Genotype-phenotype correlations in SCN8A-related disorders reveal prognostic and therapeutic implications

We report detailed functional analyses and genotype-phenotype correlations in 392 individuals carrying disease-causing variants in SCN8A, encoding the voltage-gated Na+ channel Nav1.6, with the aim of describing clinical phenotypes related to functional effects. Six different clinical subgroups were identified: Group 1, benign familial infantile epilepsy (n = 15, normal cognition, treatable seizures); Group 2, intermediate epilepsy (n = 33, mild intellectual disability, partially pharmaco-responsive); Group 3, developmental and epileptic encephalopathy (n = 177, severe intellectual disability, majority pharmaco-resistant); Group 4, generalized epilepsy (n = 20, mild to moderate intellectual disability, frequently with absence seizures); Group 5, unclassifiable epilepsy (n = 127); and Group 6, neurodevelopmental disorder without epilepsy (n = 20, mild to moderate intellectual disability). Those in Groups 1-3 presented with focal or multifocal seizures (median age of onset: 4 months) and focal epileptiform discharges, whereas the onset of seizures in patients with generalized epilepsy was later (median: 42 months) with generalized epileptiform discharges. We performed functional studies expressing missense variants in ND7/23 neuroblastoma cells and primary neuronal cultures using recombinant tetrodotoxin-insensitive human Nav1.6 channels and whole-cell patch-clamping. Two variants causing developmental and epileptic encephalopathy showed a strong gain-of-function (hyperpolarizing shift of steady-state activation, strongly increased neuronal firing rate) and one variant causing benign familial infantile epilepsy or intermediate epilepsy showed a mild gain-of-function (defective fast inactivation, less increased firing). In contrast, all three variants causing generalized epilepsy induced a loss-of-function (reduced current amplitudes, depolarizing shift of steady-state activation, reduced neuronal firing). Functional effects were known for 170 individuals. All 136 individuals carrying a functionally tested gain-of-function variant had either focal (n = 97, Groups 1-3) or unclassifiable (n = 39) epilepsy, whereas 34 individuals with a loss-of-function variant had either generalized (n = 14), no (n = 11) or unclassifiable (n = 6) epilepsy; only three had developmental and epileptic encephalopathy. Computational modelling in the gain-of-function group revealed a significant correlation between the severity of the electrophysiological and clinical phenotypes. Gain-of-function variant carriers responded significantly better to sodium channel blockers than to other anti-seizure medications, and the same applied for all individuals in Groups 1-3. In conclusion, our data reveal clear genotype-phenotype correlations between age at seizure onset, type of epilepsy and gain- or loss-of-function effects of SCN8A variants. Generalized epilepsy with absence seizures is the main epilepsy phenotype of loss-of-function variant carriers and the extent of the electrophysiological dysfunction of the gain-of-function variants is a main determinant of the severity of the clinical phenotype in focal epilepsies. Our pharmacological data indicate that sodium channel blockers present a treatment option in SCN8A-related focal epilepsy with onset in the first year of life.

Defining the clinical, molecular and imaging spectrum of adaptor protein complex 4-associated hereditary spastic paraplegia

Bi-allelic loss-of-function variants in genes that encode subunits of the adaptor protein complex 4 (AP-4) lead to prototypical yet poorly understood forms of childhood-onset and complex hereditary spastic paraplegia: SPG47 (AP4B1), SPG50 (AP4M1), SPG51 (AP4E1) and SPG52 (AP4S1). Here, we report a detailed cross-sectional analysis of clinical, imaging and molecular data of 156 patients from 101 families. Enrolled patients were of diverse ethnic backgrounds and covered a wide age range (1.0-49.3 years). While the mean age at symptom onset was 0.8 ± 0.6 years [standard deviation (SD), range 0.2-5.0], the mean age at diagnosis was 10.2 ± 8.5 years (SD, range 0.1-46.3). We define a set of core features: early-onset developmental delay with delayed motor milestones and significant speech delay (50% non-verbal); intellectual disability in the moderate to severe range; mild hypotonia in infancy followed by spastic diplegia (mean age: 8.4 ± 5.1 years, SD) and later tetraplegia (mean age: 16.1 ± 9.8 years, SD); postnatal microcephaly (83%); foot deformities (69%); and epilepsy (66%) that is intractable in a subset. At last follow-up, 36% ambulated with assistance (mean age: 8.9 ± 6.4 years, SD) and 54% were wheelchair-dependent (mean age: 13.4 ± 9.8 years, SD). Episodes of stereotypic laughing, possibly consistent with a pseudobulbar affect, were found in 56% of patients. Key features on neuroimaging include a thin corpus callosum (90%), ventriculomegaly (65%) often with colpocephaly, and periventricular white-matter signal abnormalities (68%). Iron deposition and polymicrogyria were found in a subset of patients. AP4B1-associated SPG47 and AP4M1-associated SPG50 accounted for the majority of cases. About two-thirds of patients were born to consanguineous parents, and 82% carried homozygous variants. Over 70 unique variants were present, the majority of which are frameshift or nonsense mutations. To track disease progression across the age spectrum, we defined the relationship between disease severity as measured by several rating scales and disease duration. We found that the presence of epilepsy, which manifested before the age of 3 years in the majority of patients, was associated with worse motor outcomes. Exploring genotype-phenotype correlations, we found that disease severity and major phenotypes were equally distributed among the four subtypes, establishing that SPG47, SPG50, SPG51 and SPG52 share a common phenotype, an 'AP-4 deficiency syndrome'. By delineating the core clinical, imaging, and molecular features of AP-4-associated hereditary spastic paraplegia across the age spectrum our results will facilitate early diagnosis, enable counselling and anticipatory guidance of affected families and help define endpoints for future interventional trials.

[Optic neuritis]

Optic neuritis is a frequent neuro-ophthalmological disease in which the diagnosis can be based on just a few symptoms and findings. It is not only important to differentiate from other optic nerve disorders but also to recognise special types of optic neuritis, which is mostly only possible during the course of the disease. This article presents a review of the current state in diagnosis and therapy from the authors' personal point of view.

Liver transplantation in children weighing less than 10 kg: Chilean experience

BACKGROUND

Orthotopic liver transplantation is the treatment of choice for most terminal liver diseases in children. In small children (≤ 10 kg), this procedure is challenging and has special considerations. The aim of this study is to describe the experience of a Chilean liver transplantation program in this subgroup of patients.

METHODS

The liver transplant database of Hospital Luis Calvo Mackenna and Clinica Las Condes was reviewed. All children less than 10 kg undergoing liver transplantation between January 1994 and July 2011 were included. Patient and graft outcomes and main complications were analyzed.

RESULTS

We have performed 230 pediatric liver transplantations, 49 of them in 41 patients weighing less than 10 kg. The first indication for transplantation was biliary atresia in 25 patients (61%). A living related donor was used in 23 cases (51%). Actuarial survival was 75.7% at 1 year and 67.1% at 5 years. The main cause of death was infection, and the leading cause of graft loss was vascular complication.

DISCUSSION

Our transplant program includes 2 centers that perform more than 90% of pediatric liver transplantations in Chile, including public health pediatric patients from all around the country. Patients weighing less than 10 kg represent the most challenging group in pediatric liver transplantation due to higher rates of vascular and biliary complications and postoperative infections.

[Pupillary diameter in every day situations]

AIM OF THE STUDY

For the construction of true accommodating intraocular lenses and for refractive surgery a knowledge about pupil diameter in daily life is important. Sufficient data are available only in darkness.

MATERIAL AND METHODS

206 volunteers aged between 18 and 72 years without disorders influencing the pupil have been examined by means of pupillography at two luminance conditions (3 and 30 cd/m2) and 3 fixation distances (5 m, 1 m, 0.33 m).

RESULTS

Pupil size decreases by 0.42 mm per decade with the darker condition and 0.25 mm per decade with brighter light. Fixation change from 5 to 1 m has hardly any influence on pupil size, changing to 0.33 m constricts the pupil by 0.43 mm at dark condition and 0.33 mm at the lighter condition.

CONCLUSION

Luminance has the strongest influence on pupil size, near fixation has hardly any influence down to 1 m. The well-known age relation of pupil size in darkness is also valid for mesopic and photopic conditions. At 3 cd/m2 it was the same as reported in darkness, at 30 cd/m2 it was less in absolute numbers, but relative as compared to young adults it was approximately the same.

Phosphodiesterase 2 inhibitors promote axonal outgrowth in organotypic slice co-cultures

The development of appropriate models assessing the potential of substances for regeneration of neuronal circuits is of great importance. Here, we present procedures to analyze effects of substances on fiber outgrowth based on organotypic slice co-cultures of the nigrostriatal dopaminergic system in combination with biocytin tracing and tyrosine hydroxylase labeling and subsequent automated image quantification. Selected phosphodiesterase inhibitors (PDE-Is) were studied to identify their potential growth-promoting capacities. Immunohistochemical methods were used to visualize developing fibers in the border region between ventral tegmental area/substantia nigra co-cultivated with the striatum as well as the cellular expression of PDE2A and PDE10. The quantification shows a significant increase of fiber density in the border region induced by PDE2-Is (BAY60-7550; ND7001), comparable with the potential of the nerve growth factor and in contrast to PDE10-I (MP-10). Analysis of tyrosine hydroxylase-positive fibers indicated a significant increase after treatment with BAY60-7550 and nerve growth factor in relation to dimethyl sulfoxide. Additionally, a dose-dependent increase of intracellular cGMP levels in response to the applied PDE2-Is in PDE2-transfected HEK293 cells was found. In summary, our findings show that PDE2-Is are able to significantly promote axonal outgrowth in organotypic slice co-cultures, which are a suitable model to assess growth-related effects in neuro(re)generation.

Large deletions and splicing-site mutations in the STK11 gene in Peutz-Jeghers Chilean families

Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder characterized by mucocutaneous melanocytic macules, gastrointestinal hamartomatous polyposis and an increased risk of various neoplasms. Germline mutations in the serine/threonine kinase 11 (STK11) gene have been identified as a cause for PJS. The aim of this study was to characterize the genotype of Chilean PJS patients. Mutation screening of 13 patients from eight PJS families was performed using a single strand conformation polymorphism analysis, DNA sequencing and multiplex ligation-dependent probe amplification assay. The breakpoints of the genomic rearrangements were assessed by a long-range polymerase chain reaction and sequencing. The results revealed the existence of seven different pathogenic mutations in STK11 gene in seven unrelated families, including three point mutations and four large genomic deletions. Three of these point mutations (43%, 3/7) may be considered as novel. Our results showed that a germline mutation is present in STK11 in 88% of probands fulfilling the diagnostic criteria of PJS. In this study, the combination of two different experimental approaches in the screening of the STK11 in PJS, led to a higher percentage of mutation detection.

Drawing Contour Trees in the Plane

The contour tree compactly describes scalar field topology. From the viewpoint of graph drawing, it is a tree with attributes at vertices and optionally on edges. Standard tree drawing algorithms emphasize structural properties of the tree and neglect the attributes. Applying known techniques to convey this information proves hard and sometimes even impossible. We present several adaptions of popular graph drawing approaches to the problem of contour tree drawing and evaluate them. We identify five esthetic criteria for drawing contour trees and present a novel algorithm for drawing contour trees in the plane that satisfies four of these criteria. Our implementation is fast and effective for contour tree sizes usually used in interactive systems (around 100 branches) and also produces readable pictures for larger trees, as is shown for an 800 branch example.

Visualization of High-Dimensional Point Clouds Using Their Density Distribution's Topology

We present a novel method to visualize multidimensional point clouds. While conventional visualization techniques, like scatterplot matrices or parallel coordinates, have issues with either overplotting of entities or handling many dimensions, we abstract the data using topological methods before presenting it. We assume the input points to be samples of a random variable with a high-dimensional probability distribution which we approximate using kernel density estimates on a suitably reconstructed mesh. From the resulting scalar field we extract the join tree and present it as a topological landscape, a visualization metaphor that utilizes the human capability of understanding natural terrains. In this landscape, dense clusters of points show up as hills. The nesting of hills indicates the nesting of clusters. We augment the landscape with the data points to allow selection and inspection of single points and point sets. We also present optimizations to make our algorithm applicable to large data sets and to allow interactive adaption of our visualization to the kernel window width used in the density estimation.

P2 receptor expression in the dopaminergic system of the rat brain during development

Extracellular ATP facilitates the release of dopamine via P2 receptor activation in parts of the mesolimbic system. To characterize P2X/Y receptor subtypes in the developing dopaminergic system, their expression in organotypic slice co-cultures including the ventral tegmental area/substantia nigra (VTA/SN) complex and the prefrontal cortex (PFC) was studied in comparison to the receptor expression in 3-5 day-old and adult rats. Reverse transcriptase-polymerase chain reaction (RT-PCR) with specific primers for the P2X(1,2,3,4,6,7) and P2Y(1) receptors in the tissue extracts of organotypic co-cultures revealed the presence of the P2X and P2Y receptor mRNAs investigated. Multiple immunofluorescence labeling of the P2X/Y receptor protein indicated differences in the regional expression in the organotypic co-cultures after 10 days of cultivation (VTA/SN, P2X(1,2,3,4,6,7), P2Y(1,6,12); PFC, P2X(1,3,4,6,7), P2Y(1,2,4,6,12)). At postnatal days 3-5, an immunofluorescence mostly comparable to that of adult rats was observed (VTA/SN and PFC: P2X(1,2,3,4,6,7), P2Y(1,2,4,6,12)). There was one important exception: the P2X(7) receptor immunocytochemistry was not found in adult tissue, suggesting a potential role of this receptor in the development. Only few P2 receptors (e.g. P2X(1), P2Y(1)) were expressed at fibers interconnecting the dopaminergic VTA/SN with the PFC in the organotypic co-cultures. The treatment of the cultures with the ATP analogues 2-methylthio-ATP and alpha,beta-methylene-ATP induced an increase in axonal outgrowth and fiber density, which could be inhibited by pre-treatment with the P2X/Y receptor antagonist pyridoxal-phosphate-6-azophenyl-2',4'-disulphonic acid. The co-localization of the dopamine-(D1) receptor with the P2X(1) receptor in organotypic slice cultures was evident. In the PFC of the co-cultures, and that of young but not adult rats, a number of tyrosine hydroxylase (TH)-positive cells also possessed P2Y(1)-immunoreactivity (IR). Additionally, a strong P2Y(1)-IR was observed on astrocytes. The present results show a time-, region- and cell type-dependent in vitro and in vivo expression pattern of different P2 receptor subtypes in the dopaminergic system indicating the involvement of ATP and its receptors in neuronal development and growth.

P2 receptor-stimulation influences axonal outgrowth in the developing hippocampus in vitro

Extracellular ATP might act as a trophic factor on growing axons during development of the CNS via P2 receptors. In the present study the postnatal presence of selected P2 receptor subtypes was analyzed and their putative trophic capacity in entorhino-hippocampal slice co-cultures of mouse brain was tested. The effect of the P2 receptor ligands 2-methylthioadenosine-5'-triphosphate (P2X/Y receptor agonist) and pyridoxalphosphate-6-azophenyl-2',4'-disulphonic acid (P2X/Y receptor antagonist) on axonal growth and fiber density of biocytin-labeled hippocampal projections was compared both with untreated cultures and with cultures treated with artificial cerebrospinal fluid. After 10 days in vitro, double immunofluorescence labeling revealed the expression of P2X(1), P2X(2), P2X(4) as well as P2Y(1) and P2Y(2) receptors in the examined regions of entorhinal fiber termination. Further, quantitative analysis of identified biocytin-traced entorhinal fibers showed a significant increase in fiber density in the dentate gyrus after incubation of the slices with the P2 receptor agonist 2-methylthioadenosine-5'-triphosphate. This neurite outgrowth promoting effect was completely abolished by the P2 receptor antagonist pyridoxalphosphate-6-azophenyl-2',4'-disulphonic acid. Our in vitro data indicate that ATP via its P2X and P2Y receptors can shape hippocampal connectivity during development.

P2Y receptor expression on astrocytes in the nucleus accumbens of rats

The expression of purinoceptor (P2)Y-subtypes on astrocytes in vivo under physiological conditions and after stab wound injury was investigated. Reverse transcriptase-polymerase chain reaction with specific primers for the receptor-subtypes P2Y1,2,4,6,12 in tissue extracts of the nucleus accumbens of untreated rats revealed the presence of all P2Y receptor mRNAs investigated. Double immunofluorescence visualized with laser scanning microscopy indicated the expression of the P2Y1,4 receptors on glial fibrillary acidic protein (GFAP)-labeled astrocytes under physiological conditions. After stab wound injury the additional expression of the P2Y2 and P2Y6 receptors, and an up-regulation of the P2Y1,4 receptor-labeling on astrocytic cell bodies and/or processes was observed. Astrocytes of cortical, in contrast to accumbal areas exhibited P2Y1,2,4,6 receptor-immunoreactivity (IR) under control conditions, which was up-regulated after stab would injury. Labeling for the P2Y12 receptor was not observed on GFAP-positive cortical and accumbal astrocytes under any of the conditions used. For the first time, the co-localization of different P2 receptor-subtypes (e.g. P2Y1 and P2X3) on the same astrocyte was shown immunocytochemically. The up-regulation of P2Y1 receptor-IR on astrocytes and non-glial cells after mechanical injury could be facilitated by microinfusion of the P2Y1,12,13 receptor agonist adenosine 5'-O-(2-thiodiphosphate) (ADPbetaS). Proliferative changes after ADPbetaS-microinjection were characterized by means of double-staining with antibodies against GFAP and 5-bromo-2'-deoxyuridine. The non-selective P2 receptor antagonist pyridoxalphosphate-6-azophenyl-2',4'-disulphonic acid, the P2Y1 receptor antagonist N6-methyl-2'-deoxyadenosine 3',5'-bisphosphate and the P2Y1 receptor-antibody itself inhibited the agonist-induced effects. The data indicate the region-specific presence of P2Y receptors on astrocytes in vivo and their up-regulation after injury as well as the co-localization of P2X and P2Y receptor-subtypes on the same astrocyte. The dominant role of P2Y1 receptors in proliferation and the additional stimulation of non-P2Y1 receptors has been demonstrated in vivo suggesting the involvement of this receptor-type in the gliotic response under physiological and pathological conditions.

Communication and psychosocial consequences of sensory loss in older adults: overview and rehabilitation directions

With increasing longevity among populations, age-related vision and hearing impairments are becoming prevalent conditions in the older adult populations. In combination dual sensory loss occurs. Dual sensory loss is becoming a more common condition seen by clinicians and previous research has shown that 6% of non-institutionalized older adults had a dual sensory impairment, whilst 70% of severely vision-impaired older adults also demonstrated a significant hearing loss. Decreased vision and/or hearing acuity interferes with reception of the spoken message and hence people with sensory loss frequently experience communication breakdown. Many personal, situational and environmental triggers are also responsible for communication breakdown. Limited ability to improve communication performance frequently results in poor psychosocial functioning. Older adults with sensory loss often experience difficulty adjusting to their sensory loss. Depression, anxiety, lethargy and social dissatisfaction are often reported. Sensory loss, decreased communication performance and psychosocial functioning impacts on one's quality of life and feelings of well-being. Rehabilitation services for older adults with age-related sensory loss need to accommodate these difficulties. Improved staff education and rehabilitation programmes providing clients and carers with strategies to overcome communication breakdown is required. A multidisciplinary perspective to the assessment and remediation of older adults is recommended.

Communication perceptions of older adults with sensory loss and their communication partners: implications for intervention

INTRODUCTION

Vision and hearing loss are prevalent disorders in older adults although their effects on communication are not well documented.

METHOD

The purpose of this study was to investigate the perceptions of older adults with sensory loss and their communication partners with regard to their communication, situational difficulties and conversational needs.

RESULTS

Questionnaire results revealed that the sensory loss group experienced a range of functional vision and hearing difficulties. Over two-thirds of subjects reported frequent conversational difficulty, particularly in background noise and group conversations. Most subjects used clarification requests (mainly non-specific clarification and repetition requests) to overcome misunderstandings. By contrast, the communication partners reported few communication difficulties and claimed that they proactively eliminated or controlled environmental, speaker and listener variables to optimize conversation. The most frequently reported strategy was repetition.

CONCLUSION

The findings suggest that older adults with sensory loss experience communication disruptions, which in many instances are not resolved. To optimize communication efficacy in this population, a communication training programme for people with sensory loss and their communication partners is highly recommended.

Three-dimensional MR visualization of the intracisternal course of the cranial nerves V-VIII by virtual cisternoscopy

PURPOSE

A post-processing protocol for 3D visualization of the cranial nerves V-VIII along their intracisternal course is presented.

MATERIAL AND METHODS

Six healthy volunteers underwent MR imaging (1.5 T) to obtain high-resolution heavily T2-weighted data sets (3DFT CISS) with isotropic voxels (0.5 mm3). The data sets were post-processed by using volume rendering software in order to visualize the intracisternal courses of the cranial nerves V-VIII as well as their root entry zones. The data acquisition and post-processing protocol was then applied in 14 patients with a suspected neural compression syndrome according to the clinical findings as well as cross-sectional images and evaluated with respect to image quality and diagnostic value by two neuroradiologists, using a five-point scale.

RESULTS

Virtual cisternoscopy allowed a comprehensive intracisternal 3D visualization of the affected cranial nerves in 12/14 patients. The mean post-processing time amounted to 13.1/5.6/13.7 min for the cranial nerves V/VI/VII and VIII. The mean score for image quality was 4.2, that for diagnostic value 4.1. 2D and/or 3D reference images were indispensable for appreciating the spatial information provided by virtual cisternoscopy.

CONCLUSION

The data acquisition and post-processing protocol presented here allows comprehensive and standardized intracisternal 3D visualization of the cranial nerves V-VIII in a routine setting as a complementary imaging procedure.

NMR velocimetry of falling liquid films

First results on NMR velocimetry of falling liquid films are presented. A film of average thickness 1 mm and width 40 mm is sustained by a continuous flow of silicon oil over a vertical plate made from PMMA. The spatial distribution of velocities is measured using a double spin--echo imaging pulse sequence supplemented by a bipolar velocity encoding gradient. Spin density and velocity images as well as two-dimensional velocity maps of different situations, i.e., undisturbed and disturbed falling film flow, are discussed. Experimental and theoretical velocity data for undisturbed film flow are compared.

Modelled influences of non-exchanging trichomes on leaf boundary layers and gas exchange

The two main resistances in the exchange of gases between plants and the atmosphere are stomatal and boundary layer resistances. We modeled boundary layer dynamics over glabrous and pubescent leaves (assuming non-exchanging trichomes) with leaf lengths varying from 0.01 to 0.2 m, and windspeeds of 0.1-5.0 m x s(-1). Results from theoretical and semi-empirical formulae were compared. As expected, boundary layer thickness decreased with decreasing leaf length and increasing windspeed. The presence of trichomes increased leaf surface roughness, resulting in lowered Reynolds numbers at which the boundary layer became turbulent. This effect is especially important at low windspeeds and over small leaves, where the Reynolds number over glabrous surfaces would be low. We derived a new simple dimensionless number, the trip factor, to distinguish field conditions that would lead to a turbulent boundary layer based on the influence of trichomes. Because modeled rates of CO2 and H2O(v) exchange over turbulent boundary layers are one or more orders of magnitude faster than over laminar boundary layers, a turbulent boundary layer may lead to increased carbon uptake by plants. The biological trade-off is potentially increased transpirational water loss. However, in understory habitats characterized by low windspeeds, even a few trichomes may increase turbulence in the boundary layer, thus facilitating photosynthetic gas exchange. Preliminary field data show that critical trip factors are exceeded for several plant species, both in understory and open habitats.

Fabrication and simulation of diffractive optical elements with superimposed antireflection subwavelength gratings

With the aim of reducing surface reflections and increasing the diffraction efficiency we investigated the superposition of subwavelength phase gratings onto blazed phase gratings. With direct-write electron-beam lithography bare blazed gratings and blazed gratings carrying subwavelength gratings were fabricated and their optical performances compared. For TE polarization the subwavelength-carrying gratings showed a maximum diffraction efficiency of 90.6%, whereas the corresponding maximum value for the bare grating was 86.3%. The experiment was simulated with rigorous diffraction theory.

Tandem triple-pass Fabry-Perot interferometer for applications in the near infrared

A standard tandem triple-pass scanning Fabry-Perot interferometer of the Vernier type for applications in the near infrared is described. The Fabry-Perot etalons have been coated with a specially designed dielectric multilayer stack with low loss factors and a uniform reflectivity of (92.5 +/- 1.0)% between 730 and 860 nm. The performances of the instrument, such as resolution, total transmission, and contrast, are equivalent to conventional tandem Fabry-Perot spectrometers but over the whole near-infrared wavelength range. Applications of the system to Brillouin scattering on semiconductors in the transparent wavelength regime and high-resolution spectroscopy of vertical cavity surface-emitting lasers are given.

Design and fabrication of double-chirped mirrors

We present an analytic design method for the reproducible fabrication of double-chirped mirrors to achieve simultaneously a high reflectivity and dispersion compensation over an extended bandwidth compared with those of standard quarter-wave Bragg mirrors. The mirrors are fabricated by ion beam sputtering. Use of these mirrors in a Ti:sapphire laser leads to 6.5-fs pulses directly out of the laser. The method can also be applied to the design of chirped-fiber gratings and general optical filters.

Submicrometer gratings for solar energy applications

Diffractive optical structures for increasing the efficiency of crystalline silicon solar cells are discussed. As a consequence of the indirect band gap, light absorption becomes very ineffective near the band edge. This can be remedied by use of optimized diffraction gratings that lead to light trapping. We present blazed gratings that increase the optically effective cell thickness by approximately a factor of 5. In addition we present a wideband antireflection structure for glass that consists of a diffraction grating with a dielectric overcoat, which leads to an average reflection of less than 0.6% in the wavelength range between 300 and 2100 nm.

Development of gerontological nursing theory. Applying the man-living-health theory of nursing

The development of gerontological nursing is an important focus for nursing, given the increasing population of older persons that is requiring nursing care. There are a variety of approaches that have been proposed to provide direction in the development of gerontological nursing theory. The theory of Man-Living-Health was used to describe how gerontological nursing knowledge could be developed through the utilization of a nursing conceptual model that includes a defined practice and research methodology. Continued work in identifying and expanding the theory that underpins gerontological nursing is essential for gerontological nursing practice, research, and education.

Is gerontological nursing included in baccalaureate nursing programs?

There is a significant effort to include gerontological nursing in baccalaureate nursing programs, but there needs to be continuous evaluation as to the nature and extent of this content. The four stages of the Curriculum Process Model (directive, formative, functional, and evaluative) provide a logical and systematic approach for developing or revising a curriculum. Although the status of gerontological nursing content, faculty preparation, and clinical settings for gerontological experiences have improved, they still do not provide the necessary educational background for students.

Determination of Settings of a Tilted Head Cutter for Generation of Hypoid and Spiral Bevel Gears

Kinematics of mechanisms of hypoid and spiral bevel cutting machines is considered. These mechanisms are designated to install the position and tilt of the head cutter. The tilt of the head cutter with standard blades provides the required pressure angle. The authors have developed the matrix presentation of kinematics of these mechanisms and basic equations for the required settings. An example is presented based on the developed computation procedure.

[Effects and side effects of transdermal scopolamine for premedication in general anesthesia in elderly patients]

Transdermal scopolamine has already proved an effective premedication to prevent postoperative nausea and vomiting. In a double-blind study, the effects and above all the side effects of TTS-scopolamine (TTS-s) and TTS-placebo (TTS-p) were investigated in elderly patients (greater than 50 years), who are particularly susceptible to adverse drug reactions. The 59 (out of 61) male and female patients who could finally be evaluated had to undergo long (1-6.3 hrs.) surgical or gynaecological interventions in general anaesthesia after premedication with benzodiazepines in the evening and in the morning. The operations were performed under intubation anaesthesia induced by barbiturate (3-5 mg/kg bw) or etomidate (0.2-0.3 mg/kg bw), together with enflurane (0.5-2.5 vol.%) or isoflurane (0.5-1.5 vol.%), N2O/O2 (2:1) and fentanyl (0.05-0.45 mg). Alcuronium or vecuronium were given for relaxation, pyridostigmine/atropine was administered for antagonisation. The patient groups did not differ significantly with regard to age (mean = 65 years vs. 63 years), sex, height, weight, concomitant diseases, method and duration of operation, method and duration of anaesthesia, postoperative antagonisation and analgesia. In patients under TTS-s postoperative nausea was less intensive and of shorter duration. In contrast to 7 patients of the placebo group (p less than 0.05), no case of vomiting could be observed in the TTS-s group. The efficacy of TTS-s was significantly better than that of TTS-p. TTS-s and TTS-p were both tolerated equally well. In both groups, the most frequent side effect was dryness of the mouth, but without any significant differences between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)