Role of Many-Body Effects in Describing Low-Lying Excited States of π-Conjugated Chromophores: High-Level Equation-of-Motion Coupled-Cluster Studies of Fused Porphyrin Systems.

The unusual photophysical properties of the π-conjugated chromophores make them potential building blocks of various molecular devices. In particular, significant narrowing of the HOMO-LUMO gaps can be observed as an effect of functionalization chromophores with polycyclic aromatic hydrocarbons (PAHs). In this paper we present equation-of-motion coupled cluster (EOMCC) calculations for vertical excitation energies of several functionalized forms of porphyrins. The results for free-base porphyrin (FBP) clearly demonstrate significant differences between functionalization of FBP with one- (anthracene) and two-dimensional (coronene) structures. We also compare the EOMCC results with the experimentally available results for anthracene fused zinc-porphyrin. The impact of various types of correlation effects is illustrated on several benchmark models, where the comparison with the experiment is possible. In particular, we demonstrate that for all excited states considered in this paper, all of them being dominated by single excitations, the inclusion of triply excited configurations is crucial for attaining qualitative agreement with experiment. We also demonstrate the parallel performance of the most computationally intensive part of the completely renormalized EOMCCSD(T) approach (CR-EOMCCSD(T)) across 120 000 cores.

The effect of staged decompression while breathing 100% oxygen on altitude decompression sickness.

INTRODUCTION: Space Shuttle extravehicular activity (EVA) requires decompression from sea level pressure (14.7 psia) to a 4.3 psia (30,300 ft) pressure suit. The transition currently involves altering the shuttle atmosphere to allow shirt-sleeve denitrogenation to occur during a 12 to 36-h staged decompression (SD) at 10.2 psia (9,800 ft) with an oxygen-enriched breathing gas (26.5% oxygen, 73.5% nitrogen). The denitrogenation provides protection from decompression sickness (DCS) during EVA in a 4.3 psia pressure suit. Our goal was to determine the highest altitude at which SD while breathing 100% oxygen (SD100) could provide effective protection from development of DCS symptoms after further decompression to 29,500 ft (4.5 psia). METHODS: There were 30 male subjects exposed to at least 6 of 11 conditions in random order on successive months to 29,500 ft for 4 h while performing mild exercise and being monitored for venous gas emboli (VGE) with an echo-imaging system. The subjects received 15 min of ground-level (GL) preoxygenation and an additional 60 or 120 min of SD100 at one of four altitudes between 8,000 ft (10.9 psia) and 18,000 ft (7.3 psia). Control exposures followed a 75- or 135-min ground-level preoxygenation. RESULTS: During SD100, one case of DCS occurred at 18,000 ft, but not at lower staging altitudes. Higher levels of VGE were observed during SD100 at 18,000 ft than during SD100 at any lower altitude. CONCLUSION: Staged decompression at 16,000 ft and below results in decompression risk during subsequent decompression to 29,500 ft similar to that following equivalent periods of ground-level preoxygenation.

Exercise-induced altitude decompression sickness.

BACKGROUND: It has been known since World War II that exercise at altitude increases incidence of decompression sickness (DCS). However, data on the effects of specific exercise types at altitude are lacking. This research focused on the relative hazards of exercise without motion (isometric, straining) vs. dynamic exercise involving motion. The study also compared arm vs. leg exercise. METHODS: There were 32 healthy male subjects exposed, while resting, to 29,500 ft (8992 m) for 4 h or until DCS occurred, at which time they were brought to ground level. If the subject developed DCS on this exposure, he was exposed in successive months to lower altitudes, using the same procedure, until the subject was free of symptoms for the 4-h exposure. At this symptom-free altitude, as low as 20,000 ft (6096 m), the subject performed isometric arm, isometric leg, dynamic arm and dynamic leg exercises at less than 10% of maximal oxygen consumption, each during separate exposure months. Precordial venous gas emboli (VGE) were monitored every 20 min during each exposure with a Hewlett-Packard SONOS 1000 Echo Imaging System. RESULTS: Dynamic arm, dynamic leg, isometric arm, and isometric leg exercise induced DCS in 50%, 38%, 41% and 31% of the subjects, respectively. VGE incidence varied from 47-66%. No significant differences in DCS or VGE were found. CONCLUSIONS: Under our test conditions, there was no difference between dynamic and isometric exercise in eliciting DCS. Exercise during exposure to the symptom-free altitude for 4 h produced a 40% incidence DCS.

Determination of the "reflex range" and appropriate cutpoints for percent free prostate-specific antigen in 413 men referred for prostatic evaluation using the AxSYM system.

OBJECTIVES: Prostate-specific antigen (PSA) exists in the serum in two clinically important molecular forms: free PSA and PSA complexed to alpha 1-antichymotrypsin. Total PSA approximates the sum of the free and complexed forms. Preliminary investigations have illustrated the potential benefits of using percent free PSA to enhance the clinical utility of PSA in distinguishing benign prostate disease from prostate cancer. The current study defines the optimal range of total PSA for measuring percent free PSA (reflex range) and generates appropriate cutpoints for percent free PSA within this range. METHODS: A total of 413 patients, 225 (54%) with benign prostate disease (mean age, 67 years) and 188 (46%) with prostate cancer (mean age, 66 years), who had PSA values between 2.0 and 20.0 ng/mL participated in the investigation. All patients underwent a sextant biopsy to establish the diagnosis. The serum specimens were assayed with the AxSYM PSA assay (total PSA) and AxSYM Free PSA assay (Abbott Laboratories; Abbott Park, IL). Percent free PSA was calculated for all patients. Receiver operating characteristic (ROC) curves were generated for various ranges of total PSA to determine the reflex range that maximized the increase in sensitivity and specificity of percent free PSA over total PSA. Within the optimal range, the ROC curves were utilized to generate cutpoints for percent free PSA to be used in clinical practice. RESULTS: The appropriate reflex range for the utility of percent free PSA was 3.0 to 10.0 ng/mL. The appropriate cutpoint for percent free PSA when the total PSA value was 3.0 to 4.0 ng/mL to achieve 90% sensitivity for the detection of prostate cancer was 0.19. This approach resulted in a biopsy rate of 73% and a cancer detection rate of 44% in men with a total PSA value between 3.0 and 4.0 ng/mL. The appropriate cutpoint for percent free PSA when the total PSA value was 4.1 to 10.0 ng/mL to ensure 95% sensitivity for detection of prostate cancer was 0.24. Within the range of 4.1 to 10.0 ng/mL, this approach resulted in 13% fewer negative biopsies and failure to detect 5% of the cancers. CONCLUSIONS: Percent free PSA should be utilized in patients with a total serum PSA value between 3.0 and 10.0 ng/mL. In patients with a total PSA value between 3.0 and 4.0 ng/mL, percent free PSA enhanced the detection of prostate cancer (improving sensitivity). In patients with a total PSA concentration ranging from 4.1 to 10.0 ng/mL, negative biopsies were eliminated (improving specificity).

Left ventricular gas emboli in six cases of altitude-induced decompression sickness.

BACKGROUND: Ultrasonic techniques have demonstrated venous gas emboli (VGE) during exposure to high altitude. VGE per se have not been considered clinically hazardous. Arterial gas emboli (AGE), however, are viewed with great concern. The crossing-over of venous gas to the arterial circulation has not previously been seen in human subjects at altitude. This transfer may occur via either intracardiac defects, pulmonary shunts, or the pulmonary microcirculation. METHODS: A non-invasive ultrasonic echo imaging Doppler system was used to monitor volunteer human subjects for gas emboli simultaneously in the right and left sides of the heart at simulated altitude in a chamber. Subjects found to have gas cross-over were evaluated for septal defects with either transthoracic or transesophageal echocardiography. RESULTS: Previously unreported left ventricular gas emboli were observed with echo imaging in six subjects at altitude. In all six cases, at the time of AGE onset, the VGE scores were high from all monitored sites. Three subjects had no septal defect, another had a small sinus venosus defect, a third had a patent foramen ovale, and one was not available for evaluation. Five of the cases became symptomatic at the time of AGE onset. CONCLUSIONS: Operational altitude exposures known to elicit high VGE counts in the majority of people should be avoided because of an increased risk of right-to-left gas cross-over and resulting potential for severe cerebral symptomatology.

Understanding medication-related needs of low-literacy patients.

An important thrust in preparing pharmacy students to provide pharmaceutical care is acquiring sensitivity to the unique medication-related needs of at-risk patient populations. Low literacy, which affects 21% to 23% of the American population, defines one such population. In collaboration with the Lafayette Adult Reading Academy (LARA), the authors developed an evolving project to increase pharmacy studies' understanding of the medication-related needs and perspectives of low-literacy patients. This was accomplished through a relation-building, three-step oral interview process. The interviewers asked open-ended questions to assess each patient's medication use habits and perspectives. The interview sensitized the pharmacy students to the needs of low-literacy patients for pharmaceutical care. The principal finding was that a caring relationship between pharmacists and patients is prerequisite to patients' openness to share and receive advice about problems and misconceptions associated with their medication use experiences.

Serum prostate-specific antigen and digital rectal examination for early detection of prostate cancer in a national community-based program. The Prostate Cancer Education Council.

OBJECTIVES: This study analyzed methods of prostate cancer early detection in community settings throughout the United States against standards and findings of earlier studies conducted at academic medical centers. METHODS: The study was conducted at 148 clinical centers during Prostate Cancer Awareness Week in September 1993 and continued through June 1994. A total of 31,953 eligible subjects were tested by both digital rectal examination (DRE) and prostate-specific antigen (PSA). PSA was tested with the Abbott IMx PSA assay and reported by Roche Biomedical, Inc. RESULTS: The study confirmed that elevated PSA levels (greater than 4.0 ng/mL) aid in the detection of organ-confined prostate cancer when used in conjunction with the DRE. Reflecting more conservative biopsy decision-making practices, study results nonetheless are comparable to earlier reports. Among 1307 subjects who underwent biopsy, 322 cancers were detected. The cancer detection rate was 3.6% for PSA, 3.0% for DRE, and 4.7% if either test result was positive. The positive predictive value (PPV) for elevated PSA levels (greater than 4.0 ng/mL) was 3l.6%, significantly better (P < 0.0001) than the PPV for abnormal DRE results (25.5%). Nearly 90% (88.9%) of staged cancers were diagnosed as localized. Elevated PSA levels detected more localized cancers (76 of 105 [72.4%]) than the DRE (72 of 105 [68.6%]). Of localized tumors, 33 (31.4%) were missed by DRE and detected solely by PSA, and 29 (27.6%) were missed by PSA and detected solely by DRE. The combined use of the two methods detected 33 additional localized tumors. CONCLUSIONS: Community practice throughout the United States demonstrates that PSA and DRE are consistently effective and efficient in the early detection of prostate cancer.

Comparison of the metabolism of alcohols by rat hepatic and pulmonary alcohol dehydrogenase.

The metabolism of 1-butanol, 1-pentanol and 1-propanol by rat hepatic and pulmonary cytosolic preparations was measured with regard to ADH activity as influenced by pH and substrate concentration. Compared to lung, hepatic ADH activity showed little pH dependence with apparent Vmax values similar for the 3 alcohols. Apparent Km values were also similar and were lower than previously reported for ethanol. In contrast to the liver, little ADH activity was observed in pulmonary preparations at pH 7.2 or 9.0 with any alcohol. Pulmonary apparent Km values were considerably higher than those in the liver. Thus the optimum conditions for pulmonary ADH activity require an alkaline pH and high substrate concentrations.

Regulation of collagen gene expression in keloids and hypertrophic scars.

The synthesis of type I and III collagens in cultured skin fibroblasts from normal skin, normal scar, hypertrophic scar, and keloids was examined. The ratio of type I/III collagen was significantly elevated in keloids compared to that in the other groups. When mRNA steady-state levels coding for alpha 1(I) procollagen were determined, it was apparent that this increase in the type I/III collagen ratio in keloids was paralleled by a specific increase in alpha 1(I) procollagen mRNA. This specific increase in alpha 1(I) procollagen mRNA in keloids was the result of increased gene expression because the transcription rate of the alpha 1(I) procollagen gene was significantly elevated in keloids, as determined by nuclear runoff transcription. The rate of transcription of the alpha 1(I) procollagen gene was also elevated in hypertrophic scars, although no concomitant increase in alpha 1(I) procollagen mRNA levels or alteration in the type I/III collagen ratio was observed. These data indicate that the rate of gene transcription of alpha 1(I) procollagen is increased in both hypertrophic scars and keloids, but only keloids exhibit increased steady-state levels of alpha 1(I) procollagen mRNA and concurrent increases in type I collagen. These results suggest that at least two distinct mechanisms, one pretranscriptional and one post-transcriptional, regulate type I collagen synthesis. It is possible, therefore, that in keloids, neither mechanism functions efficiently to down-regulate type I collagen. In hypertrophic scars, however, the post-transcriptional mechanisms are able to decrease elevated levels of mRNA coding for alpha 1(I) procollagen that result from increased transcription of the alpha 1(I) procollagen gene.

Zalcitabine compared with zidovudine in patients with advanced HIV-1 infection who received previous zidovudine therapy.

OBJECTIVE: To evaluate the safety and efficacy of zalcitabine (also known as dideoxycytidine [ddC]) in patients with advanced human immunodeficiency virus (HIV) infection. DESIGN: Open-label, randomized study. SETTING: AIDS Clinical Trials Units, university-affiliated medical centers, and private practice groups. PATIENTS: Patients with the acquired immunodeficiency syndrome (AIDS) or advanced AIDS-related complex who had tolerated zidovudine for 48 weeks or more. INTERVENTION: Fifty-nine patients received zidovudine (500 to 1200 mg/d) and 52 patients received zalcitabine (2.25 mg/d). MEASUREMENTS: The primary end points were survival and time to an AIDS-defining event or death. RESULTS: Because significantly more patients withdrew from zidovudine therapy, the median duration of treatment was greater in the zalcitabine group than in the zidovudine group (279.0 days compared with 174.5 days; P = 0.001). The estimated 12-month, event-free probabilities were 53% for the zalcitabine group and 57% for the zidovudine group (relative risk, 1.02; 95% CI, 0.5 to 2.2). The estimated 12-month survival rates were 81% for the zalcitabine group and 75% for the zidovudine group (relative risk, 1.39; CI, 0.5 to 3.8). The rate of decline in CD4 lymphocyte counts was significantly slower in the zalcitabine group than in the zidovudine group (-0.08 cells/day compared with -0.17 cells/day). Patients in the zalcitabine group had gained an average of 0.5 kg at week 20 and 0.4 kg at week 24, whereas patients in the zidovudine group had lost an average of 1.8 kg at week 20 and 2.4 kg at week 24 (P = 0.04 and P = 0.05, respectively). Moderate to severe peripheral neuropathy and ulcerative stomatitis occurred in 10 and 9 patients, respectively, in the zalcitabine group. CONCLUSIONS: The sample size for this study was smaller than planned, and no differences in survival and clinical end points were found. Slower rates of decline in CD4 lymphocyte counts and weight, however, were noted for the zalcitabine group.

Significance of delayed symptom onset and bubble growth in altitude decompression sickness.

Three characteristics of altitude induced decompression sickness (DCS) are: 1) symptoms occur some time after arrival at altitude; 2) symptoms seldom occur below 18,000 ft, even though bubbles are frequently detected at that low altitude; 3) symptoms seldom occur after 4 h at altitude. These observations could be explained if it were postulated that bubbles must reach a threshold size before symptoms of DCS occur. In vitro techniques were used in this study to measure bubble growth at various altitudes. The results indicate that although the growth rate of bubbles depends strongly on the altitude where they form, bubble growth requires time. This helps explain the first observation above. We found that bubbles stop growing early at a small size below 18,000 ft. This helps explain the second observation above. Finally, we found that bubbles stop growing when the fluid immediately surrounding the bubble is cleared of supersaturated gas regardless of the fluid composition a few centimeters from the bubble. This helps explain the last observation above.

Human tolerance to 100% oxygen at 9.5 psia during five daily simulated 8-hour EVA exposures.

Extravehicular activity (EVA) currently involves decompression to 4.3 psia. This degree of decompression carries a significant potential for decompression sickness (DCS) which could be alleviated if a pressure of 9.5 psia could be maintained in the pressure suit. Previous studies have not evaluated the potential for oxygen toxicity at 9.5 psia. Twenty-one subjects were exposed to 100% oxygen at 9.5 psia for 5 consecutive days, 8 h.d-1 while performing moderate exercise to simulate a typical work-week in the proposed pressure suit environment. No DCS or venous gas bubbles were detected. Pulmonary function tests, physical exams, blood analyses, arterial oxygen saturation monitoring, and X-rays showed no evidence of oxygen toxicity under these conditions. These results suggest that a 100% oxygen, 9.5 psia pressure suit environment could avoid both DCS and oxygen toxicity during EVAs of comparable duration and physical activity.

Wound healing using a collagen matrix: effect of DC electrical stimulation.

Rapid fibroblast ingrowth and collagen deposition occurs in a reconstituted type I collagen matrix that is implanted on full-thickness excised animal dermal wounds. The purpose of this study is to evaluate the effects of direct current stimulation on dermal fibroblast ingrowth using carbon fiber electrodes incorporated into a collagen sponge matrix. Preliminary results suggest that fibroblast ingrowth and collagen fiber alignment are increased in collagen sponges stimulated with direct currents between 20 and 100 microA. Maximum fibroblast ingrowth into the collagen sponge is observed near the cathode at a current of 100 microA. These results suggest that electrical stimulation combined with a collagen matrix may be a method to enhance the healing of chronic dermal wounds.

An evaluation of precordial ultrasonic monitoring to avoid bends at altitude.

Several investigators have reported that intravascular bubbles can be detected in decompressed subjects before they develop bends. The altitude exposures were generally of short duration with a limited number of subjects. This important preliminary finding needed to be verified in a larger sampling of long duration altitude exposures. In this experiment, 32 subjects in 82 flights were taken to 27,500 ft simulated altitude for 8 h or until the subject developed mild but steady joint pain (bends). Many subjects took more than one flight. At altitude, the subjects were monitored for circulating bubbles by a team of well-trained, experienced technicians. It was determined that bubbles, clearly audible even to untrained observers, occurred in 77% of the flights in which the subjects developed bends. On the other hand, no bubbles were found in 61% of the flights in which the subjects remained bends free even though the subjects were monitored by more than one experienced technician. Therefore, at 27,500 ft ultrasonic monitoring will miss about 25% of the subjects who developed bends (false negatives) and will incorrectly identify a little less than half of the subjects who do not develop bends as potential benders (false positives).

Fibroblast and epidermal cell-type I collagen interactions: cell culture and human studies.

Fibroblast and epidermal cell-type I collagen sponge interactions were studied in cell culture as well as in humans. In cell culture, fibroblasts were observed to migrate and proliferate throughout a type I collagen sponge containing either hyaluronic acid (HA) or fibronectin (FN). Fibroblasts accumulated in the center of the pores in sponges containing HA and appeared to surround themselves with newly synthesized extracellular matrix. In sponges containing FN, fibroblasts attached to and elongated along the collagen fibers of the sponge. In the absence of FN or HA protein synthesis of fibroblasts appeared to be inhibited by the presence of the type I collagen sponge. Epidermal cells grown on plastic or on type I collagen, formed sheets. Epidermal cells grown on a collagen sponge morphologically appeared different than cells grown on plastic. The type I collagen matrix studied in cell culture was applied to dermal wounds of patients with pressure ulcers in order to evaluate its effect on dermal wound healing. The areas of ulcers treated for 6 weeks with a type I collagen sponge decreased by about 40% compared with no change in the areas of untreated controls. Preliminary results suggest that a type I collagen sponge is a biocompatible substrate with fibroblasts and epidermal cells and may be effective in enhancing healing of chronic skin ulcers.

Routes of viral spread in the von Szily model of herpes simplex virus retinopathy.

Intraocular inoculation of herpes simplex virus type 1 (HSV-1) in one eye of rabbits results in encephalitis and contralateral necrotizing viral retinopathy. The effects of viral inoculation site and optic nerve (ON) transection on the spread of virus to the brain and contralateral eye in this model were investigated. A surgical technique was developed for transection of the retrobulbar optic nerve posterior to the entrance of the central retinal vessels. HSV-1 was inoculated into the AC or vitreous of one eye in normal rabbits and in rabbits with one ON transected, either ipsilateral or contralateral to the side of inoculation. Animals were followed clinically for signs of disease. Encephalitis and contralateral retinopathy (CR) occurred following both AC and vitreous inoculation of virus, although CR developed later in AC-inoculated rabbits. Ipsilateral retinopathy (IR) developed in 83% of vitreous-inoculated rabbits, but in only 5% of AC-inoculated animals. IR developed 8 days after the onset of CR in the AC-inoculated group. ON transection on the side of virus inoculation prevented development of CR only in vitreous-inoculated rabbits. ON transection on the side opposite virus inoculation prevented CR regardless of the site of inoculation. These findings suggest that HSV-1 can leave the inoculated eye by multiple routes depending on the site of virus inoculation, but that virus reaches the retina of the contralateral eye via the optic nerve.

Fibroblast-collagen sponge interactions and the spatial deposition of newly synthesized collagen fibers in vitro and in vivo.

Fibroblast-collagen sponge interactions were studied in cell culture and dermal wound systems. In both models fibroblasts appear to adhere, attach and orient in the presence of type I collagen fibrils. In the presence of fibronectin, purified from bovine blood, adhesion and alignment of fibroblasts appeared to be enhanced as well as the deposition of thick collagen fibers. When collagen sponges were grafted onto full thickness dermal wounds the granulation tissue that was laid down within the collagen sponge appeared to differ from granulation tissue laid down below the collagen sponge or on similar wounds in the absence of a sponge. In the absence of a collagen sponge the granulation tissue is characterized by wavy collagen fibers that exhibit an extinction pattern characteristic of crimped fibers found in tendon when examined under polarized light. In contrast, collagen fibers laid down within the sponge appear to be highly oriented and lack evidence of crimp. These results suggest that the presence of a collagen matrix acts as a template that allows for the organized spatial deposition of newly synthesized collagen fibers. The enhanced biosynthesis of thick collagen fibers in the presence of a collagen sponge containing fibronectin may decrease the remodeling phase that is associated with dermal scarring.

Evaluation of collagen crosslinking techniques.

The properties of collagen films crosslinked by physical and chemical techniques were compared to the properties of films crosslinked with glutaraldehyde (GTA). Physical techniques studied include exposure to short wave (254 nm) u.v. irradiation and severe dehydration. Chemical techniques studied include immersion of collagen films in aqueous solutions of cyanamide or GTA. Collagen films exposed to combinations of aqueous solutions of cyanamide and severe dehydration had moduli of elasticity, swelling ratios and resistance to bacterial collagenase similar to films crosslinked with GTA. Theoretical calculations based on amino acid composition indicate that approximately seven times as many amino acid residues are capable of forming crosslinks using cyanamide or severe dehydration procedures as compared to GTA crosslinking. In addition, using severe dehydration or cyanamide forms crosslinks involving both amino and carboxyl residues which may allow these procedures to act synergistically. Based on our studies this two-step procedure effectively crosslinks collagen-based biomaterials while the only by-product of this reaction is water-soluble urea. Preliminary biocompatibility studies suggest that this crosslinking procedure may allow for pronounced tissue ingrowth.

Microvascular free-flap coverage of mechanical injuries to the upper extremity.

Extensive soft-tissue avulsion injuries of the upper extremities with or without bony involvement are difficult reconstructive problems. They usually cannot be adequately managed by traditional methods using skin grafts or local flaps. Microvascular free-tissue transplantation may offer the best chance for success with these severe injuries. Free-tissue transfer is indicated in this type of injury (1) when no simpler method of obtaining a closed wound is available, or (2) when the quality of soft-tissue coverage by simpler methods would not be adequate from a functional standpoint. For example, if a skin graft is placed over bone and tendons, there may be impairment of function, and certainly this is a poor environment for tendon transfers, nerve repairs, and so forth. The much more adequate tissue of a free-flap coverage provides a better environment for reconstruction. Three cases demonstrating these principles have been presented.

Noninvasive measurement of human right intraventricular blood velocity by an ultrasonic technique.

A noninvasive ultrasonic technique has been designed to measure the hemodynamic variables associated with human right ventricular diastole. For convenience, diastole is divided into five phases: rapid filling, slow filling, early resting, atrial systole, and late resting phases. The technique measures the velocity with which blood enters the ventricule during each phase, and relates these measurements to ventricular wall motion. The technique has been evaluated by comparing the measurements with data derived from an alternative technique: forward angiocardiography taken during cardiac catheterization. In this procedure, blood containing dye can be followed through the ventricle by X-ray, and velocity measurements can be made from the cinefluoroscopic films. Cinefluoroscopy has also defined potential problems related to turbulence and heart motion. Ultrasonic and cardiac catheterization measurements agreed well. The ultrasonic equipment can be carried by hand from one room to another is inexpensive, and is readily available. This equipment can be used on the same subject repeatedly without discomfort or danger, and can be used during exercise.