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141.
OBJECTIVE: To evaluate the relationships between patient and physician pretreatment expectations of pain relief and subsequent pain relief reported by chronic pain patients immediately after treatment. DESIGN: Prospective study of consecutive patients undergoing a procedure in a pain clinic for treatment of chronic pain. Patients rated their current pain level and their expectation of pain relief immediately prior to undergoing a procedure (e.g., intravenous drug infusion, nerve block) for the treatment of chronic pain. Simultaneously and independently, the treating physician completed a similar questionnaire. At completion of the procedure, patients rated their current pain level and degree of pain relief. SETTING: University of Washington Multidisciplinary Pain Center procedure suite. PATIENTS: Forty-six consecutive chronic pain patients. INTERVENTION: Intravenous drug infusions and nerve blocks. OUTCOME MEASURES: Current pain and pain relief ratings. RESULTS: Patients' pain relief expectation ratings were not correlated significantly with their postprocedure pain relief ratings or pre-post procedure changes in pain ratings. However, a statistically significant correlation was found between physician expectations of pain relief and patient pain relief ratings and patient pre-post procedure changes in pain. CONCLUSIONS: The results of this study suggest that physicians are better predictors than are patients of patients responses to these procedures and/or that physicians may somehow subtly communicate their expectations to patients during the procedure, and these expectations then influence patient response. Patient pretreatment expectations may not always play a significant role in nonspecific treatment effects.  相似文献   
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Primary biliary cirrhosis (PBC) is an immunologically mediated disease in which activated T lymphocytes attack and destroy epithelial cells in the small intralobular bile ducts of genetically susceptible patients. This article reviews the results of treatment of PBC with immunomodulatory agents. Results with drugs such as glucocorticoids, azathioprine, and chlorambucil have been disappointing because of either limited efficacy (azathioprine), toxicity (chlorambucil), or both (glucocorticoids). Colchicine improved tests of liver function in three prospective studies and was associated with improved survival for up to 4 years. However, survival benefits were lost at 8 years. Colchicine appears to slow the rate of progression of PBC but not to stop it. Preliminary results suggest that colchicine may have synergistic effects if used together with ursodeoxycholic acid, particularly in patients who are only partially responsive to ursodeoxycholic acid. Results with cyclosporine have been disappointing because of limited efficacy and predictable toxicity. The modest improvement in tests of liver function and survival are counterbalanced by the development of hypertension in some and worsening renal function in most. There is little beneficial effect on symptoms or histology. Results with methotrexate are promising. There are improvements in symptoms and tests of liver function that are equal to those seen with ursodeoxycholic acid and significant improvement in liver histology. Some patients, particularly those with striking inflammation and granulomas in portal triads, appear to have achieved sustained remission while on methotrexate. The effects of methotrexate are additive to those of ursodeoxycholic acid in patients whose blood tests have responded only partially to ursodeoxycholic acid. The most effective treatment of PBC will most likely use a combination of drugs such as ursodeoxycholic acid, colchicine, and methotrexate.  相似文献   
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The ITER magnet system consists of structurally linked sets of toroidal (TF) and poloidal (PF) field coils, central solenoid (CS), and various support structures. The coils are superconducting, force flow Helium cooled with a Kapton-Glass-Epoxy multilayer insulation system. The stored magnetic energy is about 100GJ in the TF system and 20GJ in the PF-CS. Coils and structure are maintained at 4 K by enclosing them in a vacuum cryostat. The cryostat, comprising an outer envelope to the magnets, forms most of the second radioactivity confinement barrier. The inner primary barrier is formed by the vacuum vessel, its ports and their extensions. To keep the machine size within acceptable bounds, it is essential that the magnets are in close proximity to both of the nuclear confinement barriers. The objective of the magnet design is that, although local damage to one of the barriers may occur in very exceptional circumstances, large scale magnet structural or thermal failure leading to simultaneous breaching of both barriers is not credible. Magnet accidents fall into three categories: thermal (which includes arcing arising from insulation failure and local overheating due to discharge failure in the event of a superconductor quench), structural (which includes component mechanical failure arising from material inadequacies, design errors and exceptional force patterns arising from coil shorts or control failures), and fluid (Helium release due to cooling line failure). After a preliminary survey to select initial faults conceivable within the present design, these faults are systematically analyzed to provide an assessment of the damage potential. The results of this damage assessment together with an assessment of the reliability of the monitoring and protective systems, shows that the magnets can operate with the required safety condition.  相似文献   
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147.
Two classes of glial cells are found in the embryonic Drosophila CNS, midline glial cells and lateral glial cells. Midline glial development is triggered by EGF-receptor signalling, whereas lateral glial development is controlled by the gcm gene. Subsequent glial cell differentiation depends partly on the pointed gene. Here we describe a novel component required for all CNS glia development. The tramtrack gene encodes two zinc-finger proteins, one of which, ttkp69, is expressed in all non-neuronal CNS cells. We show that ttkp69 is downstream of gcm and can repress neuronal differentiation. Double mutant analysis and coexpression experiments indicate that glial cell differentiation may depend on a dual process, requiring the activation of glial differentiation by pointed and the concomitant repression of neuronal development by tramtrack.  相似文献   
148.
Impact ionization is a major limiting factor to the maximum operating voltage of InGaAs-based, high-speed transistors. In this work, data on the positive temperature dependence of the electron impact ionization coefficient αn in In0.53Ga0.47As at medium-low electric fields are reported for the first time. The increase of αn with temperature is opposite to the behavior normally observed in most semiconductors. This anomalous behavior implies the onset of a positive feedback between power dissipation and avalanche generation which may adversely affect the power handling capability of In0.53Ga 0.47As-based devices, and which should be taken into account in device thermal modeling. In the experimental procedure, based on the measurement of the multiplication factor M-1 in npn In0.53Ga 0.47As/InP Heterojunction Bipolar Transistors (HBT), particular care has been taken in order to rule out possible spurious, temperature-dependent contributions to the measured multiplication current  相似文献   
149.
An algorithm is presented to enhance the resilience of block-based video-coding algorithms against channel errors. The error-resilience algorithm described suggests the use of fixed length coding to alleviate the effect of Huffman coding on the synchronisation of the decode under erroneous conditions. The proposed mechanism modifies the order of transmission of the fixed-length video parameters to increase the chance of their arrival. Synchronisation words are sent at fixed-length intervals within the bit stream to reduce the possibility of the decoder falling on similar bit patterns within the bit stream. To limit the effect of error accumulation, the motion prediction process is halted and the differential coding of motion vectors is not applied. FEC techniques are applied on some error-sensitive segments of the reordered video bitstream. The effectiveness of the proposed error-resilience algorithm is evidenced by both subjective and objective results  相似文献   
150.
Utilizing multidimensional signaling techniques, a generalized multirate wavelet-based modulation format for orthogonally multiplexed communication systems is presented. Wavelet packet modulation (WPM) employs the basis functions from an arbitrary pruning of a dyadic tree structured filter bank as orthogonal pulse shapes for conventional quadrature amplitude modulation (QAM) symbols. This generalized framework affords an entire library of basis sets with increased flexibility in time-frequency (T-F) partitioning. The bandwidth efficiency and power spectral density figures of merit for the general signal are derived and shown to be that of standard QAM  相似文献   
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