[Personnel assessment in psychiatry and psychotherapy : Results of a feasibility study on the platform model]. / Personalbemessung in der Psychiatrie und Psychotherapie : Ergebnisse einer Machbarkeitsstudie zum Plattform-Modell.

The topic of personnel assessment in psychiatry, psychotherapy and psychosomatics is currently of great importance in terms of health policy. Sufficient empirical evidence for the development of a comprehensive system for staffing is not yet available. The platform model developed by the psychiatric psychosomatic societies and associations pursues a combined empirical normative approach for a future-oriented assessment instrument for the various professional groups. The concept presented has been proven in the health policy discussion as a sensible system of comprehensive personnel assessment; however, an empirically sound control is still lacking as to whether this system can be used practically for the task described and thus can withstand the task of a resilient and future-proof measurement instrument for the necessary personnel. The task of the present study was to examine the extent to which the assumptions of the platform model are confirmed, whether methodological indications can be identified and whether there are limitations of the study that can be used in the validation and foundation of the model. The study confirmed the feasibility of the model and refers to a number of methodological findings and limitations that can be used for the further development of the model. The developed model allows the necessary staffing to be derived and justified, regardless of diagnoses and settings. It is future-oriented and dynamic.

Distribution of active forces in the cell cortex.

In this work, we study in detail the distribution of stochastic forces generated by the molecular motors activity, in the actin cortex of pre-muscular cells. By combining active and passive rheology experiments, performed on the same micro-bead bound to the actin network through membrane adhesive receptors, we measure the auto-correlation function Cff(τ) of the average force pulling on the bead. As for any out-of-equilibrium system, the force distribution differs from the thermodynamical equilibrium one, especially at long time scale τ⪆ 1 s where the bead motion becomes partially directed. Thus the fluctuation-dissipation theorem does not apply and one can measure the distance from equilibrium through its violation. We investigate the influence of different parameters on the force distribution, focusing particularly on the role of ligand density: a detailed study shows how the amplitude of active forces increases when the bead is more tightly attached to the cortex. We introduce and study a model, which takes into account the number of bonds between the bead and the cytoskeleton, as well as the viscoelastic properties of the medium. This model faithfully accounts for the experimental observations. Also, it is shown that the amplitude of active forces increases with temperature. Finally, our data confirm that ATP depletion in the cell, or partial inhibition of the actomyosin activity, leads to a decrease of the amplitude of the force distribution. Altogether, we propose a consistent and quantitative description for the motion of a micrometric probe interacting with the actin network, and for the amplitude of the stochastic forces generated by molecular motors in the cortex surrounding this probe.

[Features of regional mandatory psychiatric care in Germany: analysis using the VIPP databank]. / Merkmale einer regionalen Pflichtversorgung in Deutschland: Eine Analyse mithilfe der VIPP-Datenbank.

BACKGROUND: The regional mandatory care is a central element of psychiatric treatment in Germany. Therefore, it is possible to realize care near to the place of residence of psychiatric patients and good contact to the outpatient health system. Up to now the new payment system in psychiatry in Germany does not explicitly include this central factor. AIM: The article investigates which criteria possibly describe psychiatric mandatory care and whether they can be ascertained from routine data. MATERIAL: The results are based on the so-called § 21 records of 47 psychiatric and psychosomatic clinics all of which participated in the German VIPP (healthcare indicators in psychiatry and psychosomatics) project. It is obligatory to send the standardized § 21 record to the Institute for the Hospital Remuneration System (InEK) annually. RESULTS: The study identified two factors which could describe clinics with regional mandatory care. Many patients attend these hospitals outside the core time of Monday to Friday, 8 am to 5 pm and the distance to their place of residence is shorter. This is associated with a higher day-related valuation, the so-called day mix index (DMI). DISCUSSION: Routine data contain information describing regional mandatory psychiatric care. Patients treated in this system show a higher DMI. This means higher proceeds for the hospitals but it is not clear if these proceeds are able to cover the higher costs in clinics with regional mandatory care. Therefore, it is necessary for the InEK to set up a new cost center for all clinics which participate as a so-called calculation site. By posting all structural costs of mandatory care in this cost center it will be possible to compare them with the income of psychiatric clinics in the future.

Experimental evidence of a potentially increased thrombo-embolic disease risk by domestic electromagnetic field exposure.

We have used the EaHy926 endothelial cell line, able to secrete both pro and anti-aggregant platelet agents, as a model for thrombo-embolic diseases. We experimentally established, by comparing these two secretions with or without a Faraday cage, that the environmental electromagnetic field significantly increases the thrombo-embolic risks in this endothelial cell line.

Elasticity of the human red blood cell skeleton.

We have measured by optical tweezers micromanipulations the area expansion and the shear moduli of spectrin skeletons freshly extracted from human red blood cells, in different controlled salinity conditions. At medium osmolarity (150 mOsm/kg), we measure KC=9.7+/-3.4 microN/m, muC=5.7+/-2.3 microN/m, KC/muC=2.1+/-0.7. When decreasing the osmolarity, both KC and muC decrease, while KC/muC is nearly constant and equal to about 2. This result is consistent with the predictions made when modeling the spectrin skeleton by a two-dimensional triangular lattice of springs. From the measured elastic moduli we estimate the persistence length of a spectrin filament: xi approximately 2.5 nm at 150 mOsm/kg.

Direct measurement of the area expansion and shear moduli of the human red blood cell membrane skeleton.

The area expansion and the shear moduli of the free spectrin skeleton, freshly extracted from the membrane of a human red blood cell (RBC), are measured by using optical tweezers micromanipulation. An RBC is trapped by three silica beads bound to its membrane. After extraction, the skeleton is deformed by applying calibrated forces to the beads. The area expansion modulus K(C) and shear modulus mu(C) of the two-dimensional spectrin network are inferred from the deformations measured as functions of the applied stress. In low hypotonic buffer (25 mOsm/kg), one finds K(C) = 4.8 +/- 2.7 microN/m, mu(C) = 2.4 +/- 0.7 microN/m, and K(C)/mu(C) = 1.9 +/- 1.0. In isotonic buffer, one measures higher values for K(C), mu(C), and K(C)/mu(C), partly because the skeleton collapses in a high-ionic-strength environment. Some data concerning the time evolution of the mechanical properties of the skeleton after extraction and the influence of ATP are also reported. In the Discussion, it is shown that the measured values are consistent with estimates deduced from experiments carried out on the intact membrane and agree with theoretical and numerical predictions concerning two-dimensional networks of entropic springs.

Children's emotional and behavioral disorders: attributions of parental responsibility by professionals.

In the wake of the neurobiological "revolution," do mental health professionals still assign etiological responsibility for emotional and behavioral disorders to deficient or harmful parenting? This study investigated differences in attributions of causality by theoretical orientation, professional discipline, areas of practice, familiarity with parent support groups, and demographic characteristics. Implications for policy, research, and practice are discussed.

A new determination of the shear modulus of the human erythrocyte membrane using optical tweezers.

Optical tweezers are used to apply calibrated forces to human erythrocytes, via small silica beads bound to their membrane. The shear modulus mu of the membrane is inferred from measurements of the cell deformation in the small strain linear regime. We find the same result mu = 2.5 +/- 0.4 microN/m for both discotic and nearly spherical swollen cells. This value is smaller than the one deduced from micropipettes experiments. However the two methods do not operate in the same deformation regime and are not expected to lead to the same result.

Direct physical factors and PGI2 and TXA2 secretions by a human endothelial cell line: in vitro investigation of pressure and shear stress applied independently or in synergy.

The direct effect of two types of mechanical stress was measured through the prostacyclin (PGI2) and thromboxane A2 (TXA2) secretions by a confluent monolayer of cells from the EA.hy926 line. Eight values of constant pressure were applied in the gas phase above the culture medium, around atmospheric pressure taken as a control (0 mm Hg), from -500 to +760 mm Hg. Three amplitudes of sinewave modulated pressure (+/- 40; +/- 80; +/- 160 mm Hg) were explored at a frequency of 1 Hz. Modulated pressure (+/- 40 mm Hg) was also applied synergetically to a shear stress generated under steady state conditions by a rectilinear laminar motion of the medium. The cells remained adherent and exhibited unchanged morphology and viability. Constant pressure or depressure increased both PGI2 and TXA2 release but to an extent depending on the pressure value. Under pressure, the PGI2/TXA2 ratio was unchanged, but was higher under depressure, compared to the control. Pressure modulation strongly stimulated the secretion of PGI2 but had no effect on TXA2. Modulation strongly increased the PGI2/TXA2 ratio to a similar extent for the three amplitudes. Pressure-shear synergy enhanced secretion of PGI2 markedly more than shear stress alone, but the level reached was similar to the one induced by pressure modulation. No cumulative effect on the secretion of PGI2 was observed, whereas TXA2 synthesis undergoes a more than cumulative effect. The PGI2/TXA2 ratio remained unchanged under shear alone or under combined shear-pressure modulation but was higher with the modulated pressure alone. These results demonstrate that pressure has an outstanding effect on secretion that may be origin to local disturbances of the vascular system, thus inducing pathologies such as thrombosis or atherosclerosis.

Influence of a constant or a modulated pressure on insulin secretion by intact murine islets of Langerhans: existence of a threshold effect.

Pressure effect on cultured islets was investigated to simulate the behavior of the endocrine pancreas when subjected to an anatomical change in its environment. Insulin secretion from islets seeded on glass was determined by radioimmunoassays after 12-h exposure to constant or sine-wave pressure perturbation, at 37 degrees C and pH 7.4, under well-defined conditions applied through the culture medium. A specially devised setup allowed control of the constant component Po, the amplitude A, and the frequency f of the pressure perturbation. Under constant conditions, three Po values (760, 760 + 110, 760 + 250 mm Hg) were explored. Under sine-wave conditions, two frequencies (f = 0.2 and 4.33 Hz) were investigated for Po = 760 + 110 mm Hg and A = 10 mm Hg, as well as three amplitude values (A = +/-10, +/-50, and +/-110 mm Hg) for Po = 760 mm Hg and f = 0.2 Hz. Constant pressure inhibits secretion, by a factor of up to 60%, as well as low frequency (also by approximately 60%). Low amplitudes enhance secretion (by 41 and 31%), whereas a higher amplitude has a marked inhibiting effect (by 70%). In all cases, no linearity was observed, showing the existence of a threshold pressure effect. These results suggest that pressure may be an important parameter in certain forms of endocrine pancreatic dysfunctions.

Vascular endothelial cell responses to different electrically charged poly(vinylidene fluoride) supports under static and oscillating flow conditions.

We investigated the effect of electrically charged surface copolymers on endothelialization of four types of poly(vinylidene fluoride) (PVDF) copolymer surface films with different electrical characteristics. PVDF films without a surface charge, with a remanent surface (5 and 7 microC) and with piezoelectric characteristics were studied through the secretion by an endothelial cell (EC) line culture, under static and oscillating flow conditions of prostacyclin (PGI2) and thromboxane (TXA2), two metabolites which have directly opposing actions on platelet function. The surface electrical properties of PVDF are suitable for promoting cell adhesion. Secretion of thrombomodulatory mediators varied, depending on the surface electrical charge and on the molecular structure of the PVDF substrate. Under static conditions the ECs respond to the substrates by a similar increase of PGI2. Under oscillating flow conditions, the ratio of PGI2 to TXA2 is higher with the piezoelectric PVDF film. The piezoelectricity generated from shear stress along the entire length of the fibres may be appropriate in vivo to keep the [PGI2]/[TXA2] ratio at a level which could counteract the build-up of surface deposits which could be at the origin of thrombosis.

Morphological aspects of endothelial cells cultured in the absence of fetal calf serum under controlled electrical charges applied to the support.

The effect of constant and modulated electrical charges applied through the culture support on endothelial cell (EC) morphology was investigated. Endothelial cells tolerated electrical charges for 48 hours, in a serum-free medium. The EC had normal morphology, except at high stationary charges, for which nucleus and cell size increased. The observed cell divisions and cellular secretions indicated that the cells rapidly adapted to the imposed stresses.

Organic mental disorders (Fo). Results from the ICD-10 field trial of the Diagnostic Criteria for Research in German-speaking countries.

The results of the ICD-10 Diagnostic Criteria for Research (DCR) field trial in German-speaking countries concerning section F0 (organic mental disorders) are reported. On the comparatively small data basis of the study, acceptance and interrater-reliability cannot be estimated satisfactorily. Despite this general problem, it can be said that section F0 of ICD-10 DCR maintains a high degree of continuity with respect to ICD-10. Some categories caused diagnostic disturbances and needed further specification, especially the criteria regarding the temporal relationship between the onset of an organic disorder and the psychiatric symptomatology. The recently published definite DCR seem to avoid most of the problems of the earlier version used in this study.

Improving the Clinical Recognition of Very Mild Dementia Using Multiple Levels of Assessment.

Neuropsychological test batteries alone are often unable to differentiate very mild dementia from both normal aging and mild dementia of the Alzheimer type (DAT). The authors hypothesized that some of the difficulties of neuropsychological tests in the identification of very mild dementia could be overcome by the inclusion of additional levels of assessment (activities of daily living, psychopathology, and subjective complaints). Three groups (very mild dementia, mild-to-moderate DAT, and healthy control subjects) of community-dwelling older persons were assessed on cognitive and noncognitive variables. Results indicated that noncognitive variables improved prediction of group assignment. For accurate identification of all patients with very mild dementia, in addition to neuropsychological variables, subjective complaints of impaired orientation and disturbances of apperception were necessary and sufficient.

["The nursing care case". Costs of nursing treatment]. / "Der Pflegefall". Kosten der Behandlungspflege.

A calculation of the costs for nursing a patient with apallic syndrome in a hospital for chronically ill patients totalled 624.26 DM per day. The calculation was based upon the documented expenditure of material and therapeutic personal and the basic costs of the hospital. The patient was chosen as an example for patients needing constant and expensive care.

Expectations, experiencing and change in psychotherapy.

The relationships of client prognostic expectations and of level of Experiencing in psychotherapy with three variables of therapeutic change were explored in a correlational study that used 26 volunteer Ss who were in treatment with experienced therapists. A positive relationship was found between prognostic expectation and perceived improvement and a negative relationship between Experiencing and perceived improvement. The data also suggested positive relationships between Experiencing and cognitive change and attitude and cognitive change, while they provided no evidence for a relation between expectations and cognitive change.