Optical control of electrons during electron transfer.

The dynamics of electron transfer reactions in solution can be controlled with the use of a sequence of femtosecond laser pulses. In the charge transfer to solvent (CTTS) reaction of sodide (Na-) in tetrahydrofuran, an initial light pulse launched the CTTS reaction, ejecting an electron into either an immediate or a solvent-separated Na0:solvated electron contact pair. A second pulse was used to excite the electrons in the contact pairs, and a third pulse monitored the amount of Na- produced through the back electron transfer. Excitation of the electrons in immediate contact pairs shut off the back electron transfer, whereas excitation of the electrons in solvent-separated pairs both enhanced and hindered the back electron transfer.

Simultaneous derivatization and trapping of volatile products from aqueous photolysis of thiamethoxam insecticide.

An aqueous photolysis study was conducted with radiolabeled thiamethoxam, 4H-1,3,5-oxadiazin-2-imine, 3-[(2-chloro-5-thiazolyl)methyl]tetrahydro-5-methyl-N-nitro, to establish the relevance of aqueous photolysis as a transformation process for (14)C-[thiazolyl]-thiamethoxam. (14)C-[thiazolyl]-thiamethoxam was applied to sterile sodium acetate pH 5 buffer solution at a dose rate of approximately 10 ppm. The resulting samples were incubated for up to 30 days at 25 degrees C under irradiated and nonirradiated conditions. The irradiated samples were exposed to a 12-hour-on and 12-hour-off light cycle. Volatile fractions accounted for up to an average of 56.76% of the total dose for the irradiated incubations and <0.08% for the nonirradiated incubations. These fractions were proposed to be a mixture of carbonyl sulfide (COS) and isocyanic acid (CONH). Verification of these components was accomplished by trapping with cyclohexylamine and formation of the thiocarbamate and the isocyanic acid derivatives. A similar method of trapping thiocarbamate metabolites was reported (Chen and Casida, 1978) where filter paper saturated with isobutylamine in methanol was arranged to trap (14)COS and (14)CO(2) under a positive flow of O(2) at 25 degrees C. Mass spectroscopy of the derivatized components confirmed the presence of carbonyl sulfide as the cyclohexylamine thiocarbamate and of isocyanic acid as its cyclohexylamine derivative. Evidence from this study indicates that thiamethoxam degrades significantly under photolytic conditions.

Randomized controlled trial of yogic meditation techniques for patients with obsessive-compulsive disorder.

The objective of this study was to compare efficacy of two meditation protocols for treating patients with obsessive-compulsive disorder (OCD). Patients were randomized to two groups-matched for sex, age, and medication status-and blinded to the comparison protocol. They were told the trial would last for 12 months, unless one protocol proved to be more efficacious. If so, groups would merge, and the group that received the less efficacious treatment would also be afforded 12 months of the more effective one. The study was conducted at Children's Hospital, San Diego, Calif. Patients were selected according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised (DSM-III-R) criteria and recruited by advertisements and referral. At baseline, Group 1 included 11 adults and 1 adolescent, and Group 2 included 10 adults. Group 1 employed a kundalini yoga meditation protocol and Group 2 employed the Relaxation Response plus Mindfulness Meditation technique. Baseline and 3-month interval testing was conducted using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Symptoms Checklist-90-Revised Obsessive Compulsive (SCL-90-R OC) and Global Severity Index (SCL-90-R GSI) scales, Profile of Moods scale (POMS), Perceived Stress Scale (PSS), and Purpose in Life (PIL) test. Seven adults in each group completed 3 months of therapy. At 3 months, Group 1 demonstrated greater improvements (Student's independent groups t-test) on the Y-BOCS, SCL-90-R OC and GSI scales, and POMS, and greater but nonsignificant improvements on the PSS and PIL test. An intent-to-treat analysis (Y-BOCS) for the baseline and 3-month tests showed that only Group 1 improved. Within-group statistics (Student's paired t-tests) showed that Group 1 significantly improved on all six scales, but Group 2 had no improvements. Groups were merged for an additional year using Group 1 techniques. At 15 months, the final group (N=11) improved 71%, 62%, 66%, 74%, 39%, and 23%, respectively, on the Y-BOCS, SCL-90-R OC, SCL-90-R GSI, POMS, PSS, and PIL; P<0.003 (analysis of variance). This study demonstrates that kundalini yoga techniques are effective in the treatment of OCD.

A new approach to managed care: the provider-run organization.

Behavioral managed care has been dominated by for-profit carve-out managed care organizations who deliver mental health and substance abuse services by reducing services and fees to the detriment of patients and providers. We offer a new model of managed care based on a provider-run, hospital-based approach in which provider groups contract directly with HMOs and eliminate the managed care organization intermediaries. This approach allows providers to maintain or regain control of the delivery of behavioral health services. A model is presented of an academically based organization which has achieved utilization patterns compatible with the demands of payors. Innovations in service delivery, network management and fiscal issues are reviewed.

Single-shot two-photon exposure of commercial photoresist for the production of three-dimensional structures.

We report the use of an amplified femtosecond laser for single-shot two-photon exposure of the commercial photoresist SU-8. By scanning of the focal volume through the interior of the resist, three-dimensional (3-D) structures are fabricated on a shot-by-shot basis. The 800-nm two-photon exposure and damage thresholds are 3.2 and 8.1TW/cm(2), respectively. The nonlinear nature of the two-photon process allows the production of features that are smaller than the diffraction limit. Preliminary results suggest that Ti:sapphire oscillators can achieve single-shot two-photon exposure with thresholds as low as 1.6TW/cm(2) at 700 nm, allowing 3-D structures to be constructed at megahertz repetition rates.

Academic psychiatry and managed care: a case study.

An academic department of psychiatry in New York City eliminated the need for behavioral managed care intermediaries by transforming itself from a fee-for-service system to a system able to engage in full-risk capitation contracts. The first step was to require health maintenance organizations to contract directly with the department. The department formed two legal entities, a behavioral management services organization for utilization management and a behavioral integrated provider association. The authors describe these entities and review the first year of operation, presenting data on enrollees, capitation rates, and service utilization for the first three contracts. The fundamental differences in the treatment model under managed care and under a fee-for-service system are highlighted. The authors conclude that by contracting directly with insurers on a full-risk capitation basis, departments of psychiatry will be better able to face the economic threats posed by the cost constraints inherent in managed care and maintain or re-establish their autonomy as care managers as well as high-quality care providers.

Magnetic source imaging of abnormal low-frequency magnetic activity in presurgical evaluations of epilepsy.

PURPOSE: Regional cortical dysfunction associated with epileptogenic activity was predicted from interictal localized abnormal low frequency neuromagnetic activity (ALFMA) using Magnetic Source Imaging (MSI). ALFMA can be detected in patients who show no interictal spikes. METHODS: A large array biomagnetometer was used in a blinded, rapid screening protocol. The MSI procedure required no alteration in epileptic medications. MSI results were compared with the presumed epileptogenic region as determined by a consensus of standard techniques, which included MR and electroclinical monitoring. RESULTS: One or more sites of localized abnormality were detected by MSI ALFMA in 29 of the 33 epileptic patients. ALFMA mapped with MSI showed a 48.5% specificity with respect to the presumed epileptogenic region. MSI ALFMA was in agreement with the final consensus as often as was ictal noninvasive video EEG monitoring, and was exceeded in specificity overall only by invasive ictal video EEG monitoring, which was required for conventional localization in 21 of the 33 patients tested with MSI. CONCLUSIONS: ALFMA measurements with MSI may augment the array of noninvasive methods used for reaching a consensus for epilepsy surgery.

Presurgical localization of functional cortex using magnetic source imaging.

The boundaries of somatosensory cortex were localized noninvasively by means of a large-array biomagnetometer in six patients with mass lesions in or near eloquent cortex. The results were used by neurosurgeons and neurologists in preoperative planning and for reference in the operating room. The magnetic source imaging (MSI) localizations from somatosensory evoked potentials were used to predict the pattern of phase reversals measurable intraoperatively on the cortical surface, providing a quantitative comparison between the two measures. The magnetic localizations were found to be predictive in all six cases, with the two sets of localizations falling within an 8-mm distance on average. Somatosensory localizations using MSI offer accuracy in localizing somatosensory cortex stereotactically and in depicting its relationship to lesions. Such data are valuable preoperatively in assessing the risks associated with a proposed surgical procedure and for optimizing subsequent minimum-risk surgical strategy.

Multichannel magnetoencephalography in ablative seizure surgery outside the anteromesial temporal lobe.

Magnetoencephalography (MEG) was used to evaluate 40 candidates for seizure surgery thought to have foci outside the anteromesial temporal lobe. Of 29 cases with electrographic data suggesting a convexity focus, MEG spikes were recorded from 28. In 21, MEG and electrographic data were localized to the same area. Invasive studies were, or could have been, avoided in 13 cases based on MEG and other noninvasive data. MEG was not localizing value in 4 orbitofrontal or 7-depth-nonlocalized cases. Seventeen patients with MEG epileptiform data have had postoperative follow-up. Eight of 13 with electrographic and MEG data localized to the same area are seizure free. None of 4 with spatial discordance of MEG electrographic data are seizure free.

Noninvasive detection of cerebral plasticity in adult human somatosensory cortex.

After upper limb deafferentation, adult macaques exhibit substantial reorganization of cortical somatosensory topography with enlargement of cortical areas responsive to facial stimuli. In the present study non-invasive magnetic source imaging technology has been used to map in detail the bilateral somatosensory homunculi in four neurologically normal controls and two upper arm amputees. Bilateral homuncular maps of normals and of the unaffected hemisphere of both amputees showed a wide hand area. The affected hemisphere of both amputees showed marked intrusion of facial representations into the digit and hand area consistent with the earlier observations in macaques. Our findings provide the first evidence of massive somatosensory plasticity in human adults and suggest a mechanism for post-amputation perceptual changes.

Multichannel magnetoencephalographic mapping of sensorimotor cortex for epilepsy surgery.

Preliminary reports have shown a close correlation between the anatomic location of evoked magnetic somatosensory fields and intraoperative evoked somatosensory potentials in patients with mass lesions. We have performed magnetic source imaging (MSI) of sensory and motor (MER) evoked responses or fields on 4 patients with frontal convexity epileptic foci. The method involves (1) graphic overlaying of magnetoencephalography evoked field data and three-dimensional (3D) phase contrast magnetic resonance angiographic data on 3D MRI surface cortical renderings, and (2) correlating these data with intraoperative stimulation-mapped sensory and/or motor responses and local cortical venous anatomy. Our initial results indicate that the location of MSI evoked sensory data correlates closely with the results of intraoperative stimulation mapping. MSI MERs have tended to show a less discrete spatial topography, involving areas of cortex extending beyond the motor strip.

Noninvasive presurgical neuromagnetic mapping of somatosensory cortex.

Rapid presurgical neuromagnetic localization of the somatosensory cortex was performed successfully on five patients with a large-array biomagnetometer by a protocol called magnetic source imaging (MSI). Determination of the location of the central sulcus is important in assessing operative risk and determining the optimal operative approach to structural lesions in the vicinity of the motor strip. The use of magnetic resonance imaging anatomical methods and intraoperative visual identification can be imprecise, whereas invasive localization prolongs operative time, adds cost, and entails added risk. Until the recent development of large-array biomagnetometer systems, neuromagnetic localization of the central sulcus had been demonstrated in research but was so time consuming and laborious as to preclude routine clinical use. In this study, the validity of MSI localizations was confirmed intraoperatively by direct cortical recording of somatosensory evoked potentials and/or direct motor stimulation. Complete agreement was found between MSI and intraoperative mapping in locating the central sulcus. Objective confirmations considered together with the speed and reliability of the procedure and with the presurgical availability of the results suggests the potential utility of MSI for routine surgical planning.

Locating the central sulcus: comparison of MR anatomic and magnetoencephalographic functional methods.

PURPOSE: To compare MR anatomic and magnetoencephalographic (MEG) functional methods in locating the central sulcus. METHODS: Eleven healthy subjects and five patients with focal cerebral lesions were studied. The central sulcus was located anatomically with MR by two independent observers using axial vertex and sagittal (midline and lateral) images. Locations via the MEG functional method were based on detecting the somatosensory-evoked magnetic fields elicited by painless tactile stimuli. RESULTS: The axial method yielded the most consistent interrater results, with complete agreement in 76% of sections in both control subjects and patients. The intermethod discordance of the sagittal midline and lateral methods was 32% in control subjects and 33% in patients. The concordance of MR and MEG methods ranged from 55% to 84% in control subjects and 65% to 67% in patients. CONCLUSION: MR anatomic techniques can usually identify the central sulcus, but in the presence of anatomic distortion, the MEG functional method adds significant information.

Transcranial Doppler ultrasound and magnetoencephalography in migraine.

Eighty subjects--30 migraineurs during the attack, 30 patients in the interictal period, and 20 healthy volunteers--were studied using two technologies for functional assessment: transcranial Doppler ultrasound and magnetoencephalography. Transcranial Doppler studies showed an increased mean flow velocity at rest (p less than 0.05) in the middle cerebral artery on the side of the headache and a decreased vasomotor response to CO 2 (p less than 0.001) on the same side compared to control subjects. Biomagnetic measurements of somatosensory evoked fields of 11 patients and 11 control subjects in this study did not demonstrate differences between migraineurs and the control group in current flow or latency measures. The data from this study tend to support the hypothesis of vascular disease as a primary underlying deficit in migraine.

Noninvasive somatosensory homunculus mapping in humans by using a large-array biomagnetometer.

To validate the feasibility of precise noninvasive functional mapping in humans, a large-array biomagnetometer was used to map the somatosensory cortical locations corresponding to numerous distinct tactile sites on the fingers, hand, arm, and face in different subjects. Source localizations were calculated by using a single equivalent current dipole (ECD) model. Dipole localizations were transposed upon the corresponding subject's magnetic resonance image (MRI) to resolve the anatomic locus of the individual dipoles within a given subject. Biomagnetic measurements demonstrated that (i) there were distinct separations between the ECD locations representing discrete sites on the face and hand; (ii) the ECD localizations from facial sites clustered in a region inferior to ECD localizations from hand and digit sites; and (iii) there was clear spatial resolution of ECD locations representing closely spaced tactile sites on the hand and face. The ability of magnetoencephalography (MEG) to provide high-resolution spatial maps of the somatosensory system noninvasively in humans should make MEG a useful tool to define the normal or pathological organization of the human somatosensory system and should provide an approach to the rapid detection of neuroplasticity.

Reducing unnecessary psychiatric consultations for informed consent by liaison with administration.

The frequency of a psychiatric consultation being requested to assess a patients' capacity to give informed consent varies among institutions, with most recent surveys reporting a frequency of between 3% and 8% of all consultations. At Montefiore Medical Center, a hospital policy was interpreted as mandating such consultations for all patients with possible or even definite lack of decisional capacity. From 1987 to 1988, 55% of all psychiatric consultations in the institution were for consent. Only 9% of the consent patients seen had an Axis I diagnosis other than organic mental syndrome (OMS). Because many of these consultations were believed to be unnecessary, with patient clearly able or unable to give consent, the consultation service worked first with administration to modify the guidelines, and then educated the medical and nursing staff as to when consultation was indicated. With this program, the number of consent consultations fell from 958 in 1988 to 177 in 1990, representing a major saving of staff time and third-party billings. In this era of cost containment and outside review of professional practices, psychiatrists must take responsibility for identifying areas where patient services and billings for them are not justified by clinical indications.