Design and characterization of the time-resolved opacity spectrometer (OpSpecTR) for the NIF iron opacity campaign.

A new time-resolved opacity spectrometer (OpSpecTR) is currently under development for the National Ignition Facility (NIF) opacity campaign. The spectrometer utilizes Icarus version 2 (IV2) hybridized complementary metal-oxide-semiconductor sensors to collect gated data at the time of the opacity transmission signal, unlocking the ability to collect higher-temperature measurements on NIF. Experimental conditions to achieve higher temperatures are feasible; however, backgrounds will dominate the data collected by the current time-integrating opacity spectrometer. The shortest available OpSpecTR integration time of ∼2 ns is predicted to reduce self-emission and other late-time backgrounds by up to 80%. Initially, three Icarus sensors will be used to collect data in the self-emission, backlighter, and absorption regions of the transmission spectrum, with plans to upgrade to five Daedalus sensors in future implementations with integration times of ∼1.3 ns. We present the details of the diagnostic design along with recent characterization results of the IV2 sensors.

Techniques and complications of popliteal nerve blocks.

BACKGROUND: Use of popliteal nerve blocks (PNBs) as an alternative or adjunctive therapy to traditional methods of pain control (e.g., systemic or spinal anesthesia and opioids) is increasingly popular in foot and ankle surgery. METHODS: We reviewed online databases for literature on PNBs in foot and ankle surgery to analyze the various techniques and positioning used, the influence of drugs on their efficacy, and possible complications associated with their use. Thirty articles were identified with a predefined search criteria, followed by a review process for relevance. RESULTS: Patient demographics, procedure specifics, and block techniques, such as anesthetic used, can impact the duration and success of a PNB. Administration with ultrasound guidance proved superior to nerve stimulation, and preoperative administration was superior to postoperative administration. CONCLUSIONS: PNBs are an effective method to control postoperative pain with minimal complications, leading to decreased analgesic use, earlier discharge, and higher patient satisfaction. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Dominant and recessive congenital myasthenic syndromes caused by SYT2 mutations.

INTRODUCTION/AIMS: We studied a patient with a congenital myasthenic syndrome (CMS) caused by a dominant mutation in the synaptotagmin 2 gene (SYT2) and compared the clinical features of this patient with those of a previously described patient with a recessive mutation in the same gene. METHODS: We performed electrodiagnostic (EDX) studies, genetic studies, muscle biopsy, microelectrode recordings and electron microscopy (EM). RESULTS: Both patients presented with muscle weakness and bulbar deficits, which were worse in the recessive form. EDX studies showed presynaptic failure, which was more prominent in the recessive form. Microelectrode studies in the dominant form showed a marked reduction of the quantal content, which increased linearly with higher frequencies of nerve stimulation. The MEPP frequencies were normal at rest but increased markedly with higher frequencies of nerve stimulation. The EM demonstrated overdeveloped postsynaptic folding, and abundant endosomes, multivesicular bodies and degenerative lamellar bodies inside small nerve terminals. DISCUSSION: The recessive form of CMS caused by a SYT2 mutation showed far more severe clinical manifestations than the dominant form. The pathogenesis of the dominant form likely involves a dominant-negative effect due to disruption of the dual function of synaptotagmin as a Ca2+ -sensor and modulator of synaptic vesicle exocytosis.

Bone Structure and Turnover Status in Postmenopausal Women with Atypical Femur Fracture After Prolonged Bisphosphonate Therapy.

Atypical femur fracture (AFF), a serious complication of long-term bisphosphonate therapy, is usually preceded by an incomplete fracture appearing on the lateral femur. AFF is most likely the result of severely suppressed bone turnover (SSBT). However, the differences in bone structure and turnover between patients with incomplete and complete AFF remain unknown. We examined trans-iliac bone biopsies from 12 white postmenopausal women with AFF (incomplete = 5; complete = 7) on BP therapy of >5 years and 43 healthy white premenopausal women. Histomorphometric measurements were performed separately in cancellous, intracortical and endosteal envelopes. Of the 43 histomorphometric measurements on 3 difference bone surfaces (cancellous, intracortical and endosteal), only 2 bone resorption variables (Oc.S/BS and Oc.S/NOS) on the endosteal surface were significantly lower in patients with complete AFF than those with incomplete AFF. Compared to healthy premenopausal women, the trabecular bone volume, thickness and number were all significantly lower in patients with AFF. The dynamic bone formation variables in patients with AFF were significantly reduced on all bone surfaces. The likelihood of a biopsy with no tetracycline labeling was significantly higher in AFF patients than in healthy premenopausal women. Based on these results, we conclude that there are no significant differences in bone turnover between patients with incomplete and complete AFF, suggesting that the suppression of bone turnover had already existed in the femur with incomplete AFF. Compared to healthy premenopausal women, bone turnover is similarly suppressed in patients with either type of AFF.

Neurological Management of Von Hippel-Lindau Disease.

Von Hippel-Lindau disease is a genetic condition due to mutation of the Von Hippel-Lindau gene, which leads to an increased risk in the development of hemangioblastomas of the brain and spinal cord. The pathophysiology of disease and its clinical manifestations, as they pertain to the general neurologist, are discussed. Therapeutic management of central nervous system hemangioblastomas ranging from neurosurgical resection, radiation therapy, and systemic therapies is reviewed.

Self-reference in psychosis and depression: a language marker of illness.

BACKGROUND: Language use is of increasing interest in the study of mental illness. Analytical approaches range from phenomenological and qualitative to formal computational quantitative methods. Practically, the approach may have utility in predicting clinical outcomes. We harnessed a real-world sample (blog entries) from groups with psychosis, strong beliefs, odd beliefs, illness, mental illness and/or social isolation to validate and extend laboratory findings about lexical differences between psychosis and control subjects. METHOD: We describe the results of two experiments using Linguistic Inquiry and Word Count software to assess word category frequencies. In experiment 1, we compared word use in psychosis and control subjects in the laboratory (23 per group), and related results to subject symptoms. In experiment 2, we examined lexical patterns in blog entries written by people with psychosis and eight comparison groups. In addition to between-group comparisons, we used factor analysis followed by clustering to discern the contributions of strong belief, odd belief and illness identity to lexical patterns. RESULTS: Consistent with others' work, we found that first-person pronouns, biological process words and negative emotion words were more frequent in psychosis language. We tested lexical differences between bloggers with psychosis and multiple relevant comparison groups. Clustering analysis revealed that word use frequencies did not group individuals with strong or odd beliefs, but instead grouped individuals with any illness (mental or physical). CONCLUSIONS: Pairing of laboratory and real-world samples reveals that lexical markers previously identified as specific language changes in depression and psychosis are probably markers of illness in general.

Hybrid position/force control of an active handheld micromanipulator for membrane peeling.

BACKGROUND: Peeling procedures in retinal surgery require micron-scale manipulation and control of sub-tactile forces. METHODS: Hybrid position/force control of an actuated handheld microsurgical instrument is presented as a means for simultaneously improving positioning accuracy and reducing forces to prevent avoidable trauma to tissue. The system response was evaluated, and membrane-peeling trials were performed by four test subjects in both artificial and animal models. RESULTS: Maximum force was reduced by 56% in both models compared with position control. No statistically significant effect on procedure duration was observed. CONCLUSIONS: A hybrid position/force control system has been implemented that successfully attenuates forces and minimizes unwanted excursions during microsurgical procedures such as membrane peeling. Results also suggest that improvements in safety using this technique may be attained without increasing the duration of the procedure.

Toward Hybrid Position/Force Control for an Active Handheld Micromanipulator.

Vitreoretinal microsurgery requires precise hand-eye coordination to manipulate delicate structures within the eye on the order of tens of microns. To achieve these tasks, surgeons use tools of diameter 0.9 mm or less to access the eye's interior structures. The level of force required during these manipulations is often below the human tactile threshold, requiring the surgeon to rely on subtle visual cues or to apply larger forces above the tactile threshold for feedback. However, both of these methods can lead to tissue damage. Excursions can be made into tissues which are not felt by the surgeon, while larger forces have a higher chance of damaging tissue within the eye. To prevent damage to the retina and other anatomy, we present the implementation of hybrid position/force control operating in the sub-tactile force range for a handheld robotic system. This approach resulted in a 42% reduction in the mean force and 52% reduction in maximum force during peeling tasks.

Performance of a 6-degree-of-freedom active microsurgical manipulator in handheld tasks.

This paper presents the first experimental results from human users of a new 6-degree-of-freedom handheld micromanipulator. This is the latest prototype of a fully-handheld system, known as "Micron," which performs active compensation of hand tremor for microsurgery. The manipulator is a miniature Gough-Stewart platform incorporating linear ultrasonic motors that provide a cylindrical workspace 4 mm long and 4 mm wide. In addition, the platform allows the possibility of imposing a remote center of motion for controlling motion not only at the tip but also at the entry point in the sclera of the eye. We demonstrate hand tremor reduction in both static and dynamic micromanipulation tasks on a rubber pad. The handheld performance is also evaluated in an artificial eye model while imposing a remote center of motion. In all cases, hand tremor is significantly reduced.

Improvement of optical coherence tomography using active handheld micromanipulator in vitreoretinal surgery.

An active handheld micromanipulator has been developed to cancel hand tremor during microsurgery. The micromanipulator is also applicable in optical coherence tomography to improve the quality of scanning and minimize surgical risks during the scans. The manipulator can maneuver the tool tip with six degrees of freedom within a cylindrical workspace 4 mm in diameter and 4 mm high. The imaging system is equipped with a 25-gauge Fourier-domain common-path OCT probe. This paper introduces the handheld OCT imaging system and techniques involved and presents stabilized OCT images of A-mode and M-mode scans in air and live rabbit eyes. We show the first demonstration of OCT imaging using the active handheld micromanipulator in vivo.

Comparison of Baseline Tremor Under Various Microsurgical Conditions.

This paper presents the characterization and comparison of physiological tremor for pointing tasks in multiple environments, as a baseline for performance evaluation of microsurgical robotics. Previous studies have examined the characteristics of physiological tremor under laboratory settings as well as different operating conditions. However, different test methods make the comparison of results across trials and conditions difficult. Two vitroretinal microsurgeons were evaluated while performing a pointing task with no entry-point constraint, constrained by an artificial eye model, and constrained by a rabbit eye in vivo. For the three respective conditions the 3D RMS positioning error was 144 µm, 258 µm, and 285 µm, and maximum 3D error was 349 µm, 647 µm, and 696 µm. A spectral analysis was also performed, confirming a distinct peak near in the 6-12 Hz frequency range, characteristic of hand tremor during tasks in all three environments.

Changing emotion: the use of therapeutic storytelling.

Even though using metaphors in a therapeutic context is common, there are very few studies that address their effects. This study examines the effects of storytelling in therapy. After discussing a problem in a current relationship, 42 female participants were randomly assigned to receive either a story or psychoeducational information. Results indicated that both treatments were equally successful in reducing amounts of negative affect and negative feelings toward the relationship. In addition, each story was able to facilitate a change in emotional valence. Finally, participants saw no difference between the depth and smoothness of each session. Examples on using storytelling within different models of marriage and family therapy are provided.

Temozolomide as second-line chemotherapy for relapsed gliomas.

BACKGROUND: Temozolomide, an imidazotetrazine prodrug has shown activity in phase II studies in patients with high-grade glioma at first recurrence. We assessed the efficacy of temozolomide as second-line therapy following failure of PCV chemotherapy in patients with recurrent/progressive gliomas. PATIENTS AND METHODS: Between September 1994 and November 2000, 32 patients with high-grade gliomas at second recurrence/progression received temozolomide as salvage therapy and results were reviewed retrospectively. RESULTS: Of 32 assessable patients 7 had clinical improvement; there were no imaging responses. Median survival of the cohort was 4 months, with 28% alive at 6 months. Age, performance status, histology and previous response to PCV chemotherapy did not predict for clinical response to temozolomide. CONCLUSION: In the small cohort of patients with recurrent malignant glioma who failed PCV chemotherapy temozolomide demonstrated limited activity as second-line treatment although this remains within the confidence intervals of response seen in patients with glioblastoma.

Effects of consonantal context on perceptual assimilation of American English vowels by Japanese listeners.

This study investigated the extent to which adult Japanese listeners' perceived phonetic similarity of American English (AE) and Japanese (J) vowels varied with consonantal context. Four AE speakers produced multiple instances of the 11 AE vowels in six syllabic contexts /b-b, b-p, d-d, d-t, g-g, g-k/ embedded in a short carrier sentence. Twenty-four native speakers of Japanese were asked to categorize each vowel utterance as most similar to one of 18 Japanese categories [five one-mora vowels, five two-mora vowels, plus/ei, ou/ and one-mora and two-mora vowels in palatalized consonant CV syllables, C(j)a(a), C(j)u(u), C(j)o(o)]. They then rated the "category goodness" of the AE vowel to the selected Japanese category on a seven-point scale. None of the 11 AE vowels was assimilated unanimously to a single J response category in all context/speaker conditions; consistency in selecting a single response category ranged from 77% for /eI/ to only 32% for /ae/. Median ratings of category goodness for modal response categories were somewhat restricted overall, ranging from 5 to 3. Results indicated that temporal assimilation patterns (judged similarity to one-mora versus two-mora Japanese categories) differed as a function of the voicing of the final consonant, especially for the AE vowels, /see text/. Patterns of spectral assimilation (judged similarity to the five J vowel qualities) of /see text/ also varied systematically with consonantal context and speakers. On the basis of these results, it was predicted that relative difficulty in the identification and discrimination of AE vowels by Japanese speakers would vary significantly as a function of the contexts in which they were produced and presented.

Context-independent dynamic information for the perception of coarticulated vowels.

Most investigators agree that the acoustic information for American English vowels includes dynamic (time-varying) parameters as well as static "target" information contained in a single cross section of the syllable. Using the silent-center (SC) paradigm, the present experiment examined the case in which the initial and final portions of stop consonant-vowel-stop consonant (CVC) syllables containing the same vowel but different consonants were recombined into mixed-consonant SC syllables and presented to listeners for vowel identification. Ten vowels were spoken in six different syllables, /b Vb, bVd, bVt, dVb, dVd, dVt/, embedded in a carrier sentence. Initial and final transitional portions of these syllables were cross-matched in: (1) silent-center syllables with original syllable durations (silences) preserved (mixed-consonant SC condition) and (2) mixed-consonant SC syllables with syllable duration equated across the ten vowels (fixed duration mixed-consonant SC condition). Vowel-identification accuracy in these two mixed consonant SC conditions was compared with performance on the original SC and fixed duration SC stimuli, and in initial and final control conditions in which initial and final transitional portions were each presented alone. Vowels were identified highly accurately in both mixed-consonant SC and original syllable SC conditions (only 7%-8% overall errors). Neutralizing duration information led to small, but significant, increases in identification errors in both mixed-consonant and original fixed-duration SC conditions (14%-15% errors), but performance was still much more accurate than for initial and finals control conditions (35% and 52% errors, respectively). Acoustical analysis confirmed that direction and extent of formant change from initial to final portions of mixed-consonant stimuli differed from that of original syllables, arguing against a target + offglide explanation of the perceptual results. Results do support the hypothesis that temporal trajectories specifying "style of movement" provide information for the differentiation of American English tense and lax vowels, and that this information is invariant over the place of articulation and voicing of the surrounding stop consonants.

False starts and other dilemmas of a secondary general education collaborative teacher: a case study.

Currently, many special education policymakers, researchers, and practitioners are questioning the efficacy of pull-out programs for students with disabilities and advocating service delivery in inclusive or general education settings at both the elementary and the secondary level. I investigated the implementation of a collaborative teaching model in a suburban high school to determine how this move toward inclusive education benefited teachers and students. Through examination of the "ups and downs" of a U.S. History teacher, I concluded that replicating and sustaining collaborative teaching can be difficult and complex and, without careful consideration of contextual variables, may not lead to improved outcomes for either teachers or students. Implications for research and practice are discussed.