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BACKGROUND: To treat stenosed coronary arteries, percutaneous transluminal coronary angioplasty (PTCA) balloon catheters must combine pushability, trackability, crossability, and rewrap behavior. The existing anatomic track model (ASTM F2394) for catheter testing lacks 3D morphology, vessel tortuosity, and compliance, making evaluating performance characteristics difficult. This study aimed to develop a three-dimensional patient-specific phantom (3DPSP) for device testing and safe training for interventional cardiologists. METHODS: A range of silicone materials with different shore hardnesses (00-30-45 A) and wall thicknesses (0.5 mm, 1 mm, 2 mm) were tested to determine compliance for creating coronary vessel phantoms. Compliance was assessed using optical coherence tomography (OCT) and compared to values in the literature. Stenosis was induced using multilayer casting and brushing methods, with gypsum added for calcification. The radial tensile properties of the samples were investigated, and the relationship between Young's modulus and compliance was determined. Various methods have been introduced to approximate the friction between silicone and real coronary vessel walls. Computerized tomography (CT) scans were used to obtain patient-specific anatomy from the femoral artery to the coronary arteries. Artery lumens were segmented from the CT scans to create dissolvable 3D-printed core models. RESULTS: A 15A shore hardness silicone yielded an experimental compliance of 12.3-22.4 m m 2 mmHg · 10 3 for stenosed tubes and 14.7-57.9 m m 2 mmHg · 10 3 for uniform tubes, aligning closely with the literature data (6.28-40.88 m m 2 mmHg · 10 3 ). The Young's modulus ranged from 43.2 to 75.5 kPa and 56.6-67.9 kPa for the uniform and calcified materials, respectively. The dependency of the compliance on the wall thickness, Young's modulus, and inner diameter could be shown. Introducing a lubricant reduced the silicone friction coefficient from 0.52 to 0.13. The 3DPSP was successfully fabricated, and comparative analyses were conducted among eight commercially available catheters. CONCLUSION: This study presents a novel method for crafting 3DPSPs with realistic mechanical and frictional properties. The proposed approach enables the creation of comprehensive and anatomically precise setups spanning the right femoral artery to the coronary arteries, highlighting the importance of such realistic environments for advancing medical device development and fostering safe training conditions.

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We present the design and characterization of a cladding-pumped amplifier with erbium doping located in an annular region near the core. This erbium-doped fiber is proposed to reduce gain saturation, leading to smaller gain compression when compared to uniform core doping. Through numerical simulations, we first compare the performance of three fibers with different erbium doping profiles in the core or the cladding. When the doped fibers are operated at the optimum length, results show that the smaller overlap of the signal mode field with the annular erbium doping region leads to higher gain and lower saturation of the amplifier. A single-core erbium-doped fiber with an annular doping and a D-shaped cladding was fabricated. Measurements demonstrate less than 4 dB of gain compression over the C-band for input power ranging from -40 dBm to 3 dBm. Small gain compression EDFAs are of interest for applications that require input channel reconfiguration. Higher gain and saturation output power are also key issues in cladding-pumped multi-core amplifiers.

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The first realization of a wavelength-selective switch (WSS) with direct integration of few mode fibers (FMF) is fully described. The free-space optics FMF-WSS dynamically steers spectral information-bearing beams containing three spatial modes from an input port to one of nine output ports using a phase spatial light modulator. Sources of mode dependent losses (MDL) are identified, analytically analyzed and experimentally confirmed on account of different modal sensitivities to fiber coupling in imperfect imaging and at spectral channel edges due to mode clipping. These performance impacting effects can be reduced by adhering to provided design guidelines, which scale in support of higher spatial mode counts. The effect on data transmission of cascaded passband filtering and MDL build-up is experimentally investigated in detail.

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We present experimental results for combined mode-multiplexed and wavelength multiplexed transmission over conventional graded-index multimode fibers. We use mode-selective photonic lanterns as mode couplers to precisely excite a subset of the modes of the multimode fiber and additionally to compensate for the differential group delay between the excited modes. Spatial mode filters are added to suppress undesired higher order modes. We transmit 30-Gbaud QPSK signals over 60 WDM channels, 3 spatial modes, and 2 polarizations, reaching a distance of 310 km based on a 44.3 km long span. We also report about transmission experiments over 6 spatial modes for a 17-km single-span experiment. The results indicate that multimode fibers support scalable mode-division multiplexing approaches, where modes can be added over time if desired. Also the results indicate that mode-multiplexed transmission distance over 300 km are possible in conventional multimode fibers.

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We demonstrate nonlinearity compensation of 37.5-GHz-spaced 128-Gb/s PDM-QPSK signals using dispersion-folded digital-backward-propagation and a spectrally-sliced receiver that simultaneously receives three WDM signals, showing mitigation of intra-channel and inter-channel nonlinear effects in a 2560-km dispersion-managed TWRS-fiber link. Intra-channel and adjacent inter-channel nonlinear compensation gains when WDM channels are fully populated in the C-band are estimated based on the GN-model.

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OBJECTIVES: BAHA implants have been shown to be effective in certain forms of conductive hearing loss, but the presence of the titanium abutment is responsible for sometimes severe skin reactions. The objective of this study was to compare two operative techniques: skin flap, and full-thickness skin graft. MATERIAL AND METHODS: Between January 2004 and January 2011, 72 patients were treated by BAHA implant and 32 of these patients (total of 41 implants) were included in the study. Two surgical techniques were used: full-thickness skin graft (n=21) and skin flap (n=20). RESULTS: Four types of skin complications were observed: necrosis, inflammation/infection, hypertrophic scar, and fixture loss due to inadequate osseointegration. Complications requiring surgical revision were observed in 20% of cases with the skin flap method and 38% of cases with the skin graft technique, with no significant difference between the two groups (P=0.31). CONCLUSION: The skin graft technique appears to be associated with a higher rate of major complications. The most common complication is hypertrophic scar. The apparently high complication rate in this series can be explained by a selection bias (exclusion of a large number of complication-free patients).

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INTRODUCTION: Spontaneous intracranial hypotension (SIH) is a rare pathology caused by unexplained and variably localized leakage of cerebrospinal fluid (CSF). The prime symptom is orthostatic headache, although other less specific clinical signs may predominate, and mislead diagnosis. CASE REPORT: A 47-year-old man presented with Ménière-like symptoms of sudden onset. Secondary orthostatic headache led to the performance of cerebral MRI, which found signs suggestive of intracranial hypotension. A blood-patch was immediately carried out, and was followed by consciousness disorder associated with onset of bilateral subdural hematoma, which required iterative neurosurgical drainage. Myelo-CT confirmed CSF leakage facing the right 12th dorsal nerve root sheath. Radio-guided sealing with biologic glue provided complete regression of all symptoms. DISCUSSION/CONCLUSION: Auditory signs may predominate in the clinical presentation of SIH. Their orthostatic character is suggestive. The present case is of a rare severe form. The role of neurosurgery in such cases remains to be defined.

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We demonstrate high-fidelity optical arbitrary waveform generation with 5 GHz waveform switching via time-domain multiplexing. Compact, integrated waveform shapers based on silica arrayed-waveguide grating pairs with 10 GHz channel spacing are used to shape (line-by-line) two different waveforms from the output of a 10-mode x 10 GHz optical frequency comb generator. Characterization of the time multiplexer's complex transfer function (amplitude and phase) by frequency-resolved optical gating permits compensation of its impact on the switched waveforms and matching of the measured and target waveforms to better than G'=5%.

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We describe the precise shaping and mode-resolved amplitude and phase characterization of optical arbitrary waveforms by using a 20 GHz optical frequency comb and integrated 64 x 20 GHz channel arrayed waveguide grating pair. Complex waveforms with large variations in phase and amplitude between adjacent modes were generated and characterized.

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A stable optical frequency comb with 20-GHz spacing is shaped by a compact integrated silica arrayed waveguide grating (AWG) pair to produce optical waveforms with unprecedented fidelity. Complete characterization of both the intensity and phase of the crafted optical fields is accomplished with cross-correlation frequency resolved optical gating (XFROG) which has been optimized for periodic waveforms with resolvable modes. A new method is proposed to quantify, in a single number, the quality of the match in both the amplitude and phase between the measured optical waveform and the target waveform.

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OBJECTIVE: To assess the prevalence of undiagnosed diabetes and glucose intolerance in individuals > or =40 years of age who contacted their family physician for routine care. RESEARCH DESIGN AND METHODS: The study used a stratified randomized selection of family physicians across Canada that was proportional to provincial and urban/rural populations based on Statistics Canada Census data (1996). Consecutive patients > or =40 years of age were screened for diabetes. If a casual fingerprick blood glucose was >5.5 mmol/l, the patient returned for a fasting venous blood glucose test. If the fasting blood glucose was 6.1-6.9 mmol/l, a 2-h 75-g post-glucose load venous blood glucose was obtained. Results of these tests were used to classify patients in diagnostic categories. RESULTS: Data were available for 9,042 patients. Previously undiagnosed diabetes was discovered in 2.2% of the patients, and new glucose intolerance was found in an additional 3.5% of patients. Overall, 16.4% of patients had previously known diabetes. The decrease in fasting plasma glucose criterion from 7.8 to 7.0 mmol/l resulted in a 2.2% versus a 1.6% prevalence of new diabetes. Several risk factors were reported in a significantly greater proportion of patients with new glucose intolerance and either new and known diabetes compared with the normal glucose tolerance group of patients. CONCLUSIONS: Routine screening for diabetes by family physicians is justified in patients > or =40 years of age, given the finding of previously undiagnosed diabetes in 2.2% of these patients and newly diagnosed glucose intolerance in an additional 3.5% of these patients. Another 16.4% of primary care patients > or =40 years of age have known diabetes. This has important implications regarding health resources and physician education.

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PURPOSE: To determine whether visual acuity (VA) measurements performed at low levels of contrast and glare are a better diagnostic tool for determining whether corneal clouding warrants surgery. METHODS: Fifty-nine subjects were recruited from among the candidates for corneal graft. Monocular VA was measured with three Regan contrast VA charts: 96, 25, and 11%, with and without glare provided by the Brightness Acuity Tester (BAT). The discriminative ability of the tests was estimated using the area (AR) under receiver operating characteristic (ROC) curves. Associations between the different VA tests and the Visual Function Index (VF-14) score were studied, using Spearman coefficients. RESULTS: When comparing candidate eyes with contralateral eyes with corneal disease, lower contrasts VA tests provided greater discriminative power. VA measurements made with glare also tended to provide greater discrimination. In fact, discrimination was best with 11% contrast VA with glare, but "testability" was poor. The most practical test in a clinical setting, which retained high discriminative ability (0.798), was the 25% contrast VA with glare. The eye with the best VA correlated strongly with the VF-14, especially at 25% contrast without glare, resulting in an Rs of -0.729. CONCLUSION: Twenty-five percent contrast VA with BAT could help the practitioner to decide whether a corneal transplant is warranted when symptoms of reduced vision are more important than what high-contrast VA might indicate.

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The influence of the intestinal microflora on mucin types was studied in the small intestine, caecum and colon of conventional (CV) rats as compared to germ-free (GF) rats. A colorimetric method was used on purified water-soluble mucin extracted from mucosal scrapings and contents. Variations occurred between the three anatomical sites both in the mucosas and intestinal contents of GF rats. In CV rats, the presence of the bacterial flora led to different effects depending on the intestinal site: in the small intestinal mucosa, neutral and sulphomucins values were higher whereas sialomucin was much lower. Conversely, sialomucin was higher in the caecal and colonic mucosas and contents whereas sulphated mucins were decreased significantly in caecal contents and caecal and colonic mucosas. These variations in the contents may reflect the bacterial mucolytic activity and the effect of bacterial metabolites on the mucosa.

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PURPOSE: To validate the Visual Function-14 (VF-14) index of functional visual impairment in candidates for a corneal graft. METHODS: One hundred thirty-four patients who were candidates for a corneal graft participated in this study between August 1996 and February 1997. Demographic, ocular history, best-corrected visual acuity, and detailed ocular examination data were collected. Functional visual impairment information was obtained by telephone interviews using the following: VF-14, SF-36 (Short Form-36, a more generic measure of general health function), and Visual Symptom Score, and four questions measuring the overall amount of trouble with vision, dissatisfaction with vision, ocular pain, and discomfort. RESULTS: The average age of corneal graft candidates was 64 +/- 18 years (range, 18 to 90 years) and 60% were women. The most frequent corneal disease was pseudophakic bullous keratopathy (41%). Ocular comorbidities included glaucoma or ocular hypertension (30%) and cataract (19%). The mean best-corrected visual acuity of the eye scheduled for surgery was 1.33 +/- 0.56 logMAR whereas the best eye best-corrected visual acuity was 0.36 +/- 0.44 logMAR. The mean VF-14 score was 73% +/- 26%, and the internal consistency was high, with a Cronbach alpha value of 0.94. The VF-14 correlated strongly with the best eye best-corrected visual acuity. It also correlated strongly with the Visual Symptom Score, the global measures of trouble and dissatisfaction with vision. Candidates for a corneal graft had low scores for all eight general health concepts evaluated with the SF-36, and the VF-14 correlated with seven of the eight SF-36 subscales. CONCLUSION: The VF-14 is a valid measure of functional visual impairment in candidates for a corneal graft. The Visual Symptom Score and the SF-36 are also useful indices in such patients.

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We have constructed a two-dimensional refracted-ray scanner that can resolve index-of-refraction increments of approximately 4 x 10(-5). This resolution is an order of magnitude finer than the uncertainty of the measurement. The scanner can be adapted to evaluate either fibers or planar waveguides. The two-dimensional scan and the high precision allow visualization of features, such as deposition layers, that are difficult if not impossible to see in conventional one-dimensional scans.

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Mucins, which are synthesized throughout the gastrointestinal tract, may be degraded by the microflora of the large intestine. The present study was undertaken to determine the differential fate of the various types of mucins. Mucins from germ-free rats were incubated in vitro in the presence of whole caecal flora from the conventional rat. Neutral, acidic and acidic sulphated mucins were spectrophotometrically assayed over time upon anaerobic incubation. Sialylated mucins were more rapidly degraded (90%) than the other two types after 1 h and almost completely within 4 h. Neutral and acidic sulphated mucins, with a 10-fold and 30-fold lower content than the sialylated fraction in the original substrate, were more slowly degraded and to a lesser extent within 4 h, (55 and 40%, respectively). The method used in the present study made it possible to investigate the activity of gut bacteria towards the various types of mucins. The degradation of the three mucin types was not uniform, the highest rate and extent of degradation being observed for sialylated mucins.

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Variations of power errors in the periphery of concave aspheric lenses were assessed as a function of vertex distance. Comparisons were made between the performance of different types of spherical lenses and that of aspheric lenses (-6.00 and -8.00 D lenses were used). Off-axis measurements were made by means of a modified focimeter, which enabled rotation of the lens around the center of the vertex sphere. Reduction of the vertex sphere's radius from 27 to 23 mm simulated a 4-mm decrease in vertex distance. Results of the measurements are compared with a computed model. These results indicate that off-axis performance is more affected by a reduction of vertex distance in the case of aspheric lenses compared to spherical lenses. Resulting increases in oblique astigmatism (OA) and mean oblique error (MOE) are at the limit of clinical acceptance. The importance, for the practitioner, of respecting the vertex distance selected for a specific aspheric design when fitting this type of lens is emphasized.

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UNLABELLED: Advocacy in the mental health services field is gaining importance since the traditional role of mental health hospitals is changing, particularly in North America and in Western Europe. This review will define advocacy, its goals and fundamental principles. It will then delineate the skills and strategies needed for any intervention on behalf of a patient or a group of patients. It will also deal with the issues and approaches most frequently raised and used, and finally, with the limits of advocacy. METHOD: The method used for this review was mainly a recension of the literature concerning advocacy throughout North America and Europe, having in view to see emerging the principal stakes and concerns related to this process. RESULTS: Advocacy has a significant impact on patients' awareness of their rights and their capacity to exercise them. It also prevents potential abuse of patients. On the other hand, some patients have an increased opportunity to cease treatment, and this could lead to serious medical consequences. There is also the possibility of retaliation from staff, as a result of being involved with an advocate. The combination of high quality care and effective advocacy is the best guarantee that a mental health patient will get the care he wants and needs with human dignity.

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A 34-year-old pregnant woman developed a myelodysplastic syndrome during pregnancy which resulted in a refractory anaemia and an extreme thrombocytopenia. The report describes the anaesthetic management of elective caesarean section and successful childbirth in this patient. Following replacement therapy with packed red cells and platelets, general anaesthesia was used for the procedure.