Simulation is used in many aspects of medical training but less so for echocardiography instruction in paediatric cardiology. We report our experience with the introduction of simulator-based echocardiography training at Weill Cornell Medicine for paediatric cardiology fellows of the New York–Presbyterian Hospital of Columbia University and Weill Cornell Medicine. Knowledge of CHD and echocardiographic performance improved following simulation-based training. Simulator training in echocardiography can be an effective addition to standard training for paediatric cardiology trainees.

Yield and landscape are commonly used to guide management zone delineation. However, production system choice and management can interact with landscape attributes and weather. The objective of this study was to evaluate forage yield and soil properties in three landscape defined (elevation based) management zones, and under two different grazing systems. Changes in soil properties (soil strength, bulk density, moisture, bioavailable nutrients) and forage productivity (biomass), as related to grazing management and management zone, were measured. Bulk density, moisture, and forage biomass were greater at higher elevation. Soil strength decreased as elevation increased, and was greater near-surface after winter grazing ended. The response of landscape delineated management zones varied with extreme weather conditions and treatment. Lower zones were more sensitive to weather extremes than higher elevations, directly affecting biomass accumulation. In conclusion, we observed interactions between the grazing treatments and the management zones.

We present an existence and stability theory for gravity–capillary solitary waves with constant vorticity on the surface of a body of water of finite depth. Exploiting a rotational version of the classical variational principle, we prove the existence of a minimizer of the wave energy 𝓗 subject to the constraint 𝓘 = 2µ, where 𝓘 is the wave momentum and 0 < µ ≪ 1. Since 𝓗 and 𝓘 are both conserved quantities, a standard argument asserts the stability of the set Dµ of minimizers: solutions starting near Dµ remain close to Dµ in a suitably defined energy space over their interval of existence. In the applied mathematics literature solitary water waves of the present kind are described by solutions of a Korteweg–de Vries equation (for strong surface tension) or a nonlinear Schrödinger equation (for weak surface tension). We show that the waves detected by our variational method converge (after an appropriate rescaling) to solutions of the appropriate model equation as µ ↓ 0.

Stochastic Efficiency with Respect to a Function (SERF) is used to rank transgenic cotton technology groups and place an upper and lower bound on their value. Yield and production data from replicated plot experiments are used to build cumulative distribution functions of returns for nontransgenic, Roundup Ready, Bollgard, and stacked gene cotton cultivars. Analysis of Arkansas data indicated that the stacked gene and Roundup Ready technologies would be preferred by a large number of risk neutral and risk averse producers as long as the costs of the technology and seed are below the lower bounds calculated in this manuscript.

A consensus of expert opinion was used to provide both face and consensual validity to a list of potential indicators of sheep welfare. This approach was used as a first step in the identification of valid welfare indicators for sheep. The consensus methodology of the National Institute of Health, using pre-meeting consultation and focus group discussions, was used to ascertain the consensus opinion of a panel of sheep welfare experts. The Farm Animal Welfare Council's five freedoms were used as a framework to organise a list of current on-farm welfare issues for sheep. The five freedoms were also the welfare criterion used to identify potential on-farm welfare indicators for sheep. As a result, experts identified 193 welfare issues for sheep and lambs managed on farms across England and Wales. Subsequently, a combination of animal- (n = 26), resource- (n = 13) and management- (n = 22) based indicators was suggested for (i) adult rams, (ii) adult ewes (male and female sheep, over 1 year old), (iii) growing lambs (male and female sheep, over 6 weeks to 1 year old) and (iv) young lambs (male and female lambs, 6 weeks old and under). The results from this study could therefore be used to inform the further development of valid methods of assessing the on-farm welfare of sheep.

The host-parasite interaction at the site of attachment of the adult hookworm, Ancylostoma ceylanicum, to the small bowel mucosa of the dog has been examined by transmission electron microscopy. The lamina propria around the heads of the worms showed intense infiltration with neutrophilic and cosinophilic leucocytes, and plasma cells were also prominent. Erythrocytcs were cxtravasatcd within the lamina propria while the portions of mucosa engulfed into the buccal cavities of the worms were nccrotic and included aggregates of collagen fibres. Within the lumina of the worms were erythrocytcs in varying stages of lysis together with other nccrotic debris.The mucous membrane adjacent to the heads of the worms was ulcerated while more distant cntcrocytcs were small, distorted and displayed various degrees of microvillar loss. Many mucosal blood vessels had platelet aggregates within their iumina but no fibrin deposition was observed. Vessels were often seen in the bases of the ulcers and were prone to rupture. Erythrocytcs and leucocytes were seen in the dog intestinal lumen in close proximity to the bodies of the worms.

Stratigraphically and geographically restricted ocellar komatiite flows at Kambalda, Western Australia, appear to represent the products of ground melting of sulphidic sediments by komatiites in lava channels that localized the Fe–Ni–Cu sulphide ores. An immiscible sulphide liquid formed and gravitationally separated from the melted sediment (xenomelt), the resultant buoyant silicate liquid being partly or wholly assimilated by the turbulently convecting komatiite magma. Rarely, the xenomelt gravitationally migrated to the top of flows, and overflowed into the less turbulent lava levees where it collected to form a separate layer overlying a komatiitic layer within a single flow. There was selective preservation of the hybrid felsic layer, as an upper ocellar unit within an ocellar komatiite flow, in lava levees flanking lava channels. The ocellar unit is enriched in elements previously concentrated in the sediments, and shows U–Th–Pb isotopic systematics akin to the underlying sediments. Moreover, the partitioning relationships of U and Pb between the immiscible xenomelt and sulphide liquid enhances the range of U/Pb ratios for components of the ocellar unit, thus allowing sufficient spread of modern uranogenic Pb isotopic ratios to form isochrons, albeit imprecise ones. The range and similarity of model Th/U data from these flows (2.8−3.9) and adjacent sulphidic sediments (2.3−4.4; mostly 2.8−3.9) contrasts with the generally invariable Th/U within Kambalda ultrabasic–basic flows (3.6−3.9), and further supports the ground-melting hypothesis.

The course of infection with a Malaysian dog strain of Ancylostoma ceylanicum was investigated in 15 inbred strains of mice, in outbred and inbred mice immunosuppressed with prednisolone, and in immuno-deficient hypothymic mice. Oral, percutaneous and subcutaneous routes of infection, in both sexes of mice, were assessed. In only one instance was a single small adult male worm found. Following oral infection, larvae migrated from the stomach to the large bowel and then a proportion of worms penetrated the perianal skin. This was followed by the appearance of larvae in the lungs. Living 3rd-stage larvae were seen in the anterior small intestine, perianal skin and lungs for the 6 weeks of the study, with peak recoveries being at 12 h, 8 days and 3 weeks, respectively. It is clear that systemic migration of larvae occurs after oral infection, and it is possible that recirculation may occur. Only a small percentage of larvae penetrated the abdominal skin after being administered percutaneously. In subcutaneous infections, a small proportion of larvae moved rapidly from the site of injection and were recovered from the lungs 2 h after infection. Most larvae, however, migrated from the injection site over the ensuing few days. Living 3rd-stage larvae were seen in the lungs and in the small intestine for the 4 weeks of observation. The strain of A. ceylanicum employed does not complete its development in mice. Nevertheless, this model offers significant potential for studying the immune responses, as well as investigating the means by which these parasites evade host defences.

Large outbreaks of giardiasis caused by person-to-person transmission, or a combination of transmission routes, have not previously been reported. A large, prolonged giardiasis outbreak affected families belonging to a country club in a suburb of Boston, Massachusetts, during June–December 2003. We conducted a retrospective cohort study to determine the source of this outbreak. Giardiasis-compatible illness was experienced by 149 (25%) respondents to a questionnaire, and was laboratory confirmed in 97 (65%) of these cases. Of the 30 primary cases, exposure to the children's pool at the country club was significantly associated with illness (risk ratio 3·3, 95% confidence interval 1·7–6·5). In addition, 105 secondary cases probably resulted from person-to-person spread; 14 cases did not report an onset date. This outbreak illustrates the potential for Giardia to spread through multiple modes of transmission, with a common-source outbreak caused by exposure to a contaminated water source resulting in subsequent prolonged propagation through person-to-person transmission in the community. This capacity for a common-source outbreak to continue propagation through secondary person-to-person spread has been reported with Shigella and Cryptosporidium and may also be a feature of other enteric pathogens having low infectious doses.

We sought to determine the source of a norovirus outbreak among attendees of 46 weddings taking place during a single weekend. Norovirus-compatible illness was experienced by 332 (39%) of wedding guests surveyed; the outbreak affected up to 2700 persons. Illness was associated with eating wedding cake provided by a bakery common to the weddings (adjusted RR 4·5, P<0·001). A cake requiring direct hand contact during its preparation accounted for the majority of illness. At least two bakery employees experienced norovirus-compatible illness during the week preceding the weddings. Identical sequence types of norovirus were detected in stool specimens submitted by two wedding guests, a wedding hall employee, and one of the ill bakery employees. It is likely that one or more food workers at the bakery contaminated the wedding cakes through direct and indirect contact. These findings reinforce the necessity of proper food-handling practices and of policies that discourage food handlers from working while ill.

A single LaMnO3 buffer layer was developed for the growth of superconducting thick YBa2Cu3O7−δ (YBCO) films on polycrystalline Ni-alloy substrates where a biaxially textured MgO layer, produced by ion-beam assisted deposition (IBAD), was used as a template. Using pulsed laser deposition, a 1.65-μm-thick YBCO film with a critical current density of 1.4 × 106 A/cm2 in self field at 75 K was achieved on sputtered LaMnO3-buffered IBAD MgO substrates. This corresponds to a critical current (Ic) of 231 A/cm-width. This result demonstrates the possibility of using both LaMnO3 buffer and IBAD MgO template for producing high current density YBCO-coated conductors.

This paper contains a rigorous existence theory for three-dimensional steady gravity-capillary finite-depth water waves which are uniformly translating in one horizontal spatial direction x and periodic in the transverse direction z. Physically motivated arguments are used to find a formulation of the problem as an infinite-dimensional Hamiltonian system in which x is the time-like variable, and a centre-manifold reduction technique is applied to demonstrate that the problem is locally equivalent to a finite-dimensional Hamiltonian system. General statements concerning the existence of waves which are periodic or quasiperiodic in x (and periodic in z) are made by applying standard tools in Hamiltonian-systems theory to the reduced equations.

A critical curve in Bond number–Froude number parameter space is identified which is associated with bifurcations of generalized solitary waves. These waves are three dimensional but decay to two-dimensional periodic waves (small-amplitude Stokes waves) far upstream and downstream. Their existence as solutions of the water-wave problem confirms previous predictions made on the basis of model equations.

Federal [U.S.] law and the Joint Commission on the Accreditation of Healthcare Organizations mandate plans and mechanisms for response by hospitals to hazardous material incidents/accidents be developed and implemented. This paper describes the response of the University Hospitals of Cleveland to these regulations and to the anticipated needs of the community and local industiy. The physical plant constructed and its relationship to the emergency department personnel for staffing this unit are described. Utilization patterns since implementation of this program are presented.