The Origin of the Magnetic Channel of the Thermal Boundary Resistance Between Liquid 3He and Ag Sinters at Very Low Temperatures

At temperatures below about 10mK, the temperature dependence of the thermal boundary resistance between liquid ³ He and metal sinters deviates significantly from the behaviour expected from the acoustic mismatch theory (R _K T ^–3). This behaviour is explained in terms of the existence of a magnetic channel for the coupling between the ³ He quasiparticles and the sinter; the origin of this coupling, however, is unknown so far. In our studies of the magnetic properties of Ag sinters made of powders of submicron grain size we have detected and identified a magnetically ordering subsystem which, although it contributes only a few ppms to the total mass, dominates the magnetic properties of the sinters. We present the results of our investigation of the magnetic properties of these Ag sinters which strongly deviate from the behaviour of bulk silver, and discuss a possible mechanism how a magnetically ordered subsystem may open up the magnetic channel of the thermal boundary resistance to liquid ³ He at very low temperatures. The main conclusion of our study is that our results should allow the tuning of the thermal boundary resistance between liquid ³ He and sintered metal heat exchangers at very low temperatures.     

Pulse oximetry: an added criterion for discharge from the post-operative care unit

BACKGROUND: In previous studies, transcutaneous electrical nerve stimulation (TENS), tactile stimulation, and a combination of the two resulted in cognitive and affective improvements in patients with Alzheimer's disease (AD). As in those studies the therapist was present during the treatment of the experimental and control group (sham stimulation), a positive effect of the combination of TENS with interpersonal communication could not be excluded. Therefore, the effects of "isolated" TENS, i.e., in the absence of the therapist, on memory and affective disturbances in AD patients were examined. METHODS: Eighteen subjects (78-92 years old) met the NINCDS-ADRDA criteria for the clinical diagnosis of probable AD. To evaluate treatment effects, the experimental group (9) and the control group (9) underwent a number of neuropsychological tests and two observation scales. RESULTS: Treatment effects were observed for nonverbal short-term (Visual Memory) and long-term (Face Recognition) memory, word fluency (Verbal Fluency), and need of help, whereas patients' affective behavior did not improve. CONCLUSIONS: The results of the present study show that isolated TENS has a positive effect on patients' cognitive and independent functioning; however, isolated TENS appeared not to have a therapeutic effect on patients' affective behavior.     

Videostroboscopy of the pharyngoesophageal segment in total laryngectomees

OBJECTIVES: The reconstructed pharyngoesophageal segment (PES) serves as the neoglottis following total laryngectomy, as it provides the source of vibration for production of tracheoesophageal puncture (TEP) voice. To date, little information exists regarding the vibratory characteristics of the PES. The purpose of this investigation was to study the anatomy and physiology of the PES using videostroboscopy. STUDY DESIGN: Prospective study investigating the anatomy and physiology of the PES in 34 laryngectomees who used TEP speech as their primary form of communication. MATERIALS AND METHODS: Videostroboscopy and voice recordings were graded by three trained, blinded judges using a seven-point scale. RESULTS: The patients demonstrated differences that allowed for separation of patients into two main groups: "poor" and "effective" TEP speakers. The voice quality differences were explained by anatomic and physiologic characteristics of the PES. Redundant, thick, and dyssynchronous PES features were observed in patients with poor TEP speech skills; the effective speakers exhibited less redundant, thinner mucosa and more synchronous vibratory patterns. Moreover, the latter subgroup consistently demonstrated a greater degree of volitional PES control and less spasmodic activity than their poorly speaking counterparts. Length of the PES opening (measured in the horizontal plane) as well as amount and consistency of secretions did not appear to influence TEP speech or voice proficiency. CONCLUSION: Videostroboscopy in laryngectomees is a noninvasive, inexpensive, easily performed procedure that may contribute valuable information regarding the anatomy and physiology of the PES, especially in patients who experience difficulties achieving satisfactory TEP voice and speech production.     

Allegations of sexual abuse by nonverbal autistic people via facilitated communication: testing of validity

OBJECTIVE: The aim of the paper is to offer a comprehensive approach to establishing the validity of allegations of sexual abuse by nonverbal autistic children and adults produced through facilitated communication (FC). This approach is offered as an alternative to existing methodology that relies exclusively on the "message passing" task, and has been used to advantage in the courts. METHOD: Three components to the battery are included: (a) specialized psychometric testing; (b) a variant of the message passing task; and (c) systematic analysis of the allegations themselves. Through the juxtaposition of the data from the different sources, conclusions can be reached as to the allegations' authorship. RESULTS: The results of a series of studies addressing the issue of validity of FC in general are briefly presented. Then a case presentation is offered to demonstrate how the technique can be employed to clarify allegations of sexual abuse. Elements of two other cases are also briefly discussed. CONCLUSIONS: Facilitated communication has been heralded as a breakthrough, allowing nonverbal people with autism to express themselves. It relies on manual guidance by a facilitator. Its proponents' resistance to allowing the technique's validation relying on the paradigm of normal science has resulted in its broad dissemination without support. In the case of sexual abuse allegations thus far the "message passing" task has been used to assess their verity. The present methodology is offered as a more comprehensive alternative to "message passing," with relevance to other populations of nonverbal individuals.     

Congestive heart failure in the community: a study of all incident cases in Olmsted County, Minnesota, in 1991

BACKGROUND: Data are limited regarding the classification and prognosis of patients with congestive heart failure (CHF) in the community. METHODS AND RESULTS: Using the resources of the Rochester Epidemiology Project, we evaluated all patients receiving a first diagnosis of CHF in Olmsted County, Minnesota, in 1991 (n=216). Among these patients, 88% were >/=65 years and 49% were >/=80 years of age. The prognosis of patients with a new diagnosis of CHF was poor; survival was 86+/-2% at 3 months, 76+/-3% at 1 year, and 35+/-3% at 5 years. Of the 216 patients, 137 (63%) had an assessment of ejection fraction. In these patients, systolic function was preserved (ejection fraction >/=50%) in 59 (43%) and reduced (ejection fraction <50%) in 78 (57%). Survival adjusted for age, sex, NYHA class, and coronary artery disease was not significantly different between patients with preserved and those with reduced systolic function (relative risk, 0.80; P=0.369). ACE inhibitors were used in only 44% of the total population with CHF. CONCLUSIONS: The present study reports the clinical characteristics and natural history of CHF as it presents in the community in the vasodilator era. CHF is a disease of the "very elderly," frequently occurs in the setting of normal ejection fraction, and has a poor prognosis, regardless of the level of systolic function. Diagnostic and therapeutic methods are underused in the community.     

Cyclical vomiting as the leading symptom of regression

A 17-year old boy with primary mental retardation of unknown aetiology and cyclic vomiting syndrome (CVS) is reported. Missing an organic cause of the episodes therapeutic procedures remained symptomatic for a 15 years time period. The report focusses the CVS as a regressive mechanism triggered by a mental retardation of the child which permanently disturbed the interaction between parents and child. Psychotherapeutic approach was successful in the following respects: The advantage by illness to vomit at home was continuously reduced by admitting the boy to a hospital at every ongoing attack. Hypnotherapeutic techniques were able to substitute the "malign" regression (CVS) successively by inducing a "benign" kind of regression. Family therapy could induce new and more intense non-verbal patterns of communication which where hitherto unknown in this family.     

Clinical acceptability and immunogenicity of a pentavalent parenteral combination vaccine containing diphtheria, tetanus, acellular pertussis, inactivated poliomyelitis and Haemophilus influenzae type b conjugate antigens in two-, four- and six-month-old Chilean infants

The syndromes of Sotos and Weaver are paradigmatic of the daily nosologic difficulties faced by clinical geneticists attempting to diagnose and counsel, and to give accurate prognoses in cases of extensive phenotypic overlap between molecularly undefined entities. Vertebrate development is constrained into only very few final or common developmental paths; therefore, no developmental anomaly seen in humans is unique to ("pathognomonic" of) one syndrome. Thus, it is not surprising that prenatal overgrowth occurs in several syndromes, including the Sotos and Weaver syndromes. Are they sufficiently different in other respects to allow the postulation of locus (rather than allele) heterogeneity? Phenotypic data in both conditions are biased because of ascertainment of propositi, and the apparent differences between them may be entirely artificial as they were between the G and BBB syndromes. On the other hand, the Sotos syndrome may be a cancer syndrome, the Weaver syndrome not (though a neuroblastoma was reported in the latter); in the former there is also remarkably advanced dental maturation rarely commented on in the latter. In Weaver syndrome there are more conspicuous contractures and a facial appearance that experts find convincingly different from that of Sotos individuals. Nevertheless, the hypothesis of locus heterogeneity is testable; at the moment we are inclined to favor the hypothesis of allele heterogeneity. An international effort is required to map, isolate, and sequence the causal gene or genes.     

Clinical experience and indications of the free serratus fascia flap: a report of 21 cases

The free "serratus fascia" flap as a free flap was first described by Wintsch and named a free fascia flap of gliding tissue; however, it has not yet been given a distinct name. The particular advantages of this flap consist of an easy access and a low donor-site morbidity without functional deficit. Additionally, it may be designed very variably and molded even three-dimensionally as a tendon wraparound flap or folded to fill up cavities. In our clinic, we used this flap in 21 patients for distinct indications and in 7 patients as a vascular graft in fingers or great toe with a minimal adjacent layer of gliding tissue around the vessels for the treatment of cold intolerance after finger replantation or severe finger or toe trauma. In the other cases, this versatile flap served for the coverage of traumatically exposed tendons or bones at the extremities, covered with a skin graft. Eighteen flaps survived completely, whereas 3 flaps developed partial or superficial necrosis. Only once did a major complication by unintentional sacrification of the long thoracic nerve during flap harvesting occur, resulting in a wing scapula. We recommend this flap for defect cover at sites where a thin vascularized gliding layer for defect cover is needed, especially in distal extremities with exposed tendons or nerves, and present the current indications in discussing our experiences.