Search

Background: Children and adolescents with type 1 diabetes require frequent outpatient evaluation to assess glucose trends, modify insulin doses, and screen for comorbidities. Continuous glucose monitoring (CGM) provides a detailed glycemic control assessment. Telemedicine has been increasingly used since the COVID-19 pandemic., Objective: To investigate CGM profile parameter improvement immediately following pediatric outpatient diabetes visits and determine if visit modality impacted these metrics, completion of screening laboratory tests, or diabetic emergency occurrence., Methods: A dual-center retrospective review of medical records assessed the CGM metrics time in range and glucose management indicator for pediatric outpatient diabetes visits during 2021. Baseline values were compared with those at 2 and 4 weeks post visit. Rates of completion of screening laboratory tests and diabetic emergencies following visits were determined., Results: A total of 269 outpatient visits (41.2% telemedicine) were included. Mean time in range increased by 1.63% and 1.35% at 2 and 4 weeks post visit (P=.003 and .01, respectively). Mean glucose management indicator decreased by 0.07% and 0.06% at 2 and 4 weeks post visit (P=.003 and .02, respectively). These improvements in time in range and glucose management indicator were seen across both telemedicine visits and in-person visits without a significant difference. However, patients seen in person were 2.69 times more likely to complete screening laboratory tests (P=.03). Diabetic emergencies occurred too infrequently to analyze., Conclusions: Our findings demonstrate an immediate improvement in CGM metrics following outpatient visits, regardless of modality. While statistically significant, the magnitude of these changes was small; hence, multiple visits over time would be required to achieve clinically relevant improvement. However, completion of screening laboratory tests was found to be more likely after visits occurring in person. Therefore, we suggest a hybrid approach that allows patient convenience with telemedicine but also incorporates periodic in-person assessment., (©Christopher Ferber, Steven D Mittelman, Tannaz Moin, Holly Wilhalme, Rebecca Hicks. Originally published in JMIR Diabetes (https://diabetes.jmir.org), 01.10.2024.)

Competing Interests: Disclosure The authors have nothing to disclose.

In this paper we study the shape characteristics of star-like polymers in various solvent quality using a mesoscopic level of modeling. The dissipative particle dynamics simulations are performed for the homogeneous and four different heterogeneous star polymers with the same molecular weight. We analyse the gyration radius and asphericity at the poor, good and θ-solvent regimes. Detailed explanation based on interplay between enthalpic and entropic contributions to the free energy and analyses on of the asphericity of individual branches are provided to explain the increase of the apsphericity in θ-solvent regime.

In this paper we study the shape characteristics of a polymer chain in a good solvent using a mesoscopic level of modelling. The dissipative particle dynamics simulations are performed in 3D space at a range of chain lengths N. The scaling laws for the end-to-end distance and gyration radius are examined first and found to hold for [Formula: see text] yielding a reasonably accurate value for the Flory exponent ν. Within the same interval of chain lengths, the asphericity, prolateness and some other shape characteristics of the chain are found to become independent of N. Their mean values are found to agree reasonably well with the respective theoretical results and lattice Monte Carlo (MC) simulations. We found the probability distribution for a wide range of shape characteristics. For the asphericity and prolateness they are quite broad, resembling in form the results of lattice MC simulations. By means of the analytic fitting of these distributions, the most probable values for the shape characteristics are found to supplement their mean values.

Introduction: Diabetes mellitus is a disease affecting a lot of organs. One of the little known diabetes complication is impairment of pulmonary function. The aim of this study was to compare pulmonary function in two groups: diabetic individuals and obese non-diabetic individuals and to investigate predictive factors of alteration of diffusing capacity of lung for carbon monoxide (DLCO)., Patients and Method: We retrospectively included all patients hospitalized in department of endocrinology between 1st July 2013 and 31 December 2013 and who underwent pulmonary function tests. All these medical charts of patients were reviewed and patients were classified in two groups: diabetic and obese non-diabetic individuals., Results: Overall, 89 patients were included, 62 diabetic patients and 27 obese non-diabetic patients. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), medium expiratory flow, expiratory residual volume, total lung capacity (TLC) and DLCO were significantly lower in patients with diabetes mellitus compared to obese non-diabetic patients. A low DLCO was significantly associated with diabetic neuropathy, macrovascular complication (carotid atheroma), impairment of renal function, and insulin treatment., Conclusion: Respiratory function is impaired in diabetes mellitus, with a significant decrease in FVC, FEV1, TLC and DLCO., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

We study the swelling of a flexible linear chain composed of active particles by analytical theory and computer simulation. Three different situations are considered: a free chain, a chain confined to an external harmonic trap, and a chain dragged at one end. First, we consider an ideal chain with harmonic springs and no excluded volume between the monomers. The Rouse model of polymers is generalized to the case of self-propelled monomers and solved analytically. The swelling, as characterized by the spatial extension of the chain, scales with the monomer number defining a Flory exponent ν which is ν = 1/2, 0, 1 in the three different situations. As a result, we find that activity does not change the Flory exponent but affects the prefactor of the scaling law. This can be quantitatively understood by mapping the system onto an equilibrium chain with a higher effective temperature such that the chain swells under an increase of the self-propulsion strength. We then use computer simulations to study the effect of self-avoidance on active polymer swelling. In the three different situations, the Flory exponent is now ν = 3/4, 1/4, 1 and again unchanged under self-propulsion. However, the chain extension behaves non-monotonic in the self-propulsion strength.

A scheme originally proposed by G. Wei [Physica A 222, 152 (1995); Physica A 222, 155 (1995)] is redesigned to produce numerical shape parameters of arbitrary tree-branched polymers based on the Kirchhoff matrix eigenvalue spectrum. This method and two different Monte Carlo techniques (pivot and growth) are employed to investigate the asphericity of three and four junction comb polymers in both the ideal and excluded volume regimes. It is found that the extrapolated g-ratio and asphericity values obtained by all of these methods are in excellent agreement with each other and the available theory in the ideal regime and that polymers with a complete set of interior branches display a more sphere-like shape.

Thoracic radiotherapy is a usual treatment for lung cancer. Early-stages may be treated in stereotactic mode while locally advanced stages are usually treated with conventional radiotherapy mode. Pulmonary function tests show that thoracic irradiation has no impact on lung volume such as forced expiratory volume in one second (FEV1) or forced vital capacity (FCV). However, some studies found that CO (carbon monoxide) diffusing capacity (TLCO) may be altered under thoracic radiotherapy. DLCO alteration is usually symptomatic of either a lesion in the alveolar membrane or a pulmonary capillary alteration. Pulmonary diffusion may be also appreciated by the NO (azote monoxide) diffusion capacity. Moreover, using a double measurement of NO and CO diffusing capacities permit to assess which lung compartment (capillary or membrane) is affected. CONORT is an observational prospective monocentric study, aiming to assess the CO and NO diffusing capacity (as well as other pulmonary function tests) during thoracic radiotherapy. Inclusion criteria are patients with lung cancer, treated by thoracic radiotherapy (conformational or stereotactic), who signed consent. Pulmonary function tests are performed before, during, at the end and six weeks and six months after thoracic irradiation. To estimate a difference of 15% in diffusing capacity test, we have to include 112 patients with a 90% power and a 5% alpha risk. Four months after beginning, 36 patients were included. Preliminary data will be presented at the SFRO meeting., (Copyright © 2014 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)

Background: Comorbid substance use disorder in patients with schizophrenia is associated with poor clinical and social outcome and low compliance with integrated outpatient treatment programs. For the first time the present trial compares the efficacy of four sessions of motivational interviewing (MI) and four sessions of supportive therapy (ST). The primary outcome was compliance with integrated outpatient treatment post-intervention. Secondary outcomes were substance use, psychopathology, compliance with medication and stage of change in psychotherapy., Methods: Sixty inpatients with schizophrenia and substance use disorder were randomised to receive either four sessions of MI or four sessions of ST. Masked assessments took place at baseline, post-treatment and 3- and 6-month follow-ups., Results: The integrated outpatient program was attended by 70.0% of the MI (n=30) and 40.0% of the ST patients (n=30; p=0.020). There were no differences regarding secondary outcome between MI and ST groups., Conclusion: The study design allows one for the first time to attribute the findings to the specific effects of MI and thereby emphasizes the effectiveness of this particular treatment approach. In summary, these findings show that the integration of short-term MI for people with both psychosis and substance abuse could significantly improve their chances of attending appropriate outpatient settings and thereby improve their well-being.

We analyze the entropic equation of state for a many-particle interacting system in a scale-free network. The analysis is performed in terms of scaling functions, which are of fundamental interest in the theory of critical phenomena and have previously been theoretically and experimentally explored in the context of various magnetic, fluid, and superconducting systems in two and three dimensions. Here, we obtain general scaling functions for the entropy, the constant-field heat capacity, and the isothermal magnetocaloric coefficient near the critical point in uncorrelated scale-free networks, where the node-degree distribution exponent λ appears to be a global variable and plays a crucial role, similar to the dimensionality d for systems on lattices. This extends the principle of universality to systems on scale-free networks and allows quantification of the impact of fluctuations in the network structure on critical behavior.

We consider star polymers, consisting of two different polymer species, in a solvent subject to quenched correlated structural obstacles. We assume that the disorder is correlated with a power-law decay of the pair-correlation function g(x)~x(-a). Applying the field-theoretical renormalization group approach in d dimensions, we analyze different scenarios of scaling behavior working to first order of a double ɛ=4-d, δ=4-a expansion. We discuss the influence of the correlated disorder on the resulting scaling laws and possible manifestations such as diffusion-controlled reactions in the vicinity of absorbing traps placed on polymers as well as the effective short-distance interaction between star copolymers.

In this paper, we address the logarithmic corrections to the leading power laws that govern thermodynamic quantities as a second-order phase transition point is approached. For phase transitions of spin systems on d-dimensional lattices, such corrections appear at some marginal values of the order parameter or space dimension. We present scaling relations for these exponents. We also consider a spin system on a scale-free network which exhibits logarithmic corrections due to the specific network properties. To this end, we analyze the phase behavior of a model with coupled order parameters on a scale-free network and extract leading and logarithmic correction-to-scaling exponents that determine its field and temperature behavior. Although both nontrivial sets of exponents emerge from the network structure rather than from the spin fluctuations they fulfill the respective thermodynamic scaling relations. For the scale-free networks the logarithmic corrections appear at marginal values of the node degree distribution exponent. In addition we calculate scaling functions, which also exhibit nontrivial dependence on intrinsic network properties.

The system of two scalar order parameters on a complex scale-free network is analyzed in the spirit of Landau theory. To add a microscopic background to the phenomenological approach, we also study a particular spin Hamiltonian that leads to coupled scalar order behavior using the mean-field approximation. Our results show that the system is characterized by either of two types of ordering: either one of the two order parameters is zero or both are nonzero but have the same value. While the critical exponents do not differ from those of a model with a single order parameter on a scale-free network, there are notable differences for the amplitude ratios and the susceptibilities. Another peculiarity of the model is that the transverse susceptibility is divergent at all T

Background: Previous studies have aimed to identify subtypes of obsessive-compulsive disorder (OCD) based on their age of onset (AOO). Obsessive-compulsive spectrum disorders (OCS disorders) such as tic disorders have been particularly associated with an early onset in some studies. However, subtypes of early- and late-onset OCD are unevenly determined, and the biological and the clinical validity of these subtypes are unknown. This study was undertaken to discriminate the subtypes of OCD in different AOO levels and to test the hypothesis that different AOO bands are associated with a differential pattern of comorbidity., Methods: Two hundred fifty-two patients with OCD were interviewed directly with the German version of the Schedule for Affective Disorders and Schizophrenia-Lifetime Anxiety Version, which provides DSM-IV diagnosis. Subgroups with different ages of onset were investigated (cut-off levels of 10, 15, and 18 years)., Results: Subjects with an early AOO (onset < or =10 years) were significantly more likely to have OCS disorders (odds ratio [OR]=3.46; P=.001; 95% confidence interval [CI]: 1.72-6.96), in particular tic/Tourette's disorders (OR=4.63; P=.002; 95% CI: 1.78-12.05), than were late-onset subjects., Conclusions: For most mental disorders (e.g., anxiety and mood disorders), no associations with AOO of OCD were identified. However, subjects in the early-onset group (< or =10 years) had a significant increase in comorbid tic and Tourette's disorders. Future research should examine potential neurobiological features associated with early-onset presentations of OCD. Early detection and management of comorbidities may offset impairments later in life.

It is generally accepted that physical entanglements are essential to explain some mechanical properties of polymers, like viscoelasticity. The current view is that entanglements behave as dynamic links that are destroyed and created in time. It is less clear whether entanglements could alternatively produce local and stable links, with similar effects to chemical bonds. Here we show that local and stable entanglements, that we call physical pseudo-knots, exist and are formed with high probability in helical structures. The energies required to create and destroy physical pseudo-knots can differ by at least one order of magnitude. Together with their localized nature this makes them controllable, opening the possibility for a wide range of applications in material science, nano- and biotechnology. Physical pseudo-knots can also have implications in living systems, that may use them, or try to avoid them and hence be related to disease.

We present a quantitative picture of the separation of star polymers in a solution where part of the volume is influenced by a porous medium. To this end, we study the impact of long-range-correlated quenched disorder on the entropy and scaling properties of f-arm star polymers in a good solvent. We assume that the disorder is correlated on the polymer length scale with a power-law decay of the pair correlation function g(r) approximately r-a. Applying the field-theoretical renormalization group approach we show in a double expansion in epsilon=4-d and delta=4-a that there is a range of correlation strengths delta for which the disorder changes the scaling behavior of star polymers. In a second approach we calculate for fixed space dimension d=3 and different values of the correlation parameter a the corresponding scaling exponents gammaf that govern entropic effects. We find that gammaf-1, the deviation of gammaf from its mean field value is amplified by the disorder once we increase delta beyond a threshold. The consequences for a solution of diluted chain and star polymers of equal molecular weight inside a porous medium are that star polymers exert a higher osmotic pressure than chain polymers and in general higher branched star polymers are expelled more strongly from the correlated porous medium. Surprisingly, polymer chains will prefer a stronger correlated medium to a less or uncorrelated medium of the same density while the opposite is the case for star polymers.

We investigate hyperbranched polymers (HBPs) and highlight the relation between their architecture and their viscoelastic behavior, while paying special attention to the role of the chainlike spacer segments between branching points. For this we study the dynamics of HBP in solution, based on the generalized Gaussian structure formalism, an extension of the Rouse model, which disregards hydrodynamical and excluded volume effects. For HBP the dynamical effects display, beside the obvious contributions of localized modes on the spacers, also remarkable features, as we highlight based on the exact renormalization procedure recently developed by us in J. Chem. Phys. 123, 034907 (2005). We exemplify these features by analyzing the dynamics of randomly linked star polymers and study the impact both of the length and of the spacers' mobility on the normal modes' spectra. We compute these modes both by numerical diagonalization and also by employing our renormalization procedure; the excellent agreement between these methods allows us to extend the range of investigations to very large HBP.

Patients with schizophrenia and substance abuse disorders [dually diagnosed patients (DD)] show an unfavourable course of the illness and little interest in participating on specific integrated treatment programmes. Motivational interviewing (MI) has been shown to be effective among other substance abuse disorders and it aims to enhance intrinsic motivation to change problem behaviour. MI has been adapted for DD. The present paper reviews the empirical evidence for the efficacy of MI in DD. A search in the databases MEDLINE, EMBASE, PsycINFO was conducted and the methodological quality of the identified trials was assessed according to the Cochrane Collaboration and to the JADAD Scale. We identified 4 randomised studies with a total of 346 participants, in which MI interventions of 1 to 3 sessions were compared with various control conditions over a follow-up period of up to 6 months. With regard to the main outcome measures "subsequent participation at integrated treatment programme" (1 x positive, 2 x negative) and "substance use" (1 x positive, 1 x negative,) the studies gained contradictory results. In all 4 studies, there were relevant general methodological limitations (randomisation, blindness of raters, description of the reasons for drop-outs) and specific methodological shortcomings (sample size and sample homogenity, numbers of MI sessions, assessment of motivational status). Hence, at present the evidence for supporting MI in DD is not clear. This may be due to the methodological problems mentioned above or it may be that there is, in fact, no effect. Therefore, there is an urgent need for further research of MI in DD.

Objectives: The self-reported emotional and behavioural disorders among adolescents were assessed by the Youth Self-Report (YSR). The YSR was administered either in households or in classrooms. The goal of the study was to prove whether these different settings affect the prevalence rates of symptoms reported in the YSR., Methods: Mean scores and standard deviations of problem scales of two classroom samples and one household sample that was generally used as a reference were compared. The data were also compared with two classroom samples from Sweden and Greece. Statistical analyses were performed by means of t-test (unpaired), the evaluation of the magnitude of the effects by means of Cohen's criteria., Results: Classroom samples detected a significantly higher prevalence of symptoms than did household samples. This is the case for almost all of the problem scales in the YSR. The result of our study supports the finding that the setting of surveys that use self-administered questionnaires in classrooms themselves affect the prevalence of self-reported symptoms assessed by the YSR., Conclusions: The results of surveys may be influenced, to a much greater degree than previously thought, by the settings in which they are administered. Further research is needed to identify the specific influences that differ for surveys administered at home, respectively at school.

In this work we focus on the dynamics of macromolecular networks formed by end-linking identical polymer stars. The resulting macromolecular network can then be viewed as consisting of spacers which connect branching points (the cores of the stars). We succeed in analyzing exactly, in the framework of the generalized Gaussian model, the eigenvalue spectrum of such networks. As applications we focus on several topologies, such as regular networks and dendrimers; furthermore, we compare the results to those found for regular hyperbranched structures. In so doing, we also consider situations in which the beads of the cores differ from the beads of the spacers. The analytical procedure which we use involves an exact real-space renormalization, which allows to relate the star network to a (much simpler) network, in which each star is reduced to its core. It turns out that the eigenvalue spectrum of the star-polymer structure consists of two parts: one follows in terms of polynomial equations from the relaxation spectrum of the corresponding renormalized structure, while the second part involves the motion of the spacer chains themselves. Finally, we show exemplarily the situation for copolymeric dendrimers, calculate their spectra, and from them their storage and the loss moduli.

Purpose: To what extent are recommendations of guidelines relevant in everyday practice?, Methods: 142 general practitioners (GPs) participating in ten different quality circles administered by the statutory medical association of Hesse were interviewed by questionnaire, which of 135 recommendations selected from eight guidelines they had used during the last 6 weeks. The guidelines proposed recommendations for eight frequent indications in primary care. The findings were presented to 15 authors of the guidelines. The authors were asked to assess each recommendation as essential, important or nonessential to therapy., Results: By setting a benchmark of 75% for adherence to each recommendation, 50% of all recommendations had been used by the GPs. With very few exceptions the authors of the guidelines assessed these recommendations as essential or important to therapy. On the other hand, many recommendations that missed the benchmark were assessed as nonessential by the authors., Conclusion: Recommendations of guidelines should be systematically assessed by users and authors together to find out which of them are really of clinical relevance.

We study the structure of complexes formed between ionic surfactants (SF) and a single oppositely charged polyelectrolyte (PE) chain. For our computer simulation we use the "primitive" electrolyte model: while the polyelectrolyte is modeled by a tethered chain of charged hard sphere beads, the surfactant molecules consist of a single charged head bead tethered to a tail of tethered hard spheres. A hydrophobic attraction between the tail beads is introduced by assuming a Lennard-Jones potential outside the hard-sphere diameter. As a function of the strengths of both the electrostatic and the hydrophobic interactions, we find the following scenario: switching on and increasing the electrostatic forces first leads to a stretching of the PE and then by condensation of SF to the formation of a complex. For vanishing hydrophobic forces this complex has the architecture of a molecular bottle-brush cylindrically centered around the stretched PE molecule. Upon increasing the hydrophobic attraction between the SF tails, a transition occurs inverting this structure to a spherical micelle with a neutral core of SF tails and a charged corona of SF heads with the PE molecule wrapped around. At intermediate hydrophobicity there is a competition between the two structures indicated by a non-monotonic dependence of the shape as function of the Coulomb strength, favoring the cylindrical shape for weak and the spherical micellar complex for strong interaction.

The scaling properties of self-avoiding walks on a d -dimensional diluted lattice at the percolation threshold are analyzed by a field-theoretical renormalization group approach. To this end we reconsider the model of Phys. Rev. Lett. 63, 2819 (1989)] and argue that via renormalization its multifractal properties are directly accessible. While the former first order perturbation did not agree with the results of other methods our analytic result gives an accurate description of the available MC and exact enumeration data in a wide range of dimensions 2

Preventing habitual smoking by young people forms an important goal of health promotion in schools. In achieving this target, information is needed about the age at which smoking becomes a temptation for young people as well as knowledge about the attitudes that are associated with smoking. At two elementary schools and at one grammar school in a community of a former coalmining area, 985 German pupils aged 11-18 years were interviewed with the Youth Self Report (YSR) together with a questionnaire concerning their smoking habits. The rate of smoking among the pupils rose from the age group 11-15 years to the age group 16-18 years (in this age access to cigarettes is no longer restricted by law) from 12% to 63%; between the sexes there is no difference in smoking habits. According to the scales of the YSR in both types of school, smokers scored significantly higher on scales of "antisocial" and ,,aggressive behaviour". On the other hand non-smokers scored significantly higher on the scale "social problems". The significantly higher rate of smokers in both elementary schools compared with the corresponding rate in the grammar school will be interpreted by two interrelated explanations: the influence of lower social class as well as the lack of the deferred gratification pattern as an ingredient of the culture in elementary schools. The difference between smoking and non-smoking juveniles according to the scales of the YSR can be explained by the association of smoking behaviour with the juvenile culture of deviant groups on the one hand and by the attitudes of the non-smokers, who are more reluctant in joining peer groups. The results support a strategy for effectively preventing habitual smoking habits of juveniles in schools by combining youth activities inside and outside the schools.

In "Isotropic Sequence Order Learning" (pp. 831-864 in this issue), we introduced a novel algorithm for temporal sequence learning (ISO learning). Here, we embed this algorithm into a formal nonevaluating (teacher free) environment, which establishes a sensor-motor feedback. The system is initially guided by a fixed reflex reaction, which has the objective disadvantage that it can react only after a disturbance has occurred. ISO learning eliminates this disadvantage by replacing the reflex-loop reactions with earlier anticipatory actions. In this article, we analytically demonstrate that this process can be understood in terms of control theory, showing that the system learns the inverse controller of its own reflex. Thereby, this system is able to learn a simple form of feedforward motor control.

We analyze the scaling laws for a set of two different species of long flexible polymer chains joined together at one of their extremities (copolymer stars) in space dimension D=2. We use a formerly constructed field-theoretic description and compare our perturbative results for the scaling exponents with recent conjectures for exact conformal scaling dimensions derived by a conformal invariance technique in the context of D=2 quantum gravity. A simple Monte Carlo simulation brings about reasonable agreement with both approaches. We analyze the remarkable multifractal properties of the spectrum of scaling exponents.

In order to study ternary amphiphilic mixtures, we introduce a simplistic model of hard spheres corresponding to water and hard needles corresponding to oil and amphiphilic particles, where the hydrophilic head is modeled as a hard sphere and the hydrophobic tail as an infinitely thin needle attached radially to the sphere. For this system, we construct a geometry-based density functional and perform Monte Carlo computer simulations. The equation of state derived from the theory is found to be in remarkable agreement with our simulation results. We investigate the theoretical demixing phase diagram, and find that the predicted trends strongly support the amphiphilic character of the model.

We study the scaling properties of polymers in a d-dimensional medium with quenched defects that have power law correlations approximately r(-a) for large separations r. This type of disorder is known to be relevant for magnetic phase transitions. We find strong evidence that this is true also for the polymer case. Applying the field-theoretical renormalization group approach we perform calculations both in a double expansion in epsilon=4-d and delta=4-a up to the one-loop order and second in a fixed dimension (d=3) approach up to the two-loop approximation for different fixed values of the correlation parameter, 2

We examine the demixing transition in star-polymer-colloid mixtures for star arm numbers f=2,6,16,32 and different star-polymer-colloid size ratios 0.18< or =q< or =0.50. Theoretically, we solve the thermodynamically self-consistent Rogers-Young integral equations for binary mixtures using three effective pair potentials obtained from direct molecular computer simulations. The numerical results show a spinodal instability. The demixing binodals are approximately calculated and found to be consistent with experimental observations.

We analyze the effect of polydispersity in the arm number on the effective interactions, structural correlations, and phase behavior of star polymers in a good solvent. The effective interaction potential between two star polymers with different arm numbers is derived using scaling theory. The resulting expression is tested against monomer-resolved molecular dynamics simulations. We find that the theoretical pair potential is in agreement with the simulation data in a much wider polydispersity range than other proposed potentials. We then use this pair potential as an input in a many-body theory to investigate polydispersity effects on the structural correlations and the phase diagram of dense star polymer solutions. In particular, we find that a polydispersity of 10%, which is typical in experimental samples, does not significantly alter previous findings for the phase diagram of monodisperse solutions.

We present a fast and robust cluster update algorithm that is especially efficient in implementing the task of image segmentation using the method of superparamagnetic clustering. We apply it to a Potts model with spin interactions that are are defined by gray-scale differences within the image. Motivated by biological systems, we introduce the concept of neural inhibition to the Potts model realization of the segmentation problem. Including the inhibition term in the Hamiltonian results in enhanced contrast and thereby significantly improves segmentation quality. As a second benefit we can, after equilibration, directly identify the image segments as the clusters formed by the clustering algorithm. To construct a subsequent spin configuration the algorithm performs the standard steps of (i) forming clusters and of (ii) updating the spins in a cluster simultaneously. As opposed to standard algorithms, however, we share the interaction energy between the two steps. Thus, the update probabilities are not independent of the interaction energies. As a consequence, we observe an acceleration of the relaxation by a factor of 10 compared to the Swendson and Wang [Phys. Rev. Lett. 58, 86 (1987)] procedure.

To study the functional development of the medial olivocochlear system, transient-evoked otoacoustic emission suppression experiments were conducted in 73 ears of 38 pre-term and 11 full-term neonates. The continuous contralateral stimulation was a broad band white noise, presented at 70 dB SPL. Efferent suppression was determined by subtracting the without-contralateral stimulation condition from the with-contralateral stimulation condition. Across this population, a mean suppression effect of contralateral stimulation on transient-evoked otoacoustic emissions was found, with most of the suppression effect observed after 8 ms. The amount of suppression is linearly, positively correlated with the conceptional age. In the subgroup of bilaterally tested neonates, the suppression of transient-evoked otoacoustic emissions is similar in the right ear and the left ear in subjects whose conceptional age is less than 36 weeks and significantly higher in the right ear than in the left ear in older neonates. This last observation was seen at frequencies where transient-evoked otoacoustic emission amplitudes became higher in the right ear than in the left ear as the conceptional age increased, a finding already reported in adults. This study shows that the functional adult pattern of the medial efferent system, probably involved in the detection of signals in noise such as speech sounds, seems to appear gradually in neonates and represents one of the several arguments in favor of functional auditory lateralization in humans, with a right ear advantage.

We characterize the multifractal behavior of Brownian motion in the vicinity of an absorbing star polymer. We map the problem to an O(M)-symmetric phi(4)-field theory relating higher moments of the Laplacian field of Brownian motion to corresponding composite operators. The resulting spectra of scaling dimensions of these operators display the convexity properties that are necessarily found for multifractal scaling but unusual for power of field operators in field theory. Using a field-theoretic renormalization group approach we obtain the multifractal spectrum for absorption at the core of a polymer star as an asymptotic series. We evaluate these series using resummation techniques.

This article presents the ments of the nonresilient hybrid removable prosthesis, which is the treatment of choice for the atrophic maxilla. The technique described may be adapted to yield a predictable outcome that provides functional and biomechanical stability that are superior to a resilient over-denture, along with a cosmetic and phonetic result that often proves superior to that of the fixed prosthesis.

Despite onset of function early during the third term of gestation, the human auditory system demonstrates continued maturation, thought previously to occur primarily at the neural level. The electromotile properties of outer hair cells appear to contribute substantially to hearing sensitivity and frequency selectivity and lead to the generation of otoacoustic emissions (OAEs). This report demonstrates continued development of cochlear active mechanisms (i.e. end-organ level) after onset of cochlear function, as reflected by OAEs. Significant gender differences also are reported, corresponding to recently observed intersex differences in cochlear length and precursory to gender differences observed in the adult.

The role of nitric oxide (NO) in cerebral autoregulation is controversial. The purpose of this study was to compare the effects on the lower limit of the cortical cerebral autoregulation of the inhibition of NO synthesis by N omega-nitro-L-arginine (L-NNA) infusion to saline and phenylephrine in pentobarbital-anaesthetized rats. Variations of the cortical cerebral blood flow (CBF), the cortical cerebrovascular resistances, the mean arterial pressure and the lower limit of cerebral autoregulation were compared in three groups: a group pretreated with L-NNA (n = 8), a group pretreated with saline (n = 8) and a group pretreated with phenylephrine (n = 5). The laser-Doppler flowmetry continuously measured CBF. Controlled haemorrhage was performed after the intravenous infusion of L-NNA, saline, or phenylephrine. The lower limit of cerebral autoregulation of each rat was computed by the least-squares method. The lower limit of cerebral autoregulation was significantly higher after L-NNA infusion (74 +/- 5 mm Hg) than after saline (43 +/- 3 mm Hg; p < 0.01) or phenylephrine infusions (52 +/- 5 mm Hg; p < 0.05). In conclusion, the role of NO on the cerebral autoregulation has been controversial; our results confirm the hypothesis that NO exerts a significant role in maintaining the lower limit of cerebral autoregulation in pentobarbital-anaesthetized rats.

A number of lines of evidence indicate that the human cochlea is fully functional as a mature sound transducer by 6 months of age. However, information about the development of the active cochlear mechanisms and notably the development of outer hair cell (OHC) activity is yet incomplete. Recording and analysis of otoacoustic emissions (OAEs), probably generated by the OHCs of the organ of Corti, have led to a better understanding, in humans, of how sounds are analysed in the cochlea by means of active mechanisms. Evoked OAEs (EOAEs) and spontaneous OAEs (SOAEs), when they can be recorded in full-term and preterm neonates, show different characteristics from those in adults, suggesting that maturation of the peripheral auditory system is incomplete at birth. To learn more about this maturation, using the best-established facts concerning SOAEs in adults, such as their greater prevalence in females and also in right ears, SOAEs were studied in more detail in 81 preterm neonates, from 30 to 40 weeks of conceptional age, all presenting bilateral EOAEs according to objective criteria. The first finding of this study was that SOAEs existed and could be recorded as of 30 weeks of conceptional age in humans. Some SOAE characteristics in preterm neonates, such as prevalence, peak number and acoustic frequencies, showed similarity with full-term neonates. Comparison of other criteria between the two populations, such as greater SOAE prevalence in right ears and higher SOAE peak number in females, suggested that these developmental factors emerge around term in humans. Comparison of SOAE characteristics between male and female preterms suggested that male preterms were less advanced in peripheral auditory development than were female preterms.

We examined 129 patients recruited from two sleep clinics to study the sleep apnea syndrome (SAS), defined by the apnea-hypopnea index (AHI) > or = 10. Information was registered from a self-administered questionnaire, basal physical measurements, and polysomnography. In 68 subjects recorded for two consecutive nights, a high correlation was found between first- and second-night AHIs (r = 0.89). Habitual loud snoring and breathing arrests during sleep were associated with AHI > or = 10. A model including these two variables, sex, age, and body mass index was created in order to predict AHI > or = 10 and with which it was possible to successfully classify almost three of four patients. Among subjective sleep questionnaire items, only daytime sleepiness was related to drops of transcutaneous oxygen tension. These discrepancies in the observed relationship between sleep parameters and subjective sleep items reduce the questionnaire value in epidemiologic settings where it aimed to detect SAS, as defined solely by the AHI value.

Changes in transiently evoked otoacoustic emissions (TEOAEs) occur during sleep and during tasks requiring attention. This can be due to a central nervous system effect on the cochlea. But, an additional or dominant influence by non-controlled factors is possible. In this paper, the effect of click-stimulus repetition, lying and sitting positions, state of alertness (awake or asleep) and CSF pressure variation on TEOAE features were studied. None of these factors affected TEOAE amplitude. In 2 subjects, TEOAE amplitude increased considerably during the night while remaining stable in 7 subjects during daytime sleep. This may be due to circadian variations of TEOAE amplitude.

Transiently evoked oto-acoustic emissions (TEOAEs) are generated by active contractions of the outer hair cells (OHC) of the organ of Corti. TEOAE are inhibited by the medial efferent olivocochlear system which originates in the brainstem and innervates the OHC. TEOAEs are a rapid non-invasive objective method of auditory screening in infants. Because in infants sleep represents 75% of their time, it was of interest to determine whether sleep stages which are induced in the brainstem could concomitantly affect TEOAEs. Repeated TEOAE recordings during polygraphic recordings of sleep stages were made on seven, 6-week-old infants. Results showed that: (i) TEOAE spectrum frequency components remained stable over sleep stages; (ii) TEOAE amplitude tended to increase during recording sessions; (iii) sleep stages (quiet, active and indeterminate sleep) did not affect TEOAE amplitude. This pilot study reveals that sleep mechanisms seem to have no effect on active OHC micromechanical properties. Therefore, in auditory screening, TEOAEs may serve to study active cochlear mechanisms in infants even during sleep which is the better time to perform recordings because of the quietness required.

The sleep apnea syndrome (SAS), which is defined by more than 5 apneas or hypopneas per hour of sleep (9), is quite a frequent affection which concerns 1.4 to 10% of general population (1.7). The major daytime complaints of the SAS are daytime sleepiness, memory and attention disorders, headaches and asthenia especially in the morning, and sexual impotence (9). The nocturnal manifestations are dominated by sonorous and generally long standing snoring, increased by dorsal decubitus and intake of alcohol, with repeated interruptions by respiratory arrests. These manifestations are always noted but rarely spontaneously reported. The sleep, non refreshing, is agitated and perturbed by numerous awakenings. The findings of the clinical examination are poor: obesity is found in 2/3 of the cases and arterial hypertension in 1/2 of the cases (20). Polygraphic recording during sleep only permits an absolute diagnosis. This frequent affection is a real problem of public health because of its numerous complications (3, 10, 12, 13, 18, 21). Symptoms of depression are often found when a patient with a SAS is examined and conversely, symptoms which evoke a SAS can be found in the clinical examination of depressed patients. We decided so to study the thymic and anxious status of 24 patients investigated for a SAS and submitted to a polygraphic recording during sleep. Four clinical parameters were studied: DSM III-R diagnosis criteria, Montgomery and Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HARS) and thymasthenia rating scale of Lecrubier, Payan and Puech. We also reported Total Sleep Time (TST = 6.5 +/- 1.5), Apnea Hypopnea Index (AHI = 26.7 +/- 21.6), number (2.1 +/- 2.8/h) and duration (174.2 +/- 150.8 s/h) of hypoxic events. Results showed that among 24 patients, 8 were depressed according to DSM III-R diagnosis criteria and had MADRS > 25, 22 were anxious, 11 had a major anxiety (HARS > 15) and 15 presented thymasthenia (SET > 15). Significative correlations existed between anxiety and depression (r = 0.82; p < 0.0001), depression and thymasthenia (r = 0.77; p < 0.0001) and thymasthenia and anxiety (r = 0.75; p < 0.0001). Among the 8 depressed patients a correlation existed between AHI and depression (r = 0.72; p = 0.04), but no correlation was found between depression and hypoxic events. These results were comparable to those of Guilleminault (10), Reynolds (21), Kales (12), Bliwise (3), Klonoff (13) and Millman (18) who studied relations between SAS and depression. The evaluation of thymasthenia gave a more precise typology of the depressive state associated to SAS: the type of the mood disorder is more "blunted" and "anhedonic" than "sorrowful", particularly characterised by asthenia, lack of energy, reduction of interests (leisures, libido, work), loss of initiative, difficulties to organise tasks, fall of performances and reduction of pleasure usually felt in pleasant events (15). The physic symptomatology dominated the psychic one. The sleep disorganization, more than metabolic consequences of apneas, could be involved in this associated depressive state. Other neuropsychiatric troubles can be associated to the SAS. In fact, cognitive troubles (2, 8, 14, 16, 19, 22, 24) and personality disorders (12, 18) have been described. Our data confirm previous observations suggesting a frequent association between SAS, depression, fatigue and anxiety. Clinicians should consequently be aware that a depression with severe complaints of fatigue should deserve an investigation oriented towards SAS. Conversely, when a SAS is diagnosed, it is necessary to look for a possible depression in order to set up the most appropriate treatment. The frequency of SAS, like depression's one, increases with age. Prescription and consummation of sedative psychotropic drugs increase too with age. Since respiratory depressant effects of these drugs have been clearly demonstrated, it is important to evoke SAS when depressive and/or anxious states are diagnosed and not to aggravate it. An efficacious treatment of SAS can also cure the associated depressive state, but this one can persist. It is necessary, in this case, to select a non sedative antidepressant.

Endogenous opiates have been shown to depress ventilation, and could therefore play a role in sleep apnoea syndrome (SAS). Hence, opiate antagonists have been used to treat SAS. The improvement they seem to give in blood-gas monitoring could derive either from a direct blocking of endorphins that inhibit respiration or else, indirectly, through an influence on sleep patterns. The present study used a double blind cross-over protocol to investigate the relationships between the effects on blood-gas and on sleep patterns of the oral opiate antagonist naltrexone in obstructive SAS. Sleep patterns and transcutaneous blood gas (tcPO2 and tcPCO2) were recorded in parallel. Control recordings, without treatment, were carried out over two nights, followed by two nights of recording after administration either of naltrexone followed by a placebo or of a placebo followed by naltrexone. The number of obstructive apnoea and hypopnoea events per hour of sleep (Apnoea-Hypopnoea Index: AHI), of hypoxic events (defined as a tcPO2 fall of at least 10, 15 or 20 mm Hg) and of hypercapnic events (defined as a tcPCO2 increase of at least 5 mm Hg) were counted. A Metabolic Suffering Index (MSI) was calculated, defined as the product of the number, duration and magnitude of hypoxic and hypercapnic events. Compared to placebo, naltrexone resulted in significant improvements in blood-gas patterns for the duration and MSI of hypoxic events and for the number, duration and MSI of hypercapnic events. Likewise, compared to placebo, naltrexone induced significant decreases in total sleep time, slow-wave sleep and rapid eye movement (REM) sleep, and, on the other hand, significant increases in total wake time and in the number of wakenings per hour of sleep (Nw h-1). Certain naltrexone-linked blood-gas improvements were closely correlated with certain of the sleep pattern changes: the decrease in number and duration of hypoxic events correlated with REM-time decrease and the decrease in number and duration of hypercapnic events correlated with the increase in Nwh-1. These findings suggest that the improvement in blood-gas patterns induced by naltrexone in SAS may be mediated by sleep pattern effects: i.e. a decrease in REM-time and an increase in intra-sleep wakening.

The report concerns findings for brainstem auditory evoked potentials (BAEPs) recorded in 116 children, aged between a few days and 7 years, having suffered from bacterial meningitis. 26% of cases occurred between birth and 6 months, 55% between 6 months and 2 years, and 19% after 2 years of age. Hemophilus was the most common bacteria (49%), followed by Pneumococcus (22%) and Meningococcus (15%). Neurological complications were found in 30% of the meningitis cases and accounted for 85% of all complications found. 29% of BAEPs were abnormal, of which 47% revealed transmission, 32% endocochlear and 21% retrocochlear impairment. Transmission impairment mainly occurred before the age of 2 years (88%), most frequently in meningococcus meningitis cases (44%), and independently of neurological complications. Retrocochlear impairment was found in association with neurological complications in 71% of cases. Endocochlear BAEP damage was found in 9.5% of cases, half of which were bilateral and total, representing cophosis: it was found at all ages, and without any particular associated neurological complication. Hemophilus was the commonest bacterial agent in endocochlear cases overall, with Pneumococcus underlying 50% of cophosis cases. The study shows BAEP recording in association with a clinical ear examination is useful following childhood bacterial meningitis, screening for definitive endocochlear and deafness, distinguishing total from partial hearing-loss and indicating suitable treatment.

The prognosis of sleep apnea syndrome (SAS) is dominated by cardiovascular complications. However, this disease is concerned with psychiatric field through specific clinical patterns. Nocturnal respiratory arrests are responsible for hypoxic and hypercapnic events including sleep fragmentation, reduction of slow wave sleep and rapid eye movement sleep. Alertness disturbances and sleep disorders are the most common functional complaints. Memory and cognitive disorders, personality changes and anxiodepressive syndromes may occur but are often neglected due to the increase of frequency with age together with the frequency of SAS; clinicians should consequently be aware of the fact that such troubles may be related to sleep respiratory disorders. In this case polysomnography should be performed before prescribing hypnotics, tranquilizers or sedative antidepressants.

Polygraphic sleep exploration is usually not necessary to evaluate and treat such dyssomnias as nightmares or anguish dreams, but it may be indispensable in case of severe repeated or refractory sleep disorders, particularly in patients with concomitant depression. Two cases of major depression (DSM III R) associated with wakings during the night and dreams of death are reported. In both cases, polygraphic sleep exploration performed after complete, two-weeks long discontinuation of medicines revealed sinus bradycardia during paradoxical sleep, particularly in pre-waking periods. Heart rates ranged from 33 to 43 beats/minute in the most pronounced bradycardic episodes. The possibility of organic cardiac pathology was excluded by additional examinations. Atropine (175 mg) administered alone resulted in complete disappearance of bradycardic episodes and in improvement of objective and subjective sleep parameters. In these two cases bradycardia seemed to be due to vagal dysfunction with exaggeration of the "rebound" bradycardia which follows the initial tachycardia that occurs during the phasic phenomena of paradoxical sleep.

The fundamental prerequisite of reorganising public health agencies is to create a new perspective of health policy. At present this realisation is the essence of the renewal of public health in the Anglo-American countries. The reorganisation of public health services in the old and in the new laender of the Federal Republic of Germany would gain by taking stock of the essential points that have been formulated by experts in the Anglo-American countries: the assessment of health problems by epidemiologists and health economists, the development of interorganizational cooperation, and the regional planning of health services. For translating these concepts into reality, public health has an unrivalled lead as far as chances and prerequisites are concerned, but the main obstacle is that continuing education and training are being blocked by the superior administrative bodies, so that there is a lack of experience in epidemiology, health policy and management.

Rehabilitation, along with curative treatment and prevention, is a function within a social system of comprehensive measures and services aimed at the maintenance and restoration of good health. Rehabilitation at the same time, however, is a task assigned to specific social service administrations within the structured system of social security. This entails deficits in the effectiveness and efficiency of rehabilitation measures. A working group on "reorientation in health care" has developed proposals for reducing these deficits, bearing reference, in its proposals, to the course of chronic diseases and pointing out the measures that would, in the various disease stages, be capable of securing care continuity as well as of improving the quality of care. Key factors involved are the rehabilitation competence of the primary-care physicians, as well as the competencies of patients themselves.