The Arc Toward Hope in Postapocalyptic American Films: From On the Beach to The Midnight Sky

An arc toward hope in postapocalyptic American films can be seen between Stanley Kramer's 1959 film On the Beach, based on Nevil Shute's 1957 novel of the same name, and George Clooney's 2020 film The Midnight Sky, adapted from Lily Brooks-Dalton's 2016 novel Good Morning, Midnight. Clooney's film makes direct and indirect references to On the Beach, which brought international attention to the threat that radiation fallout from nuclear weapons could end all human life on Earth. In On the Beach, no one survives. Already underway before the COVID-19 pandemic developed, Clooney's ambitious project for The Midnight Sky underwent a script revision after filming had begun to accommodate the unexpected pregnancy of its lead actress. In the revised ending, there is hope, albeit slight, that the expectant astronaut couple aboard spaceship Aether might avoid the environmental disaster from the unspecified "event" that has occurred on Earth by returning to the moon of Jupiter their mission had explored and found capable of sustaining human life. Released on Netflix in December 2020, The Midnight Sky was viewed by millions even as the first vaccines for COVID-19 were becoming available. The arc toward hope, Clooney believes, is the right ending.

Engineering of impact ionization characteristics in In0.53Ga0.47As/Al0.48In0.52As superlattice avalanche photodiodes on InP substrate

We report on engineering impact ionization characteristics of In_0.53Ga_0.47As/Al_0.48In_0.52As superlattice avalanche photodiodes (InGaAs/AlInAs SL APDs) on InP substrate to design and demonstrate an APD with low k-value. We design InGaAs/AlInAs SL APDs with three different SL periods (4 ML, 6 ML, and 8 ML) to achieve the same composition as Al_0.4Ga_0.07In_0.53As quaternary random alloy (RA). The simulated results of an RA and the three SLs predict that the SLs have lower k-values than the RA because the electrons can readily reach their threshold energy for impact ionization while the holes experience the multiple valence minibands scattering. The shorter period of SL shows the lower k-value. To support the theoretical prediction, the designed 6 ML and 8 ML SLs are experimentally demonstrated. The 8 ML SL shows k-value of 0.22, which is lower than the k-value of the RA. The 6 ML SL exhibits even lower k-value than the 8 ML SL, indicating that the shorter period of the SL, the lower k-value as predicted. This work is a theoretical modeling and experimental demonstration of engineering avalanche characteristics in InGaAs/AlInAs SLs and would assist one to design the SLs with improved performance for various SWIR APD application.

Frankenstein as Cautionary Tale for Medical Humanities? A Brief Coda

Amidst the recent bicentennial celebrations of the first publication, in 1818, of Mary Godwin Shelley's novel Frankenstein, little attention was given to the character Henry Clerval. Yet despite his few pages in the novel, Clerval's role as a humanist foil for Victor Frankenstein is significant. This brief coda examines what contemporary readers might learn from Clerval when his character is read allegorically, and how his presence in the novel makes clear that it can serve as a cautionary tale not only for biomedical scientists, but also for medical humanists.

Determination of Debye temperatures and Lamb-Mössbauer factors for LnFeO3 orthoferrite perovskites (Ln = La, Nd, Sm, Eu, Gd)

Lanthanide orthoferrites have wide-ranging industrial uses including solar, catalytic and electronic applications. Here a series of lanthanide orthoferrite perovskites, LnFeO₃ (Ln  =  La; Nd; Sm; Eu; Gd), prepared through a standard stoichiometric wet ball milling route using oxide precursors, has been studied. Characterisation through x-ray diffraction and x-ray fluorescence confirmed the synthesis of phase-pure or near-pure LnFeO₃ compounds. ⁵⁷Fe Mössbauer spectroscopy was performed over a temperature range of 10 K-293 K to observe hyperfine structure and to enable calculation of the recoil-free fraction and Debye temperature (θ _D) of each orthoferrite. Debye temperatures (Ln  =  La 474 K; Nd 459 K; Sm 457 K; Eu 452 K; Gd 473 K) and recoil-free fractions (Ln  =  La 0.827; Nd 0.817; Sm 0.816; Eu 0.812; Gd 0.826) were approximated through minimising the difference in the temperature dependent experimental centre shift and theoretical isomer shift, by allowing the Debye temperature and isomer shift values to vary. This method of minimising the difference between theoretical and actual values yields Debye temperatures consistent with results from other studies determined through thermal analysis methods. This displays the ability of variable-temperature Mössbauer spectroscopy to approximate Debye temperatures and recoil-free fractions, whilst observing temperature induced transitions over the temperature range observed. X-ray diffraction and Rietveld refinement show an inverse relationship between FeO₆ octahedral volume and approximated Debye temperatures. Raman spectroscopy show an increase in the band positions attributed to soft modes of A_g symmetry, A_g(3) and A_g(5) from La to GdFeO₃ corresponding to octahedral rotations and tilts in the [0 1 0] and [1 0 1] planes respectively.

Prevalence of enteric infections among hospitalized patients in two referral hospitals in Ghana

Background

Diarrhea is an important cause of morbidity and mortality worldwide. In Africa and Ghana in particular, it is estimated to contribute directly to 19 and 25% of pediatric mortality among children under 5 years, respectively.

Methods

Surveillance for hospitalized acute diarrheal illness was initiated in November 2010 through October 2012 in a referral hospital in southern Ghana, and a teaching hospital in northern Ghana. Consenting hospitalized patients who met a standardized case definition for acute diarrheal illness provided demographic and epidemiologic data. Stool samples were collected and tested by culture for bacteria and by enzyme immunoassays for a panel of viruses and parasites.

Results

A total of 429 patients were enrolled; 216 (50.3%) were under 5 years, and 221 (51.5%) were females. Stool samples were received from 153 patients. Culture isolates included Shigella sp., Salmonella spp., Plesiomonas sp. and Vibrio cholerae. Of 147 samples tested for viruses, 41 (27.9%) were positive for rotaviruses, 11 (7.5%) for astroviruses, 10 (6.8%) for noroviruses, and 8 (5.4%) for adenoviruses. Of 116 samples tested for parasitic infections; 4 (3.4%) were positive for Cryptosporidium sp. and 3 (2.6%) for Giardia lamblia. Of the enrolled patients, 78.8% had taken antibiotics prior to sample collection.

Conclusions

Diarrheal pathogens were identified across all ages, however, predominantly (81%) in the children under 5 years of age. This study also detected high antibiotic use which has the potential of increasing antibiotic resistance. The most common enteric pathogen detected (49.4%) was rotavirus.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-017-2621-x) contains supplementary material, which is available to authorized users.

Why teach literature and medicine? Answers from three decades

In this essay, I look back at some of the earliest attempts by the first generation of literature-and-medicine scholars to answer the question: Why teach literature and medicine? Reviewing the development of the field in its early years, I examine statements by practitioners to see whether their answers have held up over time and to consider how the rationales they articulated have expanded or changed in the following years and why. Greater emphasis on literary criticism, narrative ethics, narrative theory, and reflective writing has influenced current work in the field in ways that could not have been foreseen in the 1970s. The extraordinary growth of interest and work in the field nationally and, especially since 1996, internationally has included practitioners in many additional areas such as disability studies, film studies, therapeutic writing, and trauma studies. Along with the emergence of narrative medicine, this diverse community of scholars and practitioners-affiliated more through their use of narrative methodologies than the teaching of literature-makes the perennial challenge of evaluation and assessment even more complicated.

The involvement of professional medical writers in medical publications: results of a Delphi study

OBJECTIVE

Using a Delphi Consultation process, a group of medical writers established by the European Medical Writers Association (EMWA) set out to determine the current thinking on the problems of ghostwriting in medical publications and what should be done about them. In this context, ghostwriting is where a professional medical writer prepares a manuscript on behalf of a named author, but the writer is not listed as an author.

METHODS

A 4-round Delphi consultation process was conducted via email to generate statements about the main issues in ghostwriting. Participants rated their agreement with the statements on a scale of 0-10.

RESULTS AND CONCLUSIONS

Members of the task force strongly believed that professional medical writers can improve the quality of scientific papers, but that fact is often not recognised outside the medical writing profession. At least in part, this is because of a perception that ghostwritten papers may have been inappropriately influenced by pharmaceutical companies. One theme that emerged strongly from the discussions was transparency. Members thought it very important that the existence of a ghostwriter should always be made clear to the reader. Another strong theme was the importance of defining in detail what practices relating to ghostwriting are ethical, and what practices are not. This definition of ethical ghostwriting should be widely known, and unethical ghostwriting should be strongly condemned. Use of the term 'ghostwriting' itself was questioned. Members of the task force felt that use of a more neutral term should be encouraged. The task force suggested various activities for ensuring that above the objectives could be met, including discussions with other interested parties, such as journal editors and pharmaceutical companies, educating medical writers about ethical practices, further research into ghostwriting, and developing guidelines for ethical medical writing.

Medical Humanities at the University of Texas Medical Branch at Galveston

The Institute for the Medical Humanities of the University of Texas Medical Branch at Galveston (UTMB) was established in June 1973 to ensure that humanities teaching and research became an integral part of the education of future scientists and health-care professionals at UTMB. The multidisciplinary faculty of the Institute-who currently represent the disciplines of art, drama, history, law, literature, philosophy, and religious studies-teach in all four years of the undergraduate medical curriculum as well as in various residency programs. In addition to its focus on students and residents in the School of Medicine, the Institute has a vibrant graduate program in medical humanities with several joint degree options, including an MD/MA and an MD/PhD program, and the Institute has always included the School of Nursing, the School of Allied Health Sciences, and the Graduate School of Biomedical Sciences in its activities. After 30 years, the Institute's commitment to health-professional education remains strong and enduring. Challenged by major curriculum reform in the School of Medicine and increasingly tight state budgets, Institute faculty members look forward to continued collaboration with their basic science and clinical colleagues to improve our evolving curriculum and to seek research funding from external sources.

Can authorship policies help prevent scientific misconduct? What role for scientific societies?

The purpose of this article is to encourage and help inform active discussion of authorship policies among members of scientific societies. The article explains the history and rationale of the influential criteria for authorship developed by the International Committee of Medical Journal Editors, examines questions about those criteria that emerge from authorship policies adopted by several U.S. medical schools, and summarizes the arguments for replacing authorship with the contributor-guarantor model. Finally, it concludes with a plea for scientific societies to play a prominent role in the ongoing debates about authorship and the alternatives as part of their efforts to encourage ethical conduct among their members. Whether or not scientific societies develop authorship policies of their own, they should undertake vigorous educational efforts to keep their new members adequately informed about the importance of authorship practices in ethical scientific research and publication.

The next step in infectious disease: taming bacteria

Except for immunization programs our warfare with bacteria has always been a frontal assault with antibiotics. In this warfare we win battles, but with every new battle the enemy gets stronger. We need other options. Recent experience suggests two alternatives. First, public health measures designed to control the spread of infectious disease are associated with the selection of less virulent strains of microorganisms. Second, the same selection pressures obtained by public health measures outside the body are brought into play when we inhibit the adherence of bacteria within the body. Two recent studies using food sugars known to inhibit bacterial adherence show long-term benefits best explained by the previously observed decreases in bacterial virulence, following chronic exposure to the respective substances. Cranberry juice selects for less uropathogenic strains of Escherichia coli and xylitol for less caries producing Streptococcus mutans. The ability of these substances to reduce bacterial adherence in the human host has been known for some time, but poorly utilized. Their in vitro ability to decrease virulence has been reported but not clinically studied.

Why the increases in upper respiratory problems?

The incidence of ear infections has roughly tripled in the last 25 years. Sinus infections and allergies also have increased. Asthma, triggered by chronic sinus infections and allergies, has paralleled the increases of otitis. These increases began in the early 1970s when antihistamines, decongestants, and combinations thereof, became available without prescription and were heavily advertised in the growing media of television. These drugs are designed to block the immune system's attempts to wash pollutants and irritants from the nasopharynx. The alternative is helping the immune system with this washing. I have used such a technique in my office for the past three years. Its rationale is discussed as well as my own experience.

Microhardness of provisional fixed prosthodontic materials

STATEMENT OF PROBLEM

Provisional restorations play a critical role in the success of restorative treatment. Thus, the provisional restoration must maintain its surface integrity throughout the restorative process.

PURPOSE

This study evaluated the microhardness of 5 prosthodontic provisional materials.

MATERIAL AND METHODS

Cylindrical samples of 3 bis-acryl resin composites (Integrity, Protemp Garant, Temphase) and 2 methyl methacrylate acrylic resins (Jet, Temporary Bridge) were fabricated (n = 5 per material). Specimens were wet-sanded through 600 grit abrasive and stored in artificial saliva at 37 degrees C for a total of 14 days. Baseline Knoop hardness (KHN) was measured 24 hours after specimen fabrication. Three microhardness measurements were obtained from each specimen. Knoop hardness was again recorded after 14 days of storage.

RESULTS

ANOVA and Duncan's tests (P<.05) indicated a significant difference between the methyl methacrylate type resins and the bis-acryl resin composites at both time intervals.

CONCLUSION

The hardness of most materials (Integrity, Protemp Garant, Jet) decreased over time. All of the bis-acryl resin composite materials exhibited superior microhardness over traditional methyl methacrylate (Jet, Temporary Bridge) resins.

Colorimetric assessment of laser and home bleaching techniques

PURPOSE

This study recorded in vitro color change of three tooth bleaching techniques that included laser-activated hydrogen peroxide and two concentrations of carbamide peroxide.

MATERIALS AND METHODS

Forty extracted human central incisors were exposed to argon laser-activated 35% H2O2, 10% carbamide peroxide, or 20% carbamide peroxide. A fourth group (control) did not receive any bleach treatment (n = 10/group). Commission International de l'Eclariage (CIE) L*a*b* coordinates were recorded prior to bleaching (baseline), at 1 week, and at 2 weeks. The color difference (delta E*ab) between baseline and subsequent measurements was calculated.

RESULTS

The control group did not demonstrate significant color difference over time (p > .05). The laser group was not statistically different from the control group (p > .01). The color difference of the 10% and 20% carbamide peroxide groups was statistically different from the control group (p < .01).

CLINICAL SIGNIFICANCE

Exposure to 20% carbamide peroxide produced the greatest perceivable change in color. The recommended one-time application of laser-activated hydrogen peroxide did not demonstrate any perceivable color change. The clinician should be aware that additional or longer applications may be required.

Narrative in medical ethics

Images

Biosafety and antibody responses of adult bison bulls after vaccination with Brucella abortus strain RB51

OBJECTIVE

To evaluate clearance, antibody responses, potential shedding, and histologic lesions in reproductive tissues of adult bison bulls after vaccination with Brucella abortus strain RB51.

ANIMALS

61 two- and 3-year-old bison bulls.

PROCEDURE

12 bison bulls were vaccinated s.c. with B abortus strain RB51, 3 were inoculated s.c. with 0.15 M NaCl, and antibody responses were evaluated. Various specimens were obtained to evaluate bacterial shedding. Four vaccinates and 1 control were necropsied 10, 20, and 30 weeks after vaccination. In a separate experiment, bison bulls were vaccinated s.c. with 0.15 M NaCl, or by hand or ballistically with strain RB51. Antibody responses were monitored 6 weeks after vaccination and during necropsy 13 weeks after vaccination. Tissue specimens obtained during necropsy from both studies were evaluated bacteriologically and histologically.

RESULTS

Strain RB51 was recovered at various times from semen of 3 of 12 vaccinated bison bulls in experiment 1. During necropsy, strain RB51 was recovered 10 and 20, but not 30, weeks after vaccination. In experiment 2, strain RB51 was recovered from lymphoid tissues of hand- and ballistic-vaccinated bison bulls during necropsy. In both experiments, microscopic lesions in testes, epididymis, and seminal vesicles were minimal and did not differ between strain RB51-vaccinated and saline-inoculated bison bulls.

CONCLUSIONS AND CLINICAL RELEVANCE

Strain RB51 does not induce relevant inflammatory lesions in reproductive tissues of adult bison bulls. Shedding of strain RB51 in semen may be transient in some bison bulls; however, the importance of this observation is unknown.

Darren's case: narrative ethics in Perri Klass's Other Women's Children

During the past fifteen years, the relationship between literature and medical ethics has evolved from the occasional use of stories as a substitute for the traditional case study in medical ethics to the emergence of a narrative approach to ethical analysis and decision making. Thus far, literary theory has been more important to narrative medical ethics than have works of literature themselves. Perri Klass's novel Other Women's Children deserves special scrutiny, however, because an analysis of it demonstrates ways that a narrative approach could enhance traditional philosophical and legal approaches to resolving ethical dilemmas in medicine.

Literature and medicine: contributions to clinical practice

Introduced to U.S. medical schools in 1972, the field of literature and medicine contributes methods and texts that help physicians develop skills in the human dimensions of medical practice. Five broad goals are met by including the study of literature in medical education: 1) Literary accounts of illness can teach physicians concrete and powerful lessons about the lives of sick people; 2) great works of fiction about medicine enable physicians to recognize the power and implications of what they do; 3) through the study of narrative, the physician can better understand patients' stories of sickness and his or her own personal stake in medical practice; 4) literary study contributes to physicians' expertise in narrative ethics; and 5) literary theory offers new perspectives on the work and the genres of medicine. Particular texts and methods have been found to be well suited to the fulfillment of each of these goals. Chosen from the traditional literary canon and from among the works of contemporary and culturally diverse writers, novels, short stories, poetry, and drama can convey both the concrete particularity and the metaphorical richness of the predicaments of sick people and the challenges and rewards offered to their physicians. In more than 20 years of teaching literature to medical students and physicians, practitioners of literature and medicine have clarified its conceptual frameworks and have identified the means by which its studies strengthen the human competencies of doctoring, which are a central feature of the art of medicine.

Pulmicort Turbohaler once daily as initial prophylactic therapy for asthma

In a double-blind, randomized, parallel-group clinical trial, 340 asthmatic patients aged 12-70 years received budesonide 400 micrograms once daily in the morning, budesonide 400 micrograms once daily in the evening, budesonide 200 micrograms twice daily or placebo, for 12 weeks in addition to inhaled short-acting beta 2-agonists used as required (p.r.n.). Budesonide was given as Pulmicort Turbohaler. Peak expiratory flow rate (PEFR) increased by 20 to 30 1 min-1 in each of the active treatment groups, significantly more than in the placebo group (P < 0.01). There were no significant differences between the active treatment groups. Symptom improvement and decreased beta 2-agonist use reflected the PEFR data. Incidences of adverse events in the active treatment groups were similar to those observed in the placebo group. Budesonide 400 micrograms given once daily morning or evening is equieffective with the same total daily dose given twice daily in the treatment of mild to moderate stable asthmatics.

New approaches and concepts in the study of differentiation of oral epithelia

Epithelial structural proteins, the keratins and keratin-associated proteins, are useful as markers of differentiation because their expression is both region-specific and differentiation-specific. In general, basal cells in all stratified oral epithelia express similar keratins, while the suprabasal cells express a specific set of markers indicating commitment to a distinct program of differentiation. Critical factors in the regulation of epithelial protein expression are now under investigation. The promoter regions of keratin genes are being characterized to determine what sequences within the genes are responsible for differential expression. One important extracellular factor that influences epithelial protein expression is retinol (vitamin A), which exerts its effects via a group of nuclear receptor proteins that may also be expressed in a region-specific manner. These molecular biological approaches enhance our understanding of the mechanisms regulating differentiation of oral epithelia and its regional complexity.

Tympanometry as a screening test for treatable hearing loss in the elderly

One hundred and fourteen adults with hearing loss, but without otorrhoea, were studied with the aim of establishing whether tympanometry could be used as a screening test to identify potentially treatable aural pathology. Tympanometry was compared with independent otoscopy. No middle ear pathology likely to be of significance in an elderly person was found in ears with a normal tympanogram. All ears with significant pathology gave an abnormal tympanogram, and in addition there was a false positive rate of 6.8%. We suggest that elderly patients with dry ears and a normal tympanogram could be fitted with a hearing aid without specialist otological examination.

Surface localization of sialic acid on Actinomyces viscosus

This study reports the presence of sialic acid in Actinomyces viscosus strains T14V and T14AV. Mild acid hydrolysis of whole organisms released a compound which reacted positively in the periodate-thiobarbituric acid, direct Ehrlich's and resorcinol assays, and which co-chromatographed on paper with authentic N-acetylneuraminic acid. Strain T14V contained 10-fold greater concentrations of sialic acid than did strain T14AV. Sialic acid content was dependent upon the stage of growth of the culture, reaching a maximum in early stationary phase. Epifluorescence microscopy of fluorescein isothiocyanate (FITC)-conjugated Limulus polyphemus agglutinin (LPA), a lectin specific for sialic acid, revealed a uniform distribution of bound lectin on the surfaces of strains T14V and T14AV. Additional evidence for surface localization was obtained by demonstration of whole-cell agglutination of both strains with LPA. All LPA interactions with A. viscosus were inhibited by the presence of 0.1 M-N-acetylneuraminic acid. Neuraminidases from Clostridium perfringens, Arthrobacter ureafaciens and Vibrio cholerae did not release detectable amounts of sialic acid, but the extracellular enzyme from A. viscosus cleaved amounts equivalent to those obtained by acid hydrolysis. Other laboratory strains (W1053, M100, W859, 5-5S, RC45, ATCC 19246, and 'binder') as well as recent clinical isolates of A. viscosus were agglutinated by LPA and released sialic acid upon mild acid hydrolysis. Surface-available sialic acid has been implicated in the inhibition of alternative complement pathway activation and subsequent opsonophagocytosis. Thus the occurrence of surface sialic acid in A. viscosus may represent a mechanism of pathogenesis for this oral bacterium.

Evaluation of occupational exposure to carbon disulphide by blood, exhaled air, and urine analysis

This paper compares three analytical methods that may be considered for monitoring workers who are exposed to carbon disulphide (CS2). An estimate of the uptake of CS2 was assessed by the measurement of "bound" CS2 in blood, CS2 in expired alveolar air, and 2-thiothiazolidine-4-carboxylic acid (TTCA) in urine. The concentration of TTCA in end-of-shift urine samples was related to exposure and appears to be a good measure of uptake of CS2.