Refractive index variation in a free-standing diamond thin film induced by irradiation with fully transmitted high-energy protons.

Ion irradiation is a widely employed tool to fabricate diamond micro- and nano-structures for applications in integrated photonics and quantum optics. In this context, it is essential to accurately assess the effect of ion-induced damage on the variation of the refractive index of the material, both to control the side effects in the fabrication process and possibly finely tune such variations. Several partially contradictory accounts have been provided on the effect of the ion irradiation on the refractive index of single crystal diamond. These discrepancies may be attributable to the fact that in all cases the ions are implanted in the bulk of the material, thus inducing a series of concurrent effects (volume expansion, stress, doping, etc.). Here we report the systematic characterization of the refractive index variations occurring in a 38 µm thin artificial diamond sample upon irradiation with high-energy (3 MeV and 5 MeV) protons. In this configuration the ions are fully transmitted through the sample, while inducing an almost uniform damage profile with depth. Therefore, our findings conclusively identify and accurately quantify the change in the material polarizability as a function of ion beam damage as the primary cause for the modification of its refractive index.

Produção de novilhos castrados ou não castrados terminados em confinamento em idade jovem ou superjovem / Production of steers or bulls finished in feedlot at a young age or young steers

Avaliaram-se o desempenho produtivo e o rendimento de cortes comercias da carcaça de animais castrados ou não castrados terminados em confinamento e abatidos em idade jovem ou superjovem, alimentados com uma dieta contendo 11,2% de proteína bruta e 3,07Mcal de energia digestível/kg de matéria seca, composta de 50% de volumoso e 50% de concentrado. A idade no início do confinamento dos animais superjovens e jovens foi de nove e 22 meses, respectivamente. Maior PF foi observado para os animais jovens não castrados. O GMD foi 31% superior em favor dos novilhos jovens em relação aos superjovens. O CMS foi 27% superior para os novilhos jovens sobre os superjovens, e os novilhos não castrados consumiram 9% mais kg de matéria seca quando comparados aos castrados. A diferença de peso da meia carcaça entre animais não castrados e castrados foi de 43% para os jovens e de 18% para os superjovens. Maior percentual do corte serrote foi observado nos novilhos jovens castrados. Novilhos jovens apresentaram maior ganho de peso médio diário, bem como novilhos jovens não castrados apresentaram maior peso final. Animais não castrados apresentaram maiores pesos de meia carcaça fria, percentual de dianteiro e porção comestível do dianteiro em relação aos castrados.(AU)

The productive performance and yield of commercial cuts of the carcass of non-castrate or castrated males feedlot finished and slaughtered at a young age or young steers, fed a diet containing 11.2% crude protein and 3.07 Mcal of digestible energy / kg of dry matter, composed of 50% roughage and 50% concentrate were evaluated. The initial age at the beginning of confinement of young steers and steers were 9 and 22 months, respectively. Greater FW was observed for young non-castrate. The ADG was 31% higher for the steers in relation to young steers. The DMI was 27% higher for steers than young steers and non-castrated consumed 9% more dry matter kg compared to the castrated. The half-carcass weight difference between non-castrated and castrated animals was 43% for steers and 18% for young steers. Higher percentage hacksaw cut was observed in castrated steers. Steers showed higher average daily weight gain, as well as non-castrate steers showed higher final weight. Non-castrate animals have higher half cold carcass weights, front percentage, and of edible portion of the front in relation to castrated.(AU)

Transfer of airway skills from manikin training to patient: success of ventilation with facemask or LMA-Supreme(TM) by medical students.

During emergency care, the ability to ventilate the patient's lungs is a crucial skill. Supraglottic airway devices have an established role in emergency care, and manikin trials have shown that placement is easy even for inexperienced users. However, there is current discussion as to what extent these results can be transferred to patients. We studied the transfer of skills learnt on a manikin to the clinical situation in novice medical students during their anaesthesia rotation. They were required to ventilate the lungs of a manikin using a facemask and then position a supraglottic airway device (LMA-Supreme™) and ventilate the lungs. This process was then repeated on anaesthetised patients, with standard ventilator settings to assess adequacy of ventilation. Sixty-three students participated in the manikin study. The success rate for ventilating the lungs was 100% for both devices, but the mean (SD) time to achieve successful ventilation was 27.8 (24.4) s with the facemask compared with 38.6 (22.0) s with the LMA-Supreme (p = 0.008). Fifty-one of the students progressed to the second part of the study. In anaesthetised patients, the success rate for ventilating the lungs was lower for the facemask, 27/41 (66%) compared with the LMA-Supreme 37/41 (90%, p = 0.006). For 26 students who succeeded with both devices, the tidal volume was lower using the facemask, 431 (192) ml compared with the LMA-Supreme 751 (221) ml (p = 0.001), but the time to successful ventilation did not differ, 60.0 (26.2) s vs 57.3 (26.6) s (p = 0.71). We conclude that the results obtained in manikin studies cannot be transferred directly to the clinical situation and that guidelines should take this into account. Based on our findings, a supraglottic airway device may be preferable to a facemask as the first choice for inexperienced emergency caregivers.

Magnetic resonance imaging study of the in vivo position of the extraglottic airway devices i-gel™ and LMA-Supreme™ in anaesthetized human volunteers.

BACKGROUND: Exact information on the anatomical in situ position of extraglottic airway (EGA) devices is lacking. We used magnetic resonance imaging (MRI) to visualize the positions of the i-gel™ and the LMA-Supreme™ (LMA-S) relative to skeletal and soft-tissue structures. METHODS: Twelve volunteers participated in this randomized, prospective, cross-over study. Native MRI scans were performed before induction of anaesthesia. Anaesthesia was induced, and the two EGAs were inserted in a randomized sequence. Their positions were assessed functionally, optically by fibrescope, and with MRI scans of the head and neck. RESULTS: The LMA-S protruded deeper into the upper oesophageal sphincter than the i-gel™ (P<0.001). Both devices reduced the area of the glottic aperture (P<0.001), and the LMA-S had the largest effect (P=0.049). The i-gel™ significantly compressed the tongue (P<0.001). Both devices displaced the hyoid bone ventrally (P<0.001); the i-gel™ to a greater degree (P=0.029). The fibreoptically determined position of the bowl of the devices was identical. CONCLUSIONS: The LMA-S and i-gel™ differ significantly with regard to in situ position and spatial relationship with adjacent structures assessed by MRI, despite similar clinical and fibreoptical findings. This could be relevant with regard to risk of aspiration, glottic narrowing, and airway resistance and soft-tissue morbidity.

A controlled rapid-sequence induction technique for infants may reduce unsafe actions and stress.

BACKGROUND: Classic rapid-sequence induction of anaesthesia (RSI-classic) in infants and small children presents a time-critical procedure, regularly associated with hypoxia. This results in high stress levels for the provider and may trigger unsafe actions. Hence, a controlled induction technique (RSI-controlled) that involves gentle mask ventilation until full non-depolarizing muscular blockade has become increasingly popular. Clinical observation suggests that RSI-controlled may reduce the adverse effects noted above. We aimed to evaluate both techniques with respect to unsafe actions and stress. METHODS: In this controlled, randomized simulator-based study, 30 male trainees and specialists in anaesthesiology performed a simulated anaesthesia induction in a 4-week-old infant with pyloric stenosis. Two different RSI techniques, classic and controlled, were applied to 15 candidates each. We recorded the incidence of hypoxaemia, forced mask ventilation, and intubation difficulties. In addition, we measured individual stress levels by ergospirometry, salivary cortisol, and alpha-amylase, as well as a post-trial questionnaire. RESULTS: Hypoxaemia always occurred in RSI-classic but not in RSI-controlled, repeatedly resulting in unsafe actions. Subjective stress perception and some objective stress levels were lower in the volunteers performing RSI-controlled. CONCLUSIONS: Our data suggest that RSI-controlled, as compared with RSI-classic, leads to fewer unsafe actions and may reduce individual stress levels.

Family representations in relationship episodes of patients with a diagnosis of bulimia nervosa.

The influence of the family on the development and the maintenance of bulimia nervosa can be seen both biologically and psychosocially. Genetic influences are discussed, but their effects do not explain the aetiology exclusively. Clinical observations and research findings support the role of family dynamics, family environment, and family functioning. In particular, a low level of cohesion, a lower degree of expressiveness, and more conflicts seem to characterize the family of patients with a diagnosis of bulimia nervosa. The present study addresses the question of how patients suffering from bulimia differ from other patients in psychotherapy and from non-clinical control subjects in the way they perceive their ongoing and their past family relationships. The Core Conflictual Relationship Theme method is applied to narrative material from patients belonging to these three groups. Results show expected differences between patients and normal control subjects and virtually no differences between the group of patients with a diagnosis of bulimia nervosa and the group of patients with diagnoses different from bulimia.

[Course of symptom severity and prediction of outcome in inpatient psychotherapy]. / Verlauf der Symptombelastung und Vorhersage des Behandlungserfolges in der stationären Psychotherapie.

OBJECTIVES: The study looks for typical curves of symptom development in inpatients and investigates the influence of initial remoralisation and terminal improvement on the global therapy outcome. METHODS: 71 psychotherapy inpatients (affective, anxiety, eating and personality disorders; average treatment duration 11.9 weeks) gave weekly self-reports on symptom severity (BSI, Derogatis, 1983) and had a complete outcome evaluation. Regression parameters of the symptom curves were taken for correlational and path analytic calculations. RESULTS: Initial symptom alleviation is able to predict better global outcome. However there is a relevant subgroup of patients which has a good outcome despite an initial deterioration. CONCLUSIONS: Initial remoralisation predicts better outcome but is not a necessary condition. The results partly call into question the group statistical "dose-response-curves". Further studies should test the influence of other process parameters (group cohesion, therapeutic alliance etc.) on the course of treatment.

[Effectiveness of a systematic treatment model in an inpatient department of child and adolescent psychiatry]. / Effektivität eines systemischen Behandlungsmodells in der stationären Kinder- und Jugendpsychiatrie.

This is a report on the findings of the effectiveness of the "Viersener Modell", a inpatient systemic child psychiatry model. The therapy effects were recorded, by means of self and therapists assessment, in several relevant areas of change. The index clients (ic) show typical characteristics of a child psychiatry population. The ic (n = 43) and also their parents (37 mothers and 22 fathers) showed significant improvement on the level of psychiatric symptoms, individual problems and in general experience and behavior. The psychiatric symptoms that were conspicuous by both ic and parents at the beginning of therapy, were mainly inconspicuous at the end of the treatment (effectsize (es): icfemale, n = 28 = .82, icmale, n = 15 = .22, motherswithout partner(accompanying) = .20, motherswith partner(accompanying) = .44, fathers = .44). There was no essential improvement in the quality of the couples relationship, on the other hand the relationships were not clinically conspicuous at the beginning of therapy. Family members and therapists assessed quality of the treatment results and process mainly in accordance with our hypothesis. While the therapists noticed a significant improvement in the functioning of the family relationships (es = .87) at the end of the therapy, the parents (reported no difficulties in family functioning at the beginning of therapy) reported no essential improvement of family relationships in the follow-up questionnaire (n = 32). The improvement of the problems and the assessment of the quality of the treatment results remained stable over an eight month period.

The influence of interpersonal problems and symptom severity on the duration and outcome of short-term psychodynamic psychotherapy.

This naturalistic outcome study investigated validity aspects of the Inventory of Interpersonal Problems (IIP [Horowitz, Strauß, & Kordy, 1995]). The sample consisted of 180 patients who received short-term psychodynamic psychotherapy for an average number of 7.8 sessions and an average duration of 3.4 months. Small changes in pre-post-measures imply that the IIP is not to be recommended as an instrument for outcome evaluation in short-term psychotherapy, due to the traitlike character of its items. However, we showed by path analyses that a higher score on the affiliative dimension of the interpersonal circumplex goes along with a better treatment outcome. The influence of the dominance dimension is gender specific: male patients (who generally showed more dismissive and introverted behavior in this sample) received, if dismissive and introverted, a longer introductory therapy, whereafter they - in cases of high symptom load - were often referred to long-term treatment. Dominant male patients and, in general, female patients with high symptom scores, were referred faster, after only a few sessions. Results are discussed under aspects of adaptive therapist behavior.

Measuring psychotherapeutic change with the symptom checklist SCL 90 R.

BACKGROUND: Despite a long tradition of discussions on the evaluation of psychotherapy, there is still a lack of agreement for measuring change after psychological treatment. In this paper we describe the concept of statistical and clinical significance of change. We use the Symptom Checklist 90 R as a commonly administered instrument to propose conventions and cutoff points for psychological symptoms and their change after therapy. METHOD: A German norm population and several psychotherapy samples have been aggregated to calculate cutoffs and confidence intervals (reliable change indices) for statistically and clinically significant changes after psychotherapy. RESULTS: The cutoff point between a 'functional' and a 'dysfunctional' population was calculated as C = 0.57 (Global Severity Index, GSI). Patients above this score need a change of at least RCI = 0.43 (GSI difference) for a statististically significant change. Below this score the RCI = 0.16. The use of multiple clinical groups (e.g. inpatients and outpatients) for a more realistic determination of a 'stepwise' clinically significant change, as proposed by Tingey et al. in the USA, is not possible in the German samples collected so far. Initial SCL 90-R scores in these groups do not show enough differences to call a move from one group to the other a clinically significant change. CONCLUSION: In the German samples investigated the move from a 'functional' to a 'dysfunctional' population and vice versa has to be taken as the criterion for a clinically significant change up to now.

[The Symptom Checklist-90-R (SCL-90-R) for presenting statistically and clinically significant psychotherapy outcome]. / Die Symptom Checklist-90-R (SCL-90-R) zur Darstellung, von statistisch und klinischsignifikanten Psychotherapieergebnissen.

After a long period of discussions on the efficacy of psychotherapy, there is still a lack of conventions for measuring change after psychological treatment. This paper first describes the concept of statistical and clinical significance of change. Using the SCL-90-R as a commonly administered instrument we then propose conventions and cut-off points for its global severity score (GSI) and change after therapy. A German standard population and several psychotherapy samples were aggregated to determine cut-off points and confidence intervals (reliable change indices) for statistically and clinically significant changes. Tingey et al. (1996) proposed the use of multiple clinical groups (inpatients and outpatients) aiming at a more realistic determination of "stepwise" changes. We examined this procedure with our data. Results show that it is not applicable in the German samples collected so far. Initial SCL-90-R scores in these groups did not differentiate sufficiently between inpatients and outpatients. Therefore, according to Jacobson and Truax (1991), moving from a "functional" to a "dysfunctional" population is still the criterion for a clinically significant change.

Stereotypical relationship patterns and psychopathology.

BACKGROUND: We explored the relationship between the consistency of relationship patterns and the severity of psychopathology. METHOD: Relationship patterns were assessed by means of Relationship Anecdote Paradigm interviews rated according to the Core Conflictual Relationship Theme (CCRT) method. The repetition of the same type of CCRT components across relationship narratives indicated stereotypical patterns. RESULTS: Subjects treated in an inpatient setting (n = 25) told narratives with more consistent patterns than subjects in an outpatient setting (n = 32). Relationship episodes of normal adults (n = 23) were more flexible compared with the two clinical groups. Especially repetitions of the wish component were closely associated with the severity of psychopathology assessed by SCL-90R. CONCLUSIONS: The consistency of relationship patterns seems to be connected with the severity of psychopathology.

Pseudohypercalcemia in an elderly patient with multiple myeloma: report of a case and review of literature.

Hypercalcemia, a common complication of multiple myeloma, is primarily caused by increased bone resorption. The increase in total calcium is usually associated with an increase in the ionized calcium (Ca(I)), and the hypercalcemia is frequently symptomatic. Rarely, pseudohypercalcemia in multiple myeloma is caused by binding of calcium to the abnormal immunoglobulin. In this setting, the Ca(I) is normal. We describe a 90-year-old woman with an IgA-k myeloma who had substantial increases in the total calcium but normal levels of Ca(I). Clinicians should recognize this unusual phenomenon to avoid unnecessary and potentially toxic therapy.

A distinct coagulopathy associated with interleukin-2 therapy.

We studied the coagulation profiles of 14 patients with advanced malignancies treated with Interleukin-2 (IL-2). A 43% prolongation of the PTT (P < 0.001) and a significant decrease in functional levels of factors II, IX, X, XI, and XII were observed 6 h post IL-2 treatment in comparison to pretreatment values. These parameters normalized within 2-3 d following IL-2 administration. The PT, factors V, VII, VIII, fibrinogen and D-dimer levels were unchanged with IL-2 treatment. This pattern of coagulopathy has not previously been reported.

Infusional cyclophosphamide, doxorubicin and etoposide in HIV-related non-Hodgkin's lymphoma: a follow-up report of a highly active regimen.

Based on our prior data suggesting a therapeutic advantage for infusional administration of cyclophosphamide (C), doxorubicin (D), and etoposide (E) in patients with relapsed and resistant non-Hodgkin's lymphoma (NHL), we administered C (750 mg/m2), D (50 mg/m2), and E (240 mg/m2) via continuous intravenous infusion over 96 hours as first line therapy for 21 patients with intermediate- or high-grade non-Hodgkin's lymphoma associated with human immunodeficiency virus (HIV) infection. Treatment was repeated every 28 or more days. The median CD4 count of the study group was 87/ul, and the median serum lactate dehydrogenase was 383 IU/L. Extranodal disease, lymphomatous marrow involvement, and lymphomatous meningitis were present at diagnosis in 90%, 33%, and 10% of patients, respectively. Complete response (CR) occurred in 13 patients (62%, 95% confidence intervals 41%, 81%) and partial response occurred in five patients (24%). The estimated median survival of the study group was 18.0 months. Hematologic toxicity required dose reduction for 47% of cycles and for 79% of patients who received at least two cycles. The mean dose intensity for C, D, and E were 73%, 70%, and 73% of the intended dose intensity, respectively. Opportunistic infection included oral/esophageal candidiasis (N = 7), herpes labialis (N = 3), pulmonary Mycobacterium avium-intracellulare (N = 1), candidemia (N = 1), pneumonitis (N = 1), and disseminated aspergillosis than resulted in a single treatment-related death (5%). Treatment resulted in a significant decrease in the CD4+ lymphocytes, as well as total lymphocytes, T lymphocytes, and CD8+ lymphocytes.(ABSTRACT TRUNCATED AT 250 WORDS)

Erythropoietin-augmented isovolemic hemodilution in skull-base surgery. Case report.

Human erythropoietin in concert with intraoperative hemodilution, tumor embolization, and surgical staging was used to manage a red blood cell mass in an anemic Jehovah's Witness patient with a hypervascular meningioma. Erythropoietin (3000 U thrice weekly) and oral iron (1300 mg daily) were given for 1 month prior to surgery, raising the hemoglobin level from 11.8 to 14.1 gm/100 ml. A posterior fossa craniectomy combined with a temporal craniectomy was then performed so that partial petrosectomy, section of the transverse sinus, incision of the tentorium, and exposure of the lesion could be carried out. The first stage of the surgery was terminated immediately prior to tumor mobilization. Isovolemic hemodilution was initiated just before the skin incision. Postoperatively, the hemoglobin concentration dropped to 11.5 gm/100 ml. The erythropoietin dose was doubled and administration of oral iron continued, leading to a hemoglobin level of 14.0 gm/100 ml at 1 month after the first operation. The tumor was embolized using superselective catheterization. The next day, at the second stage of the surgery, the tumor was extirpated, again employing isovolemic hemodilution. By the 4th postoperative day, the hemoglobin level had dropped to 9.4 gm/100 ml. The patient made an uncomplicated recovery. Erythropoietin therapy contributed substantially to the successful outcome of this case. Since erythropoietin has the potential to augment all other forms of autologous banking, its role in elective neurosurgery may become increasingly important in an era of heightened concern about heterologous transfusion.

Two cases of Caroli's disease: diagnosis and management.

Caroli's disease is an uncommon congenital malformation involving the intrahepatic bile ducts. This paper reports two cases presenting with biliary tract infection. Diagnosis was established by non-invasive imaging and cholangiography. The infecting organisms were cultured from bile obtained by percutaneous aspiration and the results were used to direct antimicrobial therapy. The role of antibiotics and other management options in preventing recurrent infection is discussed.

Infusional cyclophosphamide, doxorubicin, and etoposide in human immunodeficiency virus- and human T-cell leukemia virus type I-related non-Hodgkin's lymphoma: a highly active regimen.

Fourteen patients with poor-prognosis intermediate- to high-grade non-Hodgkin's lymphoma (NHL) associated with human immunodeficiency virus (HIV) infection (12 patients) or human T-cell leukemia virus type I (HTLV-I) infection (two patients) received cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, and etoposide 240 mg/m2 administered as a continuous intravenous (IV) infusion over 4 days (infusional CDE); treatment was repeated every 28 or more days for up to six cycles. All HIV-positive patients had at least one poor prognostic feature, which included either extranodal disease (10 patients), Karnofsky performance status less than 70% (six patients), a CD4 count less than 100/microL (six patients), or a prior history of acquired immunodeficiency syndrome (AIDS; one patient). Both HTLV-I-positive patients had an elevated serum lactate dehydrogenase (LDH) level, a poor prognostic feature in that setting. Complete response (CR) occurred in 10 patients (71%; 95% confidence interval, 48% to 95%) and partial response (PR) occurred in three patients (21%), yielding an overall objective response rate of approximately 93%. The estimated Kaplan-Meier median survival was 17.4 months; seven of 12 HIV-positive patients are alive and disease-free with a median follow-up of 15 months (range, 7 to 24 months). Hospitalization was required after 19% of treatment cycles due to fever associated with granulocytopenia. Documented or suspected opportunistic infection occurred in five patients (36%), bacteremia occurred in three patients (21%), and candidemia occurred in one patient (7%). There was one treatment-related death attributable to disseminated aspergillosis. This pilot study suggests that infusional CDE may be a highly active regimen capable of producing durable remissions in a high proportion of patients with HIV-related NHL. Further study is required to confirm this observation.