Imaging the neonate in the incubator: an investigation of the technical, radiological and nursing issues.

Modern neonatal incubators incorporate an X-ray tray device into the mattress support structure to facilitate patient examination with minimal disturbance and distress. However, the usual method of examination is to place the image plate directly underneath the baby. Users often cite radiological reasons for not using X-ray trays but modern quantitative evidence is lacking. This work looks at the technical and clinical aspects of imaging neonates in incubators and the impact that these may have in determining the imaging protocol. A number of hospitals were surveyed to determine their current method of examination and the reasons for their preference. Experimental measurements of the radiological impact of using (or not using) the X-ray tray were performed for a range of neonatal incubators. The average dose to the image plate was 5.9 microGy (range 5.4-6.4 microGy) for the "plate on mattress" method and 3.0 microGy (2.0-3.8 microGy) when using the tray--a 49% reduction owing to the mattress support materials. However, when using a computed radiography (CR) imaging system, the image quality differences were marginal. Survey results indicated that nurses preferred to use the tray but that radiographers were reluctant. We conclude that incubator manufacturers could do much to improve the radiological performance of their equipment and we offer recommendations. We also conclude that, with appropriate nurse and radiographer training and the advent of CR imaging systems, use of X-ray tray facilities may optimize imaging of the neonate in the incubator.

Truncated hexa-octahedral magnetite crystals in ALH84001: presumptive biosignatures.

McKay et al. [(1996) Science 273, 924-930] suggested that carbonate globules in the meteorite ALH84001 contained the fossil remains of Martian microbes. We have characterized a subpopulation of magnetite (Fe(3)O(4)) crystals present in abundance within the Fe-rich rims of these carbonate globules. We find these Martian magnetites to be both chemically and physically identical to terrestrial, biogenically precipitated, intracellular magnetites produced by magnetotactic bacteria strain MV-1. Specifically, both magnetite populations are single-domain and chemically pure, and exhibit a unique crystal habit we describe as truncated hexa-octahedral. There are no known reports of inorganic processes to explain the observation of truncated hexa-octahedral magnetites in a terrestrial sample. In bacteria strain MV-1 their presence is therefore likely a product of Natural Selection. Unless there is an unknown and unexplained inorganic process on Mars that is conspicuously absent on the Earth and forms truncated hexa-octahedral magnetites, we suggest that these magnetite crystals in the Martian meteorite ALH84001 were likely produced by a biogenic process. As such, these crystals are interpreted as Martian magnetofossils and constitute evidence of the oldest life yet found.

Income growth and future poverty rates of the aged.

This article estimates the effects of 50 years of steady growth in incomes on poverty rates among the elderly. It assumes that the poverty threshold continues to be adjusted for inflation but not for increases in real incomes. Simulations with the March 1998 Current Population Survey indicate that if the benefit rules for Social Security and Supplemental Security Income (SSI) are not changed and if earnings and other sources of income in an otherwise unchanging population grow by 1 percent per year (the intermediate assumption about earnings growth used in the Social Security Trustees' Report), poverty among the elderly will decrease from 10.5 percent in 1997 to about 7.2 percent in 2020 and to 4.1 percent in 2047. These projected poverty rates are quite sensitive to both the assumption about earnings growth and the assumption that benefits are not further reduced to maintain solvency. This article quantifies the sensitivity of the results to these assumptions and discusses several other aspects that might affect future poverty rates--changes in other income components like SSI, earnings, and pensions; changes in longevity and marital patterns; and changes in the distribution of earnings.

Elongated prismatic magnetite crystals in ALH84001 carbonate globules: potential Martian magnetofossils.

Using transmission electron microscopy (TEM), we have analyzed magnetite (Fe3O4) crystals acid-extracted from carbonate globules in Martian meteorite ALH84001. We studied 594 magnetites from ALH84001 and grouped them into three populations on the basis of morphology: 389 were irregularly shaped, 164 were elongated prisms, and 41 were whisker-like. As a possible terrestrial analog for the ALH84001 elongated prisms, we compared these magnetites with those produced by the terrestrial magnetotactic bacteria strain MV-1. By TEM again, we examined 206 magnetites recovered from strain MV-1 cells. Natural (Darwinian) selection in terrestrial magnetotactic bacteria appears to have resulted in the formation of intracellular magnetite crystals having the physical and chemical properties that optimize their magnetic moment. In this study, we describe six properties of magnetite produced by biologically controlled mechanisms (e.g., magnetotactic bacteria), properties that, collectively, are not observed in any known population of inorganic magnetites. These criteria can be used to distinguish one of the modes of origin for magnetites from samples with complex or unknown histories. Of the ALH84001 magnetites that we have examined, the elongated prismatic magnetite particles (similar to 27% of the total) are indistinguishable from the MV-1 magnetites in five of these six characteristics observed for biogenically controlled mineralization of magnetite crystals.

Martian soil component in impact glasses in a Martian meteorite.

Chemical compositions of impact melt glass veins, called Lithology C (Lith C) in Martian meteorite EET79001 were determined by electron microprobe analysis. A large enrichment of S, and significant enrichments of Al, Ca, and Na were observed in Lith C glass compared to Lithology A (Lith A). The S enrichment is due to mixing of plagioclase- enriched Lith A material with Martian soil, either prior to or during impact on Mars. A mixture of 87% Lith A, 7% plagioclase, and 6% Martian soil reproduces the average elemental abundances observed in Lith C. Shock melting of such a mixture of plagioclase-enriched, fine-grained Lith A host rock and Martian soil could yield large excesses of S (observed in this study) and Martian atmospheric noble gases (found by Bogard et al., 1983) in Lith C. These mixing proportions can be used to constrain the elemental abundance of phosphorus in Martian soil.

Bacterial mineralization patterns in basaltic aquifers: implications for possible life in martian meteorite ALH84001.

To explore the formation and preservation of biogenic features in igneous rocks, we have examined the organisms in experimental basaltic microcosms using scanning and transmission electron microscopy. Four types of microorganisms were recognized on the basis of size, morphology, and chemical composition. Some of the organisms mineralized rapidly, whereas others show no evidence of mineralization. Many mineralized cells are hollow and do not contain evidence of microstructure. Filaments, either attached or no longer attached to organisms, are common. Unattached filaments are mineralized and are most likely bacterial appendages (e.g., prosthecae). Features similar in size and morphology to unattached, mineralized filaments are recognized in martian meteorite ALH84001.

Chemiluminescence receptor assay for measuring vitamin B12 in serum evaluated.

We evaluated a chemiluminescence receptor assay for vitamin B12 in serum (Magic Lite; Ciba Corning Diagnostics), in which an acridinium ester label is used with magnetic particle separation. Within- and between-batch precisions were generally acceptable, except at low analyte concentrations. The reference range determined from 104 elective preoperative patients was 120-610 pmol/L, compared with 150-590 pmol/L for our in-house radioligand-binding assay. Magic Lite discriminated between normal and abnormal results as effectively as the in-house method when local reference ranges were applied. Magic Lite demonstrated a negative bias at low analyte concentrations and was unable to detect any vitamin B12 in two B12-deficient patients. Assay accuracy--judged from analytical recovery and comparisons with the in-house method and two other radioassay kits (Quantaphase, Bio-Rad Labs., and Immophase, Ciba Corning Diagnostics)--was poor at low B12 concentrations when the manufacturer's recommended two-point calibration was used. This problem was partially corrected by using a full set of calibrators.

Prevalence of anorexia nervosa and bulimia among young diabetic women.

To assess the prevalence of anorexia nervosa and bulimia among young diabetic women, a questionnaire was sent to 264 young women with insulin-dependent diabetes mellitus in two clinical settings. Among the women who responded (30%), none reported a history of anorexia nervosa, but 28 (35%) reported a history of bulimia. These results suggest that bulimia represents a common problem among young women with diabetes.

Evaluation of bone mass and growth in young diabetics.

To determine the relationships among bone mass, bone growth and serum glucose control in young, insulin-dependent diabetics, we performed photon absorptiometry and radiogrammetry on a clinically well-characterized group of 78 diabetics (mean age 15.2 yr, mean duration of diabetes 6.7 yr). Total and ionized calcium (TCa, ICa), magnesium (Mg), immunoreactive parathyroid hormone (iPTH) and phosphorus (P) were measured in fasting serum. Bone age was calculated from hand x-rays; and bone measurements, heights, and weights were standardized against normal groups of corresponding age, sex, and race. Mean deviation of bone mass measurement score was 1.24 SD below the normal mean (p less than .001); mean cortical area score was .22 SD and percent cortical area .25 SD below the normal means (both p less than .05). Radical width and metacarpal width for the diabetics were not less than normal. Mean percentiles for height and weight were 52.3 and 57.1 respectively, the latter significantly elevated (p less than .02). Bone mass and cortical area were inversely related to duration of disease (r = -.228, p less than .05; r = -.216, p less than .05). They were not correlated with serum parameters of mineral metabolism or of glucose control. Bone age was not significantly different from chronological age in those who had not achieved maturity (14.4 versus 14.5 yr). Mean age of menarche was 12.9 yr. When compared to normals the diabetic sample had diminished serum ICa (p less than .001), and Mg (p less than .001), though P and iPTH were not significantly different. We have demonstrated: (1) bone mass in this sample of juvenile diabetics is depressed, without evidence of impaired overall growth or delayed maturation, (2) this reduced bone mass probably results from a failure to gain the normal component of endosteal bone expected at this age, (3) this abnormality in bone growth progresses with disease but does not appear to vary with serum glucose control, and (4) in this population of diabetics there is a minimal but significant reduction in serum total and ionized calcium and serum magnesium without compensatory elevation of parathyroid hormone. The relationship of this metabolic abnormality of impaired bone growth in unknown.

Trapping of peripheral blood lymphocytes in the pancreas of patients with acute-onset insulin-dependent diabetes mellitus.

Involvement of humoral and cellular autoimmunity in the pathogenesis of insulin-dependent diabetes mellitus (IDDM) is demonstrated by the presence of circulating autoantibodies and the early pancreatic lesion of insulitis. In an effort to detect the early pancreatic lesion in acute onset IDDM, we have labeled peripheral blood lymphocytes with indium oxine 111, reinjected these autologous cells intravenously into the patients, and followed their kinetics over 96 h using an emission computerized tomography (ECT) scanner. The reinjected cells are acutely distributed in the patients' lungs, liver, and spleen (2-12 h). At 24, 48, and 72 h, the labeled lymphocytes are no longer detectable in the lungs or the liver, but are clearly present in the spleen and in the pancreas. Lymphocytic pancreatic infiltration was observed in two of three acute-onset IDDM patients, but not in large number of patients undergoing similar scans for other diseases, suggesting ongoing mononuclear cell infiltration of the pancreas, a possible marker of the lesion of insulitis. Lymphocyte scanning may provide a powerful noninvasive tool for studying patients with IDDM and for selecting those who might benefit from immunosuppressive therapy.

Factors influencing the absorption, serum insulin concentration, and blood glucose responses after injections of regular insulin and various insulin mixtures.

Normal fasting subjects received regular insulin and mixtures of regular with NPH or lente to assess the effects of the combinations on serum insulin concentrations (SIC) and blood glucose responses (BGR). In addition, the influence of concentration, depth, and method and site of administration was investigated. In studies of mixtures of regular with NPH and with lente, it was observed that the regular: lente ratio needed to achieve peak SIC was higher than with the regular: NPH combination. Increased SIC, including either the peak and/or the time interval required to achieve the peak, were related to the depth and site (deltoid and abdominal greater than anterior thigh or buttocks). Assuming linear kinetics of absorption, significant quantities of insulin fail to reach the serum. Marked intra- and intersubject variations in SIC and BGR to regular, NPH, and lente insulins were observed.