The corticomuscular response to experimental pain via blood flow occlusion when applied to the ipsilateral and contralateral leg during an isometric force task.

Blood flow occlusion (BFO) has been previously used to investigate physiological responses to muscle ischemia, showing increased perceptual effort (RPE) and pain along with impaired neuromuscular performance. However, at present, it is unclear how BFO alters corticomuscular activities when either applied to the exercising or nonexercising musculature. The present study therefore set out to assess the corticomuscular response to these distinct BFO paradigms during an isometric contraction precision task. In a repeated measures design, fifteen participants (age = 27.00 ± 5.77) completed 15 isometric contractions across three experimental conditions; no occlusion (CNTRL), occlusion of the contralateral (i.e., nonexercising) limb (CON-OCC), and occlusion of the ipsilateral (i.e., exercising) limb (IPS-OCC). Measures of force, electroencephalographic (EEG), and electromyographic (EMG) were recorded during contractions. We observed that IPS-OCC broadly impaired force steadiness, elevated EMG of the vastus lateralis, and heightened RPE and pain. IPSI-OCC also significantly decreased corticomuscular coherence during the early phase of contraction and decreased EEG alpha activity across the sensorimotor and temporoparietal regions during the middle and late phases of contraction compared with CNTRL. By contrast, CON-OCC increased perceived levels of pain (but not RPE) and decreased EEG alpha activity across the prefrontal cortex during the middle and late phases of contraction, with no changes observed for EMG and force steadiness. Together, these findings highlight distinctive psychophysiological responses to experimental pain via BFO showing altered cortical activities (CON-OCC) and altered cortical, corticomuscular, and neuromuscular activities (IPS-OCC) when applied to the lower limbs during an isometric force precision task.

Heat flux estimates of power balance on Proto-MPEX with IR imaging.

The Prototype Material Plasma Exposure eXperiment (Proto-MPEX) at Oak Ridge National Laboratory (ORNL) is a precursor linear plasma device to the Material Plasma Exposure eXperiment (MPEX), which will study plasma material interactions (PMIs) for future fusion reactors. This paper will discuss the initial steps performed towards completing a power balance on Proto-MPEX to quantify where energy is lost from the plasma, including the relevant diagnostic package implemented. Machine operating parameters that will improve Proto-MPEX's performance may be identified, increasing its PMI research capabilities.

A Bayesian network model to assess the public health risk associated with wet weather sewer overflows discharging into waterways.

Overflows from sanitary sewers during wet weather, which occur when the hydraulic capacity of the sewer system is exceeded, are considered a potential threat to the ecological and public health of the waterways which receive these overflows. As a result, water retailers in Australia and internationally commit significant resources to manage and abate sewer overflows. However, whilst some studies have contributed to an increased understanding of the impacts and risks associated with these events, they are relatively few in number and there still is a general lack of knowledge in this area. A Bayesian network model to assess the public health risk associated with wet weather sewer overflows is presented in this paper. The Bayesian network approach is shown to provide significant benefits in the assessment of public health risks associated with wet weather sewer overflows. In particular, the ability for the model to account for the uncertainty inherent in sewer overflow events and subsequent impacts through the use of probabilities is a valuable function. In addition, the paper highlights the benefits of the probabilistic inference function of the Bayesian network in prioritising management options to minimise public health risks associated with sewer overflows.

rf improvements for Spallation Neutron Source H- ion source.

The Spallation Neutron Source at Oak Ridge National Laboratory is ramping up the accelerated proton beam power to 1.4 MW and just reached 1 MW. The rf-driven multicusp ion source that originates from the Lawrence Berkeley National Laboratory has been delivering approximately 38 mA H(-) beam in the linac at 60 Hz, 0.9 ms. To improve availability, a rf-driven external antenna multicusp ion source with a water-cooled ceramic aluminum nitride (AlN) plasma chamber is developed. Computer modeling and simulations have been made to analyze and optimize the rf performance of the new ion source. Operational statistics and test runs with up to 56 mA medium energy beam transport beam current identify the 2 MHz rf system as a limiting factor in the system availability and beam production. Plasma ignition system is under development by using a separate 13 MHz system. To improve the availability of the rf power system with easier maintenance, we tested a 70 kV isolation transformer for the 80 kW, 6% duty cycle 2 MHz amplifier to power the ion source from a grounded solid-state amplifier.

The continued development of the Spallation Neutron Source external antenna H- ion source.

The U.S. Spallation Neutron Source (SNS) is an accelerator-based, pulsed neutron-scattering facility, currently in the process of ramping up neutron production. In order to ensure that the SNS will meet its operational commitments as well as provide for future facility upgrades with high reliability, we are developing a rf-driven, H(-) ion source based on a water-cooled, ceramic aluminum nitride (AlN) plasma chamber. To date, early versions of this source have delivered up to 42 mA to the SNS front end and unanalyzed beam currents up to approximately 100 mA (60 Hz, 1 ms) to the ion source test stand. This source was operated on the SNS accelerator from February to April 2009 and produced approximately 35 mA (beam current required by the ramp up plan) with availability of approximately 97%. During this run several ion source failures identified reliability issues, which must be addressed before the source re-enters production: plasma ignition, antenna lifetime, magnet cooling, and cooling jacket integrity. This report discusses these issues, details proposed engineering solutions, and notes progress to date.

Computer simulations for rf design of a Spallation Neutron Source external antenna H- ion source.

Electromagnetic modeling of the multicusp external antenna H(-) ion source for the Spallation Neutron Source (SNS) has been performed in order to optimize high-power performance. During development of the SNS external antenna ion source, antenna failures due to high voltage and multicusp magnet holder rf heating concerns under stressful operating conditions led to rf characteristics analysis. In rf simulations, the plasma was modeled as an equivalent lossy metal by defining conductivity as sigma. Insulation designs along with material selections such as ferrite and Teflon could be included in the computer simulations to compare antenna gap potentials, surface power dissipations, and input impedance at the operating frequencies, 2 and 13.56 MHz. Further modeling and design improvements are outlined in the conclusion.

H(-) ion source developments at the SNS.

The U.S. Spallation Neutron Source (SNS) will require substantially higher average and pulse H(-) beam currents than can be produced from conventional ion sources such as the base line SNS source. H(-) currents of 40-50 mA (SNS operations) and 70-100 mA (power upgrade project) with a rms emittance of 0.20-0.35pi mm mrad and a approximately 7% duty factor will be needed. We are therefore investigating several advanced ion source concepts based on rf plasma excitation. First, the performance characteristics of an external antenna source based on an Al(2)O(3) plasma chamber combined with an external multicusp magnetic configuration, an elemental Cs system, and plasma gun will be discussed. Second, the first plasma measurements of a helicon-driven H(-) ion source will also be presented.

Immune haemolytic anaemia following T cell-depleted allogeneic bone marrow transplantation for chronic myeloid leukaemia: association with leukaemic relapse and treatment with donor lymphocyte infusions.

Immune haemolytic anaemia (IHA) is a recognised complication after allogeneic stem cell transplantation (SCT) and occurs more frequently if marrow cells have been subjected to T cell depletion (TCD). Among 58 consecutive patients who underwent TCD-allogeneic SCT from volunteer unrelated donors for the treatment of CML at the Hammersmith Hospital during a 3-year period (1 March 1996 to 28 February 1999) we identified nine cases of IHA. All patients had a strongly positive direct and indirect antiglobulin test and in eight patients the serological findings were typical of warm-type haemolysis often with antibody specificities within the Rh system. All nine cases had clinically significant haemolysis and were treated initially with prednisolone and immunoglobulin. The onset of IHA coincided with the occurrence of leukaemic relapse in six cases, and the presence of host haemopoiesis confirmed by lineage-specific chimerism in all four cases studied. Five patients received donor lymphocyte infusions (DLI); in three molecular remission and the restoration of full donor chimerism coincided with resolution of haemolysis. We conclude that in the context of leukaemic relapse, DLI is an effective therapy for IHA following allografts involving TCD.

Short Report: Engraftment of T-cell-depleted allogeneic haematopoietic stem cells using a reduced intensity conditioning regimen.

Graft-versus-host disease (GVHD) remains a significant complication in patients undergoing allogeneic stem cell transplantation (SCT) using a reduced intensity conditioning regimen. Although T-cell depletion (TCD) reduces the risk of GVHD after a myeloablative conditioning regimen, it is associated with an increased risk of graft failure. We have therefore examined whether TCD compromises engraftment using a fludarabine-based conditioning regimen. Fifteen patients have been transplanted using such a regimen of whom 13 underwent ex vivo TCD. All but one patient demonstrated durable engraftment and no patient receiving a TCD product developed severe GVHD. Thus, TCD may play a role in GvHD prophylaxis using such regimens.

Evaluation of the benefits of monitoring fluid thickness in the dietary management of dysphagic stroke patients.

OBJECTIVE: Safe swallowing may be achieved in most patients with neurogenic dysphagia by manipulating the viscosity of ingested fluids. However, in clinical practice fluids are thickened using subjective judgement. This may lead to errors in the preparation of drinks to the prescribed viscosity. The aim of the present study is to examine whether the use of a viscometer improves the dietary management of dysphagic stroke patients. STUDY DESIGN: A randomized controlled study design was used. The speech and language therapist determined the optimal fluid thickness for each patient. The prescribed fluid viscosity for the study group was obtained using a viscometer. Patients in the control group received fluids prepared according to current practice, i.e. the amount of thickener required to produce the prescribed viscosity was judged subjectively by the nursing staff. The two methods of fluid thickening were used for seven consecutive days. Assessment was made blind to randomization. MAIN OUTCOME MEASURE: Pulmonary aspiration, assessed clinically and with pulse oximetry. If the patient did not drink all the fluid that was offered the residue was measured. RESULTS: Ten patients in the study group (n = 23) and nine in the control group (n = 23) aspirated. The mean viscosity of fluids offered to patients in the control group was significantly higher than that of the study patients. There was a statistically significant correlation between the viscosity and the residual volume of fluid (Pearson's test: r = 0.7, p <0.02). The findings of the study suggest that fluids prepared by subjectively assessing the amount of thickener required to produce a given consistency tend to have a higher viscosity than those prepared using the viscometer. However, the higher viscosity does not appear to protect against pulmonary aspiration and may lead to a reduced fluid intake. CONCLUSION: Manipulation of fluid thickness using objective measurements with a viscometer may improve the dietary management of dysphagic stroke patients.

Anesthesia for the superior laryngeal nerves and tartaric acid-induced cough.

OBJECTIVE: The internal branch of the superior laryngeal nerve (ibSLN) conveys impulses for the laryngeal cough reflex, which protects the laryngeal aditus and prevents the development of aspiration pneumonia. The purpose of this study was to determine the effect of bilateral anesthesia of the ibSLN on the cough reflex after inhalation of a nebulized chemoirritant solution of tartaric acid. DESIGN: Prospective, clinical investigation. SETTING: Outpatient. PARTICIPANTS: Nine healthy volunteers. INTERVENTIONS: Bilateral injections of 2% lidocaine solution without epinephrine into the paraglottic space containing the ibSLN. MAIN OUTCOME MEASURES: The tidal volume after inhalation of a nebulized 20% tartaric acid solution and forced vital capacity (FVC) were measured before and after injection. Data were analyzed using the Wilcoxon signed ranks, Mann-Whitney, and sign tests. RESULTS: Complete anesthesia of the ibSLN abolished the laryngeal cough reflex. Postinjection tidal volumes were significantly lower than preinjection volumes (p<.01). The decrease in tidal volumes for six subjects with complete bilateral anesthesia was significantly larger than the decrease in tidal volumes for three subjects with partial anesthesia (p<.05). FVC in both the six subjects with complete bilateral anesthesia and the three subjects with partial anesthesia did not significantly change from preinjection to postinjection. None of the subjects in this study had complications or adverse respiratory sequelae. CONCLUSION: Tartaric acid-induced cough may be useful in assessing the integrity of the laryngeal cough reflex after anesthesia or in patients with neurologic injury who are at risk of developing aspiration pneumonia. It may also be useful in making the decision whether to resume oral feeding.

Pharmacokinetics of single oral doses of feprazone in patients with rheumatoid arthritis or with impaired renal clearance.

1. The pharmacokinetics of feprazone have been studied in 10 patients with rheumatoid arthritis (RA), and in a further six patients with renal impairment (RI) who were not suffering from rheumatoid disease. 2. For RA patients, the mean elimination half-life (t1/2) of feprazone after a single oral dose was 21 +/- 5 h (SD), the mean apparent clearance (Cl) was 0.012 +/- 0.009 l/h per kg, and the mean apparent volume of distribution (Vd) was 0.33 +/- 0.17 l/kg. Corresponding values for RI patients were 25 +/- 13 h, 0.016 +/- 0.011 l/h per kg, and 0.46 +/- 0.24 l/kg, respectively. 3. These results show no impairment of the elimination of feprazone in RA or RI patients; Vd and Cl are greater than in healthy young volunteers or elderly subjects, the AUC values are lower, but t1/2 values are similar in all groups. 4. It is suggested that the greater Cl and Vd, and lower AUC, in RA and RI patients may be due to renal insufficiency and decreased plasma protein binding of feprazone and its metabolite, or to induction of glucuronyl transferase activity by the prior medication, thus enhancing the formation of the major metabolite, the C(4)-glucuronide, and increasing drug elimination.

Poisons information services: a look ahead.

1. Following the establishment, in the USA, of the first poisons information centre, in 1953, the movement has grown globally. Originally, such a service was intended to meet an emergency need. Its efficacy has still not been objectively audited. 2. The suggestion now is that clinical toxicology has become such a diverse subject within the community that simply answering emergency calls over the telephone is not enough. Instead, expertly staffed clinical toxicology units should be set up to cater for much wider problems.