Hand function following accidental automatic animal syringe injector injuries

Accidental self-injection injury is a common occurrence among veterinary and farm workers handling automatic syringe injectors. Most of the time, these injuries are asymptomatic or cause self-resolving mild symptoms, but these injuries may lead to significant morbidity. The aim of the study was to evaluate hand function after inadvertent injection of a poultry influenza or cholera vaccine in patients admitted to our department with infection. We retrospectively gathered data from admission to last follow-up. Functional assessment and physical exam of the hand were done at each stage by either an orthopedic resident or a fellowship-trained hand surgeon. The exam included evaluation of sensation using monofilament, joint range of motion using a goniometer, and a Quick DASH questionnaire. The study included 21 patients, all men, with a mean age of 33.4 years (range 23-44). Of the 21 patients only eight had attended all follow-ups. All patients had injury to the non-dominant hand. Seventeen of 21 of the cases had finger injuries, out of which 11 involved the thumb. The mean hospitalization time was 3.75 days (1-10). Of the 21 patients, seven underwent surgery to drain a collection during hospitalization. Seven out of eight patients had lowest disability scores on Quick Dash questionnaire. Three out of eight patients lost superficial sensation at the tip of the finger. The largest loss of range of motion was found in the distal interphalangeal joint in the finger or interphalangeal joint in the thumb, especially following surgical drainage. Of the eight patients presenting for follow-up, most had returned to the same job. Hand function was normal, as expressed in a DASH questionnaire. Sensory examination demonstrated that the sensation was almost unaffected over the injured finger. Range of motion of the joint closest to the injection site was usually the most impaired. Patients who underwent surgical drainage had a reduced range of motion.

Computer-Generated Radiographic Measurements of Distal Radius Fractures: Does It Help With Decision Making?

PURPOSE

Operative management of distal radius fractures (DRFs) has become increasingly common. Age, activity levels, and comorbid conditions are major factors influencing the treatment decision, although operative indications are still controversial. Radiographic parameters (RPs), such as radial inclination, dorsal tilt, and articular step-off, can provide objective support for effective decision making. However, manual measurement of RPs may be imprecise and subject to inconsistency. To address this problem, we developed custom software of an algorithm to automatically detect and compute 6 common RPs associated with DRF in anteroposterior and lateral radiographs. The aim in this study was to assess the effect of this software on radiographic interobserver variability among orthopedic surgeons. Our hypothesis was that precise and consistent measurement of RPs will improve radiographic interpretation variability among surgeons and, consequently, may aid in clinical decision making.

METHODS

Thirty-five radiograph series of DRFs were presented to 9 fellowship-trained hand and orthopedic trauma surgeons. Each case was presented with basic clinical information, together with plain anteroposterior and lateral radiographs. One of the 2 possible treatment options was selected: casting or open reduction with a locking plate. The survey was repeated 3 weeks later, this time with computer-generated RP measurements. Data were analyzed for interobserver and intraobserver variability for both surveys, and the interclass coefficient, kappa value, was calculated.

RESULTS

The interobserver reliability (interclass coefficient value) improved from poor to moderate, 0.35 to 0.50, with the provided RP. The average intraobserver interclass coefficient was 0.68. When participants were assessed separately according to their subspecialties (trauma and hand), improved interobserver variability was found as well.

CONCLUSIONS

Providing computed RPs to orthopedic surgeons may improve the consistency of the radiographic judgment and influence their clinical decision for the treatment of DRFs.

CLINICAL RELEVANCE

Orthopedic surgeons' consistency in the radiographic judgment of DRFs slightly improved by providing automatically calculated radiographic measurements to them.

"No matter what, I will not give up": Community practice on the front lines of COVID-19

The COVID-19 pandemic has required frontline health care workers to cope with an unexpected and almost unprecedented emergency situation. Community social workers had played a crucial role during the pandemic, working to alleviate its adverse effects on marginalized communities. The present study investigated community social workers' experiences and hardships in coping with the "age of COVID-19." Drawing on in-depth interviews with 30 frontline community social workers in Israel, the findings highlighted three main themes: (a) the hope for recognition and the reality of underutilization; (b) the impact of the dysfunctional state on community social workers; and (c) realizing the core values and activities of community social work practice during the pandemic. Findings pointed to community social workers' professionalism and integrity despite the hardships they endured at the local and national levels. Committing on an altruistic level seemed to be an adaptive coping style, alongside facing "the politics of pandemics." Implications for community practice are outlined. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Identifying safe corridors for anterior pelvic percutaneous instrumentation using computed tomography-based anatomical relationships

INTRODUCTION

Percutaneous anterior pelvic ring instrumentation is performed for retrograde screw fixation of ramus fractures, as well as for repair of pubic symphysis diastasis. The anatomic relationships of critical structures around the anterior pelvic ring, such as the spermatic cord and round ligament, have been described in only a few studies regarding the risk of iatrogenic injury during surgery. Our goal is to further describe these relationships, as well as provide radiographic information on safe corridors for percutaneous fixation.

METHODS

Eighty (80) axial computed tomography scans of the abdomen, obtained for non traumatic diagnostic purposes and screened for prior abdominal trauma or procedures, were evaluated by 3 fellowship trained radiologists. Mid-symphyseal cuts were used to obtain several measurements relative to the spermatic cords (SC) or round ligaments (RL): inter-cord or inter-ligament distance, skin to cortex of symphysis distance (vertical), skin to cortex of symphysis distance (oblique), safe corridor distance (between SC/RL and femoral triangle), center safe angle (relative to bilateral ischia), maximal safe angle, and minimal safe angle.

RESULTS

There were 41 male and 39 female scans included in the final analysis. The average inter-cord distance was 50.2 mm, skin to cortex vertical distance of 43.0 mm, skin to cortex oblique distance of 83.5 mm, safe corridor distance 26.3 mm, center safe angle 19.3˚, maximal safe angle 32.3˚, and minimal safe angle 13.6˚. These were further broken down by range and gender in Table 1. Agreement between radiologists was high for these different measurements with the exception of the skin to cortex oblique distance in female patients and the maximal safe angle in female patients, due to absence of round ligament in a majority of the scans. The round ligament was only present at the mid-symphyseal level for our three reviewers in 37/39, 36/39, and 24/39 of female patient scans.

CONCLUSIONS

We have identified defined safe corridors for instrumentation of the anterior pelvic ring that can assist the surgeon in percutaneous application of fixation for fracture care.

Effects of the COVID-19 pandemic on the outcome and mortality of patients with diabetic foot ulcer

The outbreak of the coronavirus disease 2019 (COVID-19) led to events that significantly impaired the treatment and management of patients with chronic diabetes. Therefore, elective treatments at hospitals were cancelled and patients with chronic ailments were instructed to stay at home and minimise the time spent in public areas. The second was due to COVID-19-induced anxiety that deterred many patients from seeking care and adhering to periodic out-patient visits. In this study, we examined the short-term effects of the COVID-19 pandemic on patients with chronic diabetes who suffered from contaminated diabetic ulcers. We conducted a retrospective study with patients who had undergone amputations following diabetic ulcers during 2019-2020. The research group included diabetic amputees during the COVID-19 outbreak period ranging from March 2020 to December 2020. The control group included diabetic amputees from the corresponding period in 2019. Using the Wagner Scale, we measured the difference in the severity of ulcers upon the patient's initial admission. Additionally, we examined patient survival rates based on the size of amputations, by specifically focusing on the period between 1- and 6-months post-surgery. The results failed to suggest a clear and statistically significant worsening trend in the condition of patients in the research and control groups. Due to public lockdowns, transportation restrictions, scarcity of healthcare staff, and reduced adherence to exposure anxiety, patients with diabetic foot ulcers received inferior medical care during the COVID-19 pandemic. However, this study could not find a statistically significant difference in the mortality and major amputation rates in patients with diabetic ulcer before and during the pandemic. The health system should incorporate the existing institutional and technological recommendations to facilitate care and follow-up of patients with diabetic foot ulcers during the current and future pandemics.

Proton Compton Scattering from Linearly Polarized Gamma Rays

Differential cross sections for Compton scattering from the proton have been measured at scattering angles of 55°, 90°, and 125° in the laboratory frame using quasimonoenergetic linearly (circularly) polarized photon beams with a weighted mean energy value of 83.4 MeV (81.3 MeV). These measurements were performed at the High Intensity Gamma-Ray Source facility at the Triangle Universities Nuclear Laboratory. The results are compared to previous measurements and are interpreted in the chiral effective field theory framework to extract the electromagnetic dipole polarizabilities of the proton, which gives α_{E1}^{p}=13.8±1.2_{stat}±0.1_{BSR}±0.3_{theo},β_{M1}^{p}=0.2∓1.2_{stat}±0.1_{BSR}∓0.3_{theo} in units of 10^{-4}  fm^{3}.

Initial definitive treatment of open femoral shaft fractures with retrograde nailing - is it safe? A retrospective analysis comparing antegrade to retrograde nailing

INTRODUCTION

Treatment of severe open femoral fractures with retrograde intramedullary nailing, raises concerns of septic arthritis of the knee due to its intra-articular entrance point. There is little evidence concerning the safety of retrograde femoral nailing (RFN) usage in these cases, and what evidence there is does not necessarily include severe open fractures. Furthermore, the outcome of ballistic injuries treated in this manner and a comparison with antegrade femoral nailing (AFN), is yet to be established. The aim of this study was to examine the outcome of primary retrograde femoral nailing in high-grade open fractures and compare our results with similar fractures treated with AFN.

PATIENTS AND METHODS

A retrospective analysis of treated high-grade open femoral fractures, was performed at an academic level one trauma centre between 2006 and 2016. Included were all open femur shaft fractures treated with either RFN or AFN as primary fixation. We analysed both patient groups and compared outcomes including the infection rate, non-union rate and secondary interventions. Presence of knee pain and long-term function, was evaluated using the Short-Form 12 (SF-12) questionnaire.

RESULTS

Forty-nine patients with open femoral shaft fractures whose primary treatment was intramedullary nailing (IMN), were included in the cohort. Thirty patients were treated with RFN and 19 with AFN. No septic arthritis of the knee was detected in either group. One patient in the RFN group and two in the AFN had a deep surgical wound infection. Excluding reoperations for locking screw removal due to local irritation, the reoperation rate was 22% with two patients treated for non-union in the RFN group and two in the AFN. When comparing outcome measures, including SF-12 scores and the reported knee pain rates of AFN and RFN groups, no significant differences were observed.

CONCLUSION

Our study showed that retrograde femoral nailing as initial definitive treatment in high-grade open femoral shaft fractures, resulted neither in septic arthritis of the knee nor in an unacceptable infection rate. General outcomes regarding complications and reoperations, was similar to antegrade femoral nailing performed in our centre for similar injuries.

Recommendations for Orthopedic Surgeons during the COVID-19 Pandemic

BACKGROUND

Toward the end of 2019, the coronavirus disease-2019 (COVID-19) pandemic began to create turmoil for global health organizations. The illness, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), spreads by droplets and fomites and can rapidly lead to life-threatening lung disease, especially for the old and those with health co-morbidities. Treating orthopedic patients, who presented with COVID-19 while avoiding nosocomial transmission, became of paramount importance.

OBJECTIVES

To present relevant methods for pandemic control and hospital accommodation with emphasis on orthopedic surgery.

METHODS

We searched search PubMed and Google Scholar electronic databases using the following keywords: COVID-19, SARS-CoV-2, screening tools, personal protective equipment, and surgery triage.

RESULTS

We included 25 records in our analysis. The recommendations from these records were divided into the following categories: COVID-19 disease, managing orthopedic surgery in the COVID-19 era, general institution precautions, triage of orthopedic surgeries, preoperative assessment, surgical room setting, personal protection equipment, anesthesia, orthopedic surgery technical precautions, and department stay and rehabilitation.

CONCLUSIONS

Special accommodations tailored for each medical facility, based on disease burden and available resources can improve patient and staff safety and reduce elective surgery cancellations. This article will assist orthopedic surgeons during the COVID-19 medical crisis, and possibly for future pandemics.

An Uncommon Complication of Arteriovenous Fistula Following Intramedullary Nail Distal Locking – A Case Report

Introduction:An arterial pseudo aneurysm formation is an unusual complication following intramedullary nail distal locking screw insertion. During such surgical procedure, arterial laceration might damage the wall, allowing blood leakage into the soft- tissue surrounding. Only few records are available regarding such injuries. Case Report: A 19-year-old male diagnosed with femoral shaft fracture after a trauma event, was treated using Antegrade Long Intra-Medullary Nail with distal locking screw. Following post-operative serial blood count indicating a consistent decrease in his Haemoglobin levels, a Computed Tomography angiogram was performed and showed an arteriovenous fistula of the lateral superior geniculate artery. The artery was coiled, and haemoglobin levels were stabilized again. Conclusion: A distal interlocking screw should be carefully placed, including blunt dissection before the drilling and screw placement. In addition, blood counts were proved essential in routine. Keywords: Arteriovenous fistula, intramedullary nail distal locking, antegrade long intra-medullary nail.

Evolution of treatment of femoral shaft fracture in polytrauma: Did damage control orthopaedics improve the outcome? A retrospective study

BACKGROUND

Treatment of polytrauma patients with femoral shaft fracture has changed considerably during the past few decades. A transition from early total care (ETC) to "Damage Control" Orthopaedics (DCO) in selected patients was proposed in order to decrease mortality. The aim of the study was to investigate whether this policy change resulted in improved patient outcome.

METHODS

We present a retrospective, comparative study, held in a Level I trauma center in Jerusalem, Israel. Polytrauma patients with Injury Severity Score higher than 16 with femoral shaft fracture were included. Data was extracted from our institute's electronic trauma registry. The study examines two time periods: Between the years 1996 and 2006 patients were treated according to the ETC protocol, with immediate intramedullary nailing (IMN) within 12 h. From 2007 until 2019 a DCO policy was adopted, implementing temporary external fixator for high risk patients, according to the "Hannover" criteria. Following resolution of the acute phase, these were converted to IMN. Patients eligible for DCO were matched to controls who received ETC during the earlier period.

RESULTS

A total of ninety-six patients were included (DCO n = 44, ETC n = 52). The groups were comparable in terms of age, gender, mechanism of injury, injury to surgery time and Injury severity score (DCO median 31.5, ETC median 29). No statistical difference was found between the groups in terms of mortality (P = 0.757), acute respiratory distress syndrome (P = 0.534), sepsis (P = 0.519) and hospital stay (DCO median 24 days, ETC median 21.5 days) or ICU stay (Median 7 days in both groups).

CONCLUSIONS

This pilot study did not demonstrate better outcome by implementing DCO concepts in the polytrauma patient.

LEVEL OF EVIDENCE

III prognostic.

Beautiful stranger: Voices from the front lines of community practice in Israel

Over the past few decades, economic, political and cultural forces have altered the development of social policies and affected the life circumstances of oppressed communities in many countries. In response, calls for greater understanding and awareness of macro practice skills and interventions have been increasing within many of the social care professions. These calls have been particularly strong within the social work profession. A major field in macro social work is community practice, which aims to help people organise, plan and act for change. To date, there has been a dearth of studies examining social workers' involvement in community practice at the ground level. Drawing on in-depth interviews with 26 community social workers in public social services in Israel, this qualitative study examines community social workers' everyday experiences of community practice and the meanings they attribute to it. Findings highlight three main themes: (a) the elusive and unbounded nature of community practice; (b) the tense relations that community social workers maintain with various actors within the profession; and (c) the complex relations they maintain with the communities in which they work. We discuss these findings in light of Georg Simmel's concept of 'the stranger'. Implications to community practice are outlined.

Usefulness of prophylactic antibiotics in preventing infection after internal fixation of closed hand fractures

Prophylactic antibiotics (PA) have been shown to be ineffective in reducing the incidence of surgical site infection (SSI) in clean wounds associated with elective surgery of the hand. Routine administration of PA for internal fixation of hand fractures is a subject that has been scarcely studied. We hypothesized that PA do not reduce SSI incidence in fixation of closed hand fractures. We did a retrospective comparative study in patients who underwent open or closed reduction and internal fixation of a hand and carpus fracture. Patient demographics, past medical history, fracture characteristics and the type of internal fixation used were extracted from our electronic archives. Follow-up period lasted for 1 year, during which any form of clinically evident SSI, such as pus formation, wound dehiscence and positive bacterial culture was documented. A total of 107 patients met the inclusion criteria, 63 in the control group and 44 in the test group. The overall infection rate was 6.5%. All infections (3 in the control group and 4 in the test group) were pin-tract infections that resolved completely after pin extraction. Our study did not find significant differences between groups (P = 0.442). No specific fracture pattern was associated with increased total infection rate (p = 0.898). In this study, we found no support for routine administration of PA prior to internal fixation of closed fractures of the hand and carpus. PA should still be administered in selected patients, such as those with decreased immunity or open fractures. Further large-scale research is needed to establish proper guidelines, to reduce the adverse effects of antibiotic treatment.

Molten metal high pressure injection injury of the hand

The second case of high temperature molten metal, high-pressure injection injury of the hand is reported here. Like in the previous case, there was an innocent-looking entry point with deep thermal injury to the flexor tendons and the digital nerves that appeared a few days after the injury and lead to finger amputation. LEVEL OF EVIDENCE: 5.

High-pressure injection injuries of the fingers: Long-term follow-up in patients after extensive debridement

High-pressure injection injuries to the fingers resulting from the introduction of a foreign substance, such as oil or paint, through a minor puncture wound are rare but can have serious clinical consequences. The objective of this article was to examine the long-term outcomes after surgical debridement of these injuries. We present a retrospective case series of 8 adults who had a high-pressure injection injury to their hand and underwent surgical debridement in our facility. Data were extracted from our outpatient registry. Assessment included a full physical examination, grip strength, range of motion, two-point discrimination and Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. We followed 8 male patients for an average of 12.7 years. Their average age was 37 at time of injury and all had injured their right dominant hand. Seventy-five percent of the injuries were to the index finger. Seven out of the 8 patients returned to their pre-injury occupation, 4 out of 8 patients had reduced range of motion of the affected digit. Injury sequelae adversely affected activities of daily living (ADL) with an average QuickDASH score of 26. Grip strength in the injured hand was reduced by an average of 35% in 6 out of 8 patients compared with the uninjured hand. Sensation was also reduced in the affected digit in 7 out of 8 patients. All patients suffered from some level of neuropathic pain and/or cold intolerance. High pressure injection injury to the fingers is a serious event found amongst industrial laborers. In most patients, this injury will lead to long-term disability along with a negative impact on ADL. However, most patients eventually return to their pre-injury occupation. Extensive, single or repeat debridement of high-pressure injection injuries remains a valid treatment option with good long-term results.

3D Reconstruction of Scoliotic Spines from Stereoradiography and Depth Imaging

Spine shape can be reconstructed from stereoradiography, but often requires specialized infrastructure or fails to account for subject posture. In this paper a protocol is presented for stereo reconstructions that integrates surface recordings with radiography and naturally accounts for variations in patient posture. Low cost depth cameras are added to an existing radiographic system to capture patient pose. A statistical model of human body shape is learned from public datasets and registered to depth scans, providing 3D correspondence across images for stereo reconstruction of radiographic landmarks. A radiographic phantom was used to validate these methods in vitro with RMS 3D landmark reconstruction error of 2.0 mm. Surfaces were automatically and reliably registered, with SD 12 mm translation disparity and SD .5° rotation. The proposed method is suitable for 3D radiographic reconstructions and may be beneficial in compensating for involuntary patient motion.

Dupuytren's Contracture: Current Treatment Methods

Dupuytren's disease is a common benign fibromatosis of the palmar and digital fascia. The exact pathophysiology and epidemiology of this condition have not been entirely identified. Pathologic fibrous bands cause a flexion contracture of the metacarpal phalangeal joints and proximal interphalangeal joint. Treatment includes fasciectomy, needle fasciotomy, and enzymatic fasciectomy.

Comparison of Wrist Motion and Grip Strength in a Normal Chinese and Caucasian Population

BACKGROUND

Anatomical and functional differences between Asian and Caucasian populations have been described and are important in treatment of wrist pathology. The purpose of this study was to establish and compare normal values in an Asian and Caucasian population. We hypothesized that a normal Asian population will have greater wrist ROM and reduced grip- strength when compared to a normal Caucasian population.

METHODS

One hundred and-seventy-one normal Asian and 156 normal Caucasian wrists were evaluated. We excluded wrists with current or a history of wrist pathology including past surgery, injury or congenital malformation. We collected demographic information regarding occupation, body mass index (BMI), and previous wrist pathology. The wrist measurements included: wrist extension, flexion, radial, ulnar deviation, and grip strength. Wrists were also evaluated for a mid-carpal clunk, and scaphoid shift test. Mixed models accounted for evaluation of both hands in the same individual and for the relative contribution of different factors to the outcome measures of ROM and grip- strength.

RESULTS

The two groups differed in height, BMI and the distribution of occupation. The Asian group had more flexion, less extension and similar radial/ulnar wrist deviation when compared to the Caucasian group. Ethnicity was a significant predictor of wrist joint flexion and extension significantly predicting grip- strength. Age was associated with ROM while occupation, hand side and gender were not significant factors in the mixed model.

CONCLUSIONS

We found discrete differences between values in the two populations. More study of anatomical morphological patterns may explain the reason for variations in motion and grip- strength. The differences identified in this study between Asian and Caucasian populations should be taken into account when evaluating outcomes of wrist therapeutic procedures and rehabilitation in different communities.

Measurement of Compton scattering from the deuteron and an improved extraction of the neutron electromagnetic polarizabilities

The electromagnetic polarizabilities of the nucleon are fundamental properties that describe its response to external electric and magnetic fields. They can be extracted from Compton-scattering data-and have been, with good accuracy, in the case of the proton. In contradistinction, information for the neutron requires the use of Compton scattering from nuclear targets. Here, we report a new measurement of elastic photon scattering from deuterium using quasimonoenergetic tagged photons at the MAX IV Laboratory in Lund, Sweden. These first new data in more than a decade effectively double the world data set. Their energy range overlaps with previous experiments and extends it by 20 MeV to higher energies. An analysis using chiral effective field theory with dynamical Δ(1232) degrees of freedom shows the data are consistent with and within the world data set. After demonstrating that the fit is consistent with the Baldin sum rule, extracting values for the isoscalar nucleon polarizabilities, and combining them with a recent result for the proton, we obtain the neutron polarizabilities as αn=[11.55±1.25(stat)±0.2(BSR)±0.8(th)]×10(-4)  fm(3) and βn=[3.65∓1.25(stat)±0.2(BSR)∓0.8(th)]×10(-4)  fm(3), with χ(2)=45.2 for 44 degrees of freedom.

Novel mutations causing biotinidase deficiency in individuals identified by newborn screening in Michigan including an unique intronic mutation that alters mRNA expression of the biotinidase gene

Biotinidase deficiency (BD) is an autosomal recessive disorder resulting in the inability to recycle the vitamin biotin. Individuals with biotinidase deficiency can develop neurological and cutaneous symptoms if they are not treated with biotin. To date, more than 165 mutations in the biotinidase gene (BTD) have been reported. Essentially all the mutations result in enzymatic activities with less than 10% of mean normal serum enzyme activity (profound biotinidase deficiency) with the exception of the c.1330G>C (p.D444H) mutation, which results in an enzyme having 50% of mean normal serum activity and causes partial biotinidase deficiency (10-30% of mean normal serum biotinidase activity) if there is a mutation for profound biotinidase deficiency on the second allele. We now reported eight novel mutations in ten children identified by newborn screening in Michigan from 1988 to the end of 2012. Interestingly, one intronic mutation, c.310-15delT, results in an approximately two-fold down-regulation of BTD mRNA expression by Quantitative real-time reverse-transcription PCR (qRT-PCR). This is the first report of an intronic mutation in the BTD gene with demonstration of its effect on enzymatic activity by altering mRNA expression. This study identified three other mutations likely to cause partial biotinidase deficiency. These results emphasize the importance of full gene sequencing of BTD on patients with biotinidase deficiency to better understand the genotype and phenotype correlation in the future.

Individual and collective dimensions of resilience within political violence

Research has documented a link between political violence and the functioning of individuals and communities. Yet, despite the hardships that political violence creates, evidence suggests remarkable fortitude and resilience within both individuals and communities. Individual characteristics that appear to build resilience against political violence include demographic factors such as gender and age, and internal resources, such as hope, optimism, determination, and religious convictions. Research has also documented the protective influence of individuals' connection to community and their involvement in work, school, or political action. Additionally, research on political violence and resilience has increasingly focused on communities themselves as a unit of analysis. Community resilience, like individual resilience, is a process supported by various traits, capacities, and emotional orientations toward hardship. This review addresses various findings related to both individual and community resilience within political violence and offers recommendations for research, practice, and policy.

New method for precise determination of the isovector giant quadrupole resonances in nuclei

The intense, nearly monoenergetic, 100% polarized γ-ray beams available at the HIγS facility, along with the realization that the E1-E2 interference term that appears in the Compton scattering polarization observable has opposite signs in the forward and backward angles, make it possible to obtain an order-of-magnitude improvement in the determination of the parameters of the isovector giant quadrupole resonance (IVGQR). Accurate IVGQR parameters will lead to a more detailed knowledge of the symmetry energy in the nuclear equation of state which is important for understanding nuclear matter under extreme conditions such as those present in neutron stars. Our new method is demonstrated for the case of (209)Bi.

Satellite color observations of the phytoplankton distribution in the eastern equatorial pacific during the 1982-1983. El nino

Dramatic changes in the patterns of satellite-derived pigment concentrations around the Galápagos Islands during February and March 1983 are associated with unusual oceanographic conditions observed during the 1982-1983 El Niño. The redistribution of food resources might have contributed to the reproductive failure of seabirds and marine mammals on these islands during this El Niño.

Measurement of deeply virtual compton scattering beam-spin asymmetries

The beam-spin asymmetries in the hard exclusive electroproduction of photons on the proton (e p-->epgamma) were measured over a wide kinematic range and with high statistical accuracy. These asymmetries result from the interference of the Bethe-Heitler process and of deeply virtual Compton scattering. Over the whole kinematic range (x(B) from 0.11 to 0.58, Q2 from 1 to 4.8 GeV2, -t from 0.09 to 1.8 GeV2), the azimuthal dependence of the asymmetries is compatible with expectations from leading-twist dominance, A approximately a sinphi/(1+c cosphi). This extensive set of data can thus be used to constrain significantly the generalized parton distributions of the nucleon in the valence quark sector.

Bayesian analysis of pentaquark signals from CLAS data

We examine the results of two measurements by the CLAS collaboration, one of which claimed evidence for a Theta(+) pentaquark, while the other found no such evidence. The unique feature of these two experiments was that they were performed with the same experimental setup. Using a Bayesian analysis, we find that the results of the two experiments are in fact compatible with each other, but that the first measurement did not contain sufficient information to determine unambiguously the existence of a Theta(+). Further, we suggest a means by which the existence of a new candidate particle can be tested in a rigorous manner.

Search for medium modifications of the rho meson

The photoproduction of vector mesons on various nuclei has been studied using the CLAS detector at Jefferson Laboratory. The vector mesons, rho, omega, and varphi, are observed via their decay to e;{+}e;{-}, in order to reduce the effects of final-state interactions in the nucleus. Of particular interest are possible in-medium effects on the properties of the rho meson. The rho mass spectrum is extracted from the data on various nuclei, 2H, C, Fe, and Ti. We observe no significant mass shift and some broadening consistent with expected collisional broadening for the rho meson.

Experimental study of exclusive 2H(e,e'p)n reaction mechanisms at high Q2

The reaction 2H(e,e'p)n has been studied with full kinematic coverage for photon virtuality 1.75<Q2<5.5 GeV2. Comparisons of experimental data with theory indicate that for very low values of neutron recoil momentum (p(n)<100 MeV/c) the neutron is primarily a spectator and the reaction can be described by the plane-wave impulse approximation. For 100<p(n)<750 MeV/c, proton-neutron rescattering dominates the cross section, while Delta production followed by the NDelta-->NN transition is the primary contribution at higher momenta.

Measurement of the N-->Delta(+)(1232) transition at high-momentum transfer by pi(0) electroproduction

We report a new measurement of the exclusive electroproduction reaction gamma(*)p-->pi(0)p to explore the evolution from soft nonperturbative physics to hard processes via the Q(2) dependence of the magnetic (M(1+)), electric (E(1+)), and scalar (S(1+)) multipoles in the N-->Delta transition. 9000 differential cross section data points cover W from threshold to 1.4 GeV/c(2), 4pi center-of-mass solid angle, and Q(2) from 3 to 6 GeV(2)/c(2), the highest yet achieved. It is found that the magnetic form factor G(M)(*) decreases with Q(2) more steeply than the proton magnetic form factor, the ratio E(1+)/M(1+) is small and negative, indicating strong helicity nonconservation, and the ratio S(1+)/M(1+) is negative, while its magnitude increases with Q(2).

Measurement of deeply virtual compton scattering with a polarized-proton target

The longitudinal target-spin asymmetry AUL for the exclusive electroproduction of high-energy photons was measured for the first time in ep-->e;'pgamma. The data have been accumulated at JLab with the CLAS spectrometer using 5.7 GeV electrons and a longitudinally polarized NH3 target. A significant azimuthal angular dependence was observed, resulting from the interference of the deeply virtual Compton scattering and Bethe-Heitler processes. The amplitude of the sinvarphi moment is 0.252+/-0.042stat+/-0.020sys. Theoretical calculations are in good agreement with the magnitude and the kinematic dependence of the target-spin asymmetry, which is sensitive to the generalized parton distributions H and H.

Search for the Theta+ Pentaquark in the gammad--> DeltanK+ reaction measured with the CLAS spectrometer

For the first time, the reaction gammad-->DeltanK+ has been analyzed in order to search for the exotic pentaquark baryon Theta+(1540). The data were taken at Jefferson Laboratory, using the Hall-B tagged-photon beam of energy between 0.8 and 3.6 GeV and the CEBAF Large Acceptance Spectrometer (CLAS). No statistically significant structures were observed in the nK+ invariant-mass distribution. The upper limit on the gammad-->DeltaTheta+ integrated cross section has been calculated and found to be between 5 and 25 nb, depending on the production model assumed. The upper limit on the differential cross section is also reported.

Search for the Theta+ pentaquark in the reaction gammad --> pK-K+n

A search for the Theta+ in the reaction gammad --> pK-K+n was completed using the CLAS detector at Jefferson Lab. A study of the same reaction, published earlier, reported the observation of a narrow Theta+ resonance. The present experiment, with more than 30 times the integrated luminosity of our earlier measurement, does not show any evidence for a narrow pentaquark resonance. The angle-integrated upper limit on Theta+ production in the mass range of 1.52-1.56 GeV/c2 for the gammad --> pK-Theta+ reaction is 0.3 nb (95% C.L.). This upper limit depends on assumptions made for the mass and angular distribution of Theta+ production. Using Lambda(1520) production as an empirical measure of rescattering in the deuteron, the cross section upper limit for the elementary gamman --> K-Theta+ reaction is estimated to be a factor of 10 higher, i.e., approximately 3 nb (95% C.L.).

Eta' photoproduction on the proton for photon energies from 1.527 to 2.227 GeV

Differential cross sections for the reaction gamma p --> eta' p have been measured with the CLAS spectrometer and a tagged photon beam with energies from 1.527 to 2.227 GeV. The results reported here possess much greater accuracy than previous measurements. Analyses of these data suggest for the first time the coupling of the eta'N channel to both the S11(1535) and P11(1710) resonances, known to couple strongly to the etaN channel in photoproduction on the proton, and the importance of J = 3/2 resonances in the process.

Beam-helicity asymmetries in double-charged-pion photoproduction on the proton

Beam-helicity asymmetries for the two-pion-photoproduction reaction gammap-->ppi(+)pi(-) have been studied for the first time in the resonance region for center-of-mass energies between 1.35 and 2.30 GeV. The experiment was performed at Jefferson Lab with the CEBAF Large Acceptance Spectrometer using circularly polarized tagged photons incident on an unpolarized hydrogen target. Beam-helicity-dependent angular distributions of the final-state particles were measured. The large cross-section asymmetries exhibit strong sensitivity to the kinematics and dynamics of the reaction. The data are compared with the results of various phenomenological model calculations, and show that these models currently do not provide an adequate description for the behavior of this new observable.

Glycolytic enzymes associated with the cell surface of Streptococcus pneumoniae are antigenic in humans and elicit protective immune responses in the mouse

Streptococcus pneumoniae is a leading cause of otitis media, sinusitis, pneumonia, bacteraemia and meningitis worldwide. The drawbacks associated with the limited number of various capsular polysaccharides that can be included in the polysaccharide-based vaccines focuses much attention on pneumococcal proteins as vaccine candidates. We extracted an enriched cell wall fraction from S. pneumoniae WU2. Approximately 150 soluble proteins could be identified by 2D gel electrophoresis. The proteins were screened by 2D-Western blotting using sera that were obtained longitudinally from children attending day-care centres at 18, 30 and 42 months of age and sera from healthy adult volunteers. The proteins were further identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry. Seventeen proteins were antigenic in children and adults, of which 13 showed an increasing antibody response with age in all eight children analysed. Two immunogenic proteins, fructose-bisphosphate aldolase (FBA) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH), and a control protein with known low immunogenicity, heat shock protein 70 (DnaK), were expressed in Escherichia coli, purified and used to immunize mice. Mouse antibodies elicited to the recombinant (r) FBA and rGAPDH were cross-reactive with several genetically unrelated strains of different serotypes and conferred protection to respiratory challenge with virulent pneumococci. In addition, the FBA used in this study (NP_345117) does not have a human ortholog and warrants further investigation as a candidate for a pneumococcal vaccine. In conclusion, the immunoproteomics based approach utilized in the present study appears to be a suitable tool for identification of novel S. pneumoniae vaccine candidates.

In vivo determination of prostatic zinc: phantom feasibility study

This paper describes a phantom-based feasibility study for a potential in vivo determination of zinc in prostate, which could bring about improved diagnosis of prostate cancer. An x-ray fluorescence topographic technique was developed, which will permit determination of the Zn content in the prostate through the rectum, namely behind a 2-3 mm thick layer of the rectal wall. The topographic approach, together with a reconstruction method developed here, minimizes the interference of Zn from non-prostatic tissue. The phantom studies show that it will be possible to determine Zn in a prostatic compartment behind a few mm thick layer of tissue using a specially designed transrectal probe. Such a probe is currently under development in our laboratories.

Measurement of ep-->e' ppi+ pi- and baryon resonance analysis

The cross section for the reaction ep-->e(')ppi(+)pi(-) was measured in the resonance region for 1.4<W<2.1 GeV and 0.5<Q2<1.5 GeV(2)/c(2) using the CLAS detector at Jefferson Laboratory. The data show resonant structures not visible in previous experiments. The comparison of our data to a phenomenological prediction using available information on N(*) and Delta states shows an evident discrepancy. A better description of the data is obtained either by a sizable change of the properties of the P13(1720) resonance or by introducing a new baryon state, not reported in published analyses.

Eta photoproduction on the proton for photon energies from 0.75 to 1.95 GeV

Differential cross sections for gammap-->etap have been measured with tagged real photons for incident photon energies from 0.75 to 1.95 GeV. Mesons were identified by missing mass reconstruction using kinematical information for protons scattered in the production process. The data provide the first extensive angular distribution measurements for the process above W=1.75 GeV. Comparison with preliminary results from a constituent quark model support the suggestion that a third S11 resonance with mass approximately 1.8 GeV couples to the etaN channel.

Development of a decision aid for atrial fibrillation who are considering antithrombotic therapy

With patients demanding a greater role in the clinical decision-making process, many researchers are developing and disseminating decision aids for various medical conditions. In this article, we outline the essential elements in the development and evaluation of a decision aid to help patients with atrial fibrillation choose, in consultation with their physicians, appropriate antithrombotic therapy (warfarin, aspirin, or no therapy) to prevent stroke. We also outline possible future directions regarding the implementation and evaluation of this decision aid. This information should enable clinicians to better understand the role that decision aids may have in their interactions with patients.

Linkage exclusion and mutational analysis of the noggin gene in patients with fibrodysplasia ossificans progressiva (FOP)

Fibrodysplasia ossificans progressiva (FOP) is an extremely rare and disabling genetic disorder characterized by congenital malformation of the great toes and by progressive heterotopic endochondral ossification in predictable anatomical patterns. Although elevated levels of bone morphogenetic protein 4 (BMP4) occur in lymphoblastoid cells and in lesional cells of patients with FOP, mutations have not been identified in the BMP4 gene, suggesting that the mutation in FOP may reside in a BMP4-interacting factor or in another component of the BMP4 pathway. A powerful antagonist of BMP4 is the secreted polypeptide noggin. A recent case report described a heterozygous 42-bp deletion in the protein-coding region of the noggin gene in a patient with FOP. In order to determine if noggin mutations are a widespread finding in FOP, we examined 31 families with 1 or more FOP patients. Linkage analysis with an array of highly polymorphic microsatellite markers closely linked to the noggin gene was performed in four classically-affected multigenerational FOP families and excluded linkage of the noggin locus to FOP (the multipoint lod score was -2 or less throughout the entire range of markers). We sequenced the noggin gene in affected members of all four families, as well as in 18 patients with sporadic FOP, and failed to detect any mutations. Single-strand conformation polymorphism (SSCP) analysis of 4 of these patients plus an additional 9 patients also failed to reveal any mutations. Among the samples analyzed by SSCP and DNA sequencing was an independently obtained DNA sample from the identical FOP patient previously described with the 42-bp noggin deletion; no mutation was detected. Examination of the DNA sequences of 20 cloned noggin PCR products, undertaken to evaluate the possibility of a somatic mutation in the noggin gene which could be carried by a small subset of white blood cells, also failed to detect the presence of the reported 42-bp deletion. We conclude that mutations in the coding region of noggin are not associated with FOP.

Quasifree compton scattering from the deuteron and nucleon polarizabilities

Cross sections for quasifree Compton scattering from the deuteron were measured for incident energies of E(gamma) = 236-260 MeV at the laboratory angle straight theta(gamma(')) = -135 degrees. The recoil nucleons were detected in a liquid-scintillator array situated at straight theta(N) = 20 degrees. The measured differential cross sections were used, with the calculations of Levchuk et al., to determine the polarizabilities of the bound nucleons. For the bound proton, the extracted values were consistent with the accepted value for the free proton. Combining our results for the bound neutron with those from Rose et al., we obtain 1-sigma constraints of alpha;(n) = 7.6-14.0 and beta;(n) = 1.2-7.6.

Primary prevention studies and the healthy elderly: evaluating barriers to recruitment

Although primary prevention studies are important tools in helping the healthy elderly stay healthy, recruiting from a community-based cohort of healthy elderly individuals for a primary prevention study involves numerous barriers. To better identify and understand these barriers, we conducted and evaluated a comprehensive recruitment strategy for a primary prevention study testing aspirin in an HMO population. In the recruitment phase, we identified healthy individuals (65 years of age or older) who were members of a large, group-model HMO in Oregon and Washington, and used computerized medical database screening, statistical sampling, health plan mailings, e-mail communication with primary care providers, and the experience of a well-established research clinic in an effort to enroll health elderly in this primary prevention trial. Among a random sample of 47,453 eligible patients over the age of 65, 44% responded to recruitment efforts, but only 3% were enrolled--an overall yield of slightly less than 2%. To evaluate these results, we then conducted focus groups with 225 randomly selected "eligible refusers." We determined that healthy elders were hesitant to give up their choice to use aspirin, unwilling to travel to the research center, and reluctant to risk their tenuous hold on good health to participate in a study of primary prevention. Awareness of these attitudes is an indispensable step toward designing effective recruitment strategies for primary prevention studies involving the healthy elderly.