Indications of proton-dominated cosmic-ray composition above 1.6 EeV.

We report studies of ultrahigh-energy cosmic-ray composition via analysis of depth of air shower maximum (X(max)), for air shower events collected by the High-Resolution Fly's Eye (HiRes) observatory. The HiRes data are consistent with a constant elongation rate d/d[log(E)] of 47.9+/-6.0(stat)+/-3.2(syst) g/cm2/decade for energies between 1.6 and 63 EeV, and are consistent with a predominantly protonic composition of cosmic rays when interpreted via the QGSJET01 and QGSJET-II high-energy hadronic interaction models. These measurements constrain models in which the galactic-to-extragalactic transition is the cause of the energy spectrum ankle at 4x10(18) eV.

First observation of the Greisen-Zatsepin-Kuzmin suppression.

The High Resolution Fly's Eye (HiRes) experiment has observed the Greisen-Zatsepin-Kuzmin suppression (called the GZK cutoff) with a statistical significance of five standard deviations. HiRes' measurement of the flux of ultrahigh energy cosmic rays shows a sharp suppression at an energy of 6 x 10(19) eV, consistent with the expected cutoff energy. We observe the ankle of the cosmic-ray energy spectrum as well, at an energy of 4 x 10(18) eV. We describe the experiment, data collection, and analysis and estimate the systematic uncertainties. The results are presented and the calculation of the statistical significance of our observation is described.

Measurement of the flux of ultrahigh energy cosmic rays from monocular observations by the High Resolution Fly's Eye experiment.

We have measured the cosmic ray spectrum above 10(17.2) eV using the two air-fluorescence detectors of the High Resolution Fly's Eye observatory operating in monocular mode. We describe the detector, phototube, and atmospheric calibrations, as well as the analysis techniques for the two detectors. We fit the spectrum to a model consisting of galactic and extragalactic sources.

Guidelines for safe disposal of unwanted pharmaceuticals in and after emergencies.

It provides advice on the implementation of safe disposal of unusable pharmaceuticals in emergencies and in countries in transition where official assistance and advice may not be available.

Triage of war wounded: the experience of the International Committee of the Red Cross.

The hospitals of the International Committee of the Red Cross are often faced with situations in which the number of war wounded requiring surgical attention overwhelms the available facilities. Hospital organization, equipment and changes of attitude necessary for health professionals are considered with respect to triage. Practical aspects of assessment and categorization of the wounded are considered in the light of a large experience; relocation and reassessment of those who do not warrant immediate surgery benefit patients and hospital staff alike. The importance of adherence to an emergency plan and respect for the decisions of the person in charge of the triage are emphasized. The difficult and stressful nature of triage of war wounded should always be taken into account.

Major thoracic surgery during active tetanus.

This report describes the anaesthetic and intensive care management of a patient who had a thoracotomy during active tetanus. The dilemmas which faced the clinicians involved with the case are discussed.

A randomised comparison of polydioxanone (PDS) and polypropylene (Prolene) for abdominal wound closure.

Two hundred and eighty four patients undergoing laparotomy by vertical incision were randomly allocated to closure with interrupted mass sutures of No. 1 polydioxanone (PDS) or No. 1 polypropylene (Prolene). Dehiscence occurred in 0.7% of the PDS group but in 6.4% of the Prolene group (P = 0.018). Wound infection occurred in 8.6% of the PDS group and 15.4% of the Prolene group (P = 0.1). One hundred and ninety patients attended for review at a minimum of one year. Incisional herniation, usually asymptomatic, was present in 11% of each group. Knots were palpable in 2% of the PDS patients but in 12% of the Prolene: wound pain occurred in 12% of the PDS group but in 23% of the Prolene group (P = 0.06). These results suggest that PDS may be useful for abdominal closure.

Abdominal wound closure: a trial of Prolene and Dexon.

The incidence of wound infection, burst abdomen and incisional herniation after a vertical abdominal incision was studied in a prospective trial comparing polypropylene (Prolene) with polyglycolic acid (Dexon). Wounds were closed by interrupted mass suture with an optional reinforcing continuous closure of the anterior rectus sheath. A total of 347 patients was studied, randomly allocated to suture with either Prolene or Dexon. The two groups were well matched for known risk factors. Dehiscence occurred in 0.6 per cent of patients overall and at 6 months 5.7 per cent of cases had an incisional hernia, although many of these were asymptomatic. There was no difference in the rate of infection, disruption or herniation between the two suture materials.

alpha-globulin follicular fluid proteins within small and large bovine follicles.

Fluids from small (FF-S) and large (FF-L) bovine ovarian follicles were observed electrophoretically for differences in the alpha-globulin protein profile. FF-L possessed a fast migrating alpha-globulin 3 and a greater percentage of FF-L samples contained a higher number of alpha-globulin bands.

Plasma diazepam concentrations following prolonged administration.

Plasma diazepam and N-desmethyl diazepam concentrations were measured in patients receiving diazepam 5 mg or 10 mg i.v. at 4-h intervals for periods of 6-22 days. At both doses there was an accumulation of both diazepam and its metabolite, the latter reaching concentrations of up to two to three times that of the parent drug. Plasma diazepam concentrations reached a plateau after 8 days while the concentration of N-desmethyl metabolite continued to increase throughtout the period of drug administration. On discontinuation of diazepam therapy both diazepam and N-desmethyl diazepam concentrations decreased slowly, the former with a half-life of 2-4 days and the latter with a half-life of 4-8 days.

Lorazepam as a sedative-amnesic in an intensive care unit.

A clinical study was carried out to evaluate the usefulness of intravenous lorazepam, given for sedation instead of opiate narcotics or diazepam, in 25 seriously-ill patients being treated in a respiratory and intensive care unit. All but 3 patients were on assisted ventilation. Standard doses of 4 mg lorazepam were given at 4 or 6-hourly intervals for periods up to 25 days. ECG, haemodynamic stability and biological determinations were monitored constantly. Apart from some delay in onset of action, lorazepam proved to be a useful sedative with diminished recall on the part of the patients. No side-effects were reported, nor was there any local reaction to the injection. Cardiac output was measured in 9 patients following intravenous administration of a single-dose of either 4 mg or 8 mg lorazepam. No significant changes were recorded.

Potential of elastin and collagen as initiators of in vivo calcification.

The osseous repair response of the guinea pig to purified bovine elastin from ligamentum nuchae and decalcified rat femur collagen was studied by implantation of these materials into an extraction socket. A nylon mesh tube was used to carry the respective implant materials to place, and in one group of animals only the nylon tube was implanted, thereby serving as a control for the study. Neither the collagen or elastin matrix appeared to elicit an immune rejection response from the host animal. Histologic and quantitative results indicated that collagen implants accelerated the osseous repair of the extraction socket. Elastin implants, which characteristically resulted in ossicle formation, did not appear to accelerate healing, but the results were quantitatively similar to those in the experimental control animals.