Warranty Deed (Twitchell to Slavin) (1919)

Warranty Deed (Twitchell to Slavin) (1919) Warranty Deed from Emma P. Twitchell to Thomas Slavin, dated June 17, 1919. Property on Washington Street in Bath, Maine that will become the future site of the synagogue.https://digitalcommons.usm.maine.edu/jud_povich/1071/thumbnail.jp

Mercury Orbiter: Report of the Science Working Team

The results are presented of the Mercury Orbiter Science Working Team which held three workshops in 1988 to 1989 under the auspices of the Space Physics and Planetary Exploration Divisions of NASA Headquarters. Spacecraft engineering and mission design studies at the Jet Propulsion Lab were conducted in parallel with this effort and are detailed elsewhere. The findings of the engineering study, summarized herein, indicate that spin stabilized spacecraft carrying comprehensive particles and fields experiments and key planetology instruments in high elliptical orbits can survive and function in Mercury orbit without costly sun shields and active cooling systems

The Boundary Conditions of the Heliosphere: Photoionization Models Constrained by Interstellar and In Situ Data

The boundary conditions of the heliosphere are set by the ionization, density and composition of inflowing interstellar matter. Constraining the properties of the Local Interstellar Cloud (LIC) at the heliosphere requires radiative transfer ionization models. We model the background interstellar radiation field using observed stellar FUV and EUV emission and the diffuse soft X-ray background. We also model the emission from the boundary between the LIC and the hot Local Bubble (LB) plasma, assuming that the cloud is evaporating because of thermal conduction. We create a grid of models covering a plausible range of LIC and LB properties, and use the modeled radiation field as input to radiative transfer/thermal equilibrium calculations using the Cloudy code. Data from in situ observations of He^O, pickup ions and anomalous cosmic rays in the heliosphere, and absorption line measurements towards epsilon CMa were used to constrain the input parameters. A restricted range of assumed LIC HI column densities and LB plasma temperatures produce models that match all the observational constraints. The relative weakness of the constraints on N(HI) and T_h contrast with the narrow limits predicted for the H^O and electron density in the LIC at the Sun, n(H^0) = 0.19 - 0.20 cm^-3, and n(e) = 0.07 +/- 0.01 cm^-3. Derived abundances are mostly typical for low density gas, with sub-solar Mg, Si and Fe, possibly subsolar O and N, and S about solar; however C is supersolar. The interstellar gas at the Sun is warm, low density, and partially ionized, with n(H) = 0.23 - 0.27 cm^-3, T = 6300 K, X(H^+) ~ 0.2, and X(He^+) ~ 0.4. These results appear to be robust since acceptable models are found for substantially different input radiation fields. Our results favor low values for the reference solar abundances for the LIC composition.Comment: 14 pages, 4 figures, submitted to Astronomy & Astrophysics together with papers from the International Space Sciences Institute workshop on Interstellar Hydrogen in the Heliospher

Perioperative donor bone marrow infusion augments chimerism in heart and lung transplant recipients

Background.: We and others have demonstrated that a low level of donor cell chimerism was present for years after transplantation in tissues and peripheral blood of heart and lung recipients; it was associated, in the latter, with a lower incidence of chronic rejection. To augment this phenomenon, we initiated a trial combining simultaneous infusion of donor bone marrow with heart or lung allotransplantation. Methods.: Between September 1993 and January 1995, 15 nonconditioned patients received either heart (n = 10) or lung (n = 5) allografts concurrently with an infusion of unmodified donor bone marrow (3.0 × 108 cells/kg), and were maintained on an immunosuppressive regimen consisting of tacrolimus and steroids. Results.: There was no complication associated with the infusion of donor bone marrow. Chimerism was detectable in 73% of bone marrow-augmented patients up to the last sample tested. Of the 5 control recipients who did not receive bone marrow infusion, only 1 had detectable chimerism by flow on postoperative day 15, which dwindled to an undetectable level by postoperative day 36. None of the patients had evidence of donor-specific immune modulation by mixed lymphocyte reaction. Conclusions.: The combined infusion of donor bone marrow and heart or lung transplantation, without preconditioning of the recipient, is safe and is associated with an augmentation of donor cell chimerism. © 1995 The Society of Thoracic Surgeons

The harvest plot: A method for synthesising evidence about the differential effects of interventions

<p>Abstract</p> <p>Background</p> <p>One attraction of meta-analysis is the forest plot, a compact overview of the essential data included in a systematic review and the overall 'result'. However, meta-analysis is not always suitable for synthesising evidence about the effects of interventions which may influence the wider determinants of health. As part of a systematic review of the effects of population-level tobacco control interventions on social inequalities in smoking, we designed a novel approach to synthesis intended to bring aspects of the graphical directness of a forest plot to bear on the problem of synthesising evidence from a complex and diverse group of studies.</p> <p>Methods</p> <p>We coded the included studies (n = 85) on two methodological dimensions (suitability of study design and quality of execution) and extracted data on effects stratified by up to six different dimensions of inequality (income, occupation, education, gender, race or ethnicity, and age), distinguishing between 'hard' (behavioural) and 'intermediate' (process or attitudinal) outcomes. Adopting a hypothesis-testing approach, we then assessed which of three competing hypotheses (positive social gradient, negative social gradient, or no gradient) was best supported by each study for each dimension of inequality.</p> <p>Results</p> <p>We plotted the results on a matrix ('harvest plot') for each category of intervention, weighting studies by the methodological criteria and distributing them between the competing hypotheses. These matrices formed part of the analytical process and helped to encapsulate the output, for example by drawing attention to the finding that increasing the price of tobacco products may be more effective in discouraging smoking among people with lower incomes and in lower occupational groups.</p> <p>Conclusion</p> <p>The harvest plot is a novel and useful method for synthesising evidence about the differential effects of population-level interventions. It contributes to the challenge of making best use of all available evidence by incorporating all relevant data. The visual display assists both the process of synthesis and the assimilation of the findings. The method is suitable for adaptation to a variety of questions in evidence synthesis and may be particularly useful for systematic reviews addressing the broader type of research question which may be most relevant to policymakers.</p

Loss-of-function mutations in Lysyl-tRNA synthetase cause various leukoencephalopathy phenotypes

Objective: To expand the clinical spectrum of lysyl-tRNA synthetase (KARS) gene–related diseases, which so far includes Charcot-Marie-Tooth disease, congenital visual impairment and microcephaly, and nonsyndromic hearing impairment. Methods: Whole-exome sequencing was performed on index patients from 4 unrelated families with leukoencephalopathy. Candidate pathogenic variants and their cosegregation were confirmed by Sanger sequencing. Effects of mutations on KARS protein function were examined by aminoacylation assays and yeast complementation assays. Results: Common clinical features of the patients in this study included impaired cognitive ability, seizure, hypotonia, ataxia, and abnormal brain imaging, suggesting that the CNS involvement is the main clinical presentation. Six previously unreported and 1 known KARS mutations were identified and cosegregated in these families. Two patients are compound heterozygous for missense mutations, 1 patient is homozygous for a missense mutation, and 1 patient harbored an insertion mutation and a missense mutation. Functional and structural analyses revealed that these mutations impair aminoacylation activity of lysyl-tRNA synthetase, indicating that de- fective KARS function is responsible for the phenotypes in these individuals. Conclusions: Our results demonstrate that patients with loss-of-function KARS mutations can manifest CNS disorders, thus broadening the phenotypic spectrum associated with KARS-related disease

Assessing the benefits and usefulness of Schwartz Centre Rounds in Second-Year Medical Students using Clinical Educator-Facilitated Group Work Session: not just “A Facilitated Moan”!

Background An experiential curriculum exposing medical students to the clinic early has many benefits but comes with the emotional stress this environment engenders. Schwartz rounds (SR) are an effective means to combat emotional stress and increasingly used in UK and USA hospitals. Recent studies show that the SR format may also provide benefits for medical students. This study aimed to investigate whether the guidance of SR in second year medical students provides the same benefits as to healthcare professionals. Methods SR assessment involved 83 second year MBChB students in facilitated groupwork sessions. Topics discussed were “change and resilience” and “duty of candour”. Students completed a Likert Scale questionnaire evaluating outcomes proffered by the Point of Care Foundation in collaboration with the Schwartz Foundation, with freeform feedback. Results There was an 86% completion rate with 25% providing written feedback. Participants were more likely to agree than disagree that SR were beneficial. SR effectiveness in enhancing students’ working relationship awareness and skills was strongly correlated with understanding the purpose of, and engagement with, the SR (P<0.001). Similarly, engagement with the SR was strongly correlated with self-reporting of enhanced patient-centredness (P < 0.001). Freeform feedback could be grouped into five themes that revolved around understanding of the SR and engagement with the process. Many positive comments regarded the SR as a forum not only to “learn experientially” but to so in a “safe environment”. Many negative comments stemmed from students not seeing any benefits of engagement with the SR, in that sharing experiences was “unbeneficial”, “empathy is inherent and not learnt”, or that sharing emotional problems is simply “moaning”. Conclusion SRs are an effective way of fostering empathy and understanding towards patients and colleagues. However, for the students to benefit fully from the SR it is necessary for them to engage and understand the process. Therefore, for the successful implementation of SR into pre-clinical medical education, it is important to help students realise that SR are not merely a “facilitated whinge”

MESSENGER Observations of Large Flux Transfer Events at Mercury

Six flux transfer events (FTEs) were encountered during MESSENGER's first two flybys of Mercury (M1 and M2). For M1 the interplanetary magnetic field (IMF) was predominantly northward and four FTEs with durations of 1 to 6 s were observed in the magnetosheath following southward IMF turnings. The IMF was steadily southward during M2, and an FTE 4 s in duration was observed just inside the dawn magnetopause followed approx. 32 s later by a 7 s FTE in the magnetosheath. Flux rope models were fit to the magnetic field data to determine FTE dimensions and flux content. The largest FTE observed by MESSENGER had a diameter of approx. 1 R(sub M) (where R(sub M) is Mercury s radius), and its open magnetic field increased the fraction of the surface exposed to the solar wind by 10 - 20 percent and contributed up to approx. 30 kV to the cross-magnetospheric electric potential

Aspergillus polymerase chain reaction: systematic review of evidence for clinical use in comparison with antigen testing

Background. Aspergillus polymerase chain reaction (PCR) was excluded from the European Organisation for the Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) definitions of invasive fungal disease because of limited standardization and validation. The definitions are being revised. Methods. A systematic literature review was performed to identify analytical and clinical information available on inclusion of galactomannan enzyme immunoassay (GM-EIA) (2002) and β-D-glucan (2008), providing a minimal threshold when considering PCR. Categorical parameters and statistical performance were compared. Results. When incorporated, GM-EIA and β-D-glucan sensitivities and specificities for diagnosing invasive aspergillosis were 81.6% and 91.6%, and 76.9% and 89.4%, respectively. Aspergillus PCR has similar sensitivity and specificity (76.8%–88.0% and 75.0%–94.5%, respectively) and comparable utility. Methodological recommendations and commercial PCR assays assist standardization. Although all tests have limitations, currently, PCR is the only test with independent quality control. Conclusions. We propose that there is sufficient evidence that is at least equivalent to that used to include GM-EIA and β-D-glucan testing, and that PCR is now mature enough for inclusion in the EORTC/MSG definitions

Effects of donor bone marrow infusion in clinical lung transplantation

Background. We have demonstrated that donor cell chimerism is associated with a lower incidence of obliterative bronchiolitis (OB) in lung recipients, and that donor chimerism is augmented by the infusion of donor bone marrow (BM). We herein report the intermediate results of a trial combining the infusion of donor BM and lung transplantation. Methods. Clinical and in vitro data of 26 lung recipients receiving concurrent infusion of donor bone marrow (3.0 to 6.0 x 108 cells/kg) were compared with those of 13 patients receiving lung transplant alone. Results. Patient survival and freedom from acute rejection were similar between groups. Of the patients whose graft survived greater than 4 months, 5% (1 of 22) of BM and 33% (4 of 12) of control patients, developed histologic evidence of OB (p = 0.04). A higher proportion (but not statistically significant) of BM recipients (7 of 10, 70%) exhibited donor-specific hyporeactivity by mixed lymphocyte reaction assays as compared with the controls (2 of 7, 28%). Conclusions. Infusion of donor BM at the time of lung transplantation is safe, and is associated with recipients' immune modulation and a lower rate of obliterative bronchiolitis. (C) 2000 by The Society of Thoracic Surgeons