03/25/1948 Letter from the Exchange Club of Lewiston

Letter from Paul J. Fortier, President, and Romeo Poirier, Board of Control, of the Exchange Club of Lewiston to Louis-Philippe Gagné.https://digitalcommons.usm.maine.edu/fac-lpg-letters-1948-01-06/1022/thumbnail.jp

Information Systems and Healthcare XXI: A Dynamic, Client-Centric, Point-Of-Care System for the Novice Nurse

Nurse clinicians need to make complex decisions on a continual basis, while delivering cost-effective treatments. The rapid proliferation of medical and nursing knowledge complicates the decision-making process, particularly for novice nurses. We describe a Clinical Decision Support System (CDSS) for the novice nurse that combines evidence-based nursing knowledge with specific patient information to create a real-time guide through the nursing diagnostic care process. The goal of the paper is to describe how an appropriately designed and evidence-based CDSS can aid the nursing practice. An off-the-shelf handheld computer is utilized to deliver clinical knowledge to the nurse, via wireless link to a central server and a data repository. In describing the software architecture of the system, particular emphasis is paid to the issue of appropriate design by discussing the steps taken to address system extensibility, performance, reliability, and security, which are important factors in the design of a CDSS

A new experiment for the determination of the 18F(p,alpha) reaction rate at nova temperatures

The 18F(p,alpha) reaction was recognized as one of the most important for gamma ray astronomy in novae as it governs the early 511 keV emission. However, its rate remains largely uncertain at nova temperatures. A direct measurement of the cross section over the full range of nova energies is impossible because of its vanishing value at low energy and of the short 18F lifetime. Therefore, in order to better constrain this reaction rate, we have performed an indirect experiment taking advantage of the availability of a high purity and intense radioactive 18F beam at the Louvain La Neuve RIB facility. We present here the first results of the data analysis and discuss the consequences.Comment: Contribution to the Classical Novae Explosions conference, Sitges, Spain, 20-24 May 2002, 5 pages, 3 figure

Evaluation of the 13N(α,p)16O thermonuclear reaction rate and its impact on the isotopic composition of supernova grains

It has been suggested that hydrogen ingestion into the helium shell of massive stars could lead to high $^{13}$C and $^{15}$N excesses when the shock of a core-collapse supernova passes through its helium shell. This prediction questions the origin of extremely high $^{13}$C and $^{15}$N abundances observed in rare presolar SiC grains which is usually attributed to classical novae. In this context $^{13}$N($\alpha$,p)$^{16}$O the reaction plays an important role since it is in competition with $^{13}$N $\beta^+$-decay to $^{13}$C. The $^{13}$N($\alpha$,p)$^{16}$O reaction rate used in stellar evolution calculations comes from the CF88 compilation with very scarce information on the origin of this rate. The goal of this work is to provide a recommended $^{13}$N($\alpha$,p)$^{16}$O reaction rate, based on available experimental data. Unbound nuclear states in the $^{17}$F compound nucleus were studied using the spectroscopic information of the analog states in $^{17}$O nucleus that were measured at the Alto facility using the $^{13}$C($^7$Li,t)$^{17}$O alpha-transfer reaction, and spectroscopic factors were derived using a DWBA analysis. This spectroscopic information was used to calculate a recommended $^{13}$N($\alpha$,p)$^{16}$O reaction rate with meaningful uncertainty using a Monte Carlo approach. The present $^{13}$N($\alpha$,p)$^{16}$O reaction rate is found to be within a factor of two of the previous evaluation, with a typical uncertainty of a factor 2-3. The source of this uncertainty comes from the three resonances at $E_r^{c.m.} = 221$, 741 and 959 keV. This new error estimation translates to an overall uncertainty in the $^{13}$C production of a factor of 50. The main source of uncertainty on the re-evaluated $^{13}$N($\alpha$,p)$^{16}$O reaction rate currently comes from the uncertain alpha-width of relevant $^{17}$F states

Bioavailability of Macro and Micronutrients Across Global Topsoils: Main Drivers and Global Change Impacts

Understanding the chemical composition of our planet\u27s crust was one of the biggest questions of the 20th century. More than 100 years later, we are still far from understanding the global patterns in the bioavailability and spatial coupling of elements in topsoils worldwide, despite their importance for the productivity and functioning of terrestrial ecosystems. Here, we measured the bioavailability and coupling of thirteen macro- and micronutrients and phytotoxic elements in topsoils (3–8 cm) from a range of terrestrial ecosystems across all continents (∼10,000 observations) and in response to global change manipulations (∼5,000 observations). For this, we incubated between 1 and 4 pairs of anionic and cationic exchange membranes per site for a mean period of 53 days. The most bioavailable elements (Ca, Mg, and K) were also amongst the most abundant in the crust. Patterns of bioavailability were biome-dependent and controlled by soil properties such as pH, organic matter content and texture, plant cover, and climate. However, global change simulations resulted in important alterations in the bioavailability of elements. Elements were highly coupled, and coupling was predictable by the atomic properties of elements, particularly mass, mass to charge ratio, and second ionization energy. Deviations from the predictable coupling-atomic mass relationship were attributed to global change and agriculture. Our work illustrates the tight links between the bioavailability and coupling of topsoil elements and environmental context, human activities, and atomic properties of elements, thus deeply enhancing our integrated understanding of the biogeochemical connections that underlie the productivity and functioning of terrestrial ecosystems in a changing world

A new prediction model for ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy

Aims Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVC) is characterized by ventricular arrhythmias (VAs) and sudden cardiac death (SCD). We aimed to develop a model for individualized prediction of incident VA/SCD in ARVC patients.Methods and results Five hundred and twenty-eight patients with a definite diagnosis and no history of sustained VAs/SCD at baseline, aged 38.2 +/- 15.5 years, 44.7% male, were enrolled from five registries in North America and Europe. Over 4.83 (interquartile range 2.44-9.33) years of follow-up, 146 (27.7%) experienced sustained VA, defined as SCD, aborted SCD, sustained ventricular tachycardia, or appropriate implantable cardioverter-defibrillator (ICD) therapy. A prediction model estimating annual VA risk was developed using Cox regression with internal validation. Eight potential predictors were pre-specified: age, sex, cardiac syncope in the prior 6 months, non-sustained ventricular tachycardia, number of premature ventricular complexes in 24 h, number of leads with T-wave inversion, and right and left ventricular ejection fractions (LVEFs). All except LVEF were retained in the final model. The model accurately distinguished patients with and without events, with an optimism-corrected C-index of 0.77 [95% confidence interval (CI) 0.73-0.81] and minimal over-optimism [calibration slope of 0.93 (95% CI 0.92-0.95)]. By decision curve analysis, the clinical benefit of the model was superior to a current consensus-based ICD placement algorithm with a 20.6% reduction of ICD placements with the same proportion of protected patients (P &lt;0.001).Conclusion Using the largest cohort of patients with ARVC and no prior VA, a prediction model using readily available clinical parameters was devised to estimate VA risk and guide decisions regarding primary prevention ICDs (www.arvcrisk.com).</p

c-di-GMP Turn-Over in Clostridium difficile Is Controlled by a Plethora of Diguanylate Cyclases and Phosphodiesterases

Clostridium difficile infections have become a major healthcare concern in the last decade during which the emergence of new strains has underscored this bacterium's capacity to cause persistent epidemics. c-di-GMP is a bacterial second messenger regulating diverse bacterial phenotypes, notably motility and biofilm formation, in proteobacteria such as Vibrio cholerae, Pseudomonas aeruginosa, and Salmonella. c-di-GMP is synthesized by diguanylate cyclases (DGCs) that contain a conserved GGDEF domain. It is degraded by phosphodiesterases (PDEs) that contain either an EAL or an HD-GYP conserved domain. Very little is known about the role of c-di-GMP in the regulation of phenotypes of Gram-positive or fastidious bacteria. Herein, we exposed the main components of c-di-GMP signalling in 20 genomes of C. difficile, revealed their prevalence, and predicted their enzymatic activity. Ectopic expression of 31 of these conserved genes was carried out in V. cholerae to evaluate their effect on motility and biofilm formation, two well-characterized phenotype alterations associated with intracellular c-di-GMP variation in this bacterium. Most of the predicted DGCs and PDEs were found to be active in the V. cholerae model. Expression of truncated versions of CD0522, a protein with two GGDEF domains and one EAL domain, suggests that it can act alternatively as a DGC or a PDE. The activity of one purified DGC (CD1420) and one purified PDE (CD0757) was confirmed by in vitro enzymatic assays. GTP was shown to be important for the PDE activity of CD0757. Our results indicate that, in contrast to most Gram-positive bacteria including its closest relatives, C. difficile encodes a large assortment of functional DGCs and PDEs, revealing that c-di-GMP signalling is an important and well-conserved signal transduction system in this human pathogen

Haemodynamics and flow modification stents for peripheral arterial disease:a review

Endovascular stents are widely used for the treatment of peripheral arterial disease (PAD). However, the development of in-stent restenosis and downstream PAD progression remain a challenge. Stent revascularisation of PAD causes arterial trauma and introduces abnormal haemodynamics, which initiate complicated biological processes detrimental to the arterial wall. The interaction between stent struts and arterial cells in contact, and the blood flow field created in a stented region, are highly affected by stent design. Spiral flow is known as a normal physiologic characteristic of arterial circulation and is believed to prevent the development of flow disturbances. This secondary flow motion is lost in atheromatous disease and its re-introduction after endovascular treatment of PAD has been suggested as a method to induce stabilised and coherent haemodynamics. Stent designs able to generate spiral flow may support endothelial function and therefore increase patency rates. This review is focused on secondary flow phenomena in arteries and the development of flow modification stent technologies for the treatment of PAD