Controlling Exciton-Phonon Interactions via Electromagnetically Induced Transparency.

Highly excited Rydberg states of excitons in Cu_{2}O semiconductors provide a promising approach to explore and control strong particle interactions in a solid-state environment. A major obstacle has been the substantial absorption background that stems from exciton-phonon coupling and lies under the Rydberg excitation spectrum, weakening the effects of exciton interactions. Here, we demonstrate that two-photon excitation of Rydberg excitons under conditions of electromagnetically induced transparency (EIT) can be used to control this background. Based on a microscopic theory that describes the known single-photon absorption spectrum, we analyze the conditions under which two-photon EIT permits separating the optical Rydberg excitation from the phonon-induced absorption background, and even suppressing it entir7ely. Our findings thereby pave the way for the exploitation of Rydberg blockade with Cu_{2}O excitons in nonlinear optics and other applications.

Ultrasonic activation and chemical modification of photosensitizers enhances the effects of photodynamic therapy against Enterococcus faecalis root-canal isolates.

BACKGROUND: The aim of this study was to evaluate the effect of photodynamic therapy (PDT) on Enterococcus faecalis biofilms in artificially infected root canals using modified photosensitizers and passive ultrasonic activation. METHODS: Two hundred and seventy extracted human teeth with one root canal were instrumented utilizing ProTaper files, autoclaved, infected with E. faecalis T9 for 72 h and divided into different groups: irrigation with 3% sodium hypochlorite (NaOCl), 20% ethylenediaminetetraacetic acid (EDTA), or 20% citric acid, PDT without irrigation, PDT accompanied by irrigation with NaOCl, EDTA, or citric acid, PDT using an EDTA-based photosensitizer or a citric-acid-based photosensitizer and PDT with ultrasonic activation of the photosensitizer. A 15 mg/ml toluidine blue served as the photosensitizer, activated by a 100 mW LED light source. Sterile paper points were used for sampling the root canals and dentin chips were collected to assess the remaining contamination after treatment. Samples were cultured on blood agar plates and colony forming units were quantified. RESULTS: PDT alone achieved a reduction in E. faecalis counts by 92.7%, NaOCl irrigation alone and combined with PDT by 99.9%. The antibacterial effects increased by the combination of irrigation using EDTA or citric acid and PDT compared to irrigation alone. More than 99% of E. faecalis were killed using PDT with the modified photosensitizers and ultrasonic activation. CONCLUSIONS: NaOCl based disinfection achieved the highest antimicrobial effect. Using PDT with an EDTA-based or citric-acid-based phozosensitizer or activating the photosensitizer with ultrasound resulted in a significantly higher reduction in E. faecalis counts compared to conventional PDT.

Screening for psychosocial risk in an urban prenatal clinic population: a retrospective practice-based research study.

Recognition of the need for early identification of risk factors led a "practice-based research" (Epstein, 1995) team of social workers in the prenatal clinic at Mount Sinai to develop a standardized, comprehensive screening, monitoring and evaluation instrument for all patients in their service. To explore the effects of psychosocial risk factors empirically, available information collected from 435 women screened with the original instrument between 1992-93 was converted into a quantitative data-base. The intention was to conduct a retrospective study of the prenatal patient population, including demographic characteristics, problems presented, social work interventions, and treatment outcomes. Among the findings anxiety and ambivalence related to pregnancy were significant risk factors. This model of social work service delivery is consistent with the focus of prenatal care as clinical preventative medicine.

[Munchausen syndrome in a 66-year-old patient]. / Münchhausen-Syndrom bei einer 66jährigen Patientin.

The study of a 66 year old woman's medical chart revealed many discordant elements, leading to the diagnosis of Munchausen's syndrome. The patient had been treated over a period of 20 years at the Medical polyclinic for a variety of symptoms concerning virtually all organs. Her son's chart similarly contains discordant elements, rising the suspicion of a Munchausen Syndrome "by proxy". With this case report, historical aspects and the therapeutic challenge of this syndrome are outlined.

Postpartum depression: a review for perinatal social workers.

Postpartum depression is a common and treatable clinical syndrome which effects up to fifty percent of all women and which can best be considered as a triad of disorders. Postpartum blues, postpartum affective disorders or major depressions, and postpartum psychosis have distinct symptoms with corresponding implications for social work interventions and treatment strategies. The role of prevention can be pivotal in terms of reducing negative impacts of psychological problems after birth and minimizing adverse consequences for the new baby and all family members.

Pediatric AIDS at Mount Sinai Medical Center 1988-89: a study of costs and social severity.

Pediatric AIDS is a continuing problem because of maternal transmission. Medical management is often complicated by the loss of one or both parents and adverse home environments. This study explores the cost of inpatient and clinic care of children admitted with AIDS in 1988 or 1989 at Mount Sinai Medical Center in New York City, and also examines the social severity of the cases. Blue Shield allowances were used to price clinic visits and tests, and prices in a drug trade publication were used to determine medication costs. Inpatient costs calculated per person-month at risk amounted to $48,000 per year. Costs per person-month of the clinic care averaged $461 (38% of which was for drugs), annualized to around $5,500. These costs are higher than those shown by previous studies. A few cases requiring intensive inpatient services accounted for a large percentage of costs. The social severity analysis, based on the family environment at first admission and later, revealed that households were often stressed by chronic illnesses, drug abuse, marital problems and poor residential quality. Given the circumstances in which pediatric AIDS develops, the activities of social workers to strengthen families are essential to facilitating compliance, maintaining health and minimizing use of the hospital.

First-trimester multifetal pregnancy reduction: acute and persistent psychologic reactions.

OBJECTIVE: Our purpose was to determine acute and persistent psychologic impacts of multifetal pregnancy reductions and patients' ability to cope with fetal loss while simultaneously bonding to surviving infants. STUDY DESIGN: The first 100 women to undergo a multifetal reduction were invited to participate in a retrospective telephone study assessing their emotional reactions and attitudes toward multifetal reduction. The semistructured interview elicited demographic and obstetric data and contained scales used in previous studies of reproductive loss, which assessed repetitive thoughts about reduced fetuses, catastrophic fears, and lingering depressive feelings. RESULTS: More than 65% of the sample recalled acute feelings of emotional pain, stress, and fear during the reduction procedure. Mourning for the lost fetuses was reported by 70% of women, but most grieved for only 1 month. Thoughts about reduced fetuses occurred moderately frequently after the reduction but rarely at follow-up. Persistent depressive symptoms were mild, although moderately severe levels of sadness and guilt continued for many. Nonetheless, 93% would make the same decision again. Emotional reactions of patients who miscarried differed little. The small subsample who continued to be most affected were younger (p < 0.02), were more religious (p < 0.003), and had viewed the multifetal pregnancy on ultrasonography more often (p < 0.009). CONCLUSIONS: Multifetal reductions, although highly stressful psychologically, are well tolerated. Sadness and guilt may persist, especially for an identifiable subgroup. Normal maternal bonding and achievement of parenthood goals facilitate grief resolution. The large majority were reconciled to the termination of some fetuses to perserve the lives of a remaining few.

Coping with childhood asthma: caretakers' views.

Childhood asthma is a chronic health condition that affects more than 1 million school-age children and their families. Asthma is the leading cause of school absences and accounts for a substantial amount of activity limitation in children. A small pilot study of caretakers of African American and Hispanic school-age children with asthma explored the effects of the illness on families and the coping strategies used by caretakers. Large and significant correlations were found between the perceived impact in the areas of financial burden, social and familial isolation, and personal strain. Caretakers reported using active coping, planning, religion, and acceptance of the illness most frequently. The authors suggest the value of making conceptual distinctions between the burden imposed by the illness and the coping skills used by caretakers.

When in vitro fertilization fails: a prospective view.

New reproductive technologies such as in vitro fertilization (IVF) offer much hope to infertile couples, yet the odds for success are not high. In this study we examine the experiences of a cohort of women undergoing IVF or a related technology at three points in time: before technological intervention, approximately one month after the first failed cycle, and six months later. We consider the women's expectations and experiences and discuss implications of the findings for social work practice.

Development of faculty consultants in a problem-based third year community medicine clerkship.

This paper describes the development of consultancy groups in behavioral science, epidemiology and biostatistics, and information science in a required community medicine rotation with a twenty year history. The addition of consultants to individual student tutors and field preceptors has led to a structure which promotes student-project flexibility, development of critical assessment skills and independent learning while maximizing faculty expertise and effectiveness.

HIV/AIDS education in a prenatal clinic: an assessment.

An HIV/AIDS education and counseling program was integrated into the routine medical care of women attending the prenatal clinic of a major urban, inner-city, teaching hospital that serves mostly indigent minority women in an area hard hit by the HIV/AIDS epidemic. Pre- and post-intervention questionnaires were administered to a consecutive historical Control Group (n = 98) who did not receive the HIV/AIDS information and an Intervention Group (n = 515) who received all information. The data support our hypothesis that an HIV/AIDS education program would increase the level of general knowledge, but fail to support our hypothesis of a positive effect on attitudes around HIV-antibody testing and an increase in desire for voluntary testing. Our hypothesis that women reporting more risk behaviors would be more likely to agree to HIV-antibody testing was only partially supported.

Incorporating HIV education and counseling into routine prenatal care: a program model.

This article reports how a prenatal clinic in a major urban teaching hospital has developed and integrated an HIV education and counseling program into routine prenatal care. The patient population served are predominantly minority women living in an inner-city community that has been disproportionately affected by the AIDS epidemic. Implementation of the patient program has required training and support for all professional staff. Staff training served as a foundation for this comprehensive patient program, which has reached all prenatal patients regardless of risk behavior. The program has succeeded in involving a large population of women in an educational program, has identified HIV-1 seropositive pregnant women through voluntary testing, and has provided them with the necessary medical and social work services. Principles of program development are identified for use in other settings.

PIP: The process of incorporating HIV education and counseling into the Mount Sinai Medical Center's prenatal clinic in New York City is provided in terms of background, the patient program, evaluation, and conclusions. There have been endorsements for inclusion of HIV testing and education in the practice of prenatal care and reported effectiveness in delaying the onset of AID's associated infections. The prenatal clinic provides health care to predominantly minority women (36% African American and 55% Hispanic) of whom 10-12% report intravenous or nonintravenous drug use; clinic births are about 1600 a year. Early attempts in 1986-7 to provide anonymous testing and counseling demonstrated the need to reach a large audience. Observations were that considerable staff training and support was needed for an effective patient program. Encouragement and support was also needed by patients. 8 one hour training sessions were provided to the nurses, as well as a 21 hour state certification program for the social workers, both groups of whom worked directly with patients. Intense reactions to caring for HIV infected persons occurs and emotional support must be included in the training. Additional staff support was provided through an AIDs prevention grant for a year. Continuous staff training is required. Another grant provided a clinical social worker and program coordinator who worked closely with the clinic director. The target was to integrate the HIV/AIDs information into routine clinic services; specifically, a 45 minute orientation session during patient's first medical visit. The groups discussion session is lead by the nurse's introduction to the clinic, patient care, and screening, and followed by the social worker's comments on voluntary HIV screening. Nonambiguous language which is understood by various educational levels was used. Patients needed more time to discuss the concerns for dealing with their partners about STD's and contraception. Testing was available throughout the prenatal clinic period. Posttest counseling is also provided as a review, and for those seropositive or high risk patients as initial crisis intervention and case management. There was nonjudgemental discussion about termination of pregnancy. 1453 patients out of 1600 were involved in the orientation, with 20% (297) rather than the preceding years 40 screened. Success is attributed to strong collaborative working relationships with medical, nursing, social work, and clerical staffs, and extensive prior education. Those identified as seropositive were followed up in a separate clinic.

Emerging roles of social work in perinatal services.

Perinatal social work is a recent field of practice with expanding opportunities and responsibilities for social workers in direct practice, research and education. This paper discusses the emergence of high technology in the perinatal field and the specialization of social work knowledge, skills and roles which are developing in tandem with bio-medical advances. The need to reconcile compelling needs for preventive social work practice with those of specialization are examined.

[Ultrasound-guided percutaneous one-step nephrostomy]. / Ultraschallgeführte perkutane "One-step"-Nephrostomie.

The percutaneous nephrostomy-set described is a two-piece desposable set for temporary or permanent urine drainage. Under combined sonographic and radiologic control the thin but stabilised puncture needle, used alone, offers the advantage of permitting definitive establishment of the fistula in a fast and safe manner without changing of the guide instrument and without any troublesome bouginage.

[Transrectal ultrasound tomography with an electronic line scanner]. / Transrektale Ultraschalltomographie mit einem elektronischen Linearscanner.

Among the imaging techniques for the morphologic diagnosis of the prostate and seminal vesicles transrectal sonography has assumed a foremost position. With the aid of longitudinal sectional images of the prostate and seminal vesicles obtained by means of a newly developed transrectal linear scanner the typical sonic characteristics associated with morphologic alterations of these organs were well demonstrated in 58 patients. For clarifying sonographic findings suggestive of carcinomas this approach can be used for precisely guided transperineal and above all transrectal puncture. Sonographic imaging of the prostatic urethra has opened new aspects in the assessment of functional processes on the basis of morphologic changes.