Effect of arm position on image quality and radiation dose during thorax and abdomen computed tomography scans.

INTRODUCTION: During Computed Tomography (CT) scans of the Thorax-Abdomen-Pelvis (TAP) the patient's arms should be positioned above the head to obtain optimal image quality and expose the patient to the lowest possible radiation dose. This may be impossible with patients with shoulder problems leading to arms being positioned in other ways. This study aimed to investigate differences in objective image quality and estimated effective dose (E), when positioning the arms below shoulder level in CT-TAP. METHODS: An anthropomorphic phantom with cadaver arms was used. Four arm positions were tested: Along the torso (A), on the pelvis (B), on a pillow on the pelvis (C), and one arm on pillow on the pelvis and the other arm on the pelvis (D). A Siemens SOMATOM Definition Flash CT-scanner with CareDose 4D was used. The dose length product was read to estimate E. Image quality was assessed objectively by measuring noise within the region of interest in the liver and urinary bladder. RESULTS: Significant differences in E between all arm positions were seen (p = 0.005). The lowest E was obtained in position C, reducing E by 8.42%. Position A provided the best image quality but the highest E. CONCLUSION: This study showed no unequivocal optimal positioning of arms in CT-TAP. Position A provided the best object image quality, while position C yielded the lowest E. These results may impact the planning of diagnostic CT where positioning of arms may influence optimal image quality and radiation dose. IMPLICATION FOR PRACTICE: This study illustrates tendencies for objective image quality and E when arms are positioned below shoulder level. Further research is needed to assess the clinical relevance with the diagnostic potential.

Mineral Fertilizer and Manure Effects on Leached Inorganic Nitrogen, Nitrate Isotopic Composition, Phosphorus, and Dissolved Organic Carbon under Furrow Irrigation.

A better understanding of nutrient leaching in furrow irrigated agriculture is needed to optimize fertilizer use and avoid contamination of water supplies. In this field study (2003-2006), we measured deep percolation fluxes at 1.2-m depth and associated nutrient concentrations and mass losses from dairy manure nitrogen (N) or mineral N (urea, sodium nitrate [NaNO])-amended soils (372 kg available N ha in 4 yr) and nonamended controls and determined the δN-NO and δO-NO isotope ratios in the leached nitrate. Flow-weighted concentration means for individual irrigations varied widely, from near zero to as much as 250 mg L for NO-N, 480 µg L for dissolved reactive phosphorus (DRP), 43 mg L for dissolved organic C (DOC), and 390 mg L for chloride (Cl). Relative to other treatments, mineral fertilizer increased NO-N concentrations 2.6- to 3-fold and Cl concentrations 2.6- to 3.6-fold in deep leachate, particularly when NaNO was applied in 2004 and 2006, and produced maximum mean season-long NO-N and Cl losses. Manure and control treatments produced similar leachate nutrient mass losses, and for some irrigation periods, mineral fertilizer produced 85 and 97% lesser DRP losses and two times greater Cl losses compared with manure and control treatments. Four-year cumulative losses among treatments differed only for Cl. Isotopic composition of deep-leached nitrate indicates that both transformation and biologic cycling of mineral and manure N are rapid in these soils, which, with percolation volume, influence the amounts of NO-N and DOC leached. In light of the potential negative effects associated with either fertilizer type, and because even nonamended soils produced substantial amounts of leached NO-N (69.5 kg ha yr), management must minimize percolation water losses to limit nutrient losses from these fertilized, furrow-irrigated soils.

Designer, acidic biochar influences calcareous soil characteristics.

In a proof-of-concept study, an acidic (pH 5.8) biochar was created using a low pyrolysis temperature (350 °C) and steam activation (800 °C) to potentially improve the soil physicochemical status of an eroded calcareous soil. Biochar was added at 0%, 1%, 2%, and 10% (by wt.) and soils were destructively sampled at 1, 2, 3, 4, 5, and 6 month intervals. Soil was analyzed for gravimetric water content, pH, NO3-N, plant-available Fe, Zn, Mn, Cu, and P, organic C, CO2 respiration, and microbial enumeration via extractable DNA and 16S rRNA gene copies. Gravimetric soil water content increased with biochar application regardless of rate, as compared to the control. Soil pH decreased between 0.2 and 0.4 units, while plant-available Zn, Mn, and P increased with increasing biochar application rate. Micronutrient availability decreased over time likely due to insoluble mineral species precipitation. Increasing biochar application raised the soil organic C content and remained elevated over time. Increasing biochar application rate also increased respired CO2, yet the CO2 released decreased over time. Soil NO3-N concentrations significantly decreased with increasing biochar application rate likely due to microbial immobilization or denitrification. Depending on application rate, biochar produced a 1.4 to 2.1-fold increase in soil DNA extracted and 1.4- to 2.4-fold increase in 16S rRNA gene abundance over control soils, suggesting microbial stimulation and a subsequent burst of activity upon biochar addition. Our results showed that there is promise in designing a biochar to improve the quality and water relations of eroded calcareous soils.

Hardwood biochar and manure co-application to a calcareous soil.

Biochar may affect the mineralization rate of labile organic C sources such as manures via microbial community shifts, and subsequently affect nutrient release. In order to ascertain the positive or negative priming effect of biochar on manure, dairy manure (2% by wt.) and a hardwood-based, fast pyrolysis biochar were applied (0%, 1%, 2%, and 10% by wt.) to a calcareous soil. Destructive sampling occurred at 1, 2, 3, 4, 6 and 12 months to monitor for changes in soil chemistry, water content, microbial respiration, bacterial populations, and microbial community structure. Overall results showed that increasing biochar application rate improved the soil water content, which may be beneficial in limited irrigation or rainfall areas. Biochar application increased soil organic C content and plant-available Fe and Mn, while a synergistic biochar-manure effect increased plant-available Zn. Compared to the other rates, the 10% biochar application lowered concentrations of NO3-N; effects appeared masked at lower biochar rates due to manure application. Over time, soil NO3-N increased likely due to manure N mineralization, yet soil NO3-N in the 10% biochar rate remained lower as compared to other treatments. In the presence of manure, only the 10% biochar application caused subtle microbial community structure shifts by increasing the relative amounts of two fatty acids associated with Gram-negative bacteria and decreasing Gram-positive bacterial fatty acids, each by ∼1%. Our previous findings with biochar alone suggested an overall negative priming effect with increasing biochar application rates, yet when co-applied with manure the negative priming effect was eliminated.

Hardwood biochar influences calcareous soil physicochemical and microbiological status.

The effects of biochar application to calcareous soils are not well documented. In a laboratory incubation study, a hardwood-based, fast pyrolysis biochar was applied (0, 1, 2, and 10% by weight) to a calcareous soil. Changes in soil chemistry, water content, microbial respiration, and microbial community structure were monitored over a 12-mo period. Increasing the biochar application rate increased the water-holding capacity of the soil-biochar blend, a trait that could be beneficial under water-limited situations. Biochar application also caused an increase in plant-available Fe and Mn, soil C content, soil respiration rates, and bacterial populations and a decrease in soil NO-N concentration. Biochar rates of 2 and 10% altered the relative proportions of bacterial and fungal fatty acids and shifted the microbial community toward greater relative amounts of bacteria and fewer fungi. The ratio of fatty acid 19:0 cy to its precursor, 18:1ω7c, was higher in the 10% biochar rate soil than in all other soils, potentially indicating an environmental stress response. The 10% application rate of this particular biochar was extreme, causing the greatest change in microbial community structure, a physiological response to stress in Gram-negative bacteria, and a drastic reduction in soil NO-N (85-97% reduction compared with the control), all of which were sustained over time.

Biochar and manure affect calcareous soil and corn silage nutrient concentrations and uptake.

Carbon-rich biochar derived from the pyrolysis of biomass can sequester atmospheric CO, mitigate climate change, and potentially increase crop productivity. However, research is needed to confirm the suitability and sustainability of biochar application to different soils. To an irrigated calcareous soil, we applied stockpiled dairy manure (42 Mg ha dry wt) and hardwood-derived biochar (22.4 Mg ha), singly and in combination with manure, along with a control, yielding four treatments. Nitrogen fertilizer was applied when needed (based on preseason soil test N and crop requirements) in all plots and years, with N mineralized from added manure included in this determination. Available soil nutrients (NH-N; NO-N; Olsen P; and diethylenetriaminepentaacetic acid-extractable K, Mg, Na, Cu, Mn, Zn, and Fe), total C (TC), total N (TN), total organic C (TOC), and pH were evaluated annually, and silage corn nutrient concentration, yield, and uptake were measured over two growing seasons. Biochar treatment resulted in a 1.5-fold increase in available soil Mn and a 1.4-fold increase in TC and TOC, whereas manure produced a 1.2- to 1.7-fold increase in available nutrients (except Fe), compared with controls. In 2009 biochar increased corn silage B concentration but produced no yield increase; in 2010 biochar decreased corn silage TN (33%), S (7%) concentrations, and yield (36%) relative to controls. Manure produced a 1.3-fold increase in corn silage Cu, Mn, S, Mg, K, and TN concentrations and yield compared with the control in 2010. The combined biochar-manure effects were not synergistic except in the case of available soil Mn. In these calcareous soils, biochar did not alter pH or availability of P and cations, as is typically observed for acidic soils. If the second year results are representative, they suggest that biochar applications to calcareous soils may lead to reduced N availability, requiring additional soil N inputs to maintain yield targets.

Nutrients in runoff from a furrow-irrigated field after incorporating inorganic fertilizer or manure.

Use of dairy manure to supply crop nutrients is gaining broader acceptance as the cost of fertilizer rises. However, there are concerns regarding manure's effect on water quality. In 2003 and 2004, we measured sediment, NO3-N, NH4-N, K, dissolved reactive P (DRP), and total P (TP) concentrations in runoff from furrow irrigated field plots (6-7 irrigations yr(-1)) cropped to corn (Zea mays L.) in the semiarid climate of southern Idaho. Annual treatments included 13 (Year 1) and 34 Mg ha(-1) (Year 2) stockpiled dairy manure (M); 78 (Year 1) and 195 kg N ha(-1) (Year 2) inorganic N fertilizer (F); or control-no amendment (C). Available N in manure applied each year was similar to amounts applied in fertilizer. Constituent concentrations (mg L(-1)) in runoff ranged widely among all treatments: sediment, 10 to 50,000; NO3-N, 0 to 4.07; NH4-N, 0 to 2.28; K, 3.6 to 46.4; DRP, 0.02 to 14.3; and TP, 0.03 to 41.5. Over both years, fertilizer and manure treatments increased irrigation mean values (averaged across irrigations) for NO3-N runoff concentrations (M = 0.30, F = 0.26, C = 0.21 mg L(-1)) and mass losses (M = 0.50, F = 0.42, C = 0.33 kg ha(-1)) relative to the control. Over both years, the manure treatment also increased mean irrigation runoff concentrations of DRP (M = 0.19, F = 0.09, C = 0.08 mg L(-1)) and K (M = 1.13, F = 0.79, C = 0.62 mg L(-1)) compared with fertilizer and control plots. Average DRP and K runoff mass losses were 2.0 to 2.4 times greater in manure treatments than in control plots. Neither F or M affected season-long cumulative infiltration. Runoff DRP and inorganic-N losses appeared to be influenced more by the timing of the amendment application and environmental conditions than by the quantity of nutrients applied. Nutrient additions to furrow irrigated soils, whether from fertilizer or manure, can potentially increase nutrient losses in irrigation runoff, with the degree of impact depending on the nutrient, amount, and timing of application and whether inorganic fertilizer or manure was applied.

Acrylamide monomer leaching from polyacrylamide-treated irrigation furrows.

Water-soluble anionic polyacrylamide (WSPAM), which is used to reduce erosion in furrow irrigated fields and other agriculture applications, contains less than 0.05% acrylamide monomer (AMD). Acrylamide monomer, a potent neurotoxicant and suspected carcinogen, is readily dissolved and transported in flowing water. The study quantified AMD leaching losses from a WSPAM-treated corn (Zea mays L.) field using continuous extraction-walled percolation samplers buried at 1.2 m depth. The samplers were placed 30 and 150 m from the inflow source along a 180-m-long corn field. The field was furrow irrigated using WSPAM at the rate of 10 mg L(-1) during furrow advance. Percolation water and furrow inflows were monitored for AMD during and after three furrow irrigations. The samples were analyzed for AMD using a gas chromatograph equipped with an electron-capture detector. Furrow inflows contained an average AMD concentration of 5.5 microg L(-1). The AMD in percolation water samples never exceeded the minimum detection limit and the de facto potable water standard of 0.5 microg L(-1). The risk that ground water beneath these WSPAM-treated furrow irrigated soils will be contaminated with AMD appears minimal.

Solute response to changing nutrient loads in soil and walled ceramic cup samplers under continuous extraction.

This report evaluates a vacuum-assisted walled percolation sampler preconditioned in soil, and examines the dynamic response of leachate solutes. The 20-cm walled percolation sampler extracted soil water under continuous tension via a ceramic cup collector embedded in a silica flour layer, whose upper surface interfaced with field soil. In the laboratory, alternating solutions with high and low NO3-N (232 or 3.6 mg L(-1)), molybdate-reactive P (MRP) (1.75 or 0.0 mg L(-1)), K+ (568 or 3.6 mg L(-1)), and Br- (9.6 or 0.0 mg L(-1)) concentrations were delivered directly to the (i) sampler ceramic cup; (ii) silica flour bed surface, or (iii) 12-mm soil layer placed over the silica flour bed. For alternating input solutions delivered to the silica-flour bed surface, (i) solute breakthrough (95% equivalency) occurred in 4 pore volumes and was the same for both the high and low concentration input phases of the application, and (ii) concentrations of NO3-N, Br-, and MRP in cumulative extracted water volumes were within 5% of those in corresponding input volumes. Alternating nutrient loads from high to low levels in the fixed flow rate input waters caused excess MRP (1.6 times that in the high concentration MRP solution) to leach from the calcareous soil. The dynamic character of P transport in K-fertilized soils deserves further study and may have important environmental implications.

A multicenter, prospective, randomized trial evaluating a new hemostatic agent for spinal surgery.

STUDY DESIGN: A prospective, randomized trial comparing Proceed, a gelatin-based hemostatic sealant (treatment), with Gelfoam-thrombin (control) in stopping intraoperative bleeding during spinal surgery. OBJECTIVES: To determine the effectiveness and safety of Proceed. SUMMARY OF BACKGROUND DATA: Proceed has been tested in animal models to determine its safety and effectiveness as a hemostatic agent. The current study was conducted under a Food and Drug Administration-approved Investigational Device Exemption to evaluate the effectiveness and safety of Proceed in humans. METHODS: For this study, 127 patients undergoing spinal surgery were randomized into either the treatment or control group after standard surgical means to control bleeding had failed. The bleeding site was evaluated at 1, 2, 3, 6, and 10 minutes after the hemostatic agent was applied. The application was considered successful if the bleeding stopped within 10 minutes. Follow-up evaluation was performed at 12 to 36 hours, then at 6 to 8 weeks after surgery. RESULTS: Proceed stopped bleeding in 98% of the patients (first bleeding site only) within 10 minutes, as compared with 90% of the control patients (P = 0.001). At 3 minutes, successful hemostasis had been achieved in 97% of the Proceed group, as compared with 71% of the control group (P = 0.0001). There was no difference in the adverse event profile between the two groups. CONCLUSIONS: A significantly larger number of bleeding sites had achieved hemostasis with Proceed than with Gelfoam-thrombin at 1, 2, and 3 minutes after application. Proceed was as safe as Gelfoam-thrombin when used for hemostasis during spinal surgery procedures.

Geochemical evidence for magmatic water within Mars from pyroxenes in the Shergotty meteorite.

Observations of martian surface morphology have been used to argue that an ancient ocean once existed on Mars. It has been thought that significant quantities of such water could have been supplied to the martian surface through volcanic outgassing, but this suggestion is contradicted by the low magmatic water content that is generally inferred from chemical analyses of igneous martian meteorites. Here, however, we report the distributions of trace elements within pyroxenes of the Shergotty meteorite--a basalt body ejected 175 million years ago from Mars--as well as hydrous and anhydrous crystallization experiments that, together, imply that water contents of pre-eruptive magma on Mars could have been up to 1.8%. We found that in the Shergotty meteorite, the inner cores of pyroxene minerals (which formed at depth in the martian crust) are enriched in soluble trace elements when compared to the outer rims (which crystallized on or near to the martian surface). This implies that water was present in pyroxenes at depth but was largely lost as pyroxenes were carried to the surface during magma ascent. We conclude that ascending magmas possibly delivered significant quantities of water to the martian surface in recent times, reconciling geologic and petrologic constraints on the outgassing history of Mars.

[Nursing professionals and quality of life: an approach based on the dimensions proposed by Flanagan]. / O profissional de enfermagem e a qualidade de vida: uma abordagem fundamentada nas dimensões propostas por Flanagan.

The present qualitative and quantitative study had the purposes to verify the meaning of quality of life to nursing professionals using Flanagan's Scale, to identify the quality of life dimensions that are most valued by those professionals and to explore the relations between the quality of life scores obtained by the professionals working at the STD/AIDS unit and at the neonatal ICU. The two groups showed similar results with respect to the meanings and the most valued dimension of quality of life. The total scores presented a positive evaluation of quality of life by the groups, although they showed a difference in the level of quality of life experienced by the two nursing teams.

Long distance telementoring. A novel tool for laparoscopy aboard the USS Abraham Lincoln.

BACKGROUND: As general surgeons perform a growing number of laparoscopic operations in increasingly specialized environments, the ability to obtain expert advice during procedures becomes more important. Technological advances in video and computer communications are enabling surgeons to procure expertise quickly and efficiently. In this article, we present laparoscopic procedures completed through an intercontinental telementoring system and the first telementored laparoscopic procedures performed aboard a naval vessel. METHODS: Video, voice, and data streams were linked between the USS Abraham Lincoln Aircraft Carrier Battlegroup cruising the Pacific Ocean and locations in Maryland and California, creating the Battlegroup Telemedicine (BGTM) system. Three modes of BGTM communication were used: intraship, ship to ship, and ship to shore. RESULTS: Five laparoscopic inguinal hernia repairs were completed aboard the Lincoln under telementoring guidance from land-based surgeons thousands of miles away. In addition, the BGTM system proved invaluable in obtaining timely expertise on a wide variety of surgical and medical problems that would otherwise have required a shore visit. CONCLUSIONS: Successful intercontinental laparoscopic telementoring aboard a naval vessel was accomplished using "off-the-shelf" components. In many instances, the high risk and cost of transporting patients to land-based facilities was averted because of the BGTM system. Also, the relationship between the on-site and telementoring surgeon was critical to the success of this experiment. Long-distance telementoring is an invaluable tool in providing instantly available expertise during laparoscopic procedures.