Resource Document on Best Practices in Synchronous Videoconferencing-Based Telemental Health

Background: This document represents an updated collaboration between the American Psychiatric Association (APA) and the American Telemedicine Association (ATA) to create a consolidated update of the previous APA and ATA official documents and resources in telemental health, to provide a single guide on clinical best practices for providing mental health services through synchronous videoconference. Methods: A joint writing committee drawn from the APA Committee on Telepsychiatry and the ATA TMH Special Interest Group (TMH SIG). was convened to draft and finalize the guidelines. This document draws directly from the 2018 APA/ATA guide and the ATA s previous guidelines, selecting from key statements/guidelines, consolidating them across documents, and then updating them where indicated. Guideline approval was provided following internal review by the APA, the ATA, the Board of Directors of the ATA, and the Joint Reference Committee of the APA. Results: The guidelines contain requirements, recommendations, and actions that are identified by text containing the keywords "shall," "should," or "may." Conclusions: Compliance with these recommendations will not guarantee accurate diagnoses or successful outcomes. The purpose of this guide is to assist providers in providing effective and safe medical care founded on expert consensus, research evidence, available resources, and patient needs.

X-ray beam quality after a mirror reflection: Experimental and simulated results for a toroidal mirror in a 4 th generation storage-ring beamline

Background

The surface errors found in X-ray mirrors constitute a limiting factor for preserving beam quality. This is particularly important when the X-ray beam has low emittance and a significant coherence fraction, like in newly upgraded synchrotron storage rings.

Methods

We studied the fringes observed in the image of an undulator-produced X-ray beam reflected by a high-quality toroidal mirror. The measurements and simulations were performed using different conditions: a photon beam either monochromatic or with large bandwidth, reflected by a mirror with variable curvature.

Results

The experimental data are compared with up-to-date simulation including partial coherence.

Conclusions

The observed fringes in the unfocused beam correlate with low spatial frequency structures in mirror profiles, irrespective of beam coherence. Both classical ray tracing and partially coherent simulations through coherent mode decomposition are confirmed as accurate methods for such simulations.

X-ray mirrors with sub-nanometre figure errors obtained by differential deposition of thin WSi2 films

Differential deposition by DC magnetron sputtering was applied to correct for figure errors of X-ray mirrors to be deployed on low-emittance synchrotron beamlines. During the deposition process, the mirrors were moved in front of a beam-defining aperture and the required velocity profile was calculated using a deconvolution algorithm. The surface figure was characterized using conventional off-line visible-light metrology instrumentation (long trace profiler and Fizeau interferometer) before and after the deposition. WSi₂ was revealed to be a promising candidate material since it conserves the initial substrate surface roughness and limits the film stress to acceptable levels. On a 300 mm-long flat Si mirror the average height errors were reduced by a factor of 20 down to 0.2 nm root mean square. This result shows the suitability of WSi₂ for differential deposition. Potential promising applications include the upgrade of affordable, average-quality substrates to the standards of modern synchrotron beamlines.

The community engagement course and action network: strengthening community and academic research partnerships to advance health equity

Background

Historically Black Colleges and Universities and Minority Serving Institutions are uniquely positioned to implement community-campus research partnerships based on a history of service, the pursuit of community trustworthiness and student demographics often similar to surrounding marginalized communities. The Morehouse School of Medicine Prevention Research Center collaborates with members of Historically Black Colleges and Universities, Minority Serving Institutes, and community organizations on the Community Engaged Course and Action Network. This network is the first of its kind and aims to strengthen members' ability to implement Community-Based Participatory Research (CBPR) principles and partnerships. Projects address public health priorities including mental health among communities of color, zoonotic disease prevention, and urban food deserts.

Materials and methods

To assess the effectiveness of the network, a Participatory Evaluation framework was implemented to conduct process evaluation which included review of partnership structures, operations, project implementation processes, and preliminary outcomes of the research collaborations. A focus group of Community Engagement Course and Action Network members (community and academic) was also conducted to identify benefits and challenges of the network with emphasis on key areas for improvement to further enhance the relationships between partners and to facilitate their subsequent community-campus research.

Results

Network improvements were tied to themes strengthening community-academic partnerships including sharing and fellowship, coalition building and collaboration, and greater connections and awareness of community needs through their current community-academic partnerships. The need to conduct ongoing evaluation during and after implementation, for determining the early adoption of CBPR approaches was also identified.

Conclusion

Evaluation of the network's processes, infrastructure, and operation provides early lessons learned to strengthen the network. Ongoing assessment is also essential for ensuring continuous quality improvement across partnerships such as determining CBPR fidelity, assessing partnership synergy, and dynamics, and for quality improvement of research protocol. The implications and potential for advancing implementation science through this and similar networks are great towards advancing leadership in modeling how foundations in community service can advance to CBPR partnership formation and ultimately, health equity approaches, that are local defined and assessed.

Tilting refractive x-ray lenses for fine-tuning of their focal length

In this work, we measure and model tilted x-ray refractive lenses to investigate their effects on an x-ray beam. The modelling is benchmarked against at-wavelength metrology obtained with x-ray speckle vector tracking experiments (XSVT) at the BM05 beamline at the ESRF-EBS light source, showing very good agreement. This validation permits us to explore possible applications of tilted x-ray lenses in optical design. We conclude that while tilting 2D lenses does not seem interesting from the point of view of aberration-free focusing, tilting 1D lenses around their focusing direction can be used for smoothly fine-tuning their focal length. We demonstrate experimentally this continuous change in the apparent lens radius of curvature R: a reduction up to a factor of two and beyond is achieved and possible applications in beamline optical design are proposed.

Polished diamond X-ray lenses

High-quality bi-concave 2D focusing diamond X-ray lenses of apex-radius R = 100 µm produced via laser-ablation and improved via mechanical polishing are presented here. Both for polished and unpolished individual lenses and for stacks of ten lenses, the remaining figure errors determined using X-ray speckle tracking are shown and these results are compared with those of commercial R = 50 µm beryllium lenses that have similar focusing strength and physical aperture. For two stacks of ten diamond lenses (polished and unpolished) and a stack of eleven beryllium lenses, this paper presents measured 2D beam profiles out of focus and wire scans to obtain the beam size in the focal plane. These results are complemented with small-angle X-ray scattering (SAXS) measurements of a polished and an unpolished diamond lens. Again, this is compared with the SAXS of a beryllium lens. The polished X-ray lenses show similar figure errors to commercially available beryllium lenses. While the beam size in the focal plane is comparable to that of the beryllium lenses, the SAXS signal of the polished diamond lenses is considerably lower.

Measurement techniques to improve the accuracy of x-ray mirror metrology using stitching Shack-Hartmann wavefront sensors

We describe the development of specific measurement protocols to improve the accuracy of surface metrology of x-ray mirrors using a dedicated commercial instrument based on wavefront sensing techniques. This instrument, SHARPeR, uses measurements from a Shack-Hartmann wavefront sensor combined with a sub-aperture stitching method to provide two-dimensional maps of the surface slope errors and can measure curved mirrors above 1 m radii. In this paper, we describe the results of measurement methods developed on a SHARPeR system installed at the European Synchrotron (ESRF) to reduce the contribution of systematic errors to measurements of strongly curved spherical and aspherical x-ray mirrors with intrinsic slope errors of the order of 100-200 nrad rms. We demonstrate how this commercial integrated instrument can provide measurements of these mirrors with comparable accuracy to those measured with a long trace profiler.

Hemispheric asymmetry in ocean change and the productivity of ecosystem sentinels

Climate change and other human activities are causing profound effects on marine ecosystem productivity. We show that the breeding success of seabirds is tracking hemispheric differences in ocean warming and human impacts, with the strongest effects on fish-eating, surface-foraging species in the north. Hemispheric asymmetry suggests the need for ocean management at hemispheric scales. For the north, tactical, climate-based recovery plans for forage fish resources are needed to recover seabird breeding productivity. In the south, lower-magnitude change in seabird productivity presents opportunities for strategic management approaches such as large marine protected areas to sustain food webs and maintain predator productivity. Global monitoring of seabird productivity enables the detection of ecosystem change in remote regions and contributes to our understanding of marine climate impacts on ecosystems.

X-ray optics and beam characterization using random modulation: theory

X-ray near-field speckle-based phase-sensing approaches provide efficient means of characterizing optical elements. Presented here is a theoretical review of several of these speckle methods within the framework of optical characterization, and a generalization of the concept is provided. As is also demonstrated experimentally in a parallel paper [Berujon, Cojocaru, Piault, Celestre, Roth, Barrett & Ziegler (2020), J. Synchrotron Rad. 27, (this issue)], the methods theoretically developed here can be applied to different beams and optics and within a variety of situations where at-wavelength metrology is desired. By understanding the differences between the various processing methods, it is possible to find and implement the most suitable approach for each metrology scenario.

Modelling phase imperfections in compound refractive lenses

A framework based on physical optics for simulating the effect of imperfect compound refractive lenses (CRLs) upon an X-ray beam is described, taking into account measured phase errors obtained from at-wavelength metrology. A CRL stack is modelled, with increasing complexity, as a single thin phase element, then as a more realistic compound element including absorption and thickness effects, and finally adding realistic optical imperfections to the CRL. Coherent and partially coherent simulations using Synchrotron Radiation Workshop (SRW) are used to evaluate the different models, the effects of the phase errors and to check the validity of the design equations and suitability of the figures of merit.

X-ray optics and beam characterization using random modulation: experiments

A parallel paper [Berujon, Cojocaru, Piault, Celestre, Roth, Barrett & Ziegler (2020), J. Synchrotron Rad. 27, 284-292] reviewed theoretically some of the available processing schemes for X-ray wavefront sensing based on random modulation. Shown here are experimental applications of the technique for characterizing both refractive and reflective optical components. These fast and accurate X-ray at-wavelength metrology methods can assist the manufacture of X-ray optics that transport X-ray beams with a minimum amount of wavefront distortion. It is also recalled how such methods can facilitate online optimization of active optics.

X-ray mirror figure correction by differential deposition and off-line metrology

The surface figure error of a hard X-ray mirror was improved by combining differential deposition and off-line metrology tools. Thin Cr layers were deposited on flat substrates by DC magnetron sputtering. The substrates were moved in front of a beam-defining aperture. The required velocity profile was calculated using a deconvolution algorithm. The Cr thickness profiles were measured directly using hard X-ray reflectivity data. The surface figure was characterized using conventional visible-light metrology instrumentation (long trace profiler) before and after the deposition. The method converges quickly, and after two iterations the mirror surface figure had improved by a factor of 7. The surface roughness evolves with increasing Cr thickness and deteriorates the quality of subsequent multilayer coatings. The mirror curvature can change upon coating, which complicates the interpretation of the surface metrology data. In this context, the role of layer stress is discussed. Potential improvements of the process are also proposed.

The Nanodiffraction beamline ID01/ESRF: a microscope for imaging strain and structure

The ID01 beamline has been built to combine Bragg diffraction with imaging techniques to produce a strain and mosaicity microscope for materials in their native or operando state. A scanning probe with nano-focused beams, objective-lens-based full-field microscopy and coherent diffraction imaging provide a suite of tools which deliver micrometre to few nanometre spatial resolution combined with 10-5 strain and 10-3 tilt sensitivity. A detailed description of the beamline from source to sample is provided and serves as a reference for the user community. The anticipated impact of the impending upgrade to the ESRF - Extremely Brilliant Source is also discussed.

Stitching techniques for measuring X-ray synchrotron mirror topography

Optical metrology and polishing techniques are continuously evolving to satisfy the increasingly stringent specifications required for X-ray optical components for synchrotron and free-electron laser light source beamlines. For both spherical and aspherical geometries, the most demanding applications may have target residual figure errors close to 1 nm. To achieve such specifications and maintain them in the optomechanical mount, it is critical to develop methods capable of measuring the topography of the optical surface over the clear aperture of the mirror. The European Synchrotron Radiation Facility optical metrology laboratory has developed a stitching tool initially aimed at measuring long flat mirrors up to 1 m long with a Fizeau interferometer. The system is routinely used providing 2D maps of the optical surface. The instrument capabilities have been extended to characterize moderately curved optics using a transmission flat element, and results obtained on a high quality spherical mirror with 120 m of radius of curvature are presented. As a novel approach of stitching application, the technique has been used to improve the measurement accuracy of the Fizeau interferometer when measuring short plane mirrors. Acquisition of 2D topographies on a short plane mirror by micro-stitching interferometry is also presented and discussed.

In vivo strain in the deep and superficial regions of the human patellar tendon

This study investigated strain differences within the patellar tendon (PT) mid-region using an ultrasound-based digital image correlation (DIC) method. Six healthy young participants performed six knee extensions to 60% of maximal voluntary isometric contraction on 2 days. Sagittal ultrasound videos recorded during each contraction were analyzed using the DIC method to determine the strain-torque relationships of the superficial, deep, and whole PT mid-regions. Significantly greater strain was observed in the deep vs superficial layer of the PT mid-region for all contraction intensities, with peak strains of 5.8% (SD 1.7) and 4.5% (SD 1.5), respectively. DIC-based measures of peak tendon strain were repeatable within [intraclass coefficients (ICC) >0.97] and between sessions (ICCs >0.83) and agreed well with the conventional point-to-point method. This study confirmed that significant differences exist between deep and superficial layers of PT mid-region during ramped isometric extensions. These findings support the use of DIC to examine regional strain patterns within the PT mid-region that may be important in the context of tendon injury and adaptation.

Awareness of Sentinel Injuries Among Canadian Paediatricians: A Cpsp One-Time Survey

BACKGROUND: A sentinel injury is a visible or detectable minor injury in a pre-cruising infant that is poorly explained and therefore suspicious for physical abuse. Examples include bruises and intra-oral bleeding, which may be “warning injuries” for possible abuse. Timely recognition and management of a sentinel injury can potentially alter a pattern of escalating child abuse, but studies have demonstrated that in up to a third of cases, physicians miss early signs of abuse.

OBJECTIVES: Our purpose was to assess paediatrician awareness of sentinel injuries in pre-cruising children as precursors to more serious physical abuse.

DESIGN/METHODS: A Canadian Paediatric Surveillance Program (CPSP) one-time survey of Canadian paediatricians was conducted in March of 2015 to evaluate awareness of sentinel injuries and their significance. Respondents were provided with clinical vignettes describing infants with sentinel injuries and were asked questions about their differential diagnosis and management plan. Respondents were then classified as either “aware” or “not aware” based on their responses, and a multivariable logistic regression analysis was used to identify variables most strongly correlated with awareness.

RESULTS: The survey achieved a response rate of 23.4%. Of the 582 respondents, 65% were aware that bruises and intra-oral injuries in pre-cruising children are red flags for possible physical abuse. Respondents were more likely to be aware of bruises as sentinel injuries (91.9%) than they were of intra-oral injuries (67.2%). Paediatric subspecialists were significantly less likely than general paediatricians to be aware of sentinel injuries as red flags for later serious abuse (adjusted OR=0.57, 95% CI 0.37–0.88, p=0.01). Other important trends included higher awareness with more recent completion of residency, and also with additional training in the area of child abuse and neglect.

CONCLUSION: Over one-third of Canadian paediatricians are unaware that unexplained bruising and intra-oral bleeding in a pre-cruising child should prompt assessment for possible abuse. Further physician education is warranted to ensure that paediatricians understand the importance of sentinel injuries and the indications for initiating investigations to detect occult injuries of child abuse. Future directions include the development of physician training opportunities in the area of identifying and managing sentinel injuries, as well as extending the study population to include family physicians who provide primary care to children.

Stitching methods at the European Synchrotron Radiation Facility (ESRF)

X-ray mirror quality has continuously improved over the past 20 years and manufacturers are now able to provide long mirrors with slope errors below 0.2 μrad. Nevertheless, these mirrors are mounted on holders or even mechanical benders to adjust their curvature and their intrinsic quality must be preserved from any parasitic deformation such as twist. The most direct method of detecting these deformations is to measure the 3D topography of the optical surface. At the ESRF metrology laboratory, three different stitching systems are under development based on Fizeau sub-aperture measurements. The first one consists of measuring long flat mirrors, the second based on the relative angle determinable stitching interferometry (RADSI) method developed at SPring-8 is aimed primarily at the measurement of short mirrors with strong curvature down to a few meters, and the last, also based on the RADSI method, is dedicated to characterize longer mirrors with intermediate curvature. For each method we will describe the measurement setup and discuss first results obtained. Micro-stitching interferometry is also currently used at the ESRF metrology laboratory. The technique is suitable for measuring deeply curved aspherical profiles and will be illustrated with results from a Kirkpatrick-Baez mirror system for nano-focusing.

ID16B: a hard X-ray nanoprobe beamline at the ESRF for nano-analysis

Within the framework of the ESRF Phase I Upgrade Programme, a new state-of-the-art synchrotron beamline ID16B has been recently developed for hard X-ray nano-analysis. The construction of ID16B was driven by research areas with major scientific and societal impact such as nanotechnology, earth and environmental sciences, and bio-medical research. Based on a canted undulator source, this long beamline provides hard X-ray nanobeams optimized mainly for spectroscopic applications, including the combination of X-ray fluorescence, X-ray diffraction, X-ray excited optical luminescence, X-ray absorption spectroscopy and 2D/3D X-ray imaging techniques. Its end-station re-uses part of the apparatus of the earlier ID22 beamline, while improving and enlarging the spectroscopic capabilities: for example, the experimental arrangement offers improved lateral spatial resolution (∼50 nm), a larger and more flexible capability for in situ experiments, and monochromatic nanobeams tunable over a wider energy range which now includes the hard X-ray regime (5-70 keV). This paper describes the characteristics of this new facility, short-term technical developments and the first scientific results.

New challenges in beamline instrumentation for the ESRF Upgrade Programme Phase II

Although beamline instrumentation is by nature driven by science, some recent examples serve as reminders that new technologies also enable new science. Indeed, exploiting the full scientific potential of forthcoming new storage rings with unprecedented source characteristics will, in many cases, require the development and implementation of novel instrumentation. In comparison with present synchrotron radiation facilities, the majority of beamlines should reap immediate performance benefits from the improved source emittance, principally through increased flux and/or horizontal beam size reduction at the sample. Instrumentation will have to develop along similar quantitative and qualitative trends. More speculative and more challenging is anticipating instrumentation that will be required by the new science made possible thanks to the unique coherence properties of diffraction-limited storage rings (DLSRs). ESRF has recently carried out a detailed feasibility study for a new ultra-low-emittance 6 GeV hybrid multibend storage ring, identified as ESRF Upgrade Programme Phase II. Although its performance is not expected to be equivalent to a DLSR source, the successful implementation of the ESRF Phase II project has to address scientific instrumentation issues that are also common to DLSRs. This article aims at providing a comprehensive review of some of the challenges encountered by the ESRF, in the context of the preparation of Phase II of its upgrade programme.

Anisotropic elasticity of silicon and its application to the modelling of X-ray optics

The crystal lattice of single-crystal silicon gives rise to anisotropic elasticity. The stiffness and compliance coefficient matrix depend on crystal orientation and, consequently, Young's modulus, the shear modulus and Poisson's ratio as well. Computer codes (in Matlab and Python) have been developed to calculate these anisotropic elasticity parameters for a silicon crystal in any orientation. These codes facilitate the evaluation of these anisotropy effects in silicon for applications such as microelectronics, microelectromechanical systems and X-ray optics. For mechanically bent X-ray optics, it is shown that the silicon crystal orientation is an important factor which may significantly influence the optics design and manufacturing phase. Choosing the appropriate crystal orientation can both lead to improved performance whilst lowering mechanical bending stresses. The thermal deformation of the crystal depends on Poisson's ratio. For an isotropic constant Poisson's ratio, ν, the thermal deformation (RMS slope) is proportional to (1 + ν). For a cubic anisotropic material, the thermal deformation of the X-ray optics can be approximately simulated by using the average of ν12 and ν13 as an effective isotropic Poisson's ratio, where the direction 1 is normal to the optic surface, and the directions 2 and 3 are two normal orthogonal directions parallel to the optical surface. This average is independent of the direction in the optical surface (the crystal plane) for Si(100), Si(110) and Si(111). Using the effective isotropic Poisson's ratio for these orientations leads to an error in thermal deformation smaller than 5.5%.

The MRI findings of a de Garengeot hernia

The presence of the appendix within a femoral hernia is rare. It was first described by the French surgeon Jacques Croissant de Garengeot in 1731. This phenomenon accounts for 0.8-1% of all femoral hernias. Acute appendicitis occurring within a femoral hernia is even rarer and is difficult to diagnose pre-operatively. This type of hernia is termed a de Garengeot hernia. The ultrasonographic and CT imaging features of de Garengeot hernias have been described previously. We report a case of a 57-year-old female who presented with a painful right-sided groin mass. She underwent MRI of the inguinal region, which successfully diagnosed this rare hernia pre-operatively. To our knowledge, this is the first description of a de Garengeot hernia diagnosed using MRI.

Nanofocusing of hard X-ray free electron laser pulses using diamond based Fresnel zone plates

A growing number of X-ray sources based on the free-electron laser (XFEL) principle are presently under construction or have recently started operation. The intense, ultrashort pulses of these sources will enable new insights in many different fields of science. A key problem is to provide x-ray optical elements capable of collecting the largest possible fraction of the radiation and to focus into the smallest possible focus. As a key step towards this goal, we demonstrate here the first nanofocusing of hard XFEL pulses. We developed diamond based Fresnel zone plates capable of withstanding the full beam of the world's most powerful x-ray laser. Using an imprint technique, we measured the focal spot size, which was limited to 320 nm FWHM by the spectral band width of the source. A peak power density in the focal spot of 4×10¹⁷ W/cm² was obtained at 70 fs pulse length.

High efficiency nano-focusing kinoform optics for synchrotron radiation

Modern synchrotron sources have provided for decades intense beams of photons over a large energy spectrum. The availability of improved optics and detectors has opened up new opportunities for the study of matter at the micrometre and nanometre scale in many disciplines. Whilst exploitation of micro-focused beams occurs almost daily in many beamlines, the production of beams of 100 nm is achieved on few instruments which use specialised optics. Refractive lenses, zone plates, curved mirrors, multilayers, and multilayer Laue lenses, can all focus x-rays to less than 50 nm under strict beam stability conditions. Focusing the synchrotron radiation to beam sizes smaller than 10 nm is considered the ultimate goal for the current decade. Silicon micro-technology has so far provided some of the most advanced x-ray refractive lenses; we report on design and characterisation of a novel silicon kinoform lens that is capable of delivering nano-beams with high efficiency.

Smac mimetics: implications for enhancement of targeted therapies in leukemia

Drug resistance is a growing concern with clinical use of tyrosine kinase inhibitors. Utilizing in vitro models of intrinsic drug resistance and stromal-mediated chemoresistance, as well as functional mouse models of progressive and residual disease, we attempted to develop a potential therapeutic approach designed to suppress leukemia recurrence following treatment with selective kinase inhibitors. The novel IAP inhibitor, LCL161, [corrected] was observed to potentiate the effects of tyrosine kinase inhibition against leukemic disease both in the absence and presence of a stromal-protected [corrected] environment. LCL161 enhanced the proapoptotic effects of nilotinib and PKC412, against leukemic disease in vitro and potentiated the activity of both kinase inhibitors against leukemic disease in vivo. In addition, LCL161 synergized in vivo with nilotinib to reduce leukemia burden significantly below the baseline level suppression exhibited by a moderate-to-high dose of nilotinib. Finally, LCL161 displayed antiproliferative effects against cells characterized by intrinsic resistance to tyrosine kinase inhibitors as a result of expression of point mutations in the protein targets of drug inhibition. These results support the idea of using IAP inhibitors in conjunction with targeted tyrosine kinase inhibition to override drug resistance and suppress or eradicate residual disease.

The neural and vascular effects of killed Su-Streptococcus pyogenes (OK-432) in preterm fetal sheep

Fetal exposure to inflammatory mediators is associated with a greater risk of brain injury and may cause endothelial dysfunction; however, nearly all the evidence is derived from gram-negative bacteria. Intrapleural injections of OK-432, a killed Su-strain of Streptococcus pyogenes, has been used to treat fetal chylothorax. In this study, we evaluated the neural and cardiovascular effects of OK-432 in preterm fetal sheep (104 +/- 1 days, term 147 days). OK-432 (0.1 mg, n = 6) or saline vehicle (n = 7) was infused in the fetal pleura, and fetuses were monitored for 7 days. Blood samples were taken routinely for plasma nitrite measurement. Fetal brains were taken for histological assessment at the end of the experiment. Between 3 and 7 h postinjection, OK-432 administration was associated with transient suppression of fetal body and breathing movements and electtroencephalogram activity (P < 0.05), increased carotid and femoral vascular resistance (P < 0.05), but no change in blood pressure. Brain activity and behavior then returned to normal except in one fetus that developed seizures. OK-432 fetuses showed progressive, sustained vasodilatation (P < 0.05), with lower blood pressure after 4 days (P < 0.05), but normal heart rate. There were no changes in plasma nitrite levels. Histological studies showed bilateral infarction in the dorsal limb of the hippocampus of the fetus that developed seizures, but no injury in other fetuses. We conclude that a single low-dose injection of OK-432 can be associated with risk of focal cerebral injury in the preterm fetus and chronic central and peripheral vasodilatation that does not appear to be mediated by nitric oxide.

Cartilage collagen matrix reorientation and displacement in response to surface loading

An investigation of collagen fiber reorientation, as well as fluid and matrix movement of equine articular cartilage and subchondral bone under compressive mechanical loads, was undertaken using small angle X-ray scattering measurements and optical microscopy. Small angle X-ray scattering measurements were made on healthy and diseased samples of equine articular cartilage and subchondral bone mounted in a mechanical testing apparatus on station ID18F of ESRF, Grenoble, together with fiber orientation analysis using polarized light and displacement measurements of the cartilage matrix and fluid using tracers. At surface pressures of up to approximately 1.5 MPa, there was reversible compression of the tangential surface fibers and immediately subjacent zone. As load increased, deformation in these zones reached a maximum and then reorientation propagated to the radial deep zone. Between surface pressures of 4.8 MPa and 6.0 MPa, fiber orientation above the tide mark rotated 10 deg from the radial direction, with an overall loss of alignment. With further increase in load, the fibers "crimped" as shown by the appearance of subsidiary peaks approximately +/-10 deg either side of the principal fiber orientation direction. Failure at higher loads was characterized by a radial split in the deep cartilage, which propagated along the tide mark while the surface zone remained intact. In lesions, the fiber organization was disrupted and the initial response to load was consistent with early rupture of fibers, but the matrix relaxed to an organization very similar to that of the unloaded tissue. Tracer measurements revealed anisotropic solid and fluid displacement, which depended strongly on depth within the tissue.

A high-density SNP linkage scan with 142 combined subtype ADHD sib pairs identifies linkage regions on chromosomes 9 and 16

As part of the International Multi-centre ADHD Genetics project we completed an affected sibling pair study of 142 narrowly defined Diagnostic and Statistical Manual of Mental Disorders, fourth edition combined type attention deficit hyperactivity disorder (ADHD) proband-sibling pairs. No linkage was observed on the most established ADHD-linked genomic regions of 5p and 17p. We found suggestive linkage signals on chromosomes 9 and 16, respectively, with the highest multipoint nonparametric linkage signal on chromosome 16q23 at 99 cM (log of the odds, LOD=3.1) overlapping data published from the previous UCLA (University of California, Los Angeles) (LOD>1, approximately 95 cM) and Dutch (LOD>1, approximately 100 cM) studies. The second highest peak in this study was on chromosome 9q22 at 90 cM (LOD=2.13); both the previous UCLA and German studies also found some evidence of linkage at almost the same location (UCLA LOD=1.45 at 93 cM; German LOD=0.68 at 100 cM). The overlap of these two main peaks with previous findings suggests that loci linked to ADHD may lie within these regions. Meta-analysis or reanalysis of the raw data of all the available ADHD linkage scan data may help to clarify whether these represent true linked loci.