Correction of phase and depolarization distortions in a multimode fiber at 1.064 microm with stimulated-Brillouin-scattering phase conjugation.

We have used phase conjugation to compensate phase distortions and depolarization introduced in multimode fibers having 2-m lengths and 400-microm core diameters. The experiment was performed at a wavelength of 1.064 microm, and we achieved phase conjugation using Brillouin-enhanced four-wave mixing in a 0.8-mm-core hollow quartz lightguide filled with TiCl(4). The far-field conjugation fidelity was 70%, and the residual depolarization was <1%. Comparable compensation was achieved by use of either a graded-index or a step-index fiber.

The cost of accreditation: one hospital's experience.

OBJECTIVE: The 1989 survey conducted by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) at the UCLA Neuropsychiatric Hospital was the hospital's first using standards outlined in the 1989 edition of JCAHO's Accreditation Manual for Hospitals. The authors' goal was to calculate the cost of preparing for and undergoing the 1989 survey. METHODS: Costs associated with planning for the survey and conducting a mock survey and the actual survey were based on records of staff time spent on those activities, fees for consultant services, and fees for the actual survey. Costs associated with follow-up of the mock survey, preparation for the actual survey, and additional staff time spent in record keeping and treatment planning to meet accreditation standards were based on staff estimates of time spent in these activities. RESULTS: Documented and estimated costs for the survey process totaled $326,784, which represented about 1 percent of the hospital's operating budget for 1989. CONCLUSIONS: Although the hospital had a successful survey outcome and received accreditation with few contingencies, the authors question whether quality of care was improved by the survey process and whether the high cost of the survey constitutes an appropriate use of resources.

Single-frequency, 500-ns laser pulses generated by a passively Q-switched Nd laser.

We demonstrate a simple, passive technique for producing 500-ns pulse lengths with a Nd laser. The measured 1.5-MHz upper limit to the pulse spectral width indicates that it is nearly transform limited.

Stimulated Brillouin scattering phase-conjugation fidelity fluctuations.

We observe shot-to-shot fluctuations in the far-field fidelity of stimulated Brillouin scattering phase-conjugate mirrors in the saturated reflectivity regime under various experimental conditions. The fluctuations, which are not seen in the reflectivity, reflect a partial breakdown in the discrimination mechanism that selectively amplifies the conjugate mode above the stimulated Brillouin scattering noise seed.

The emotional impact of surgery and the value of informed consent.

The process of obtaining consent detailed here contains within it most of the therapeutic techniques useful in the prevention and treatment of usual postoperative psychological complications. You will note that at various points the physician will have; given information, utilized suggestions, reflected feelings, allowed ventilation and catharsis, clarified, desensitized, increased self-esteem, given reassurance, fostered identification, supported healthy defenses, encouraged autonomy, control, and responsibility, and done some social engineering. These psychotherapeutic techniques have been built into the content and process of eliciting consent. In addition, and most importantly, the process has fostered the growth of the doctor-patient relationship, the ultimate therapeutic weapon in managing most postoperative psychological reactions.

Tennis injuries: prevention and treatment. A review.

When players are engaged in the sport of tennis, injuries may occur to the eyes, in the neck, to the shoulder and back, arm and elbow, wrist and hand, and feet. The key to prevention and treatment of these injuries is good coaching and a formal stretching and strengthening program. The drooped "tennis shoulder" of professionals and senior tennis players is a natural response to heavy use. Shoulder elevating exercises are useful when soreness is associated. The treatment of tennis elbow includes wrist extensor stretching, isometrics, and light weightlifting. When a player follows this program, injections or counterforce braces are rarely needed. It is important for the player to bring his racket to the examination so that his stroke mechanics and grip can be checked. Wrist soreness in a tennis player may denote a hamate hook fracture. Special radiographic views are needed to discern the fracture and it is treated with a short arm cast and little finger extension splint. Nonunion of a hamate hook requires excision. The calf pain prodrome of "tennis leg" requires rest and then a stretching program. Tennis shoes should have rolled heels and large toe boxes with reinforced toe bumpers. The physician may have to fashion soft inserts for the tennis shoes; arch supports may be insufficient.

The Long-Term Effects of Playing Tennis.

In 50 years of competitive tennis these super seniors have stayed in good condition and overcome problems ranging from tennis shoulder to heart disease.

Problems in family practice: the suicidal patient.

Suicidal patients are common in family practice. Risk factors can alert the family physician to persons at unusual risk. Demographic factors, especially those revealing changing social status, recent loss, intentionality, lethality, past history, and high-risk groups, can be rapidly assessed. Viewing suicide as a final common pathway of system dysfunction at any or all major levels-biologic, psychologic, sociocultural-leads to an appreciation of the ubiquitous nature of passive or active "self murder" impulses. Persons depressed for any significant length of time for whatever reasons are potentially suicidal. Thus, the "typical" depression is suicidal but so are persons whose depression is related to drug side effects, primary illness effects, to living in a dysfunctional family system, or to normal grief. Diagnosis requires inquiry about the depth of the patient's depression pain. Treatment takes into account the aforementioned risk factors, plus interventions appropriate to the malfunctioning system.

Biological aspects of suicide: circadian disorganization.

Disturbances in the circadian rhythmicity of biological functions have been reported in various mental disorders. Four lines of research--hormonal, electroencephalographic, cerebral spinal fluid, and circadian rhythmicity--suggest possible changes in suicidal individuals. During a study investigating the effect of a photoperiod shift on circadian rhythms, 15 male, healthy, normal subjects were used. Following a 5-day baseline period a 12-hour photoperiod shift took place and was followed by 10 days of recovery period. Multiple parameters were monitored. Two weeks following completion of the study one subject suicided. The data were examined to determine whether the suicided subject differed, rhythmically, from other subjects. Summation dials describing phase changes and vector difference dials describing dynamic phase relationships of rhythm pairs showed that the rhythms of this subject were poorly synchronized internally during baseline. Total urinary output of all parameters was lower than all other subjects during baseline and more of his urinary parameters rephased incompletely during recovery. The results suggest that circadian asynchrony and an inability to respond effectively to a phase shift may characterize a presuicidal state. These results are discussed in terms of the four lines of research involving biological aspects of suicide and suggest some intriguing interactions.

The tired patient.

One of the most challenging diagnostic problems that comes into the physician's office is the patient who complains of "being tired." It can prove to be a frustrating experience for the physician (especially if the physician is also tired) and to the patient. This article will propose and describe a two-pronged systematic approach to the patient that can increase the probability of a satisfying outcome for both physician and patient. This approach assumes the "complaint" of every patient has both informational value ("I think there's something wrong.") and transactional meaning (Please take care of me."). Tiredness, fatigue, "exhaustion" need to be seen simultaneously as information and need. Both aspects require simultaneous work-up.

Psychologic and psychophysiologic response to 105 days of social isolation.

The responses of nine subjects to 105 d of social isolation are reported. The study reveals that crew selection plus ongoing support by psychiatric staff permits continued function in an exotic milieu. Prediction of psychophysiologic symptoms was possible using paper and pencil tests. Trait anxiety was altered by the isolation in a psychologically healthy direction. Sudden time shifts of 8 h led to an immediate significant increase in depression, aggression, and hostility, and are accompanied by marked increases in physical symptoms. During the first free-running phase of the experiment, significant shifts were found on four psychological measures. The shifts indicate that subjects became less trusting, more orderly, more routinized, less energetic, and more depressed. A reducer-augmenter scale predicted the number of psychophysiologic complaints reported by individual subjects while isolated. A group interaction effect on circadian rhythms was isolated but needs further examination.