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This case report highlights the present threat and challenges with treatment and transmission of infections caused by carbepenem-resistant enterobacteriaceae (CRE) within in-patient spinal rehabilitation units. The setting is within the Spinal Cord Injury Unit, Royal North Shore Hospital, Sydney, Australia. We report the case of a 45-year-old female with T9 complete paraplegia who developed CRE urinary tract infection (UTI) and sepsis 1 month post injury while in an in-patient spinal rehabilitation unit. We describe the challenges in treatment with colistin, the implications of infection on her rehabilitation and challenges in containing the spread of CRE to other patients in the unit. We present our experience with the management of CRE bactaeraemia in a spinal rehabilitation unit and the enhanced importance of infection control and surveillance strategies required to successfully contain risk of transmission.

Introduction The purpose of this study was to quantitatively investigate the effect of magnification on fine motor skills used in endodontics. Methods This study used a novel manual dexterity test that was performed with and without magnification. An 8× operating microscope and 2.5× dental loupes were used for the magnification tests. Forty subjects, 20 with microscope experience and 20 without, participated in the study. Performance on the test was evaluated by using an accuracy scoring system, and the time needed to complete the test was recorded for each subject. Results A significant increase in accuracy score with each level of magnification was demonstrated (P ≤ .05). In addition, the use of operating microscope significantly increased the time needed to complete the test among subjects with less than 3 years of microscope experience. Conclusions The use of magnification to enhance fine motor skills was supported in all age groups and experience levels.

The management of a fistula following retrosternal esophageal reconstruction proves particularly challenging. Two distinct tissue deficits must be considered for satisfactory reconstruction. The defect in the anterior wall of the colonic replacement and that of the adjacent soft tissues of the anterior chest wall can be closed simultaneously with a single, well-planned radial forearm free flap. A patient is presented who illustrates the design and implementation of a bivalved radial forearm free flap that provides two separate epithelial surfaces.

We determined the incidence of voiding symptoms, urodynamic etiology and satisfaction with therapy in a large cohort of men with prostatism during a 12-year period.We retrospectively analyzed the records of 2,845 consecutive men who underwent urodynamic evaluation between January 1982 and December 1994. Patients were divided into groups 1 and 2 according to the years of study (between 1982 and 1988, and between 1989 and 1994, respectively). Parameters of evaluation included prevalence and distribution of voiding symptoms, urodynamic etiology of symptoms and satisfaction with therapy (medical or surgical).There was 843 evaluable patients 50 to 94 years old (mean age 63.2) Group 2 patients were younger, and had a 22% higher prevalence of nocturia and a 12% higher prevalence of daytime frequency. The prevalence of all other symptoms was the same in both groups. On urodynamics 523 patients (62%) had demonstrable evidence of bladder outlet obstruction of whom 345 (66%) had concomitant detrusor instability. Of the 843 patients 647 (77%) had detrusor instability, which was the sole diagnosis in 199 (24%). We noted low pressure/low flow in 137 patients (16%) and impaired detrusor contractility in 152 (17%), including 57 (7%) in whom the latter condition was the only diagnosis. Urodynamic findings remained the same during the entire 12-year period. Global satisfaction and symptomatic improvement were better with surgical than medical therapy, although the degree of satisfaction was independent of the urodynamic etiology of symptoms.Symptomatic men with prostatism are presenting with a greater prevalence of significant nocturia and daytime frequency than in the past with no change in urodynamic findings. In addition, patient level of satisfaction remains greater with surgical than medical therapy regardless of the urodynamic presence of bladder outlet obstruction.

Hemangiopericytoma (HPC) is an uncommon tumor which was first described in 1942. There are no unique radiological or clinical identifiers that can reliably aid in preoperative diagnosis. Surgery is the only reliable therapy as both chemotherapy and radiotherapy have proven ineffective in several series. The outcome is difficult to predict; the only reliable predictor is the presence or absence of metastasis. We report on a 63-year-old female with a large left renal HPC.

Division of focal plane (DoFP) polarimeters are a particular class of imaging device that consists of an array of micropolarizers integrated upon a focal plane array sensor (FPA). Such devices are also called microgrid polarimeters and have been studied over the past decade with systems being designed and built in all regions of the optical spectrum. These systems are advantageous due to their rugged, compact design and ability to obtain a complete set of polarimetric measurements during a single frame capture. One inherent disadvantage of DoFP systems is that each pixel of the FPA sensor makes a polarized intensity measurement of a different scene point. These spatial measurements are then used to estimate the Stokes vectors across the scene. Since each polarized intensity measurement has a different instantaneous field-of-view (IFOV), artifacts are introduced that can degrade the quality of estimated polarization imagery. Here we develop and demonstrate a visual enhancement technique that is able to reduce false polarization caused by IFOV error while preserving true polarization content within the Stokes parameter images. The technique is straight-forward conceptually and is computationally efficient. All results are presented using data acquired from an actual LWIR microgrid sensor.

Microgrid polarimeters, also known as division of focal plane (DoFP) polarimeters, are composed of an integrated array of micropolarizing elements that immediately precedes the FPA. The result of the DoFP device is that neighboring pixels sense different polarization states. The measurements made at each pixel can be combined to estimate the Stokes vector at every reconstruction point in a scene. DoFP devices have the advantage that they are mechanically rugged and inherently optically aligned. However, they suffer from the severe disadvantage that the neighboring pixels that make up the Stokes vector estimates have different instantaneous fields of view (IFOV). This IFOV error leads to spatial differencing that causes false polarization signatures, especially in regions of the image where the scene changes rapidly in space. Furthermore, when the polarimeter is operating in the LWIR, the FPA has inherent response problems such as nonuniformity and dead pixels that make the false polarization problem that much worse. In this paper, we present methods that use spatial information from the scene to mitigate two of the biggest problems that confront DoFP devices. The first is a polarimetric dead pixel replacement (DPR) scheme, and the second is a reconstruction method that chooses the most appropriate polarimetric interpolation scheme for each particular pixel in the image based on the scene properties. We have found that these two methods can greatly improve both the visual appearance of polarization products as well as the accuracy of the polarization estimates, and can be implemented with minimal computational cost.

Remote sensing applications make use of the optical polarization characteristics of a scene to enhance target detection and discrimination. Imaging polarimeters typically utilize polarizing arrays located in front of a focal plane array as a means of extracting polarization information from the optical scene. Over the last few years, technology development efforts have resulted in FPAs that integrate the polarizer with the infrared focal plane array (FPA). This paper will report on the radiometric and polarization characterization of a micro-grid polarizer FPA from DRS Infrared Technologies, L.P. (DRS). These measurements were performed to evaluate the radiometric performance and the polarization characteristics of the FPA.

Recent developments for Long Wave InfraRed (LWIR) imaging polarimeters include incorporating a microgrid polarizer array onto the focal plane array (FPA). Inherent advantages over typical polarimeters include packaging and instantaneous acquisition of thermal and polarimetric information. This allows for real time video of thermal and polarimetric products. The microgrid approach has inherent polarization measurement error due to the spatial sampling of a non-uniform scene, residual pixel to pixel variations in the gain corrected responsivity and in the noise equivalent input (NEI), and variations in the pixel to pixel micro-polarizer performance. The Degree of Linear Polarization (DoLP) is highly sensitive to these parameters and is consequently used as a metric to explore instrument sensitivities. Image processing and fusion techniques are used to take advantage of the inherent thermal and polarimetric sensing capability of this FPA, providing additional scene information in real time. Optimal operating conditions are employed to improve FPA uniformity and sensitivity. Data from two DRS Infrared Technologies, L.P. (DRS) microgrid polarizer HgCdTe FPAs are presented. One FPA resides in a liquid nitrogen (LN2) pour filled dewar with a 80°K nominal operating temperature. The other FPA resides in a cryogenic (cryo) dewar with a 60° K nominal operating temperature.

In this paper we outline and address some of the challenges encountered in calibrating a visible 4-channel imaging reduced Stokes polarimeter. Specifically we expose the errors associated with the retardance of the optical elements in the system and show how the presence of circular polarization can affect the measurement of the linear states of polarization. These errors are analyzed in some detail and several possible solutions are proposed.

Recent developments for long-wave infrared (LWIR) imaging polarimeters include incorporating a microgrid polarizer array onto the focal plane array. Inherent advantages over other classes of polarimeters include rugged packaging, inherent alignment of the optomechanical system, and temporal synchronization that facilitates instantaneous acquisition of both thermal and polarimetric information. On the other hand, the pixel-to-pixel instantaneous field-of-view error that is inherent in the microgrid strategy leads to false polarization signatures. Because of this error, residual pixel-to-pixel variations in the gain-corrected responsivity, the noise-equivalent input, and variations in the pixel-to-pixel micropolarizer performance are extremely important. The degree of linear polarization is highly sensitive to these parameters and is consequently used as a metric to explore instrument sensitivities. We explore the unpolarized calibration issues associated with this class of LWIR polarimeters and discuss the resulting false polarization signature for thermally flat test scenes.

In the period 1972 to 1989, 92 sports men and women were treated for stress fracture. Symptoms included localized bony pain aggravated by activity. Physical examination demonstrated point tenderness and pain on loading the bone. The majority of fractures were in the lower limbs but axial skeleton and upper limb bones were also affected. Radiographs showed evidence in only 49% of fractures. Bone scanning, on the other hand, was found to be very accurate and indicative immediately. Therefore, patients with a clinical history of stress fracture and a normal radiograph should undergo a bone scan.

LWIR imaging arrays are often affected by nonresponsive pixels, or “dead pixels.” These dead pixels can severely degrade the quality of imagery and often have to be replaced before subsequent image processing and display of the imagery data. For LWIR arrays that are integrated with arrays of micropolarizers, the problem of dead pixels is amplified. Conventional dead pixel replacement (DPR) strategies cannot be employed since neighboring pixels are of different polarizations. In this paper we present two DPR schemes. The first is a modified nearest-neighbor replacement method. The second is a method based on redundancy in the polarization measurements. We find that the redundancy-based DPR scheme provides an order-of-magnitude better performance for typical LWIR polarimetric data.

The clinical features of melanoma and various regimens of treatment have been studied throughout the years. A melanoma can be cured if it is discovered early and adequately removed surgically. Survival decreases progressively as tumors recur locally, satellite nodules develop, and regional lymph nodes become involved.

Two different types of KrF lasers currently being analyzed as potential laser-fusion drivers: large electron-beam (e-beam)- pumped amplifiers using pure optical multiplexing for pulse compression and small e-beam sustained discharge lasers using a hybrid pulse compression technique. Both types of KrF lasers appear able to satisfy all of the requirements for commercial-applications ICF drivers, including cost, efficiency, pulse shaping, energy scaling, repetition rate, reliability, and target coupling. The KrF driver can effectively operate at efficiencies > 10% and can contribute < 10 mill/kWh to the cost of electric power production, with the total estimated cost of electricity from either KrF laser system being comparable (25 to 50 mill/kWh, 1985 dollars) with the cost from other methods of electric power production. The Aurora facility is described.

Intraoral minor salivary gland carcinomas are relatively uncommon. The glands are concentrated in the mucosa of the mouth but occur over a wide area in the head and neck region. Little is known about the etiologic factors responsible for these tumors. Histologically, most salivary gland tumors are similar to those occurring in the parotid gland, but are more likely to be malignant. The most common presentations is an asymptomatic submucosal mass on the palate in a patient in the fifth or sixth decade, although it can occur in any age group. Neck node metastases occur in about one fourth of these patients. Surgical resection is the treatment of choice; irradiation may be a useful adjunctive method of palliation. Multiple recurrences over a long period of time are the rule, with 5 year survival for all malignant lesions being 44.5 per cent. The survival decreases another 10 per cent for each succeeding 5-year period of follow-up.

A new technique consisting of the subcutaneous insertion of molded Silastic implants in patients with pectus excavatum deformities is presented. This method of correction should be considered for patients who are devoid of cardiac and respiratory symptoms and for those in whom the only operative indication is cosmetic. The surgical technique is simple, the complication rate is low, and patient tolerance is good. The cosmetic appearance at one year appears excellent.

This report concerns a Negro infant with interruption of the aortic arch and complete transposition of the great vessels. The presenting features were congestive heart failure and differential cyanosis. The marked cyanosis of the hands was in sharp contrast to the relatively normal color of the feet. The diagnosis was established during life by detailed hemodynamic and angiocardiographic studies. These are correlated with the salient clinical features of this case and with similar cases reported in the literature.

Congenital lip sinuses have been reported under a large variety of terms, such as lower lip pits, lip fistulae, labial cysts, lower lip labial humps, mucous pits, mandibular processes, paramedial sinuses, accessory salivary glands, and mucous glands. They were first described by Demarquay in 1845.1

A series of 100 patients in a general plastic surgery population were interviewed by standard format to determine their retention rate of preoperative information given to them. An overall recall, or retention rate, of 35 percent was found.

Two types of KrF lasers appear attractive as a driver for an ICF electric power plant. The original concept uses large electron-beam-pumped amplifiers and pure angular multiplexing to deliver short, shaped pulses to the target. A recently conceived alternate concept uses many small, long-pulse e-beam sustained discharge lasers which transfer their energy through the forward Raman process to a multiplexed set of beams to deliver the energy to target. Preliminary comparisons of the two systems indicate that the original concept has both a lower cost and a lower system efficiency, and both concepts appear to be nearly equally attractive as an ICF driver for an electric power plant. This paper examines a 4.8 MJ, 5 Hz KrF laser system designed using the original concept. The laser uses 24 main amplifiers arranged in eight sets of three amplifiers each. This layout optimizes both the optical system and the gas flow system, and uses a simple target illumination scheme that provides neutron shielding to allow hands-on maintenance in the laser hall.

The report summarizes findings obtained in the first two years of a study of the implications of possible values changes in society for Navy manpower and management practices. Multivariate analyses of data collected from Navymen in a representative sample of units and from a civilian national cross- section suggest that, while there is no perceptible generation gap on work and leadership style preferences, there is an educated-related generation gap on receptivity to autocratic versus democratic management styles. Functional characteristics of the Navy as an organization are summarized. Values and attitudes toward military service, by both Navymen and civilians, are similarly analyzed, and possible action or policy steps are suggested.

The report reviews available literature on the desirable properties of a diagnostic procedure for organizational development. A feasible, computerized diagnostic procedure termed CANOPUS (Computerized Analysis of Problems in User Systems) is proposed and conceptualized, and the necessary software for its first two functional components (Calculator and Prioritizer) is provided.

The concept of automatic threshold tracking is the most recent adaptation of artificial cardiac pacemakers to physiologic needs. Earlier pacemaker innovations were primarily in the area of timing of impulse delivery, whereas more recent changes have focused on alteration of the amplitude and duration of the pacemaker stimulus. Matching of this stimulus to the cardiac excitation threshold is important because a stimulus greater than necessary is wasteful of battery energy and may produce arrhythmias, whereas a stimulus of less than threshold intensity fails to pace the heart. Because of the wide range of clinically encountered threshold levels it is impossible to design a fixed output pacer that is efficient and safe for all patients at all times. The threshold tracking pacemaker searches for and finds the threshold level, and adjusts its stimulus to just above this level. The device ensures an adequate safety margin of stimulation, but reduces the stimulus level to the lowest safe level possible. It is fully automatic, adjusts immediately to any threshold changes and is not dependent on manual alteration.

New pacemaker devices commercially available today have evolved from a simple functional device having limited life to a sophisticated system designed to operate for an extended period, hopefully the life of the pacemaker patient. The basic pacemaker function, demand pacing, remains the preferred choice for pacing but the technology used to generate this demand function has drastically changed. There are three major technical improvements in pulse generator design which help to extend pacemaker longevity and improve system performance. They are: (1) development of the lithium power source; (2) housing the electronics and power source in a hermetic package; and (3) utilization of thickfilm hybrid circuitry.

New terms and concepts are being used today to describe new and improved pacemaker devices. Many of the terms are not medical terms, but technical expressions used to indicate significant improvements in pacemaker design. This paper will attempt to identify and define some of these new terms as they relate to specific parts in a pacemaker system.

The results of this study suggest that many malignant tumors contain low levels of fibrinolytic activator activity. Evidence is presented to suggest that this low activity may be due to the presence of an inhibitor of fibrinolysis. The presence or absence of measurable fibrinolytic activator activity, and/or inhibitor in neoplastic growths may enable one to predict the probability of viable metastases to a distant site.

Entirely satisfactory treatment of complete heart block has been prevented by an inability to measure pacemaker function after implantation. Two major problems can be identified in the long-term management of pacemaker patients: first, adequate prediction of when a pacemaker will fail; and second, accurate diagnosis of the type of pacemaker failure if it occurs. Observations on dogs gave precise measurements of interelectrode impedances. A method is described of externally measuring the interelectrode resistance and capacitance of implanted pacemakers. In studies on both dogs and human beings it was found that all changes in interelectrode impedance could be identified by changes in pacemaker rate and pulse width. Serial measurements of these two parameters allowed accurate diagnosis of the different types of “pacemaker failures.” The method also enabled anticipation of failures, other than wire breakage, before they were clinically evident. We think that pacemaker performance can be adequately evaluated by this method, making unnecessary prophylactic replacement of the unit.

A method for estimating myocardial threshold in patients with implanted artificial pacemakers has been described. By the external application of a calibrated suppression signal, the output of the implanted unit can be gradually reduced until the myocardial response ceases. The threshold level thus determined can be expressed as a per cent of available pulse energy by a simple calculation. This method promises to have clinical application because it is relatively simple and entirely external. It has been demonstrated to be safe, no sequelae having occurred during over 700 human studies. In combination with our previously reported method of estimating interelectrode impedance, it should provide a rational means of serially evaluating pacemaker function following implantation. It is applicable to both direct myocardial and transvenous modes of pacing, but its most important limitation at the present time is that it can be used with only one of the commercially available pacemakers. By application of quantitative threshold measurements, we have been able to confirm our clinical observations of exit block as a significant cause of pacemaker failure. This complication comprised the second most common cause of failure to pace, 14 per cent in a series of 128 implantations. It has also been possible by this means to verify the effectiveness of glucocorticoid and sympathomimetic drugs in lowering the myocardial threshold level. The implications of these observations have been briefly discussed. Threshold analysis may prove to be an important means of investigating the myocardial effects of other pharmacologic preparations in the future.

Increasing awareness of roadside hazards, primarily in the form of rigid fixed objects, has given rise to the development of sophisticated devices designed either to replace unsafe, outmoded, but essential roadway items, or to enhance the safety of existing difficult-to-replace items. Classed with the former group are such devices as breakaway light poles, weak-post guide railing and the New Jersey concrete median barrier, while various types of crash cushions, otherwise known as impact-attenuation devices, are referred to the latter group. Most promising among the crash cushions are the Rich system, consisting of a network of water filled rubber cells, and the Fitch system, which is made up of a number of sand-filled plastic barrels.© (1973) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

The report describes in theoretical terms the relevance of management systems theory to the problem of conflict management. Possibilities for resolving conflict constructively are seen as residing in the use of an interaction influence system characterized by a participative-group structure. (Author)

Xeroradiography can demonstrate many non-metallic foreign bodies that do not show by conventional radiography techniques. Two examples are shown.

The present report explores the organizational development uses of survey data. In form, the problem is one of testing the feasibility of developing an instrumented prescriptive capability for organizational development activities in the Navy. The strategy involved: (1) Determining whether there are relatively few 'pure' types of groups present in the civilian data bank which accompanies the Survey of Organizations questionnaire (the parent instrument of the Navy's Human Resource Management Survey); (2) determining (from the Navy data collected in the course of this Present contract) the extent to which these pure types exist in the Navy as well; and (3) examining the effect of different development activities upon the pure types thus identified.

Recent research in the area of leadership seems to point to the existence of four basic dimensions of leadership: support, interaction facilitation, goal emphasis, and work facilitation. Data from a recent study of 40 agencies of one of the leading life insurance companies are used to evaluate the impact of both supervisory and peer leadership upon outcomes of satisfaction and factorial performance measures. Results from the study suggest that this conceptual model is useful and that leadership's relation to organizational outcomes may best be studied when both leadership and effectiveness are multidimensional. Both peer and supervisory leadership measures relate to outcomes. In most instances, the ability to predict is enhanced by taking simultaneous account of certain nonleadership variables. David G. Bowers is program associate at the Center for Research on the Utilization of Scientific Knowledge, The University of Michigan. Stanley E. Seashore is professor of psychology and assistant director of the Institute for Social Research, The University of Michigan.