase the risk of free radical-induced damage. Differences in ferritin loading may explain regional differences in iron's effect on the T2 signal.

Psychophysiological manifestations of anxiety in patients undergoing electrophysiology studies.

OBJECTIVE: To measure state anxiety and related physiological correlates at 3 selected times when patient education regarding electrophysiology (EP) studies is likely to occur: 24 hours before the EP study (pre-procedure teaching), 1 hour before the EP study (reinforcement of pre-procedure teaching), and 3 hours after the EP study (explanation of results; reinforcement of post-procedure instructions). DESIGN: Descriptive-exploratory. SETTING: Military medical treatment facility in mid Atlantic region. SUBJECTS: Thirty-two adults who underwent initial EP testing. OUTCOME MEASURES: The Spielberger State Anxiety score, frontalis muscle tension, heart rate, electrodermal activity, electrothermal feedback, and mean arterial pressure. METHODS: Outcome measures were obtained 1 day before (time 1), 1 hour before (time 2), and 3 hours after (time 3) the EP study. RESULTS: Both state anxiety scores and physiological variables indicated minimal psychophysiological reactivity. CONCLUSION: Patients undergoing initial EP studies experience moderate state anxiety and manifest a paradoxical pattern of autonomic responses over time. Moderate levels of state anxiety at each of the 3 assessment points would seem to indicate that patient education is appropriate at these times.

Initial data from the 30-element ORTEC HPGe detector array and the XSPRESS pulse-processing electronics at the SRS, Daresbury Laboratory.

Following the completion of the collaborative project between CLRC Daresbury Laboratory and EG&G ORTEC to develop the world's first 30-element HPGe detector for fluorescence XAFS, it has now been tested and commissioned at the SRS. The system was commissioned with the XSPRESS digital pulse-processing electronics and this has demonstrated processed count rates in excess of 10 MHz. Initial data have been recorded and are presented.

Possibilities for unexplained chronic illnesses among reserve units deployed in Operation Desert Shield/Desert Storm.

Because Armed Forces Reserve members, especially combat support units, were rapidly mobilized during Operation Desert Shield/Desert Storm, they were at higher risk for anxiety and stress-related disorders. Personnel in reserve units in the military force structure are at greater risk for psychologic stress due to rapid mobilization and demobilization, which allows minimal time to process adverse experiences or fears. The unexpected disruption of families and careers and resulting financial pressures are magnified in older age groups who have increased personal and family commitments. Personnel in combat support units are at greatest risk when they lack necessary training, cohesion, and leadership. Prevention efforts in reserve units should involve education regarding the potential for activation and associated disruption of family and career plans. Support networks for reserve families should be encouraged. Additional training in an appropriate context regarding risks of biologic and chemical exposure, with the goal of developing confidence in training and equipment, should be stressed. Finally, group processing before demobilization and recall within 90 days of return to emphasize unit cohesion and readjustment to civilian life may be of benefit.

Combined injuries of the anterior cruciate and medial collateral ligaments of the knee. Effect of treatment on stability and function of the joint.

We performed a retrospective study of sixty-six patients (forty-one male and twenty-five female) who had a combined injury of the anterior cruciate and medial collateral ligaments. Our purpose was to determine the prevalence of late valgus instability of the knee. The mean age of the patients was thirty-five years (range, sixteen to sixty-three years). The mean follow-up interval was forty-five months (range, twenty-one to 108 months). Twenty patients had been injured while snow-skiing; twenty-four, during other sports activities; seven, in a motor-vehicle accident; and the remaining fifteen, during activities of daily living. Eleven patients had reconstruction of the anterior cruciate ligament and repair of the medial collateral ligament, thirty-three had reconstruction of only the anterior cruciate ligament, and twenty-two were managed non-operatively. There was no evidence of valgus instability on clinical examination at the most recent follow-up visit. However, there was evidence of instability on stress roentgenograms of the knee in eight (13 per cent) of sixty patients. With the numbers available, we could detect no relationship between the presence of valgus instability and the method of treatment of the ligamentous tears ( p > 0.4). We also compared the results for twenty-one of the thirty-three patients who had a combined ligamentous injury and reconstruction of only the anterior cruciate ligament with those for thirty-seven patients who had reconstruction of an isolated tear of the anterior cruciate ligament. After a mean follow-up interval of thirty-five months (range, twenty-one to sixty-six months), there was no difference in the anterior displacement, impairment of function, level of participation in sports activities, results of the one-leg-hop for distance test, or strength as determined by testing on a Cybex machine. On the basis of the findings in this study, we believe that, when there is mild or moderate valgus instability, an injury of the medial collateral ligament does not need to be repaired when the anterior cruciate ligament is repaired after a combined ligamentous injury.

Quick Fluorescence-EXAFS: an Improved Method for Collection of Conventional XAFS Data, an Improved Method for Collection of Conventional XAFS Data and for Studying Reaction Intermediates in Dilute Systems.

The quick EXAFS (QuEXAFS) technique provides an alternative way of recording X-ray absorption fine-structure (XAFS) data where the scan time is reduced by moving the monochromator at a constant angular speed and recording the data ;on the fly'. Results are presented to show that the use of fluorescence detection with QuEXAFS is eminently suitable for studying reactions in dilute systems such as metalloproteins at a sub-minute time scale. In addition, we show that the fluorescence-QuEXAFS technique can reduce the overall time for normal data collection by some 50% compared with conventional step-by-step scanning EXAFS using the same optical system, thus reducing the total X-ray exposures of the samples. The use of X-rays for studying in situ redox reactions is demonstrated.

Fate of the ACL-injured patient. A prospective outcome study.

We followed 292 patients who had sustained an acute traumatic hemarthrosis for a mean of 64 months. The KT-1000 arthrometer measurements within 90 days of injury revealed the injured knee was stable in 56 patients and unstable in 236. Forty-five unstable patients had an ACL reconstruction within 90 days of injury. Surgical procedures performed > 90 days after injury included ligament reconstruction in 46 patients. Factors that correlated with patients who had late surgery for a meniscal tear or an ACL reconstruction (P < 0.05) were preinjury hours of sports participation, arthrometer measurements, and patient age. Follow-up data are presented for the patients divided into four groups: I, early stable, no reconstruction; II, early unstable, no reconstruction; III, early reconstruction; and IV, late reconstruction. No patient changed occupation because of the knee injury. Hours per year of sports participation and levels of sports participation decreased in all groups. Joint arthrosis was documented by radiograph and bone scan. Joint surface injury abnormalities observed at surgery and meniscal surgery showed greater abnormalities by radiograph and bone scan scores (P < 0.05). Reconstructed patients had a higher level of arthrosis by radiograph and bone scan.