Controllable optical phase shift over one radian from a single isolated atom.

Fundamental optics such as lenses and prisms work by applying phase shifts of several radians to incoming light, and rapid control of such phase shifts is crucial to telecommunications. However, large, controllable optical phase shifts have remained elusive for isolated quantum systems. We have used a single trapped atomic ion to induce and measure a large optical phase shift of 1.3±0.1 radians in light scattered by the atom. Spatial interferometry between the scattered light and unscattered illumination light enables us to isolate the phase shift in the scattered component. The phase shift achieves the maximum value allowed by atomic theory over the accessible range of laser frequencies, pointing out new opportunities in microscopy and nanophotonics. Single-atom phase shifts of this magnitude open up new quantum information protocols, in particular long-range quantum phase-shift-keying cryptography.

Identification of community-residing individuals with dementia and their unmet needs for care.

BACKGROUND: Innovative approaches to the widespread delivery of evidence-based dementia care are needed. The aims of this study were to determine whether a telephone screening method could efficiently identify individuals in the community in need of care for dementia and to develop a multidimensional needs assessment tool for identifying the type and frequency of unmet needs related to memory disorders in the home setting. METHODS: This was a cross-sectional evaluation of 292 community-residing individuals aged 70 and older in Maryland. Participants were given a brief cognitive telephone screen. A subsample (n=43) received a comprehensive in-home assessment for dementia and dementia-related needs. Cognitive, functional, behavioral, and clinical factors were assessed. The Johns Hopkins Dementia Care Needs Assessment (JHDCNA) was used to identify unmet needs related to dementia. RESULTS: Telephone screening for the sample took 350 h, and 27% screened positive for dementia. Virtually all participants with dementia who received an in-home assessment had at least one unmet need, with the most frequent unmet needs being for a dementia workup, general medical care, environmental safety, assistance with ADL impairments, and access to meaningful activities. Caregivers, when present, also had a number of unmet needs, with the most common being caregiver education about dementia, knowledge of community resources, and caregiver mental health care. CONCLUSIONS: Effective and efficient means for identifying community-residing individuals with dementia are needed so that dementia care interventions can be provided to address unmet care needs of patients and their caregivers.

[Emotional instability and suicidal behavior as a consequence of transsexualism]. / Emotionale Instabilität und Suizidalität in Folge einer Transsexualität.

This contribution describes a case that led to hospitalization in our psychiatric clinic due to emotional instability and suicidal behavior resulting from a gender identity disorder (female to male transsexualism). During inpatient treatment that lasted for almost 4 months, considerable improvement of the patient's emotional instability and suicidal behavior could be achieved. Treatment success was maintained up to follow-up (18 months after discharge). The syndrome-oriented pharmacotherapy with quetiapine and valproate which had been administered as off-label medication to stabilize the patient's mood could be considered the effective factor. A few months after release from inpatient care, cross-gender hormone therapy was initiated accompanied by outpatient psychotherapy.

Proteins are secreted by both constitutive and regulated secretory pathways in lactating mouse mammary epithelial cells.

Lactating mammary epithelial cells secrete high levels of caseins and other milk proteins. The extent to which protein secretion from these cells occurs in a regulated fashion was examined in experiments on secretory acini isolated from the mammary glands of lactating mice at 10 d postpartum. Protein synthesis and secretion were assayed by following the incorporation or release, respectively, of [35S]methionine-labeled TCA-precipitable protein. The isolated cells incorporated [35S]methionine into protein linearly for at least 5 h with no discernible lag period. In contrast, protein secretion was only detectable after a lag of approximately 1 h, consistent with exocytotic secretion of proteins immediately after passage through the secretory pathway and package into secretory vesicles. The extent of protein secretion was unaffected by the phorbol ester PMA, 8-bromo-cAMP, or 8-bromo-cGMP but was doubled by the Ca2+ ionophore ionomycin. In a pulse-label protocol in which proteins were prelabeled for 1 h before a chase period, constitutive secretion was unaffected by depletion of cytosolic Ca2+ but ionomycin was found to give a twofold stimulation of the secretion of presynthesized protein in a Ca(2+)-dependent manner. Ionomycin was still able to stimulate protein secretion after constitutive secretion had terminated. These results suggest that lactating mammary cells possess both a Ca(2+)-independent constitutive pathway and a Ca(2+)-activated regulatory pathway for protein secretion. The same proteins were secreted by both pathways. No ultrastructural evidence for apocrine secretion was seen in response to ionomycin and so it appears that regulated casein release involves exocytosis. Ionomycin was unlikely to be acting by disassembling the cortical actin network since cytochalasin D did not mimic its effects on secretion. The regulated pathway may be controlled by Ca2+ acting at a late step such as exocytotic membrane fusion.

Pattern perception: integrating information presented in two modalities.

Subjects were required to organize and identify temporal patterns composed of either (i) two stimuli in one modality; (ii) two stimuli in each of two modalities, with the pattern alternately presented in the two modalities; or (iii) one stimulus in each of two modalities. Patterns (i) and (iii) are organized as structured patterns, but (ii) is organized by modality, not by pattern structure. When elements of a pattern appear in two modalities, the auditory-tactual combination produces the poorest performance.

Floral evolution: attractiveness to pollinators increases male fitness.

Because availability of resources often limits seed or fruit set, increased visits by pollinators may not always lead to increases in maternal reproduction. This observation has led evolutionary biologists to hypothesize that a plant's ability to attract pollinators may have its primary impact on male fitness achieved through the fertlization of ovules. This interpretation of angiosperm reproductive ecology is supported by field experiments. Pollinating insects strongly discriminated between two Mendelian petal-color morphs in Raphanus raphanistrum, a widespread, self-incompatible crucifer. In experimental populations composed of petal-color homozygotes. color discrimination by naturally occurring pollinators had no statistically significant effect on relative maternal function (fruit and seed production) in the two morphs. In contrast, yellow-flowered individuals were far more successful as fathers (pollen donors) than were the less visited whites. These results suggest that the evolution of floral signals such as petal color may be driven primarily by selection on male function.

A phase I study of intracarotid artery infusion of cis-Diamminedichloroplatinum(II) in patients with recurrent malignant intracerebral tumors.

A phase I study of intracarotid cis-diamminedichloroplatinum was performed in 11 patients with intracerebral tumors (five glioblastoma, four melanoma, one meningeal sarcoma, and one lung carcinoma) progressing after radiation +/- chemotherapy. The internal carotid artery was temporarily cannulated by a percutaneous transfemoral approach. All patients received i.v. heparin, mannitol, and fluids; seven received dexamethasone, 50 mg i.v., twice the day before and the day of treatment. Intracarotid cis-diamminedichloroplatinum, 60 to 100 mg/sq m in 175 to 250 ml 0.45% NaCl solution with 1000 units heparin, was infused over 1 hr. Six patients received two or more courses (maximum of 6) at 2- to 8-week intervals. Gastrointestinal toxicity was mild to moderate. Ototoxicity was minor. Central nervous system (CNS) toxicity was focal, severe, permanent, and possibly due to embolus in one patient at 75 mg/sq m; focal and reversible in one patient at 100 mg/sq m; and generalized but reversible in one patient at 75 mg/sq m. Possible CNS toxicity was noted in two additional patients. Two patients with CNS toxicity developed permanent ipsilateral retinal toxicity, and one patients without CNS toxicity developed bilateral decreased visual and auditory acuity 2 weeks after his sixth treatment. Renal and hematological toxicity and orbital pain were mild. Response status included: early death, one; probable responses, six (2+ 4+, 6, 6+, 8, and 8+ months); stabilization, two (3+ and 4 months); and failure, two. We recommend cis-diamminedichloroplatinum (60 mg/sq m) every 2 to 4 weeks for Phase II studies. Severe CNS and retinal toxicity are possible.

Activation of exocytosis by GTP analogues in adrenal chromaffin cells revealed by patch-clamp capacitance measurement.

The role of GTP-binding proteins in exocytosis in bovine adrenal chromaffin cells was examined using patch-clamp capacitance measurement. Internal dialysis with the non-hydrolysable GTP analogue guanosine 5'-[beta gamma-imido]triphosphate and xanthosine triphosphate (XTP) activated a capacitance increase. Exocytosis triggered by XTP was blocked by guanosine 5'-[beta-thio]diphosphate (GDP beta S) but Ca(2+)-induced exocytosis was unaffected. The capacitance increase due to XTP could not be explained by Ca2+ mobilisation since Ins(1,4,5)P3 and caffeine did not mimic the response. Chromaffin cells appear to possess a Ca(2+)-independent pathway for exocytosis that involves GTP-binding proteins. The magnitude of the response to XTP suggested that GTP analogues stimulate both exocytosis and recruitment of secretory granules.

Magnetic resonance imaging after 'diffuse' nonmissile head injury. A neurobehavioral study.

The diagnosis of diffuse brain injury is considered when computed tomography provides no evidence of an intracranial mass lesion in acute nonmissile head injury. Magnetic resonance imaging (MRI) of a young woman who had sustained severe diffuse brain injury five years earlier disclosed multifocal lesions involving the frontal, temporal, parietal, and occipital lobes. We report the results of serial neurobehavioral assessment for clinical correlation with the brain lesions visualized by MRI. Pending confirmation of our findings in a series of patients studied by MRI during the acute and chronic stages of recovery from head injury, we postulate that the presence and type of neurobehavioral sequelae of diffuse brain injury are related to the intrahemispheric loci of predominantly white matter lesions and degeneration.

Inability to sneeze as a manifestation of medullary neoplasm.

A young man with headache was unable to sneeze despite a strong sensory urge to do so. Magnetic resonance imaging revealed a cystic neoplasm in the medulla oblongata that presumably interrupted the efferent arc of the sneezing reflex.

Cerebral morphometric abnormalities in Tourette's syndrome: a quantitative MRI study of monozygotic twins.

Although the pathologic substrate of Tourette's syndrome (TS) is unknown, studies have implicated subtle changes in the basal ganglia. To further investigate structural basal ganglia pathology in TS, we performed morphometric analyses of MRIs of 10 monozygotic twin pairs discordant for severity of TS but concordant for the presence of tic disorders (mean age, 16.3 years; range, 9 to 31 years). Right caudate volume was slightly but significantly reduced in the relatively more severely affected twins as a group compared with the less affected twins (mean difference = 6%, p < 0.01). Most of this difference was attributable to volume reduction in the anterior right caudate (p < 0.02), which was smaller in the more severely affected twin in nine of 10 twin sets. The mean volume of the left lateral ventricle was 16% smaller in the more severely affected twins than in the less severely affected twins (p < 0.01). The normal asymmetry of the lateral ventricles (left greater than right) was not present in the more severely affected twins, who had a trend toward a larger right lateral ventricle. Moreover, the difference within a pair in the degree of loss of the normal ventricular asymmetry correlated with the difference within a pair in the severity of the tic disorder (r = 0.75, p < 0.02). There were no other basal ganglia, ventricular volumetric, or asymmetry abnormalities. These findings partially replicate other MRI studies and suggest that subtle structural abnormalities in the CNS, particularly in the caudate, may play a role in the pathophysiology of TS.(ABSTRACT TRUNCATED AT 250 WORDS)

Neuroradiologic diagnosis of subdural empyema and CT limitations.

Five cases of subdural empyema are described. Two of the cases eluded a definitive computed tomography (CT) diagnosis despite classical clinical background. Extracerebral collection with definitive border enhancement was seen in the other three cases. Mass effect, present in all five cases, was related to the extracerebral collection in three cases and diffuse cerebral edema and/or infarction in two. Angiography in four cases initially demonstrated an extracerebral collection in three and inflammatory angiospasm in two. Repeat angiography demonstrated an extracerebral collection in the fourth case. In the proper clinical setting subdural empyema should be considered even in the absence of an extracerebral collection when mass effect or an infarction pattern is seen on CT. Angiography may be diagnostic in such cases. Hopefully, newer techniques will further the diagnostic efficacy of CT in this disease.

MR imaging of optic pathways in patients with neurofibromatosis.

Twenty-one patients with documented neurofibromatosis had MR examinations to evaluate possible intracranial disease. In five cases the indication was a known or suspected optic glioma. Two patients were examined because of a history of seizures; the rest were examined as part of a baseline evaluation. Eighteen patients showed evidence of signal hyperintensity on T2-weighted images. Lesions involved the optic nerves, optic chiasm, optic tracts, lateral geniculate body, optic radiations, basal ganglia, periventricular white matter, cerebellar white matter, and dentate nucleus of the cerebellum. Comparison between MR and concurrent CT scans showed MR to be superior in demonstrating the posterior extent of optic-pathway gliomas. In addition, MR showed focal areas of hyperintensity in the basal ganglia, internal capsule, cerebellum, and/or white matter that were not detected on CT. Although we found MR to be superior to CT in detecting intracranial tumors in patients with neurofibromatosis, and in evaluating the extensive involvement of known lesions, the full clinical implications of our findings remain to be determined.

Delayed intracerebral hematoma due to traumatic aneurysm caused by a shotgun wound: a problem in prophylaxis.

A delayed traumatic intracerebral hematoma was seen in a patient after a shotgun wound to the brain. The cause of the hemorrhage seemed to be a traumatic aneurysm. Both complications are reviewed, and it is suggested that clinical and intracranial pressure monitoring should lead to early diagnosis and may minimize the effects of this problem and that angiography may be appropriate early in the course of patients who have had fragments pass near intracranial vessels.

Space is to time as vision is to audition: seductive but misleading.

Space and time serve two perceptual functions. First, space/time forms a framework for visual and auditory events. Second, spatial and temporal change defines the properties of events and objects. It is at this second level that correspondences (i.e., mappings) between visual and auditory qualities can be hypothesized. Due to the active nature of perceiving, all such mappings illustrate the possible relations between looking and listening.

The role of pattern goodness in the reproduction of backward masked patterns.

Four experiments investigated the role of pattern goodness in backward masking using five- and four-dot patterns constructed by placing dots in the cells of a 3 x 3 matrix. In Experiment 1, subjects rated the goodness of these patterns and the results replicated previous work showing that good patterns had few alternatives. In Experiment 2, the dot patterns were the target stimuli in a backward masking task using a variety of masking stimuli. For all masking, good patterns were reproduced more accurately than poor patterns. In Experiment 3, the goodness of the masking stimulus was varied. The results indicated that good patterns were reproduced more accurately (replicating Experiment 2) and that good patterns were less effective as stimulus than were poor patterns. In Experiment 4, a long interstimulus interval which precluded masking was used to determine whether goodness affected encoding or memory. At these intervals, there were no differences among patterns, suggesting that the effect of pattern goodness was on rate of encoding. These results demonstrate the importance of configural properties in pattern perception.

Effect of rhythmic grouping on stream segregation.

Three experiments investigated the role of temporal grouping on auditory stream segregation. For sounds that formed frequency streams (e.g., 400 Hz, 500 Hz, 1600 Hz, and 2000 Hz), the effect of rhythm was minimal. Temporal grouping did not affect judgments of stream segregation and did not affect difficulty of sequence identification. In contrast, for sounds that tended to form one coherent sequence (e.g., 750 Hz, 1500 Hz, 3000 Hz, and 6000 Hz), temporal grouping affected judgments of stream segregation as well as difficulty of identification. The temporal grouping could space the three lower or three higher pitch tones equally in time and this induced isochronous stream segregation. Subjects could not interleave the resulting streams, and identification became far more difficult. The role of rhythmic grouping is therefore contextual, depending on the relationships between the elements as well as the order of the elements.

Changing venous pattern in a hemangioblastoma resembling an arteriovenous malformation.

A patient with cerebellar hemangioblastoma underwent two successive cerebral arteriograms within a 48-hour period. The first arteriogram suggested an arteriovenous malformation. The second angiogram showed a dramatic change with nearly total absence of the earlier dilated draining veins. This change was found on examination of the surgical specimen to be caused by venous thrombosis.

Neurological course and correlated computerized tomography findings after severe closed head injury.

This study includes 124 patients with closed head injuries and with Glasgow Coma Scale (GCS) scores of less than or equal to 8, who were admitted over a 7 1/2-month period. The time at which death occurred after injury was bimodal: deaths occurred either within 48 hours or after 7 days or longer after injury. Neurological deterioration, however, occurred with equal frequency on Days 2 to 7 after injury. Patients who survived the first 48 hours and then suffered neurological deterioration did not differ from the total population in age, sex, GCS scores on admission, or pupillary reactivity, but had a much higher incidence of intracranial hematomas of all types. Deterioration occurred three times more frequently in those with hematomas than in those with diffuse brain injury. Patients who deteriorated were rarely among the 35% of those who rapidly improved in the first 48 hours (4 points or more on the GCS). Computerized tomography (CT) scans of those deteriorating (24 patients) could be divided into four categories: 1) those without new mass effect (eight cases); 2) those with new or increased hemispheric edema (six cases); 3) those with generalized edema (two cases); and 4) those with focal or lobar areas of new edema or hemorrhage (eight cases). Of the patients in coma who deteriorated, 19% had large, delayed intracerebral hematomas. In 11 of 16 cases deteriorating with new mass effect, prior compression by overlying extracerebral hematoma, disruption of brain by intracerebral hematoma, or preexisting hemispheric edema preceded the brain swelling that caused deterioration. Areas of disruption or compression on CT scan typically developed decreased attenuation 2 to 7 days after injury, but did not cause deterioration unless new mass effect accompanied the lucency appearing on CT scan. A mortality rate of 29% was achieved for the 124 cases, which were managed with early evacuation of hematomas and control of intracranial pressure. Certain methods are suggested for evaluating therapy and for comparing clinical series.

Corpus callosal atrophy following closed head injury: detection with magnetic resonance imaging.

To investigate evidence for diffuse white matter injury and hemispheric disconnection sequelae after severe closed head injury (CHI), this study evaluates the degree of posttraumatic atrophy of the corpus callosum. Corpus callosal atrophy was quantitatively determined using a digitizer to measure sagittal magnetic resonance images of 32 patients with moderate-to-severe CHI and those of 31 control subjects of similar age. In the CHI patients, measurements were significantly reduced for the areas of the anterior four-fifths, the posterior one-fifth, and the total corpus callosum. Moreover, the minimum width of the callosal body was reduced in the CHI patients as compared to that of control individuals. Indices of corpus callosal atrophy were significantly correlated with the chronicity of injury and the degree of lateral ventricular enlargement. There was no difference in callosal measurements between men and women. Magnetic resonance imaging provides an in vivo determination of corpus callosal atrophy which may reflect the severity of diffuse axonal injury and predict the type and severity of hemispheric disconnection effects.