The Mechanical Response and Tolerance of the Anteriorly-Tilted Human Pelvis Under Vertical Loading.

Military vehicle underbody blast (UBB) is the cause of many serious injuries in theatre today; however, the effects of these chaotic events on the human body are not well understood. The purpose of this research was to replicate UBB loading conditions on the human pelvis and investigate the resulting response in a controlled laboratory setting. In addition to better understanding the response of the human pelvis to high rate vertical loading, this test series also aimed to identify high rate injury thresholds. Twenty-seven post mortem human surrogate (PMHS) component pelvis tests were completed using the University of Virginia's (UVa) simulated blast rig under a range of loading conditions and postures. Of those tests, 17 were in the anteriorly-tilted posture and used to construct the human injury probability curve. Average seat pan (rigid) accelerations for this subset of tests ranged from 300 to 2400 g over 2 to 3 ms of positive phase duration. Post-test computed tomography (CT) scans and necropsies were performed to determine injuries and revealed a frequent occurrence of anterior and posterior injuries, resulting in unstable pelvis ring fractures. The resulting Human Injury Probability Curve (HIPC) yielded mean forces of 5529, 8516, and 12431 N as measured by mass compensated seat platen loadcells applied through the rigid seat to the bilateral ischium are associated with a 10, 25, and 50% risk for unstable pelvic ring sacrum fractures in an anteriorly-tilted pelvis (28° from vertical), respectively.

Identifying the core bacterial and fungal communities within four agricultural biobeds used for the treatment of pesticide rinsates.

AIMS: This study evaluated the variability of bacterial and fungal communities within unique pesticide remediation biobeds. METHODS AND RESULTS: Four biobeds receiving different applied pesticide rinsates, were sampled throughout an operational season to determine pesticide removal efficacy and microbial communities. Biomixture samples collected from different biobed depths, were subjected to Illumina sequencing of the 16S rRNA (bacteria) and ITS2 (fungi) genes. Pesticide removal rates for all biobeds averaged 99%, with microbial community analysis revealing biobeds shared 60-70% of the most abundant bacterial and fungal orders, respectively. Though biobed depth did not greatly impact microbial community profile or diversity, bacterial and fungal taxa profiles between biobeds notably diverge at levels of genera and OTU. Biobed bacterial communities exhibited greater diversity than fungal communities between and within all biobeds. CONCLUSIONS: Biobeds receiving variable pesticide rinsates share a 'core' microbial community, exhibiting greater bacterial diversity relative to fungal diversity. Pesticide exposure increased bacterial diversity throughout the biobeds, while fungal diversity was variable, meriting further understanding of fungicide application to biobed fungal community stability. SIGNIFICANCE AND IMPACT OF THE STUDY: Biobeds achieve high treatment efficacy of unique pesticide rinsates, regardless of differentiation of specific genera in response to specific compounds; supporting biobeds as a robust engineered system for pesticide rinsates bioremediation.

Developing culturally competent marriage and family therapists: guidelines for working with Hispanic families.

As the Hispanic population of the United States continues to grow, so will the need for therapists who have been trained to work with Hispanic families. This content analysis of the available treatment literature generated several specific guidelines that can be used in training and evaluating culturally competent therapists. Guidelines included: Use family therapy, act as advocate for the family, assess immigration experience, assess acculturation, respect father, interview family subsystems separately, do not force changes, provide concrete suggestions, and warmly engage the family. Empirical and conceptual support for each guideline is discussed and several conclusions are made regarding culturally competent therapy with Hispanic families.

The cGMP-specific phosphodiesterase inhibitor E4021 dilates the pulmonary circulation.

We investigated the pulmonary vascular effects of E4021, a potent inhibitor of cGMP-specific phosphodiesterase, in control late-gestation fetal lambs, and in newborn lambs with persistent pulmonary hypertension (PPHN) after prenatal ligation of the ductus arteriosus. E4021 alone significantly relaxed fifth-generation pulmonary arteries isolated from control fetal lambs, an effect completely blocked after inhibition of nitric oxide synthase (NOS). In contrast, E4021 did not relax pulmonary arteries isolated from hypertensive lambs. Pretreatment with E4021 (10(-7) M) significantly enhanced relaxations to the NO donor S-nitrosyl-acetyl-penicilamine (SNAP) in arteries from both control and hypertensive lambs. In control, fully instrumented fetal lambs, infusions of E4021 (31 microgram/min) selectively dilated the pulmonary circulation, an effect again blocked after inhibition of NO synthase. Further studies were performed in newborn lambs with PPHN to study the vascular effects of E4021 alone, and in combination with inhaled NO. E4021 alone (1 to 100 microgram/kg/min) decreased pulmonary artery pressure (Ppa) in a dose-dependent fashion, and had minimal effect on systemic pressure. At the highest dose (100 microgram/kg/min), the dilation was selective for the pulmonary circulation. In subsequent protocols, E4021 (10 microgram/kg/min) significantly decreased Ppa and pulmonary vascular resistance (PVR), but these pulmonary vascular effects were not enhanced after NO inhalation at 0.5 or 5 ppm. We speculate that the lack of enhancement was due to the dramatic effects of E4021 alone. Potent, specific phosphodiesterase inhibitors such as E4021 may prove to be useful in the treatment of PPHN.

Percent-of-premium capitation yields mixed results in a Rhode Island case study.

In 1996, Harvard Pilgrim Health Care of New England (HPHC-NE) established six percent-of-premium arrangements with five Rhode Island PHOs. Each PHO received a percentage of the regional earned premium amounts for members who selected a primary care physician affiliated with it, adjusted for member demographics, benefit differences, and group size. Each of these six joint venture agreements also incorporated a per-member-per-month capitation fee. Despite improved communication between the PHOs and the plan and inpatient utilization reductions, all six joint ventures experienced losses beyond the withhold amounts during the first year of the arrangement. Factors affecting the medical utilization and financial results included market pressure on premium levels; risk pool size and adverse selection; and lack of timely, complete, and reliable financial and utilization data.

18F-2-deoxyglucose deposition and regional flow in pigs with chronically dysfunctional myocardium. Evidence for transmural variations in chronic hibernating myocardium.

BACKGROUND: Hibernating myocardium in patients with collateral-dependent myocardium is characterized by relative reductions in resting flow and increases in the uptake of 18F-2-deoxyglucose (FDG) in the fasting state. We performed the present study to examine whether these key physiological alterations could be produced in a porcine model of chronic coronary occlusion and to assess whether the adaptations consistent with hibernation varied across the myocardial wall. METHODS AND RESULTS: We chronically instrumented pigs (n = 18) with a fixed occluder on the proximal left anterior descending coronary artery (LAD). Three months later, ventricular function, regional myocardial perfusion, and FDG deposition (by excised tissue counting or positron emission tomography) were assessed in pigs after an over-night fast in the closed-chest anesthetized state. Total LAD occlusion with angiographic collaterals was present in the majority of animals. Left ventriculography showed severe anterior hypokinesis, and resting perfusion was significantly reduced in the hibernating LAD region in comparison with the normal remote regions (subendocardium: 0.80 +/- 0.06 versus 1.07 +/- 0.06 mL.min-1.g-1, P < .001; full-thickness: 0.87 +/- 0.04 versus 0.99 +/- 0.06 mL.min-1.g-1, P < .01). There was a twofold increase in full-thickness fasting FDG uptake in the dysfunctional LAD region (1.8 +/- 0.2 by positron emission tomography versus 1.9 +/- 0.1 by ex vivo counting). Ex vivo tissue counting revealed a pronounced transmural variation in FDG uptake in the hibernating region (LAD/normal), which averaged 2.5 +/- 0.2 in the subendocardium, 1.9 +/- 0.2 in the midmyocardium, and 1.4 +/- 0.1 in the subepicardium. CONCLUSIONS: These results demonstrate that pigs instrumented with a proximal LAD stenosis develop hibernating myocardium characterized by relative reductions in resting function and perfusion in association with increased uptake of FDG in the fasting state. The transmural variations in relative resting flow and FDG uptake suggest that myocardial adaptations consistent with hibernation are most pronounced in the subendocardial layers and vary in relation to local coronary flow reserve.

Identification of candidate proteins binding to prion protein.

Prion diseases are disorders of protein conformation that produce neurodegeneration in humans and animals. Studies of transgenic (Tg) mice indicate that a factor designated protein X is involved in the conversion of the normal cellular prion protein (PrPC) into the scrapie isoform (PrPSc); protein X appears to interact with PrPC but not with PrPSc. To search for PrPC binding proteins, we fused PrP with alkaline phosphatase (AP) to produce a soluble, secreted probe. PrP-AP was used to screen a lambdagt11 mouse brain cDNA library, and six clones were isolated. Four cDNAs are novel while two clones are fragments of Nrf2 (NF-E2 related factor 2) transcription factor and Aplp1 (amyloid precursor-like protein 1). The observation that PrP binds to a member of the APP (amyloid precursor protein) gene family is intriguing, in light of possible relevance to Alzheimer's disease. Four of the isolated clones are expressed preferentially in the mouse brain and encode a similar motif.

Control of physiological phenomena via hypnosis with special reference to contraception.

PIP: Hypnotic suggestion has been demonstrated to facilitate changes in the physiology of the human body, particularly with reference to the autonomic nervous system and homeostasis. Examples of suggestion modifying the physical condition include regulation of the menstrual cycle, promotion of lactation in the nursing mother, inhibition of pain, inhibition of blood flow after surgery, hypnotically induced abortion, mammary augmentation and reduction of scar tissue. It is hypothesized that a continuous intercell communication system may inform the individual cell of its need to adapt in order to survive. Hypnotic contraception is postulated to make use of the existing neuronal systems concerned with survival. As a result, a woman may render herself sterile to a fertilized ovum. 5 criteria are desirable for hypnotic contraception: 1) a good hypnotic subject, able to reach medium to deep stage; 2) the absence of conditioned blocks that may counteract the process; 3) genuine desire on the part of the patient not to conceive; 4) sufficient intelligence to guarantee some understanding of the process; and 5) a relatively well adjusted patient. After hypnosis is achieved, the patient is told: "You will now realize that you are in control of the reproductive system of your body; you have decided for the time being it is inadvisable to conceive (for whatever reason given by the patient). You will now find you are able to conceive only when you have made a conscious decision to do so having regard to all circumstances at the time."^ieng

Deep vein thrombosis after thoracotomy.

In a prospective study of 183 patients undergoing lateral thoracotomy the 125 I fibrinogen uptake test and perioperative heparin prophylaxis for deep-vein thrombosis were investigated. There was an incidence of deep vein thrombosis in 51% in untreated control patients. The heparin prophylaxis effectively reduced the incidence of deep venous thrombosis to 28% (P less than 0.005) without increasing postoperative blood loss. Unilateral thrombosis was found to be significantly more frequent in the leg opposite the side of the thoracotomy (P less than 0.005). The 125I fibrinogen test is essential in assessing methods of prophylaxis but is not recommended as a routine.

A graphic display system for use with a computerized tomographic scanner.

A system for the display and analysis of computerized axial tomography scans has been developed. Selected regions of scans can be outlined using a joystick, allowing rapid statistical analysis. The difference between two scans can be displayed, and coronal and sagittal sections as well as projected displays, can be produced from a series of transverse sections. A special purpose software system has been developed to allow programming on a logical level. The system is used both for the analysis of current scans and the retrospective accumulation of data from past scans.

The analysis of radioisotope brain scans by comparison with normal patterns of uptake.

A previously described method for the computer analysis of radioisotope brain scans has been further developed. A patient scan is matched with a series of "normal" scans to find the closest fit and the "normal" scan is then subtracted from the patient scan. The results are displayed in terms of the standard deviation from the normal. In a clinical trial the computer assessments were found to be less accurate than those of two groups of observers. One reason for these disappointing results is related to the simple criteria used to choose and fit the best "normal" to a particular patient scan. A second reason is the optimization of the scanner/photoscan combination to 99Tcm pertechnetate as a brain scanning agent which results in patient-to-patient variation becoming more important. This reduces the potential of a simple numerical analysis to improve results.