Autoresonance Cooling of Ions in an Electrostatic Ion Beam Trap

Autoresonance (AR) cooling of a bunch of ions oscillating inside an electrostatic ion beam trap is demonstrated for the first time. The relatively wide initial longitudinal velocity distribution is reduced by at least an order of magnitude using AR acceleration and ramping forces. The hot ions escaping the bunch are not lost from the system but continue to oscillate in the trap outside of the bunch and may be further cooled by successive AR processes. Ion-ion collisions inside the bunch close to the turning points in the trap's mirrors contribute to the thermalization of the ions. This cooling method can be applied to any mass and any charge.

An experimental setup to study delayed electron emission upon photoexcitation of trapped polyatomic anions

A Velocity Map Imaging (VMI) spectrometer has been designed and integrated with an electrostatic ion beam trap to study delayed electron emission from trapped polyatomic anions upon photodetachment. The VMI spectrometer is small in size and can record a wide range of photoelectron energies, with variable magnification. Delayed electron emission can be recorded in our experimental setup for any time duration after the photoexcitation of the polyatomic anions. Experiments were carried out with trapped O^- and C₅^- ions to demonstrate the capability of the spectrometer. Delayed electron emissions from C₅^- as well as prompt photoelectrons from O^- were detected by the VMI spectrometer upon photoexcitation. The design and performance of the spectrometer are presented in detail.

Observation of longitudinal quadrupole ion bunch oscillations in an electrostatic ion beam trap

Ions in an ion bunch trapped inside an Electrostatic Ion Beam Trap (EIBT) exhibit collective oscillations within the bunch under the influence of an external driving force. These internal oscillations have been measured explicitly using a new method with a particle detector outside the EIBT. In this approach, the evolving ion bunch is monitored along the entire trap length, in contrast to the localized single point measurements that are often carried out in other techniques. In the present study, quadrupole oscillations have been measured for the first time in an EIBT along with the dipole oscillations that were measured previously. The frequency of the quadrupole oscillation is found to be about twice the dipole oscillation frequency. This is in agreement with the prediction of a theoretical model.

The cryogenic storage ring CSR

An electrostatic cryogenic storage ring, CSR, for beams of anions and cations with up to 300 keV kinetic energy per unit charge has been designed, constructed, and put into operation. With a circumference of 35 m, the ion-beam vacuum chambers and all beam optics are in a cryostat and cooled by a closed-cycle liquid helium system. At temperatures as low as (5.5 ± 1) K inside the ring, storage time constants of several minutes up to almost an hour were observed for atomic and molecular, anion and cation beams at an energy of 60 keV. The ion-beam intensity, energy-dependent closed-orbit shifts (dispersion), and the focusing properties of the machine were studied by a system of capacitive pickups. The Schottky-noise spectrum of the stored ions revealed a broadening of the momentum distribution on a time scale of 1000 s. Photodetachment of stored anions was used in the beam lifetime measurements. The detachment rate by anion collisions with residual-gas molecules was found to be extremely low. A residual-gas density below 140 cm(-3) is derived, equivalent to a room-temperature pressure below 10(-14) mbar. Fast atomic, molecular, and cluster ion beams stored for long periods of time in a cryogenic environment will allow experiments on collision- and radiation-induced fragmentation processes of ions in known internal quantum states with merged and crossed photon and particle beams.

Absolute photo-destruction and photo-fragmentation cross section measurements using an electrostatic ion beam trap

We describe a technique to measure absolute photo-induced cross sections for cluster anions stored in an electrostatic ion beam trap (EIBT) with a central deflector. The setup allows determination of total photo-destruction cross sections as well as partial cross sections for fragmentation and electron detachment. The unique properties of this special EIBT setup are investigated and illustrated using small Al(n)(-) clusters.

Scanning superconducting quantum interference device on a tip for magnetic imaging of nanoscale phenomena

We describe a new type of scanning probe microscope based on a superconducting quantum interference device (SQUID) that resides on the apex of a sharp tip. The SQUID-on-tip is glued to a quartz tuning fork which allows scanning at a tip-sample separation of a few nm. The magnetic flux sensitivity of the SQUID is 1.8 μΦ(0)/√Hz and the spatial resolution is about 200 nm, which can be further improved. This combination of high sensitivity, spatial resolution, bandwidth, and the very close proximity to the sample provides a powerful tool for study of dynamic magnetic phenomena on the nanoscale. The potential of the SQUID-on-tip microscope is demonstrated by imaging of the vortex lattice and of the local ac magnetic response in superconductors.

Hot water molecules from dissociative recombination of D3O+ with cold electrons

Individual product channels in the dissociative recombination of deuterated hydronium ions and cold electrons are studied in an ion storage ring by velocity imaging using spatial and mass-sensitive detection of the neutral reaction fragments. Initial and final molecular excitation are analyzed, finding the outgoing water molecules to carry internal excitation of more than 3 eV in 90% of the recombination events. Initial rotation is found to be substantial and in three-body breakup strongly asymmetric energy repartition among the deuterium products is enhanced for hot parent ions.

A cryogenic electrostatic trap for long-time storage of keV ion beams

We report on the realization and operation of a fast ion beam trap of the linear electrostatic type employing liquid helium cooling to reach extremely low blackbody radiation temperature and residual gas density and, hence, long storage times of more than 5 min which are unprecedented for keV ion beams. Inside a beam pipe that can be cooled to temperatures <15 K, with 1.8 K reached in some locations, an ion beam pulse can be stored at kinetic energies of 2-20 keV between two electrostatic mirrors. Along with an overview of the cryogenic trap design, we present a measurement of the residual gas density inside the trap resulting in only 2 x 10(3) cm(-3), which for a room temperature environment corresponds to a pressure in the 10(-14) mbar range. The device, called the cryogenic trap for fast ion beams, is now being used to investigate molecules and clusters at low temperatures, but has also served as a design prototype for the cryogenic heavy-ion storage ring currently under construction at the Max-Planck Institute for Nuclear Physics.

A novel merged beams apparatus to study anion-neutral reactions

We have developed a novel laboratory instrument for studying gas phase, anion-neutral chemistry. To the best of our knowledge, this is the first such apparatus which uses fast merged beams to investigate anion-neutral chemical reactions. As proof-of-principle we have detected the associative detachment reaction H(-)+H-->H(2)+e(-). Here we describe the apparatus in detail and discuss related technical and experimental issues.

Optical absorption to probe the quantum Hall ferromagnet at filling factor nu=1

Optical absorption measurements are used to probe the spin polarization in the integer and fractional quantum Hall effect regimes. The system is fully spin polarized only at filling factor nu=1 and at very low temperatures ( approximately 40 mK). A small change in filling factor (deltanu approximately +/-0.01) leads to a significant depolarization. This suggests that the itinerant quantum Hall ferromagnet at nu=1 is surprisingly fragile against increasing temperature, or against small changes in filling factor.

Photoluminescence ring formation in coupled quantum wells: excitonic versus ambipolar diffusion

In this Letter, we study the diffusion properties of photoexcited carriers in coupled quantum wells around the Mott transition. We find that the diffusion of unbound electrons and holes is ambipolar and is characterized by a large diffusion coefficient, similar to that found in p-i-n junctions. Correlation effects in the excitonic phase are found to significantly suppress the carriers' diffusion. We show that this difference in diffusion properties gives rise to the appearance of a photoluminescence ring pattern around the excitation spot at the Mott transition.

Multiple changes of order of the vortex melting transition in Bi2Sr2CaCu2O8 with dilute columnar defects

A low concentration of columnar defects is reported to transform a first-order vortex lattice melting line in Bi2Sr2CaCu2O8 crystals into alternating segments of first- and second-order transitions separated by two critical points. As the density of columnar defects is increased, the critical points shift apart and the range of the intermediate second-order transition expands. The measurement of equilibrium magnetization and the mapping of the melting line down to 27 K was made possible by employment of the shaking technique.

A bent electrostatic ion beam trap for simultaneous measurements of fragmentation and ionization of cluster ions

We describe a bent electrostatic ion beam trap in which cluster ions of several keV kinetic energy can be stored on a V-shaped trajectory by means of an electrostatic deflector placed between two electrostatic mirrors. While maintaining all the advantages of its linear counterpart [Zajfman et al., Phys. Rev. A 55, R1577 (1997); Dahan et al., Rev. Sci. Instrum. 69, 76 (1998)], such as long storage times, straight segments, and a field-free region for merged or crossed beam experiments, the bent trap allows for simultaneous measurement of charged and neutral fragments and determination of the average kinetic energy released in the fragmentation. These unique properties of the bent trap are illustrated by first results concerning the competition between delayed fragmentation and ionization of Al(n) (-) clusters after irradiation by a short laser pulse.

Dynamic and thermodynamic properties of porous vortex matter in Bi(2)Sr(2)CaCu(2)O(8) in an oblique magnetic field

Vortex matter in Bi(2)Sr(2)CaCu(2)O(8) with a low concentration of tilted columnar defects (CDs) was studied using magneto-optical measurements and molecular dynamics simulations. It is found that while the dynamic properties are significantly affected by tilting the magnetic field away from the CDs, the thermodynamic transitions are angle independent. The simulations indicate that vortex pancakes remain localized on the CDs even at large tilting angles. This preserves the vortex thermodynamics, while vortex pinning is considerably weakened due to kink sliding.

Crossed beam photodissociation imaging of HeH+ with vacuum ultraviolet free-electron laser pulses

Molecular photofragmentation has been studied by event imaging on HeH+ ions at 32 nm (38.7 eV) in a fast ion beam crossed with the free-electron laser in Hamburg (FLASH), analyzing neutral He product directions and energies. Fragmentation into He(1snl,n > or = 2)+H+ was observed to yield significant photodissociation at 32 nm with an absolute cross section of (1.4+/-0.7) x 10(-18) cm2, releasing energies of 10-20 eV. A clear dominance of photodissociation perpendicular to the laser polarization was found in contrast to the excitation paths so far emphasized in theoretical studies.

Fermi-edge singularity of spin-polarized electrons

We study the absorption spectrum of a two-dimensional electron gas (2DEG) in a magnetic field. We find that at low temperatures, when the 2DEG is spin polarized, the absorption spectra, which correspond to the creation of spin up or spin down electrons, differ in magnitude, linewidth, and filling factor dependence. We show that these differences can be explained as resulting from the creation of a Mahan exciton in one case, and of a power law Fermi-edge singularity in the other.

Absorption in the fractional quantum Hall regime: trion dichroism and spin polarization

We present measurements of optical interband absorption in the fractional quantum Hall regime in a GaAs quantum well in the range 0<nu<or=1. We investigate the mechanism of singlet trion absorption, and show that its circular dichroism can be used as a probe of the spin polarization of the ground state of the two-dimensional electron system (2DES). We find that at nu<or=1/3 the 2DES is fully spin polarized. Increasing the filling factor results in a gradual depolarization, with a sharp minimum in the dichroism near nu=2/3. We find that in the range 0.5<or=nu<0.85 the 2DES remains partially polarized for the broad range of magnetic fields from 2.75 to 11 T. This is consistent with the presence of a mixture of polarized and depolarized regions.

Vortex nanoliquid in high-temperature superconductors

Using a differential magneto-optical technique to visualize the flow of transport currents, we reveal a new delocalization line within the reversible vortex liquid region in the presence of a low density of columnar defects. This line separates a homogeneous vortex liquid, in which all the vortices are delocalized, from a heterogeneous "nanoliquid" phase, in which interconnected nanodroplets of vortex liquid are caged in the pores of a solid skeleton formed by vortices pinned on columnar defects. The nanoliquid phase displays high correlation along the columnar defects but no transverse critical current.

Size-dependent electron-impact detachment of internally cold Cn- and Aln- clusters

The cross sections for electron detachment of internally cold Cn- and Aln- clusters were measured using an electrostatic ion beam trap fitted with an internal electron target. The measured electron-impact detachment cross sections for the Cn- (n = 1-9) clusters exhibit even-odd oscillations reflecting the binding energy trend, namely, higher cross sections for weaker binding. Surprisingly, however, these cross sections increase on the average with cluster size, n, in spite of the increase in electron binding. In contrast, the Aln- (n = 2-5) clusters follow the known scaling laws for electron detachment. We suggest that the size-dependent polarizability of these clusters is responsible for the observed behavior.

Melting of "porous" vortex matter

Bitter decoration and magneto-optical studies reveal that in heavy-ion irradiated superconductors, a "porous" vortex matter is formed when vortices outnumber columnar defects. In this state ordered vortex crystallites are embedded in the "pores" of a rigid matrix of vortices pinned on columnar defects. The crystallites melt through a first-order transition while the matrix remains solid. The melting temperature increases with density of columnar defects and eventually turns into a continuous transition. At high temperatures a sharp kink in the melting line is found, signaling an abrupt change from crystallite melting to melting of the rigid matrix.

Negative mass instability for interacting particles in a 1D box: theory and application

We demonstrate that the synchronization effect observed [Pedersen et al., Phys. Rev. Lett. 87, 055001 (2001)]], when a bunch of ions oscillates between two mirrors in an electrostatic ion beam trap, can be explained as a negative mass instability. We derive simple necessary conditions for the existence of a regime in which this dispersionless behavior occurs and demonstrate that in this regime, the ion trap can be used as a high resolution mass spectrometer.

Long-range spatial correlations in the exciton energy distribution in GaAs/AlGaAs quantum wells

Variations in the width of a quantum well (QW) are known to be a source of broadening of the exciton line. Using low temperature near-field optical microscopy, we have exploited the dependence of exciton energy on well width to show that in GaAs QWs, these seemingly random well-width fluctuations actually exhibit well-defined order-strong long-range correlations appearing laterally, in the plane of the QW, as well as vertically, between QWs grown one on top of the other. We show that these fluctuations are correlated with the commonly found mound structure on the surface. This is an intrinsic property of molecular beam epitaxial growth.

Temperature variations of the disorder-induced vortex-lattice-melting landscape

Differential magneto-optical imaging of the vortex-lattice-melting process in Bi(2)Sr(2)CaCu(2)O(8) crystals reveals unexpected effects of quenched disorder on the broadening of the first-order phase transition. The melting patterns show that the disorder-induced melting landscape T(m)(H,r) is not fixed, but rather changes dramatically with varying field and temperature along the melting line. The changes in both the scale and shape of the landscape are found to result from the competing contributions of different types of quenched disorder which have opposite effects on the local melting transition.

Ion motion synchronization in an ion-trap resonator

Using a new type of ion trap, we demonstrate that the length of a packet of charged particles oscillating between two electrostatic mirrors will remain constant under special conditions. The effect can be understood in terms of phase synchronization, where, in a rather counterintuitive way, the repulsive Coulomb interaction between the ions actually holds the packet together. Application of this effect for mass spectrometry is discussed.

'Inverse' melting of a vortex lattice

Inverse melting is the process in which a crystal reversibly transforms into a liquid or amorphous phase when its temperature is decreased. Such a process is considered to be very rare, and the search for it is often hampered by the formation of non-equilibrium states or intermediate phases. Here we report the discovery of first-order inverse melting of the lattice formed by magnetic flux lines in a high-temperature superconductor. At low temperatures, disorder in the material pins the vortices, preventing the observation of their equilibrium properties and therefore the determination of whether a phase transition occurs. But by using a technique to 'dither' the vortices, we were able to equilibrate the lattice, which enabled us to obtain direct thermodynamic evidence of inverse melting of the ordered lattice into a disordered vortex phase as the temperature is decreased. The ordered lattice has larger entropy than the low-temperature disordered phase. The mechanism of the first-order phase transition changes gradually from thermally induced melting at high temperatures to a disorder-induced transition at low temperatures.

P300 response under active and passive attentional states and uni- and bimodality stimulus presentation conditions

P300 evoked potential patterns were evaluated for two active and two passive attentional states in which stimuli were presented in either one or two sensory modalities. Latency to an infrequent auditory tone was shortest when counting the frequent stimulus, longer when counting the infrequent stimulus, longer still under a passive condition, and longest in a non-P300 condition. P300 amplitudes identifiable in the passive attentional state were enhanced when stimuli were from two, rather than from one, sensory modality. Implications for understanding the mechanism of attention are discussed. Preliminary findings in traumatic brain injury patients suggest that passive P300 responses may be useful in assessing the extent and severity of brain dysfunction.

Instabilities and disorder-driven first-order transition of the vortex lattice

Transport studies in a Corbino disk suggest that the Bragg glass phase undergoes a first-order transition into a disordered solid. This transition shows sharp reentrant behavior at low fields. In contrast, in the conventional strip configuration, the phase transition is obscured by the injection of the disordered vortices through the sample edges, which results in the commonly observed vortex instabilities and smearing of the peak effect in NbSe2 crystals. These features are found to be absent in the Corbino geometry in which the circulating vortices do not cross the sample edges.

A storage Dewar near-field scanning optical microscope

A near-field scanning optical microscope for operation within a storage Dewar is described. It was designed for studies of opaque samples and operates in the collection mode. Illumination can be either through the tip or from the side via a separate fiber. Scans can be begun within 2 h after start of cooldown. Its rigid design allows high resolution and long scans with no additional vibration isolation. To illustrate its performance, measurements of photoluminescence in GaAs/AlGaAs heterostructures are presented. The signal and noise levels for the two illumination modes are examined.

Implementation of the Patient Self-Determination Act (PSDA) in nursing homes in New York City

OBJECTIVE

To examine implementation of the Patient Self Determination Act (PSDA), verbal directives, procedures for determination of resident' decision-making capacity, and role of ethics committees in nursing homes in New York City.

DESIGN

Telephone survey.

PARTICIPANTS

Social workers in 109 (69%) nursing homes in New York City.

MEASUREMENT

An 80-item instrument addressing: (1) social worker knowledge of the PSDA; (2) informing residents about advance directives (living wills and durable power of attorney for health care [health care proxies]); (3) determination of decision-making capacity to be informed about advance directives; (4) estimates of advance directives executed; (5) perceptions of PSDA effect; (6) ethics committees; (7) follow-up and documentation; and (8) staff and community education.

MAIN RESULTS

Virtually all social workers in nursing homes stated that they made what they perceived to be a "serious effort" to inform residents about advance directives and to have residents execute directives (preferentially a health care proxy). More residents were thought to have executed a directive pursuant to the PSDA law than before the Act went into effect. Social workers in most homes informed residents about directives through face-to-face discussions. Most homes, however, did not inform residents who were thought to lack decision-making capacity about their right to execute a directive. Only 37% of homes had written procedures to determine a resident's decision-making capacity to be informed about directives; most homes relied on physician and social work assessments. Voluntary homes differed significantly from proprietary homes in that they were larger, more likely to have an ethics committee, and more aggressive in their implementation of the PSDA. Forty-five percent of homes with an ethics committee had written procedures for determination of resident decision-making capacity compared with 26% of homes without a committee. Overall, 24% of residents were thought to have executed an advance directive. The number of directives per bed did not vary significantly by facility size, ownership, religious affiliation, or whether they did or did not have an ethics committee.

CONCLUSIONS

The fact that social workers in nursing homes speak with most residents about advance directives has the potential to improve resident understanding around end of life decisions. The practice of not informing residents about advance directives when they are perceived to lack decision-making capacity is problematic given that most homes have no clear procedures for determining residents' cognitive capacity to execute a directive. There is a need to replicate the benefits achieved by homes with ethics committees in implementing the PSDA in other homes.

Effects of stimulus intensity and duration on posterior tibial nerve somatosensory-evoked potential patterns obtained under anesthesia

STUDY DESIGN

This study analyzed systematic changes in stimulus intensity and duration on the latencies and amplitudes of somatosensory-evoked potential peaks obtained upon posterior tibial nerve stimulation of orthopedic patients under anesthesia.

OBJECTIVES

To examine the effects of systematic stimulus changes on somatosensory-evoked potential patterns and to compare the sensitivity of different peaks.

SUMMARY OF BACKGROUND DATA

Previous studies primarily examined the effects of either stimulus intensity or stimulus duration but not their interactions.

METHODS

Nine orthopedic patients were tested using three stimulus intensities and three stimulus durations. Five peak latencies and four amplitudes were measured. Data consisted of frequency of peak occurrences under each condition and analyses of variances of peak latencies and amplitudes.

RESULTS

Three latencies yielded stable findings (P40, N50, P60). Peak latencies under anesthesia were not affected by stimulus intensity or duration. Amplitudes, however, were affected differentially. P40-N50 increased with increases in stimulus intensity or stimulus duration, but no significant interaction effects were found. N50-P60 showed no significant changes associated with stimulus intensity or duration.

CONCLUSION

Under combined isoflurane/nitrous oxide anesthesia, somatosensory-evoked potential patterns obtained upon stimulation of the posterior tibial nerves showed no significant changes in major peak latencies with changes in stimulus intensity or duration. However, changes in amplitude were found. Stimulus intensity-duration interaction effects were observed, described, and interpreted.

Somatosensory evoked potential peak latencies and amplitudes in contralateral and ipsilateral hemispheres in normal and severely traumatized brain-injured subjects

The purpose of this study was to compare in normal and traumatic brain injury (TBI) subjects long latency cortical brain-evoked potential patterns obtained upon stimulation of the median nerves. Quantitative data were analysed involving nine peak latencies and eight amplitudes obtained simultaneously contralaterally and ipsilaterally. Left-right hemispheric differences were also analysed. The following was found: TBI latencies were significantly longer for five of nine peaks (N30, P40, N60, P185, P285). TBI amplitudes were significantly smaller for two of eight amplitudes (P185-N240 and N240-P285). A significant contralateral-ipsilateral latency difference occurred only at P40 where latencies in the contralateral hemisphere are shorter for both normals and TBIs. Significant contralateral-ipsilateral amplitude differences occurred in the four early amplitudes (N30-P40, P40-N60, N60-P105, P105-N140) with amplitudes being smaller on the ipsilateral side. A differential effect, however, was found for amplitudes N30-P40 and P40-N60 where the difference is significantly larger in the contralateral hemisphere for normals but not for TBIs. This suggests that contralateral-ipsilateral amplitude difference can be a marker of extent and severity of injury and may also be helpful in localizing site of injury, particularly interhemispheric or corpus callosal injury. The differential latency and amplitude responses for later peaks occurring in the P300 region suggest sensitivity to detecting impairments in pre-cognitive and early cognitive activities.

An epidemiological study of obsessive-compulsive disorder and related disorders in Israeli adolescents

Five hundred and sixty-two, 16- to 17-year-old consecutive inductees into the Israeli Army, constituting a random sample of their cohort, were screened for obsessive-compulsive disorder (OCD), Tourette's syndrome, transient tics (TT), chronic multiple tics (CMT), and attention-deficit hyperactive disorder (ADHD). Two child psychiatrists interviewed the subjects, using screening items from structured interviews that implement DSM-III-R diagnostic criteria. For OCD, a point prevalence of 3.6% was found, 3.9% for ADHD, 1.8% for CMT, and 1.6% for TT. For ADHD, TT, and CMT, but not for OCD, there was a significantly higher prevalence for males than for females. Among the OCD individuals, there was an elevation of TT, CMT, and Tourette's syndrome relative to the population rates.

Evaluation of coma and vegetative states

The Coma/Near-Coma (CNC) scale was designed to measure small clinical changes in patients with severe traumatic and nontraumatic brain injuries who were functioning at very low levels characteristic of near-vegetative and vegetative states. In 20 patients followed for 16 weeks the scale identified 25% who ultimately showed modest improvement. Interrater reliability was high (r = .95); validity was supported by significant correlations between CNC- and brain-multimodality evoked potential abnormality scores as well as between scores on the CNC and the Disability Rating Scale. The CNC scale was easily learned and it could be completed quickly and cost effectively. Staff found it useful in recognizing among relatively homogeneous low-level patients those most likely to respond to further rehabilitation care. The CNC appears to be useful for justifying ongoing intensive rehabilitation and for preventing premature transfer to lower levels of care.

Effects of stimulus intensity on posterior tibial nerve somatosensory evoked potentials

Relationships between stimulus intensity and peak latencies and amplitudes in posterior tibial nerve somatosensory evoked potential patterns were evaluated in ten healthy subjects. Eight intermediate latency peaks between 30 and 125 milliseconds (ms) after stimulus onset and seven amplitudes were analyzed. In general, there was a decrease in latency with each increase in stimulus intensity over a five step intensity range between 5 and 19 milliamps (mA) for most peaks. Similarly, increases in amplitudes generally occurred with increases in stimulus intensity for most peaks. Later peaks N105 and P115 as well as amplitudes P90-N105 and N105-P115 were least sensitive to stimulus intensity changes. The greatest changes in peak latency and amplitude occurred as stimulus intensity was increased from 7 to 11 mA. Beyond 11 mA relatively little change was observed in either peak latencies or amplitudes. Under anesthesia, by contrast, there was no stimulus intensity-peak latency interaction and beyond 11 mA there were decreases in amplitudes. Possible reasons for these findings are discussed.

Effects of anesthesia and stimulus intensity on posterior tibial nerve somatosensory evoked potentials

Under anesthesia peak latencies occurring up to 75 milliseconds after stimulus onset upon somatosensory evoked potential testing of the somatosensory evoked potential testing of the posterior tibial nerve were not affected by stimulus intensity (between 5 and 19 ma) or by length of time under isoflurane and nitrous oxide up to over 2 hours. When pre- and postoperative tests on patients who were not under anesthesia were compared with results under anesthesia, no significant latency differences were found in relation to stimulus intensity for peaks N30, P40 and N50. For peaks P60 and N75, however, significantly increased latencies were seen during anesthesia, more pronounced and consistent for N75. Amplitudes, however, were affected by both stimulus intensity and anesthesia duration. A curvilinear relationship was found during early anesthesia. Maximum amplitudes were found at 7 or 11 ma stimulus intensity levels, depending upon which peak was analyzed, with lesser amplitudes occurring at both lower and higher stimulus intensity levels. Stimulus intensity and anesthesia interacted such that maximum amplitude occurred, in general, at 11 ma after short duration anesthesia (6') and at 7 ma after long duration anesthesia (125'). Under long duration anesthesia amplitudes were significantly diminished, mostly at the 11 ma intensity level. At 15 and 19 ma intensity levels peak amplitudes remained relatively constant regardless of anesthesia duration and therefore are the intensities to use to monitor changes during prolonged surgeries. When preoperative during prolonged surgeries. When preoperative and postoperative tests were compared to tests under anesthesia, there was a decrease in amplitude under anesthesia, greater for long than short duration anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Dermatomal somatosensory evoked potentials in brachial plexus injuries

The dermatomally stimulated somatosensory evoked potential is an essentially painless, noninvasive procedure that can add useful information to the diagnosis of the site and extent of brachial plexus injuries. In this study, 13 patients with unilateral brachial plexus injuries who had previously undergone conventional electromyographic testing underwent somatosensory evoked potential recording with median, ulnar, radial, musculocutaneous nerve and C5, C6, C7, C8 and T1 dermatomal stimulation. There was no significant difference in the peak latencies, interpeak latencies, or amplitudes of the major peaks between the normal values and the values from the affected levels. However, analysis for absence or presence of major peaks from side-to-side was useful in supporting the data from electromyographic and radiologic studies, as well as in providing more specific information as to the level of injury and extent of injury in two of the cases. The accurate diagnosis can provide the information needed to determine patient treatment as well as plan the rehabilitation program of the patient. The dermatomal somatosensory evoked potential can be a useful supplement to the assessment of the patient with a brachial plexus injury.

Short and long latency auditory evoked potentials in traumatic brain injury patients

Short latency auditory nerve and brainstem evoked responses (BAERs) and long latency cortical auditory evoked responses (CAERs) in 75 long-term traumatic brain injury (TBI) cases were compared. CAERs were found to be significantly correlated with clinical disability as measured by the Disability Rating Scale, while BAERs were not. Also, BAER patterns were consistently and significantly less abnormal and less sensitive to overall dysfunction than CAER patterns. Findings support previous observations that BAERs have relatively little utility for evaluating in surviving TBI patients the degree of overall brain impairment. In general, long latency AEP patterns are better able to reflect the extent and severity of brain dysfunction and overall clinical condition than are short latency AEP patterns in long-term severe TBI patients, and these patterns should be obtained routinely in the evaluation of such patients.

Passive P300 response in traumatic brain injury patients

Severe traumatic brain injury (TBI) patients in a vegetative state were exposed to passive P300 (PP300) evoked potential tests under two conditions: two auditory tones (unimodality condition), and a flash and auditory tone (bimodality condition). A third non-P300 condition using a single repetitive auditory tone was also presented. Patients produced PP300 responses under all three conditions, even though the severity of their clinical condition did not allow them to respond to even simple commands. No peak latency differences were found. PP300 amplitude was significantly larger under the bimodality stimulus condition than either the unimodality or non-P300 condition. The PP300 amplitude under the unimodality condition, in turn, was larger than the P300-like response in the non-P300 condition. This replicates earlier findings with normal subjects. PP300 responses appear to be a tool that might find utility in evaluating TBI patients. Results raise questions about the neuropsychological/neurophysiological nature of the PP300 response.

Intermediate and long latency SEPs in relation to clinical disability in traumatic brain injury patients

Intermediate (0-60 ms) and long latency (0-500 ms) somatosensory evoked potential (SEP) patterns were compared in terms of their relationship to degree of clinical disability in severe traumatic brain injury patients. Long latency (LL) SEP patterns correlated significantly with clinical disability as measured by the Disability Rating scale while intermediate latency (IL) SEP patterns did not. Evoked potential abnormality (EPA) scores based upon LL SEP patterns appear better able to reflect extent and severity of brain dysfunction and overall clinical condition than do IL SEP patterns for severe traumatic brain injury patients.

Cost-effectiveness index (CEI): a tool to help evaluate mental health programs

A method for evaluating the cost-effectiveness of mental health programs is presented. The method takes into account the profile of mental health services a patient receives, the frequency of each service and the relative costs of each service in relation to the change in a patient's clinical condition between entrance into and release from a treatment program. It can also be used to assess change over a specified time period. An example compares the cost-effectiveness index (CEI) for similar cohorts of schizophrenia patients treated in two 24-hour acute care psychiatric systems. The CEI can use either actual dollar costs, if known, or a relative value scale associated with different services. Its utility and weaknesses are discussed. The CEI is designed to alert management to differences in the relative cost-effectiveness of programs serving populations of similar patients. Identification of such differences can contribute to improvement in program functioning.

Effects of stimulus intensity on direct recordings of eighth nerve auditory evoked responses

Effects of auditory stimulus intensity on auditory nerve and brainstem evoked potential patterns recorded simultaneously from the scalp and directly from the eighth nerve were compared for an anesthetized patient undergoing surgery for macrovascular decompression. Replicable robust potentials were readily obtained from a recording electrode on the eighth nerve less than half a second after as few as 15 stimulations. Less robust and less readable evoked potential patterns were obtained from scalp recordings after 30 seconds and about 900 stimulations. It was observed in the direct auditory evoked response (DAER) that there is a systematic decrease in peak latencies with each 10 dB increase in stimulus intensity between 60 and 90 dB nHL. Also, with each 10 dB increase in stimulus intensity there is an increase in amplitude of the DAER action potential between 70 and 90 dB nHL but not between 60 and 70 dB.

Head injury outcome up to ten years later

Head injury outcome was studied in 63 severe traumatic brain-injured (TBI) victims up to ten years after injury. Extent of improvement and residual deficits in physical and mental impairment and mood and frustration tolerance changes are reported. The impact of these changes upon ability to work and to establish living situations is presented. It was found that long-term outcome is related significantly both to elapsed time between injury and admission to an intensive rehabilitation hospital program and to level of disability at admission. Major problems and needs at follow-up are reported. Thirteen demographic and clinical profile parameters are suggested to permit meaningful comparisons of long-term outcome among different groups of TBI victims.

Financing and home health agencies

Home health agencies are examined with reference to changes that have occurred in their financing as a result of DRGs. Comparisons are made based on organizational affiliation and findings indicate agencies that become affiliated with larger and more complex organizations are more frequently proprietary agencies. In other ways, however, nonprofit and proprietary agencies are becoming more similar. Both types of agencies are increasingly interested in reducing reliance on government funding.

Somatosensory evoked responses to dermatomal stimulation in cervical spinal cord injured and normal subjects

This exploratory study investigates dermatomal evoked potential patterns in the upper extremities of normal and spinal cord injured subjects. Fifteen normal subjects without neurologic deficits and twelve patients with partial or complete spinal cord injuries were tested at dermatomal levels C5, C6, C7, C8, and T1, and also at median and ulnar nerve sites. Responses were recorded at the scalp. Analyses of evoked response patterns included measurement and comparison of peak and interpeak latencies and amplitudes as well as blind ratings of the degree of abnormality of evoked potential waveforms. Analyses were also made of relationships between evoked potential data and neurological findings on clinical examination. There appeared to be a fairly consistent SEP response among normals when dermatomes C6 through C8 are stimulated. Less consistent responses are observed when C5 and T1 are stimulated. In general, spinal cord injured subjects as compared to normal subjects had evoked responses with less consistent peaks, more amplitude diminution, and greater diffuseness and overall pattern abnormality even at dermatomal levels that were intact on clinical neurologic examination. There was also a distinct progression of overall SEP abnormality in dermatomes with impaired vibration, light touch, and position sense. There were no consistent differences in interpeak latencies between SEPs of normal and spinal cord injured subjects at intact dermatomes, but there were significant differences in EP abnormalities (EPA scores). Possible reasons for the differences in the SEP responses between normals and spinal cord injured subjects include spinal cord injury not detectable by clinical exam. Difficulty in obtaining objective and accurate sensory reports also contributes to data unreliability. In conclusion, we believe that stimulation of specific sensory dermatomes merits further study, as it has a number of possible clinical uses. These include: (1) surgical monitoring at more specific levels than monitoring with mixed nerve root stimulation, (2) for study of specific nerve root injury, and (3) as an aid in examining the neurological status in acutely injured spinal cord patients who are unable to cooperate adequately during examination, such as the very young or those with lowered levels of awareness associated with head injury. Additional information which could be useful to obtain is cervical dermatomal stimulation with spinal recording sites.

Neuropsychiatric assessment of a spinal cord injury patient with sudden recovery

Reported here is the case of a 23-year-old man who, presenting as a spinal cord injury patient with paraplegic and bilateral sensory impairments in the legs, made a rather dramatic recovery after receiving a trivial jolt while moving about in his wheelchair. In addition to clinical findings, both hypnotic and somatosensory evoked potential test results were used to help determine whether there was or was not actual spinal cord injury and whether there was or was not a psychologic overlay involving either malingering or a conversion disorder. In this case, evidence pointed to malingering in the presence of a minor spinal cord injury documented by somatosensory evoked potential patterns.

The novel anticonvulsant MK-801: a potent and specific ligand of the brain phencyclidine/sigma-receptor

MK-801 (5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine maleate) is a novel anticonvulsant agent reported to antagonize certain N-methyl-D-aspartate (NMDA)-mediated effects non-competitively. The question arises of the mechanism underlying the anti-NMDA and anticonvulsant effects of MK-801. In the present study MK-801 is shown to be an extremely potent inhibitor of the binding of N-[3H] (1-[2-thienyl]cyclohexyl)piperidine ([3H]TCP) to brain phencyclidine (PCP)/sigma-receptors. Its IC50 value of 3.8 +/- 0.8 nM in this assay ranks it as the most potent known ligand of brain PCP/sigma-receptors. Addition of MK-801 altered the apparent Kd but not the apparent Bmax values for [3H]TCP binding, indicating a competitive interaction. The specificity of action of MK-801 is supported by the finding that MK-801 strongly inhibited the binding of (+)-N-[3H]allylnormetazocine ((+)-[3H]SKF 10,047) to the PCP/sigma-receptor but its effect on (+)-[3H]SKF 10,047 binding to the non-PCP, haloperidol-sensitive sigma-binding site was weaker by several orders of magnitude. Furthermore, MK-801 exerts PCP-like antagonistic effects upon NMDA-induced [3H]norepinephrine release. These findings support the concept that the anticonvulsant and anti-NMDA effects of MK-801 result from its being the most potent known ligand of PCP/sigma-receptors.

A method for comparing two systems of acute 24-hour psychiatric care

A quasi-experimental method was developed to evaluate the cost-effectiveness of a public system of 24-hour acute psychiatric care in Santa Clara County, California, before and after a new treatment setting was introduced. The original system relied on a 54-bed psychiatric unit in a county general hospital; the new system consisted of a 20-bed unit in the general hospital plus a 45-bed nonhospital psychiatric health facility. The study demonstrated that the per diem cost of the psychiatric health facility was approximately 60 percent that of the original general hospital unit, but the average difference in cost per episode between the two systems was only about +25, primarily due to longer lengths of stay in the new system. In addition, patients treated in the new, combined system appeared sicker at discharge than those treated in the old system. The findings suggest the importance of simultaneously evaluating both cost and treatment effectiveness to make sure that one element does not dominate program direction at the expense of the other.