The atmospheric X-ray imaging spectrometer (AXIS) instrument: Quantifying energetic particle precipitation through bremsstrahlung X-ray imaging.

The Atmospheric X-ray Imaging Spectrometer (AXIS) described in this work is a compact, wide field-of-view, hard x-ray imager. The AXIS instrument will fly onboard the Atmospheric Effects of Precipitation through Energetic X-rays (AEPEX) 6U CubeSat mission and will measure bremsstrahlung x-ray photons in the 50-240 keV range with cadmium-zinc-telluride (CZT) detectors using coded aperture optics. AXIS will measure photons generated by energetic particle precipitation for the purpose of determining the spatial scales of precipitation and estimating electron precipitation characteristics. This paper describes the design and testing of the AXIS instrument, including a summary of simulations performed that motivate the shielding, optics, and mechanical design. Testing and characterization is reported that validates the instrument design and shows that the instrument design meets or exceeds the measurement requirements necessary for AEPEX mission success.

Evaluation of english and spanish health information on the internet

It provides information on the study of search engines performance, quality of health information on the internet, and readability assessment of health information on the internet.

Health information on the Internet: accessibility, quality, and readability in English and Spanish.

CONTEXT: Despite the substantial amount of health-related information available on the Internet, little is known about the accessibility, quality, and reading grade level of that health information. OBJECTIVE: To evaluate health information on breast cancer, depression, obesity, and childhood asthma available through English- and Spanish-language search engines and Web sites. DESIGN AND SETTING: Three unique studies were performed from July 2000 through December 2000. Accessibility of 14 search engines was assessed using a structured search experiment. Quality of 25 health Web sites and content provided by 1 search engine was evaluated by 34 physicians using structured implicit review (interrater reliability >0.90). The reading grade level of text selected for structured implicit review was established using the Fry Readability Graph method. MAIN OUTCOME MEASURES: For the accessibility study, proportion of links leading to relevant content; for quality, coverage and accuracy of key clinical elements; and grade level reading formulas. RESULTS: Less than one quarter of the search engine's first pages of links led to relevant content (20% of English and 12% of Spanish). On average, 45% of the clinical elements on English- and 22% on Spanish-language Web sites were more than minimally covered and completely accurate and 24% of the clinical elements on English- and 53% on Spanish-language Web sites were not covered at all. All English and 86% of Spanish Web sites required high school level or greater reading ability. CONCLUSION: Accessing health information using search engines and simple search terms is not efficient. Coverage of key information on English- and Spanish-language Web sites is poor and inconsistent, although the accuracy of the information provided is generally good. High reading levels are required to comprehend Web-based health information.

Migraine-associated vomiting and asystole in a child.

A variety of symptoms that accompany migraine in the child and adult are mediated by the autonomic nervous system. Significant effects on cardiac rhythm are uncommon, but can be life threatening. We describe a 3-year-old girl in whom migraine-associated vomiting precipitated cardiac asystole which was effectively treated with a cardiac pacemaker.

Clinical one-year outcomes after stenting in acute myocardial infarction.

We retrospectively review our results of 96 stent placements in 64 patients identified from our data base who received stents acutely and within 48 hr of acute myocardial infarction. The average age was 60 years; 77% were male. The average length of stay was 6.75 days. Three patients needed coronary artery bypass grafting (CABG) before discharge: 2 for stent occlusion and 1 for papillary muscle rupture. Need for CABG, further percutaneous transluminal coronary angioplasty (PTCA), myocardial infarction, and death defined outcome. Mean patient follow-up was 10.3 (+/-5.3) months. Seventy-two percent of patients were free of outcome events at 1 year, 17% needed CABG, and 11% required further PTCA. There were 2 myocardial infarctions and 1 death. Presence of left bundle branch block on admission electrocardiogram and angina in hospital after stent placement predicted worse outcome (P < 0.01).

Supporting future surgical innovation. Lung transplantation as a case study.

OBJECTIVE: Using lung transplantation as a case study, this article addressed the problem of supporting innovative clinical surgery in an era of increasing pressures for cost containment. SUMMARY BACKGROUND DATA: After sporadic attempts at lung transplantation during the 1960s and 1970s, its clinical development began in earnest during the early 1980s. As a result of a wide range of incremental advances, the results have improved significantly. The Health Care Financing Administration, however, has not yet issued a national policy covering lung transplants and has left the coverage decision to the discretion of its regional contractors. METHODS: The authors surveyed the major commercial insurers, the Blue Cross Blue Shield Association, and a sample of Medicare intermediaries to evaluate the coverage of lung transplantation. They also interviewed the National Heart, Lung, and Blood Institute and industrial firms about their support for clinical research. RESULTS: Government and industry funding were limited, and the development and assessment of lung transplants have been financed predominantly by academic institutions through cross-subsidization from patient care and teaching funds. The major private payers and Blue Cross Blue Shield decided to cover this procedure in the early 1990s. Coverage decisions by Medicare intermediaries, however, revealed considerable variability. Moreover, the absence of a specific diagnosis-related group for lung transplants had considerable consequences for institutions in all-payer states, in which payments appeared to be considerably lower than the mean costs of a transplant procedure (about $110,000). CONCLUSIONS: This analysis indicated that there was a growing disparity between the increasing demand for outcomes data about new procedures and the limited resources available for supporting the development and assessment of new operations. It this disparity is not addressed, the rate of surgical innovation may be jeopardized, and timely outcomes data may not be acquired. It was concluded that provisional coverage within a predetermined research protocol may be a promising mechanism to remedy this situation, providing timely assessment of new procedures before widespread application.

Evaluation of surgical procedures. Changing patterns of patient selection and costs in heart transplantation.

During the past 4 years we have observed a marked increase in costs of heart transplantation in our center. This trend coincides with a shift in our recipient population toward the more severely ill patients. The percentage of patients bound for the intensive care unit has doubled. In analyzing the components of cost, we find that the length of stay, both in special care and regular nursing units, accounts for most of the cost increase. In our study of outcomes we find no significant difference in survival, at 1 month and 1 year, between recipients operated on from the intensive care unit and those not in intensive care. We find that at 1 year after transplantation, approximately 80% of patients are rehabilitated, which we define as the ability to work or to go to school. Only 20% of patients are off disability rolls, however, primarily because of problems related to insurance and the cost of continuing care, including drugs. We conclude that the comprehensive evaluation of surgical procedures requires an approach that balances costs with results on a continuing and long-term basis.

[Takayashu disease and pregnancy]. / Maladie de Takayashu et grossesse. A propos d'une observation personnelle.

The case of a patient in whom pregnancy acted as a revelatory circumstance of a previously undetected Takayashu disease (Disease of pulseless women) fas led the authors to examine the few cases reported in the literature, and to conclude in the difficulty of diagnosis, high incidence of obstetrical operations as well as aggravation of long-term prognosis following pregnancy in such patients. Arteriography, decidual membrane biopsy of the uterus and microscopical examination of the placenta, still seldom performed studies, could perhaps help toward a better knowledge of the physiopathology of the accident occuring in these patients.