Optical performance of frequency-selective bolometers.

Frequency-selective bolometers (FSBs) are a new type of detector for millimeter and submillimeter wavelengths that are transparent to all but a narrow range of frequencies as set by characteristics of the absorber itself. Therefore stacks of FSBs tuned to different frequencies provide a low-loss compact method for utilizing a large fraction of the light collected by a telescope. Tests of prototype FSBs indicate that the absorption spectra are well predicted by models, that peak absolute absorption efficiencies of the order of 50% are attainable, and that their out-of-band transmission is high.

[Acute colonic pseudo-obstruction].

Colonic Pseudo-obstruction is a poorly understood syndrome. It was first described by Ogilvie in 1948 and is characterized by signs of large bowel obstruction with a non-mechanical etiology. The suggested cause of this pathophysiology is an imbalance in the autonomic nerve supply to the colon. The syndrome affects mainly old, bedridden patients, usually hospitalised for non-colonic causes. The actual incidence of this syndrome is unknown, mainly due to the fact that spontaneous recovery may occur. When massive abdominal distention is apparent, diagnosis and treatment are usually problematic and other causes of obstruction must be ruled out. It is usually managed by water soluble contrast administered orally or rectally, or by colonic decompression. In extreme cases surgical treatment is required with significant morbidity and mortality. Pharmacologic management with parasympathomimetic drugs has been suggested recently. We describe the successful treatment of a patient with neostigmine and review the current literature.

Gait variables of patients after lower extremity burn injuries.

Functional ambulation is an expected outcome of physical therapy after burn injuries on the lower extremities. The purpose of this study was to document temporal and spatial gait parameters of adult patients with the use of the GAITRite system (CIR Systems Inc, Clifton, NJ) after the patients were burned on their lower extremities and to compare these results with previous data reported for normal subjects. Twenty-five adults with lower extremity burns (19 men and 6 women; mean age, 35.6+/-8.3 years) were evaluated within 5 days of discharge from an acute care facility. The GAITRite system, which consists of an electronic walkway that contains 6 sensor pads encapsulated in a rolled-up carpet, was used to collect temporal and spatial variables. The patients walked at their preferred rate of ambulation and completed 2 passes; the 2 passes were then averaged by the software to determine the patients' gait parameters. A 2-tailed t test was used for comparison of the mean values for the patients and the previously published data. The results indicated that for both men and women, cycle time and base of support were significantly higher (P < or = .01) in the patients with burn injuries than in normal subjects. For men, all of the remaining parameters were significantly lower (P < or = .01) in the patients with burns except stride length, which was not significantly different (P > .05). For women, stance time as a percentage of the gait cycle and cadence, velocity, step length, and stride length, were all significantly lower (P < or = .01) in the patients with burn injuries, whereas double support as a percentage of the gait cycle was not significantly different (P > .05) between the 2 groups. These results indicate that immediately after an acute care hospitalization, patients with lower extremity burns have significantly different gait patterns than gender-and age-matched normal subjects. Future studies are necessary to determine whether these impairments in gait limit the functional abilities of a patient.

The physical, functional, and developmental outcome of pediatric burn survivors from 1 to 12 months postinjury.

Fifty-one children with an average age of 27 months and who had sustained a burn injury were tested at 1, 6, and 12 months postinjury to determine their physical, functional, and developmental outcomes. Most parents were either African-American or Hispanic, lived on public assistance, and had a high school education or less. Most children had normal range of motion and were appropriate for their age in self-care skills. On the basis of the Home Screening Questionnaire, 48% of the children came from suspect home environments. Developmental delays were noted in language acquisition that persisted over the first year postburn. Although the outcomes of these burn injuries were good in physical and functional areas, the developmental findings raised concerns. The results alert clinicians to screen for potential developmental problems during the burned child's recovery phase and to include appropriate developmental activities and parental guidance in the treatment plan.

The effects of soft tissue mobilization on the immature burn scar: results of a pilot study.

The purpose of this pilot study was determine the effects of soft tissue mobilization (STM) on range of motion (ROM), scar pliability, and vascularity. Patients received either one treatment session of standard physical therapy or standard physical therapy plus 10 to 15 minutes of STM. Before and after ROM, scar pliability and vascularity measurements were obtained. The student's t test was used to compare measurements and revealed the STM group (n = 5) had significant (p < 0.10) gains in wrist extension and radial deviation, and the control group (n = 5) had significant gains in wrist extension and ulnar deviation. No significant difference was found in ROM, scar pliability, and vascularity when the STM group was compared to the control group. Further study of a larger sample over multiple treatment sessions is necessary to determine the true efficacy of STM.

Serial casting of the lower extremity to correct contractures during the acute phase of burn care.

Severe contractures that develop early following a burn may not improve with splinting and exercise treatment. An alternative treatment is serial casting, which has been used to promote increased range of motion, to facilitate patient compliance with positioning, and to prevent the patient from scratching the burned area. This case report describes the use of serial casting for resolution of ankle plantar-flexion contractures that occurred in the acute phase of burn injury. The child described in this case report sustained a 49% total body surface area scald burn and developed contractures within 1 week after injury. The contractures, which were not corrected with thermoplastic splints, improved with casting from 45 degrees of plantar flexion to neutral dorsiflexion over 2 months with biweekly cast changes. The patient had multiple skin grafts and progressed in functional activities. Serial casting is a conservative and effective modality in correcting contractures resulting from burns. Further documentation of the efficacy of this treatment approach is necessary to support its use in burn care throughout various stages of healing.

A survey of the prevalence and application of chest physical therapy in U.S. burn centers.

The purpose of this study was to determine the prevalence and application of chest physical therapy (CPT) in burn centers. Respiratory therapists primarily administered CPT, and suctioning and coughing were the most frequently used modalities. Further study of the efficacy of treatment techniques is needed to develop congruous standards for CPT after a burn injury.

Scientific results from the Cosmic Background Explorer (COBE).

The National Aeronautics and Space Administration (NASA) has flown the COBE satellite to observe the Big Bang and the subsequent formation of galaxies and large-scale structure. Data from the Far-Infrared Absolute Spectrophotometer (FIRAS) show that the spectrum of the cosmic microwave background is that of a black body of temperature T = 2.73 +/- 0.06 K, with no deviation from a black-body spectrum greater than 0.25% of the peak brightness. The data from the Differential Microwave Radiometers (DMR) show statistically significant cosmic microwave background anisotropy, consistent with a scale-invariant primordial density fluctuation spectrum. Measurements from the Diffuse Infrared Background Experiment (DIRBE) provide new conservative upper limits to the cosmic infrared background. Extensive modeling of solar system and galactic infrared foregrounds is required for further improvement in the cosmic infrared background limits.

Direct costs of stroke for a Swedish population.

Direct costs were estimated for the treatment, rehabilitation, and nursing of 125 patients with first stroke in the Lund and Orup health districts (population of 200,191). Patients were followed from the onset of stroke in 1983 until October 31, 1985. The data were used to calculate the present value of the expected lifetime direct costs for an individual contracting his or her first stroke at various ages. For example, at the age of 72, these costs were estimated at SEK 283,000 for a man and SEK 561,000 for a woman. Hospital care was the major cost component (75% for males and 89% for females) at this age of onset. The results could be used to estimate the economic benefits of preventing new strokes, hence, forming part of a cost-effectiveness or cost-utility analysis. Together with prognoses of the expected developments in the incidence of stroke, they could also serve as the basis of forecasts of future costs of the health care and social service sectors.

Subsidizing pharmaceutical prescriptions: the experience of Denmark, Finland, Norway and Sweden.

In 1980, drug consumption per capita was 455 Swedish crowns (SEK) in Sweden, SEK 452 in Denmark, SEK 384 in Finland and SEK 382 in Norway; actual figures for Denmark, Finland and Norway being converted into Swedish crowns using the mean 1980 exchange rates. To what extent can these differences be explained by differences in the drug reimbursement programmes of these four Nordic countries? For instance, is it the greater generosity of the Swedish system--in Sweden, the share of drug reimbursement expenditures to total drug consumption is 57%, as against 33% in Norway, 38% in Finland and 34% in Denmark--that makes drug consumption per capita so much higher in Sweden? If the demand for drugs were elastic and if all other influencing factors, besides the reimbursement system, were the same in all the four Nordic countries, then a definite conclusion would, obviously, be fairly easy to reach. However, a number of factors do differ: for instance, income per capita, physician remuneration schemes (and, hence, maybe, physician behaviour) and consumer charges for inpatient and outpatient care; and other factors such as morbidity and patterns of illness may differ. A complete analysis has to take all these factors into account. Too many factors seem to vary to make the sole use of cross-section data meaningful in this case. Time-series data are available and will be used in future analyses.

Outcome of eclectic psychotherapy in private psychological practice.

The outcome of eclectic psychotherapy in a private psychological practice was examined in 69 clients. Target symptoms, life-adjustment ratings, social-adjustment ratings, and therapy expectancy were obtained before and after four months of psychotherapy from clients, therapists, and independent clinical raters. Results indicated that significant change had occurred after four months of psychotherapy for 6 of 10 categories of target complaints, in 9 of 11 areas of life adjustment and in 14 of 22 areas of social adjustment. Overall, 70 percent of clients showed improvement in their symptoms; 14 percent were unchanged and 17 percent deteriorated. The major value of the study is an exploration of psychotherapy outcome under naturalistic conditions in a growing but rarely studied treatment setting.

Variations between and within countries in hospital care for peptic ulcer. A comparison between Denmark and Sweden.

The present study tries to examine variations in utilization rates for hospital care for ulcer disease between and within Denmark and Sweden. The focus is on how utilization rates differ but an attempt is also made to explain why regional differences occur. Hospital patient statistics from both countries show that ulcer disease accounts for 35% more bed-days per 100000 inhabitants in Denmark than in Sweden. The main source for this difference is duodenal ulcer, where the number of bed-days is 63% higher in Denmark. The differences in length of stay are negligible and the numbers of surgical operations are about the same in the two countries. The greater utilization of hospital resources in Denmark is explained mainly by the fact that more medical cases are treated as in-patients in Denmark than in Sweden. Neither mortality rates nor other data support the hypothesis that the incidence of duodenal ulcer is higher in Denmark than in Sweden. The difference between Denmark and Sweden widens when utilization rates are adjusted for differences in the age structure of the population in the two countries. There are wide variations in utilization rates between regions within both countries. The findings support the hypothesis that the intertemporal change in the technology for management of ulcer disease is one of the main reasons for variations between and within countries.

Cardiokymographic wall motion pattern in patients with acute myocardial infarction.

We studied 50 patients with acute myocardial infarction by cardiokymography to record anterior left ventricular wall motion. Systolic outward motion was observed in 46 of 50 patients (92%). Holosystolic outward motion was characteristic of acute anterior infarction (93%) and acute subendocardial infarction (89%) but was less common in acute inferior infarction (29%). Partial systolic outward motion was seen in 8 of the 14 patients with acute inferior infarction, but only in 2 of 36 patients with acute anterior and subendocardial infarction. Cardiokymographic abnormalities were seen in more precordial locations in acute anterior (80%) and subendocardial infarction (97%) than in inferior infarction (74%). Holosystolic outward motion was seen in 75% of all locations in acute anterior and subendocardial infarction and only in 23% in acute inferior infarction. Thus both the extent and the severity of abnormal systolic outward motion clearly separated inferior infarction from anterior and subendocardial infarction. Dynamic changes in wall motion contraction patterns were observed during the course of acute myocardial infarction; both improvement and deterioration were observed. Cardiokymography is a simple, non-invasive method to assess changes in left ventricular segmental wall motion in patients with acute myocardial infarction.

Asymmetrical cognitive deterioration in demented and Parkinson patients.

Patients with Parkinson's disease and patients with dementia showed greater deterioration on functions attributed to the right cerebral hemisphere, than on functions attributed to the left. Relative to matched controls, Parkinson patients were significantly impaired on right hemisphere tests, but did not differ on left hemisphere tests. Demented patients were significantly deficient on all tests, but right decline was greater than left. Ninety-six patients were tested: 32 diagnosed as senile or presenile dementia, 32 Parkinson patients, and 32 non-neurological patients matched for age, sex and education. Functional performance was assessed by a battery of validated tests for left and right hemisphere cognitive functions. Patients were defined with two scores based on the results of the test: Cognitive Laterally Quotient (CLQ) reflecting the averaged performance on the left hemisphere tests, subtracted from the average performance on right hemisphere tests, and Cognitive Performance Quotient (CPQ), reflecting the total level of performance of both hemispheres. These measures defined a characteristic cognitive profile for each group.

Clinical and experimental studies on electromechanical dissociation.

Electromechanical dissociation (EMD) is the most frequent cause of unsuccessful cardiac resuscitation in critically ill patients. In a clinical study of cardiac arrest, including 54 episodes in 50 fully monitored patients, 14 episodes of ventricular fibrillation were observed and seven were reversed. In the remaining 40 instances, 36 cases of EMD were initially observed. Four patients had asystole. None of the patients with EMD or asystole were successfully resuscitated. For objective study of EMD and its treatment, we developed an experimental model in which ventricular fibrillation was induced in mechanically ventilated dogs. EMD was predictably observed when, after an interval of 120 seconds, ventricular fibrillation was reversed with an external countershock. Neither metabolic acidosis nor metabolic alkalosis modified the incidence of EMD. A few dogs were pretreated with glucose-insulin-potassium or pharmacologic doses of methylprednisolone, but this did not clearly reduce the incidence of EMD. However, the onset of EMD was delayed when the body temperature of the animal was spontaneously reduced.

The resting cardiokymogram: distribution of morphologies in normal patients and in patients with coronary heart disease.

The cardiokymograph, a relatively new noninvasive device capable of recording anterior left ventricular segmental wall motion, was used to evaluate the frequency and type of wall motion abnormalities in 25 normal patients and in 109 patients with ischemic heart disease. Of the 25 patients with normal coronary arteries and normal left ventriculograms, 24 had smooth systolic inward motion which morphologically resembles the normal pattern of systolic shortening as measured in experimental animals by various length gauges. In patients with angiographically established coronary artery disease but normal left ventriculograms and no previous myocardial infarction (MI), systolic outward motion was significantly more common than in normal patients. The most common systolic outward motion pattern seen in this group was partial outward motion characteristic of early stages of myocardial ischemia in experimental animals. In contrast, holosystolic outward motion, characteristic of severe ischemia in animals, was seen most commonly in patients with MI (73% anterior vs. 28% inferior). Thus, holosystolic outward motion was characteristic of MI especially when acute and involving the anterior wall, while partial systolic outward motion was the more common pattern in ischemic heart disease without MI, and systolic inward motion was the pattern most commonly seen in normals.