Clinical determinants of ultrasound-guided sclerotherapy. Part II: In search of the ideal injectate volume

BACKGROUND: Ablation of the incompetent saphenous vein may be accomplished by either surgical extirpation or ultrasound-guided sclerotherapy (UGS). Clinical guidelines for the selection of suitable candidates for UGS have yet to be established for this relatively new procedure. OBJECTIVE: To assess the effects of age, gender, and vein size on the outcome of UGS. METHODS: UGS was performed on 116 Class C2-6EPASPR limbs with duplex-confirmed saphenofemoral junctional incompetence using 1-mL injectate volumes of 3% sodium tetradecyl sulphate (STS) (15-mL maximum) and Class II compression. Treatment endpoint was persistent vasospasm observed on duplex imaging, with clinical and duplex ultrasound follow-up at 2 weeks, 6 months, and annually for 2 years. RESULTS: Statistical testing showed that only vein size affected recanalization. Age, gender, and vein size all affected the dosage required to achieve vasospasm, but not the clinical recurrence rate. Vein size was larger in males and correlated with age. CONCLUSIONS: Larger doses of STS are required to induce vasospasm in older patients, males, and those with larger veins. Regardless of gender and age, larger veins are more likely to recanalize, but are not necessarily associated with clinical recurrence. Although older patients and males tend to have larger veins, their recanalization rates are similar to younger patients and females when sufficiently higher STS doses are used to induce vasospasm. Ambulatory patients of all ages and either gender may be good candidates for UGS if vasospasm is used as the treatment endpoint. Contrary to prevailing opinion, large vein caliber is not an absolute contraindication for UGS.     

Patient-Appraised Couple Emotion Management and Disease Management Among Chinese American Patients With Type 2 Diabetes.

Family context exerts a strong influence on disease management among patients with chronic disease, but it is not clear which aspects of family life are most influential. This study examined the linkages between patient-appraised couple emotion management (conflict resolution, expressiveness, and respect) and disease management (biological, morale/depression, quality of life, and behavioral) among a relatively understudied group, Chinese American patients with type 2 diabetes. Significant main effects were found between patient-appraised couple emotion management, especially conflict resolution, and the morale component of disease management, but not the biological or behavioral components; both diabetes-specific and general relationship qualities (marital satisfaction) were independently linked to disease management. Acculturation did not qualify the findings. Similarities among ethnic groups in family and disease management relationships may be more common than differences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Radiofrequency catheter ablation of multiple haemodynamically unstable ventricular tachycardias in a patient with surgically repaired tetralogy of Fallot

A 55-year-old man was admitted following an overdose of sustained-release verapamil (calcium channel blocker) and ordinary-release atenolol (beta-1 blocker). At admission, there was extreme bradycardia (20-25 beats min-1) and hypotension (systolic arterial pressure 40-50 mm Hg). To counteract the cardiovascular depression, prenalterol, dopamine, dobutamine, isoprenaline, adrenaline and noradrenaline were used. A satisfactory state was obtained with adrenaline, noradrenaline and dopamine infused at high rates. Cardiac output was then more than 101 min-1, with a very low total peripheral resistance. The infusion of the adrenergic agonists could be interrupted on day 3. Prolonged ventilator treatment was necessary but the patient recovered without sequelae. Treatment options for similar cases are outlined.     

Enhancement of bright squeezing in the second harmonic byinternally seeding the χ(2) interaction

Second-harmonic generation (SHG) and parametric amplification result from the same physical configuration of the χ⁽²⁾ process, but with different input conditions for the interacting fundamental and harmonic waves. In the former, the input harmonic field is usually in the vacuum state whereas, in the latter, the fundamental is in the vacuum state (or a small-amplitude coherent state). A different set of input conditions can lead to a nonlinear phase shift in both the fundamental and the harmonic waves, while not affecting their relative magnitudes. In conjunction with SHG, we show that this configuration can be used to generate a bright (high-intensity) amplitude-squeezed (sub-Poissonian) field at the harmonic frequency. Large amounts of squeezing are possible. An integrated device with the above characteristics can be fabricated by utilizing the recently developed quasi-phase-matching techniques     

Nonlinear feedback control of multivariable non-minimum-phase processes

A new method of controlling nonlinear processes with a non-minimum-phase delay-free part is presented. Two control laws are derived for stable, multiple-input multiple-output processes. They are obtained by requesting an approximately linear, input–output response and exploiting the connections between model-predictive control and input–output linearization. Conditions under which the closed-loop system is asymptotically stable are given. The application and performance of the control laws are illustrated using numerical simulation of two chemical reactor examples that exhibit non-minimum-phase behavior.     

Mutuality in psychotherapy supervision.

Contends that mutuality, the quality of shared participation and interchange of thoughts and feelings, is a key element of the supervisory relationship in general and a specific component in contracting for supervision and in developing therapeutic skills. It is suggested that there is a parallel between the processes of supervision and psychotherapy. Supervisor–supervisee dialogs are included to illustrate mutuality in learning, in contracts, in assessment, in interventions, and in process monitoring. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Context-aware personal communication for teleliving

Personal communication with mixed voice and data can be offered as a very rich set of applications, which can be rapidly introduced at low cost. Wireless and positioning technologies in combination with the Internet's demonstrated capability to integrate voice and data are further leveraged by the use of software agents. Our work clearly demonstrates the benefits of providing context-aware personal communication in terms of its potential to bringing about the rapid introduction, at low cost, of a rich communication space where artefacts, people, and non-physical entities are integral parts.     

Appraising the performance of performance appraisal

This article provides a critical examination of formal performance appraisal systems in organizations. It argues that the role, effectiveness, and validity of appraisal data are limited by a number of organizational factors: the purposes of the appraisal (both avowed and covert), the characteristics of the tasks for which the appraisal is performed, and the location in the structure of the organization of both appraisers and appraisees. The authors conclude that data from formal performance appraisal systems should never be utilized alone and uncritically, without full consideration of the context in which the appraisal is being performed and used.