Optically detected, single nanoparticle mass spectrometer with pre-filtered electrospray nanoparticle source

An instrument designed for non-destructive mass analysis of single trapped nanoparticles is described. The heart of the instrument is a 3D quadrupole (Paul) trap constructed to give optical access to the trap center along ten directions, allowing passage of lasers for particle heating and detection, particle injection, collection of scattered or fluorescent photons for particle detection and mass analysis, and collection of particles on TEM grids for analysis, as needed. Nanoparticles are injected using an electrospray ionization (ESI) source, and conditions are described for spraying and trapping polymer particles, bare metal particles, and ligand stabilized particles with masses ranging from 200 kDa to >3 GDa. Conditions appropriate to ESI and injection of different types of particles are described. The instrument is equipped with two ion guides separating the ESI source and nanoparticle trap. The first ion guide is mostly to allow desolvation and differential pumping before the particles enter the trap section of the instrument. The second is a linear quadrupole guide, which can be operated in mass selective or mass band-pass modes to limit transmission to species with mass-to-charge ratios in the range of interest. With a little experience, the design allows injection of single particles into the trap upon demand.

Vibrationally enhanced charge transfer and mode/bond-specific H+ and D+ transfer in the reaction of HOD+ with N2O

The reaction of HOD(+) with N2O was studied over the collision energy (E(col)) range from 0.20 eV to 2.88 eV, for HOD(+) in its ground state and in each of its fundamental vibrational states: bend (010), OD stretch (100), and OH stretch (001). The dominant reaction at low E(col) is H(+) and D(+) transfer, but charge transfer becomes dominant for E(col) > 0.5 eV. Increasing E(col) enhances charge transfer only in the threshold region (E(col) < 1 eV), but all modes of HOD(+) vibrational excitation enhance this channel over the entire energy range, by up to a factor of three. For reaction of ground state HOD(+), the H(+) and D(+) transfer channels have similar cross sections, enhanced by increasing collision energy for E(col) < 0.3 eV, but suppressed by E(col) at higher energies. OD stretch excitation enhances D(+) transfer by over a factor of 2, but has little effect on H(+) transfer, except at low E(col) where a modest enhancement is observed. Excitation of the OH stretch enhances H(+) transfer by up to a factor of 2.5, but actually suppresses D(+) transfer over most of the E(col) range. Excitation of the bend mode results in ~60% enhancement of both H(+) and D(+) transfer at low E(col) but has little effect at higher energies. Recoil velocity distributions at high E(col) are strongly backscattered in the center-of-mass frame, indicating direct reaction dominated by large impact parameter collisions. At low E(col) the distributions are compatible with mediation by a short-lived collision complex. Ab initio calculations find several complexes that may be important in this context, and RRKM calculations predict lifetimes and decay branching that is consistent with observations. The recoil velocity distributions show that HOD(+) vibrational excitation enhances reactivity in all collisions at low E(col), while for high E(col) with enhancement comes entirely from the subset of collisions that generate strongly back-scattered product ions.

Effects of collisional and vibrational velocity on proton and deuteron transfer in the reaction of HOD+ with CO

Reaction of HOD(+) with CO was studied over the collision energy (E(col)) range between 0.18 and 2.87 eV, for HOD(+) in its ground state and with one quantum in each of its vibrational modes: (001)--predominantly OH stretch; (010)--bend, and (100)--predominately OD stretch. In addition to integral cross sections, product recoil velocity distributions were also measured for each initial condition. The dominant reactions are near-thermoneutral proton and deuteron transfer, generating HCO(+) and DCO(+) product ions by a predominantly direct mechanism. The HCO(+) and DCO(+) channels occur with a combined efficiency of 76% for ground state HOD(+) at our lowest E(col), increasing to 94% for E(col) around 0.33 eV, then falling at high E(col) to ~40%. The HCO(+) and DCO(+) channels have a complicated dependence on the HOD(+) vibrational state. Excitation of the OH or OD stretch modes enhances H(+) or D(+) transfer, respectively, and inhibits D(+) or H(+) transfer. Bend excitation preferentially enhances H(+) transfer, with no effect on D(+) transfer. There is no coupling of energy initially in any HOD(+) vibrational mode to recoil velocity of either of the product ions, even at low E(col) where vibrational excitation doubles or triples the energy available to products. The results suggest that transfer of H or D atoms is enhanced if the atom in question has a high vibrational velocity, and that this effect offsets what is otherwise a general inhibition of reactivity by added energy. HOCO(+) + D and DOCO(+) + H products are also observed, but as minor channels despite being barrierless and exoergic. These channels appear to be complex mediated at low E(col), essentially vanish at intermediate E(col), then reappear with a direct reaction mechanism at high E(col).

The effects of elevated CO2 and nitrogen fertilization on stomatal conductance estimated from 11 years of scaled sap flux measurements at Duke FACE

In this study, we employ a network of thermal dissipation probes (TDPs) monitoring sap flux density to estimate leaf-specific transpiration (E(L)) and stomatal conductance (G(S)) in Pinus taeda (L.) and Liquidambar styraciflua L. exposed to +200 ppm atmospheric CO(2) levels (eCO(2)) and nitrogen fertilization. Scaling half-hourly measurements from hundreds of sensors over 11 years, we found that P. taeda in eCO(2) intermittently (49% of monthly values) decreased stomatal conductance (G(S)) relative to the control, with a mean reduction of 13% in both total E(L) and mean daytime G(S). This intermittent response was related to changes in a hydraulic allometry index (A(H)), defined as sapwood area per unit leaf area per unit canopy height, which decreased a mean of 15% with eCO(2) over the course of the study, due mostly to a mean 19% increase in leaf area (A(L)). In contrast, L. styraciflua showed a consistent (76% of monthly values) reduction in G(S) with eCO(2) with a total reduction of 32% E(L), 31% G(S) and 23% A(H) (due to increased A(L) per sapwood area). For L. styraciflua, like P. taeda, the relationship between A(H) and G(S) at reference conditions suggested a decrease in G(S) across the range of A(H). Our findings suggest an indirect structural effect of eCO(2) on G(S) in P. taeda and a direct leaf level effect in L. styraciflua. In the initial year of fertilization, P. taeda in both CO(2) treatments, as well as L. styraciflua in eCO(2), exhibited higher G(S) with N(F) than expected from shifts in A(H), suggesting a transient direct effect on G(S). Whether treatment effects on mean leaf-specific G(S) are direct or indirect, this paper highlights that long-term treatment effects on G(S) are generally reflected in A(H) as well.

Hydraulic time constants for transpiration of loblolly pine at a free-air carbon dioxide enrichment site

The impact of stored water on estimates of transpiration from scaled sap flux measurements was assessed in mature Pinus taeda (L.) at the Duke Free-Air CO(2) Enrichment (FACE) site. We used a simple hydraulic model with measurements of sap flux (J) at breast height and the base of the live crown for 26 trees over 6 months to examine the effects of elevated CO(2) (eCO(2)) and fertilization (N(F)) treatments, as well as temporal variation in soil moisture (M(()(t)())), on estimates of the hydraulic time constant (κ). At low M(()(t)()), there was little (<12%) difference in κ of different treatments. At high M(()(t)()), differences were much greater, with κ reductions of 27, 52 and 34% in eCO(2), N(F) and eCO(2) × N(F) respective to the control. Incorporating κ with these effects into the analysis of a larger data set of previous J measurements at this site (1998-2008) improved agreement between modeled and measured values in 92% of cases. However, a simplified calibration of κ that neglected treatment and soil moisture effects performed more dependably, improving agreement in 98% of cases. Incorporating κ had the effect of increasing estimates of reference stomatal conductance at 1 kPa vapor pressure deficit (VPD) and saturating photosynthetic active radiation (PAR) an average of 12-14%, while increasing estimated sensitivities to VPD and PAR. A computationally efficient hydraulic model, such as the one presented here, incorporated into a hierarchical model of stomatal conductance presents a novel approach to including hydraulic time constants in estimates of stomatal responses from long-term sap flux data sets.

Individual-scale inference to anticipate climate-change vulnerability of biodiversity

Anticipating how biodiversity will respond to climate change is challenged by the fact that climate variables affect individuals in competition with others, but interest lies at the scale of species and landscapes. By omitting the individual scale, models cannot accommodate the processes that determine future biodiversity. We demonstrate how individual-scale inference can be applied to the problem of anticipating vulnerability of species to climate. The approach places climate vulnerability in the context of competition for light and soil moisture. Sensitivities to climate and competition interactions aggregated from the individual tree scale provide estimates of which species are vulnerable to which variables in different habitats. Vulnerability is explored in terms of specific demographic responses (growth, fecundity and survival) and in terms of the synthetic response (the combination of demographic rates), termed climate tracking. These indices quantify risks for individuals in the context of their competitive environments. However, by aggregating in specific ways (over individuals, years, and other input variables), we provide ways to summarize and rank species in terms of their risks from climate change.

Individual-scale variation, species-scale differences: inference needed to understand diversity

As ecological data are usually analysed at a scale different from the one at which the process of interest operates, interpretations can be confusing and controversial. For example, hypothesised differences between species do not operate at the species level, but concern individuals responding to environmental variation, including competition with neighbours. Aggregated data from many individuals subject to spatio-temporal variation are used to produce species-level averages, which marginalise away the relevant (process-level) scale. Paradoxically, the higher the dimensionality, the more ways there are to differ, yet the more species appear the same. The aggregate becomes increasingly irrelevant and misleading. Standard analyses can make species look the same, reverse species rankings along niche axes, make the surprising prediction that a species decreases in abundance when a competitor is removed from a model, or simply preclude parameter estimation. Aggregation explains why niche differences hidden at the species level become apparent upon disaggregation to the individual level, why models suggest that individual-level variation has a minor impact on diversity when disaggregation shows it to be important, and why literature-based synthesis can be unfruitful. We show how to identify when aggregation is the problem, where it has caused controversy, and propose three ways to address it.

H+ versus D+) transfer from HOD+ to N2: mode- and bond-selective effects

Reactions of HOD(+) with N(2) have been studied for HOD(+) in its ground state and with one quantum of excitation in each of its vibrational modes: (001)--predominately OH stretch, 0.396 eV, (010)--bend, 0.153 eV, and (100)--predominately OD stretch, 0.293 eV. Integral cross sections and product recoil velocities were recorded for collision energies from threshold to 4 eV. The cross sections for both H(+) and D(+) transfer rise slowly from threshold with increasing collision energy; however, all three vibrational modes enhance reaction much more strongly than equivalent amounts of collision energy and the enhancements remain large even at high collision energy, where the vibration contributes less than 10% of the total energy. Excitation of the OH stretch enhances H(+) transfer by a factor of ∼5, but the effect on D(+) transfer is only slightly larger than that from an equivalent increase in collision energy, and smaller than the effect from the much lower energy bend excitation. Similarly, OD stretch excitation strongly enhances D(+) transfer, but has essentially no effect beyond that of the additional energy on H(+) transfer. The effects of the two stretch vibrations are consistent with the expectation that stretching the bond that is broken in the reaction puts momentum in the correct coordinate to drive the system into the exit channel. From this perspective it is quite surprising that bend excitation also results in large (factor of 2) enhancements of both H(+) and D(+) transfer channels, such that its effect on the total cross section at collision energies below ∼2 eV is comparable to those from the two stretch modes, even though the bend excitation energy is much smaller. For collision energies above ∼2 eV, the vibrational effects become approximately proportional to the vibrational energy, though still much larger than the effects of equivalent addition of collision energy. Measurements of the product recoil velocity distributions show that reaction is direct at all collision energies, with roughly half the products in a sharp peak corresponding to stripping dynamics and half with a broad and approximately isotropic recoil velocity distribution. Despite the large effects of vibrational excitation on reactivity, the effects on recoil dynamics are small, indicating that vibrational excitation does not cause qualitative changes in the reaction mechanism or in the distribution of reactive impact parameters.

Inferential ecosystem models, from network data to prediction

Recent developments suggest that predictive modeling could begin to play a larger role not only for data analysis, but also for data collection. We address the example of efficient wireless sensor networks, where inferential ecosystem models can be used to weigh the value of an observation against the cost of data collection. Transmission costs make observations "expensive"; networks will typically be deployed in remote locations without access to infrastructure (e.g., power). The capacity to sample intensively makes sensor networks valuable, but high-frequency data are informative only at specific times and locations. Sampling intervals will range from meters and seconds to landscapes and years, depending on the process, the current states of the system, the uncertainty about those states, and the perceived potential for rapid change. Given that intensive sampling is sometimes critical, but more often wasteful, how do we develop tools to control the measurement and transmission processes? We address the potential of data collection controlled and/or supplemented by inferential ecosystem models. In a given model, the value of an observation can be evaluated in terms of its contribution to estimates of state variables and important parameters. There will be more than one model applied to network data that will include as state variables water, carbon, energy balance, biogeochemistry, tree ecophysiology, and forest demographic processes. The value of an observation will depend on the application. Inference is needed to weigh the contributions against transmission cost. Network control must be dynamic and driven by models capable of learning about both the environment and the network. We discuss application of Bayesian inference to model data from a developing sensor network as a basis for controlling the measurement and transmission processes. Our examples involve soil moisture and sap flux, but we discuss broader application of the approach, including its implications for network design.

Reaction of HOD+ with NO2: effects of OD and OH stretching, bending, and collision energy on reactions on the singlet and triplet potential surfaces

Integral cross sections and product recoil velocity distributions were measured for the reaction of HOD(+) with NO(2), in which the HOD(+) reactant was prepared in its ground state and with mode-selective excitation in the 001 (OH stretch), 100 (OD stretch), and 010 (bend) modes. In addition, we measured the 300 K thermal kinetics in a selected ion flow tube reactor and report product branching ratios different from previous measurements. Reaction is found to occur on both the singlet and triplet surfaces with near-unit efficiency. At 300 K, the product branching indicates that triplet → singlet transitions occur in about 60% of triplet-coupled collisions, which we attribute to long interaction times mediated by complexes on the triplet surface. Because the collision times are much shorter in the beam experiments, the product distributions show no signs of such transitions. The dominant product on the singlet surface is charge transfer. Reactions on the triplet surface lead to NO(+), NO(2)H(+), and NO(2)D(+). There is also charge transfer, producing NO(2)(+) (a(3)B(2)); however, this triplet NO(2)(+) mostly predissociates. The NO(2)H(+)/NO(2)D(+) cross sections peak at low collision energies and are insignificant above ~1 eV due to OH/OD loss from the nascent product ions. The effects of HOD(+) vibration are mode-specific. Vibration inhibits charge transfer, with the largest effect from the bend. The NO(2)H(+)/NO(2)D(+) channels are also vibrationally inhibited, and the mode dependence reveals how energy in different reactant modes couples to the internal energy of the product ions.

H+ versus D+ transfer from HOD+ to CO2: bond-selective chemistry and the anomalous effect of bending excitation

Reactions of HOD(+) with CO(2) have been studied for HOD(+) in its ground state, and with one quantum of excitation in each of its vibrational modes: (001)--predominantly OH stretch, 0.396 eV; (010)--bend, 0.153 eV; and (100)--predominantly OD stretch, 0.293 eV. Integral cross sections and product recoil velocities were recorded for collision energies from threshold to 3 eV. The cross sections for both H(+) and D(+) transfer rise with increasing collision energy from threshold to ∼1 eV, then become weakly dependent of the collision energy. All three vibrational modes enhance the total reactivity, but quite mode specifically. The H(+) transfer reaction is enhanced by OH stretch excitation, whereas OD stretch excitation has little effect. Conversely, the D(+) transfer reaction is enhanced by OD stretch excitation, while the OH stretch has little effect. Excitation of the bend strongly enhances both channels. The effects of the stretch excitations are consistent with previous studies of neutral HOD mode-selective chemistry, and can be at least qualitatively understood in terms of a late barrier to product formation. The fact that bend excitation produces the largest overall enhancement is surprising, because this is the lowest energy excitation, and is not obviously connected with the reaction coordinates for either H(+) or D(+) transfer. A rationalization in terms of the effects of water distortion on the potential surface is proposed.

Reaction of C2H2(+) (n · ν2, m · ν5) with NO2: reaction on the singlet and triplet surfaces

Integral cross sections and product recoil velocity distributions were measured for reaction of C(2)H(2)(+) with NO(2), in which the C(2)H(2)(+) reactant was prepared in its ground state, and with mode-selective excitation in the cis-bend (2ν(5)) and CC stretch (n · ν(2), n = 1, 2). Because both reactants have one unpaired electron, collisions can occur with either singlet or triplet coupling of these unpaired electrons, and the contributions are separated based on distinct recoil dynamics. For singlet coupling, reaction efficiency is near unity, with significant branching to charge transfer (NO(2)(+)), O(-) transfer (NO(+)), and O transfer (C(2)H(2)O(+)) products. For triplet coupling, reaction efficiency varies between 13% and 19%, depending on collision energy. The only significant triplet channel is NO(+) + triplet ketene, generated predominantly by O(-) transfer, with a possible contribution from dissociative charge transfer at high collision energies. NO(2)(+) formation (charge transfer) can only occur on the singlet surface, and appears to be mediated by a weakly bound complex at low energies. O transfer (C(2)H(2)O(+)) also appears to be dominated by reaction on the singlet surface, but is quite inefficient, suggesting a bottleneck limiting coupling to this product from the singlet reaction coordinate. The dominant channel is O(-) transfer, producing NO(+), with roughly equal contributions from reaction on singlet and triplet surfaces. The effects of C(2)H(2)(+) vibration are modest, but mode specific. For all three product channels (i.e., charge, O(-), and O transfer), excitation of the CC stretch fundamental (ν(2)) has little effect, 2 · ν(2) excitation results in ∼50% reduction in reactivity, and excitation of the cis-bend overtone (2 · ν(5)) results in ∼50% enhancement. The fact that all channels have similar mode dependence suggests that the rate-limiting step, where vibrational excitation has its effect, is early on the reaction coordinate, and branching to the individual product channels occurs later.

Pandemic influenza as 21st century urban public health crisis

The percentage of the world's population living in urban areas will increase from 50% in 2008 to 70% (4.9 billion) in 2025. Crowded urban areas in developing and industrialized countries are uniquely vulnerable to public health crises and face daunting challenges in surveillance, response, and public communication. The revised International Health Regulations require all countries to have core surveillance and response capacity by 2012. Innovative approaches are needed because traditional local-level strategies may not be easily scalable upward to meet the needs of huge, densely populated cities, especially in developing countries. The responses of Mexico City and New York City to the initial appearance of influenza A pandemic (H1N1) 2009 virus during spring 2009 illustrate some of the new challenges and creative response strategies that will increasingly be needed in cities worldwide.

Monitoring corneal wound strength non-invasively

Intensity of light scattered from 24 healing rabbit corneal incisions progressively increased during six weeks following the operation. After the first week, the mean value for scattered light intensity from the wounds was highly correlated with wound tensile strength measured in another group of rabbits. The correlation coefficient was 0.95 at the 0.05 confidence level. It is hoped that a simple and reliable method of measuring scattered light intensity may provide a non-invasive tool for assessing the strength of a corneal wound in the future.

Public health interventions and SARS spread, 2003

Screening at international borders should not detract from public health interventions to control SARS within a country.

The 2003 outbreak of severe acute respiratory syndrome (SARS) was contained largely through traditional public health interventions, such as finding and isolating case-patients, quarantining close contacts, and enhanced infection control. The independent effectiveness of measures to "increase social distance" and wearing masks in public places requires further evaluation. Limited data exist on the effectiveness of providing health information to travelers. Entry screening of travelers through health declarations or thermal scanning at international borders had little documented effect on detecting SARS cases; exit screening appeared slightly more effective. The value of border screening in deterring travel by ill persons and in building public confidence remains unquantified. Interventions to control global epidemics should be based on expert advice from the World Health Organization and national authorities. In the case of SARS, interventions at a country's borders should not detract from efforts to identify and isolate infected persons within the country, monitor or quarantine their contacts, and strengthen infection control in healthcare settings.

Smallpox vaccination and adverse reactions. Guidance for clinicians

The guidance in this report is for evaluation and treatment of patients with complications from smallpox vaccination in the preoutbreak setting. Information is also included related to reporting adverse events and seeking specialized consultation and therapies for these events. The frequencies of smallpox vaccine-associated adverse events were identified in studies of the 1960s. Because of the unknown prevalence of risk factors among today's population, precise predictions of adverse reaction rates after smallpox vaccination are unavailable. The majority of adverse events are minor, but the less-frequent serious adverse reactions require immediate evaluation for diagnosis and treatment. Agents for treatment of certain vaccine-associated severe adverse reactions are vaccinia immune globulin (VIG), the first-line therapy, and cidofovir, the second-line therapy. These agents will be available under Investigational New Drug (IND) protocols from CDC and the U.S. Department of Defense (DoD). Smallpox vaccination in the preoutbreak setting is contraindicated for persons who have the following conditions or have a close contact with the following conditions: 1) a history of atopic dermatitis (commonly referred to as eczema), irrespective of disease severity or activity; 2) active acute, chronic, or exfoliative skin conditions that disrupt the epidermis; 3) pregnant women or women who desire to become pregnant in the 28 days after vaccination; and 4) persons who are immunocompromised as a result of human immunodeficiency virus or acquired immunodeficiency syndrome, autoimmune conditions, cancer, radiation treatment, immunosuppressive medications, or other immunodeficiencies. Additional contraindications that apply only to vaccination candidates but do not include their close contacts are persons with smallpox vaccine-component allergies, women who are breastfeeding, those taking topical ocular steroid medications, those with moderate-to-severe intercurrent illness, and persons aged < 18 years. In addition, history of Darier disease is a contraindication in a potential vaccinee and a contraindication if a household contact has active disease. In the event of a smallpox outbreak, outbreak-specific guidance will be disseminated by CDC regarding populations to be vaccinated and specific contraindications to vaccination. Vaccinia can be transmitted from a vaccinee's unhealed vaccination site to other persons by close contact and can lead to the same adverse events as in the vaccinee. To avoid transmission of vaccinia virus (found in the smallpox vaccine) from vaccinees to their close contacts, vaccinees should wash their hands with warm soapy water or hand rubs containing > or = 60% alcohol immediately after they touch their vaccination site or change their vaccination site bandages. Used bandages should be placed in sealed plastic bags and can be disposed of in household trash. Smallpox vaccine adverse reactions are diagnosed on the basis of clinical examination and history, and certain reactions can be managed by observation and supportive care. Adverse reactions that are usually self-limited include fever, headache, fatigue, myalgia, chills, local skin reactions, nonspecific rashes, erythema multiforme, lymphadenopathy, and pain at the vaccination site. Other reactions are most often diagnosed through a complete history and physical and might require additional therapies (e.g., VIG, a first-line therapy and cidofovir, a second-line therapy). Adverse reactions that might require further evaluation or therapy include inadvertent inoculation, generalized vaccinia (GV), eczema vaccinatum (EV), progressive vaccinia (PV), postvaccinial central nervous system disease, and fetal vaccinia. Inadvertent inoculation occurs when vaccinia virus is transferred from a vaccination site to a second location on the vaccinee or to a close contact. Usually, this condition is self-limited and no additional care is needed. Inoculations of the eye and eyelid require evaluation by an ophthalmologist and might require therapy with topical antiviral or antibacterial medications, VIG, or topical steroids. GV is characterized by a disseminated maculopapular or vesicular rash, frequently on an erythematous base, which usually occurs 6-9 days after first-time vaccination. This condition is usually self-limited and benign, although treatment with VIG might be required when the patient is systemically ill or found to have an underlying immunocompromising condition. Infection-control precautions should be used to prevent secondary transmission and nosocomial infection. EV occurs among persons with a history of atopic dermatitis (eczema), irrespective of disease severity or activity, and is a localized or generalized papular, vesicular, or pustular rash, which can occur anywhere on the body, with a predilection for areas of previous atopic dermatitis lesions. Patients with EV are often systemically ill and usually require VIG. Infection-control precautions should be used to prevent secondary transmission and nosocomial infection. PV is a rare, severe, and often fatal complication among persons with immunodeficiencies, characterized by painless progressive necrosis at the vaccination site with or without metastases to distant sites (e.g., skin, bones, and other viscera). This disease carries a high mortality rate, and management of PV should include aggressive therapy with VIG, intensive monitoring, and tertiary-level supportive care. Anecdotal experience suggests that, despite treatment with VIG, persons with cell-mediated immune deficits have a poorer prognosis than those with humoral deficits. Infection-control precautions should be used to prevent secondary transmission and nosocomial infection. Central nervous system disease, which includes postvaccinial encephalopathy (PVE) and postvaccinial encephalomyelitis (or encephalitis) (PVEM), occur after smallpox vaccination. PVE is most common among infants aged < 12 months. Clinical symptoms of central nervous system disease indicate cerebral or cerebellar dysfunction with headache, fever, vomiting, altered mental status, lethargy, seizures, and coma. PVE and PVEM are not believed to be a result of replicating vaccinia virus and are diagnoses of exclusion. Although no specific therapy exists for PVE or PVEM, supportive care, anticonvulsants, and intensive care might be required. Fetal vaccinia, resulting from vaccinial transmission from mother to fetus, is a rare, but serious, complication of smallpox vaccination during pregnancy or shortly before conception. It is manifested by skin lesions and organ involvement, and often results in fetal or neonatal death. No known reliable intrauterine diagnostic test is available to confirm fetal infection. Given the rarity of congenital vaccinia among live-born infants, vaccination during pregnancy should not ordinarily be a reason to consider termination of pregnancy. No known indication exists for routine, prophylactic use of VIG in an unintentionally vaccinated pregnant woman; however, VIG should not be withheld if a pregnant woman develops a condition where VIG is needed. Other less-common adverse events after smallpox vaccination have been reported to occur in temporal association with smallpox vaccination, but causality has not been established. Prophylactic treatment with VIG is not recommended for persons or close contacts with contraindications to smallpox vaccination who are inadvertently inoculated or exposed. These persons should be followed closely for early recognition of adverse reactions that might develop, and clinicians are encouraged to enroll these persons in the CDC registry by calling the Clinician Information Line at 877-554-4625. To request clinical consultation and IND therapies for vaccinia-related adverse reactions for civilians, contact your state health department or CDC's Clinician Information Line (877-554-4625). Clinical evaluation tools are available at http.//www.bt.cdc.gov/agent/smallpox/vaccination/clineval. Clinical specimen-collection guidance is available at http://www.bt.cdc.gov/agent/smallpox/vaccination/vaccinia-specimen-collection.asp. Physicians at military medical facilities can request VIG or cidofovir by calling the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) at 301-619-2257 or 888-USA-RIID.

Promoting appropriate antimicrobial drug use: perspective from the Centers for Disease Control and Prevention

Extending the useful life of antimicrobial drugs through appropriate use-that is, use that maximizes therapeutic impact while minimizing toxicity and the development of resistance-is an important component of efforts to prevent and control the emerging threat of antimicrobial resistance. The major paradigms of antimicrobial drug use involve acute infections in outpatients, acute infections in inpatients, chronic infections, and agriculture/veterinary medicine. The factors that influence drug use and the challenges that need to be addressed in promoting more appropriate use are different in each of these paradigms. For acute respiratory infections in outpatients, data from intervention trials suggest that concurrent multifaceted interventions may be effective in promoting appropriate drug prescribing. The next challenge is to extend these interventions to larger populations by incorporating them into routine medical practice.

Markers for progression of coronary disease

Endothelial cells play numerous physiologic roles including regulation of vascular tone, regulation of hemostasis and fibrinolysis, regulation of inflammatory processes, and maintenance of a permeability barrier to provide for exchange and active transport of substances into the artery wall. Pathophysiologic stimuli can result in localized alterations in endothelial activity. These changes include increased permeability to plasma lipoproteins, imbalances in local thrombogenic substances causing a prothrombotic state, and release of vasoactive compounds resulting in vasoconstriction. Loss of endothelium-dependent vasodilatation is thought to be an early physiologic event in the development of arteriosclerosis, occurring before morphologic changes in the endothelium can be detected. Much of the effects of healthy endothelium appear to be produced by nitric oxide. Decreased bioavailability of nitric oxide results in endothelial dysfunction, which is the first step in the atherosclerotic process. Risk factor modification and pharmacologic interventions that can reverse endothelial dysfunction have the potential to decrease cardiovascular events in patients at risk.

Myocardial infarction in women: a critical appraisal of gender differences in outcomes

In every year since 1984, cardiovascular disease has claimed the lives of more women than men. Data from randomized trials indicate that gender contributes to increased mortality after myocardial infarction independent of other risk factors, but additional confounding variables cannot be discounted. Data from registry databases indicate that women are less likely to receive medically proven therapies for myocardial infarction. Women experience more vague symptoms, which may account for underuse of effective therapies. In addition, they may benefit less from thrombolytic therapy than men. Increased use of thrombolytic therapy has resulted in a continued decrease in cardiovascular deaths for men, but not for women. It is unclear if this disparity is a result of inequitable access to therapy or decreased efficacy of these agents in women.

Micro-capillary tube in situ hybridisation: a novel method for processing small individual samples

We have developed a strategy to individually analyse large numbers of small tissue samples by RNA in situ hybridisation. Samples of approximately 0.4 mm x 0.5 mm are processed in rectangular capillary tubes fitted with nylon mesh and glass beads using standard protocols. Eighteen samples can be assayed simultaneously without loss, and background is low. Specifically, mouse Sox2 RNA expression is examined in the chorion of extraembryonic tissue of 7.5 days post-coitum embryos. This technique works equally well for double RNA labelling and could potentially be used for antibody staining of proteins.

Analysis of number needed to treat and cost of platelet glycoprotein IIb/IIIa inhibitors in percutaneous coronary interventions and acute coronary syndromes

This retrospective review and analysis of pivotal clinical trials compared acquisition costs and outcomes of platelet glycoprotein IIb/IIIa inhibitors. Absolute reduction in the number of deaths and nonfatal myocardial infarctions at 30 days, number of patients that need to be treated to prevent one event, and drug costs expended to prevent one event were assessed. In patients undergoing percutaneous coronary intervention (PCI), abciximab is the better value, especially in high-risk patients. In those with unstable angina and non-Q wave myocardial infarction, costs of eptifibatide and tirofiban were not significantly different, but the cost of tirofiban was more variable. These agents have the potential to be cost-effective if administered to populations at high risk for adverse outcomes of acute coronary syndromes or PCI. Prospective methods to identify these high-risk patients are being developed.