A state secret: the closely guarded report of a hospital inquiry.

Two hundred years ago, Cork Street Fever Hospital was built by charitable subscription. Seven years after becoming a public-private partnership in 1937, its administration was subjected to a Sworn Inquiry. Why the Inquiry was held and why the Inspector's Report was never published are the questions addressed in this paper.

Marital and parental satisfaction of married physicians with children.

OBJECTIVE: To evaluate personal and professional factors associated with marital and parental satisfaction of physicians. STUDY DESIGN: Cross-sectional study. PARTICIPANTS: A survey was sent to equal numbers of licensed male and female physicians in a Southern California county. Of 964 delivered questionnaires, 656 (68%) were returned completed. Our sample includes 415 currently married physicians with children, 64% male and 36% female. MEASUREMENTS AND MAIN RESULTS: Ratings of marital and parental satisfaction were measured on a 5-point Likert scale, 5 being extremely satisfied. Prevalence of work and home life factors was also evaluated. The mean score for marital satisfaction was 3.92 (range 1.75-5.0). Approximately half of the physicians reported high levels of marital satisfaction (63% of male physicians and 45% of female physicians). The gender difference disappeared after adjusting for age differences. Two factors were associated with high marital satisfaction: a supportive spouse (odds ratio [OR] 10.37; 95% confidence interval [CI] 2.66, 40.08) and role conflict (OR 0.61; 95% CI 0.42, 0.88). The mean score for parental satisfaction was 3. 43 (range 1.0-5.0), and approximately two thirds of both male and female physicians reported at least moderate levels of parental satisfaction. The major factors associated with parental satisfaction were a supportive spouse (OR 2.24; 95% CI 1.32, 3.80), role conflict (OR 0.35; 95% CI 0.23, 0.53), salaried practice setting (OR 2.14; 95% CI 1.21, 3.81), marriage to a spouse working in a profession (OR 2.14; 95% CI 1.21, 3.81), and marriage to a spouse working as a homemaker (OR 2.33; 95% CI 1.20, 4.56). Number of hours worked was not found to be related to either satisfaction score, but rather to an intervening variable, role conflict. CONCLUSIONS: For physicians with children, our study indicates that minimizing the level of role conflict and having a supportive spouse are associated with higher levels of marital and parental satisfaction. Working in salaried positions and marriage to a spouse who is either working in a profession or who is a stay-at-home parent are also related to high parental satisfaction.

Physician role conflict and resulting career changes. Gender and generational differences.

OBJECTIVE: To evaluate gender and generational differences both in the prevalence of role conflict and in resulting career changes among married physicians with children. STUDY DESIGN: Cross-sectional survey. PARTICIPANTS: We sent a survey to equal numbers of licensed male and female physicians (1,412 total) in a Southern California county; of the 964 delivered questionnaires, 656 (68%) were returned completed. Our sample includes 415 currently married physicians with children, 64% male and 36% female. MEASUREMENTS AND MAIN RESULTS: The prevalence of perceived role conflict, or career changes for marriage, and of career changes for children were evaluated. Types of career changes were also evaluated. More female than male physicians (87% vs 62%, p < .001) and more younger than older female physicians (93% vs 80%, p < .01) and male physicians (79% vs 54%, p < .001) experienced at least moderate levels of role conflict. Younger female and male physicians did not differ in their rates of career change for marriage (57% vs 49%), but female physicians from both age cohorts were more likely than their male peers to have made career changes for their children (85% vs 35%, p < .001). Younger male physicians were twice as likely as their older peers to have made a career change for marriage (49% vs 28%, p < .001) or children (51% vs 25%, p < .001). The most common type of career change made for marriage or children was a decrease in work hours. CONCLUSIONS: Most physicians experience role conflict, and many adjust their careers in response. Flexible career options may enable physicians to combine professional and family roles more effectively.

Prednisolone and salbutamol in the hospital treatment of acute asthma.

The use of oral prednisolone (2 mg/kg) to treat children admitted to hospital with acute asthma was assessed in a placebo controlled study. Children were further randomised to receive either 0.15 mg/kg salbutamol every 30 minutes for the first three hours of admission, or 5 mg salbutamol every one to four hours as needed. Treatment was double blind and the assessor was unaware of the nebuliser regimen given. Children were examined before and after treatment with salbutamol on arrival and reassessed four hours after admission. Seventy children completed the study. Seventeen (46%) of 37 children receiving prednisolone and six (9%) of 33 receiving placebo were fit for discharge after four hours of treatment. There was no significant difference between the two nebuliser regimens. Clinical parameters indicative of asthma severity were improved in all groups. Between group comparisons at reassessment showed higher peak flows in those receiving prednisolone and nebulisers every 30 minutes but differences were not significant for other parameters. Objective parameters indicating steroid efficacy over placebo were minimal. Despite this, those receiving prednisolone were more readily identifiable as being fit for discharge within four hours of treatment.

Computer-generated multiple-phase-level holograms by use of color-printer techniques.

High-efficiency phase-only computer-generated holograms (CGH's) were produced expediently and inexpensively by a color-encoded discrete-phase-level process. Computer-generated-hologram gray levels were mapped to color with a high-resolution color printer, and color was mapped to phase by a broad-spectral-sensitivity high-resolution black-and-white film. Experimental results illustrating colorto optical-density and color-to-phase mapping are presented for Kodak 649F film. A variety of optical interconnection elements exhibiting high diffraction efficiencies and high contrast ratios for both on- and off-axis performance were fabricated by this technique. Typical experimental results are presented.

Anorectal function of children with neurological problems. I: Spina bifida.

Anorectal function was assessed with anorectal manometry in 45 children with spina bifida (21 girls and 24 boys, mean age 11 1/2 years). 24 enuretic children served as controls. The pressure in the first and second centimeters of the anal canal was lower among index children than controls and also lower among those with high spinal lesions compared with those with low lesions. Rectal activity (rectal sensation and trace appearance) during rectal distension appeared to be reduced among index children; sensation was particularly poor among those with high spinal lesions. Manometry may be useful in children with spina bifida as it provides a clearer understanding of sphincter function and leads to a more rational approach to the management of bowel problems.

Anorectal function of children with neurological problems. II: cerebral palsy.

In response to the frequent complaint of difficulties with defecation experienced by children with cerebral palsy, 34 children (13 girls and 21 boys, mean age 10 years) with cerebral palsy were investigated by questionnaire and anorectal manometry. 24 enuretic children served as controls for the anorectal manometry. Constipation affected 26 of 29, defecation distress eight and faecal incontinence 16 of the index children, but incontinence was mild in most cases. Index children had a low resting pressure in the first centimetre of the anal canal, slow anal rhythmical activity and a pressure increase in the first centimetre during maximum rectal distension. These findings suggest anal sphincter and/or pelvic floor muscle incoordination, but no evidence of abnormal rectal function. The authors conclude that surgical intervention was not indicated for the index children, but that medical treatment could be improved.

Use of budesonide in severe asthmatics aged 1-3 years.

The treatment of severe asthmatics aged 1-3 years with budesonide administered via Nebuhaler and Laerdal facemask was assessed in a six month, double blind, placebo controlled study. Patients were randomised to budesonide (n = 20) or placebo (n = 20) treatment. Daily symptom scores were recorded by parents and clinic visits occurred every six weeks. Cough scores improved significantly with budesonide: nocturnal and daytime cough scores (0-2) fell by a mean (SEM) of 0.4 (0.2) and 0.5 (0.2); while with placebo the nocturnal score increased by 0.1 (0.2) and daytime score was unchanged at 0.0 (0.2). All other data showed improvements for active over placebo treatment. Thirteen children in each group completed six months' treatment. Parents of 25 of these found the delivery system convenient and easy to use. While blinded to treatment it was assessed to be beneficial in nine of 13 receiving budesonide and four of 13 receiving placebo. The Nebuhaler and facemask is an acceptable delivery system for long term asthma treatment. Symptoms are significantly reduced when it is used to give 400-800 micrograms budesonide/day to children aged 1-3 years who cannot use other delivery systems.

Audit strategies to reduce hospital admissions for acute asthma.

An eightfold rise in hospital admissions for acute asthma from 1971-85 prompted two studies to audit the admissions policy at the Royal Alexandra Hospital. In the first study the on call senior house officer (SHO) was replaced by an experienced registrar and over a four month period 53 children out of 158 were sent home from the receiving room compared with six out of 39 seen by the SHOs. In the second study an SHO training programme was established together with a home treatment package. Over a 12 month period the on call SHOs assessed 687 children with acute asthma; 229 (43.5%) were deemed fit to be sent home. Only seven of these were readmitted within one week. Diary symptom score cards filled in by parents indicated that children sent home without admission fared no worse at home than those admitted and then discharged for the two weeks after leaving hospital. The development of strategies to improve assessment and immediate management in the hospital receiving room can reduce hospital admissions for acute asthma, allowing more children to be safely managed in the community.

Self-pumped phase conjugation and four-wave mixing in 0 degrees - and 45 degrees -cut n-type BaTiO(3):Co.

Relatively fast self-pumped phase-conjugate and four-wave-mixing rise times are reported in n-type cobalt-doped barium titanate. With the crystal oriented in a 45 degrees cut as compared with the same crystal in a 0 degrees cut we find a factor of 3 decrease in the 0-90% rise time to 800 ms with 25-mW input power at 514.5 nm. Also, the self-pumped phase-conjugate reflectivity increases from 20% to 40%. We deduce that the phase conjugation is from internally seeded stimulated photorefractive backscattering. The four-wave-mixing rise time of the 45 degrees -cut crystal is 4 ms with a reflectivity of 48% when the pumping beams are derived from self-pumped phase conjugation that has an input power of 25 mW.

Single-pixel demonstration of innovative adaptive optics by use of a charge-transfer membrane light modulator.

We have constructed and demonstrated a single-pixel implementation of an all-optical membrane-based spatial light modulator as a compact optical wave-front error correction device. High rates of response of as much as 20 kHz in an open-loop configuration were obtained. The device was then used in an adaptive-optics servo to compensate successfully for a 1-kHz sinusoidal phase error with a peak-to-peak excursion of approximately pi/7 rad. A small-signal servo gain of the order of 10 was inferred from the closed-loop measurements.

Femtosecond resolution of soft mode dynamics in structural phase transitions.

The microscopic pathway along which ions or molecules in a crystal move during a structural phase transition can often be described in terms of a collective vibrational mode of the lattice. In many cases, this mode, called a "soft" phonon mode because of its characteristically low frequency near the phase transition temperature, is difficult to characterize through conventional frequency-domain spectroscopies such as light or neutron scattering. A femtosecond time-domain analog of light-scattering spectroscopy called impulsive stimulated Raman scattering (ISRS) has been used to examine the soft modes of two perovskite ferroelectric crystals. The low-frequency lattice dynamics of KNbO(3) and BaTiO(3) are clarified in a manner that permits critical evaluation of microscopic models for their ferroelectric transitions. The results illustrate the advantages of ISRS over conventional Raman spectroscopy of low-frequency, heavily damped soft modes.

Operating modes of a charge-transfer-plate liquid-crystal phase modulator.

New results for an electron-beam-addressed liquid-crystal phase modulator are presented. Local, as well as global, control of liquid-crystal molecular reorientation is demonstrated, and the results of five different operating modes are discussed. Linear phase modulation with depths up to 30pi are demonstrated with this device, as are two-dimensional arrays of computer-generated spherical lenses with actively variable focal lengths. The spherical lenses were written without the use of specialized transfer functions to compensate for device nonlinearities. Applications are discussed in the context of adaptive optics in spaceborne systems.

Charge-transfer-plate spatial light modulators.

Charge-transfer-plate spatial light modulators (CTPSLM's) are a class of devices that employ chargetransfer plates as the interface between the charge-generation element and the light-modulation element. Both optically addressed and electrically addressed devices have been built. Chargegenerating elements for the optically addressed devices include photoconductors, photodiode and phototransistor arrays, optoelectronic integrated circuit chips, and photocathode-microchannel-plate assemblies. For electrically addressed devices, electron guns, very large-scale integrated circuits, thin-film transistors, and matrix electrodes are among the possible charge-generation elements. Lightmodulation elements used in CTPSLM's include liquid crystals, electro-optic organic and inorganic crystals, polymers, deformable membrane mirrors, oil films, multilayer dielectric films, and electroluminescent films. In principle, all combinations of charge-generation elements and light-modulating elements are possible. This paper explores the fundamental performance limitations of CTP technology, and describes the design, operation, and applications of five different CTPSLM's (three based on membrane-mirror technology and two on liquid-crystal technology).

Electron-beam-addressed membrane mirror light modulator for projection display.

The performance of a prototype, reflection-mode projection display based on an electron-beam-addressed membrane mirror light modulator (e-MLM) is described. The e-MLM converts electronic video information into a two-dimensional phase object, that is then schlieren imaged onto a screen. High-contrast dynamic projection of images is demonstrated over a broad range of wavelengths, from the visible to the midinfrared. As such this device is expected to find applications in large-screen visible displays and dynamic infrared scene projectors.

A large outbreak of salmonellosis and its economic cost.

In the summer of 1989, a large outbreak of gastroenteritis occurred in persons attending a barbeque. An investigation was carried out to determine the cause, institute control measures, and to estimate the costs involved in the outbreak. Epidemiological investigation revealed that chicken served at the barbeque was the pecant food, which was confirmed by microbiological investigation. Prompt institution of control measures resulted in early containment of secondary spread. Nevertheless, the total cost of the outbreak amounted to 77,995 pounds. The economic impact of this outbreak was therefore considerable.