Modulus-dependent macrophage adhesion and behavior.

Macrophage attachment and activation to implanted materials is crucial in determining the extent of acute and chronic inflammation, and biomaterials degradation. In an effort to improve implant performance, considerable attention has centered on altering material surface chemistry to modulate macrophage behavior. In this work, the influence of the modulus of a material on the behavior of model macrophages (i.e., human promonocytic THP-1 cells) was investigated. We synthesized interpenetrating polymer network (IPN) coatings with varying moduli to test the hypothesis that lower moduli surfaces attenuate THP-1 cell attachment and activation. The surface chemistry and moduli of the IPN coatings were characterized using X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM), respectively. THP-1 cells preferentially attached to stiffer coatings of identical surface chemistry, confirming that fewer macrophages attach to lower moduli surfaces. The secretion of human TNF-alpha, IL-10, IL-8 and IL-1beta from THP-1 cells attached to the IPNs was measured to assess the concentration of both pro- and anti-inflammatory cytokines. The global amount of TNF-alpha released did not vary for IPN surfaces of different moduli; however, the amount of the pro-inflammatory cytokine IL-8 released demonstrated a biphasic response, where lower (approx. 1.4 kPa) and very high (approx. 348 kPa) moduli IPN surfaces attenuated IL-8 secretion. The different trends for TNF-alpha and IL-8 secretion highlight the complexity of the wound healing response, suggesting that there may not be a unique surface chemistry and substratum modulus combination that minimizes the pro-inflammatory cytokines produced by activated macrophages.

Sandpiles with bistable automata rules: towards a minimal model of pedestal formation and structure.

A sandpile with two stable and two unstable ranges of slopes is presented as a minimal model for the study of H-mode pedestal formation and dynamics. Pedestals are observed to form and expand inward with increasing deposition. Transport bifurcation is not critical to pedestal formation, though the pedestal structure obtained with a second, hard stability boundary is qualitatively different from that found in standard sandpiles. Nonperiodic particle ejection events are observed, but do not initiate pedestal collapse. Pedestal formation alters the spectrum of transport avalanches.

Mitigation of tokamak disruptions using high-pressure gas injection.

High-pressure gas-jet injection of neon and argon is shown to be a simple and robust method to mitigate the deleterious effects of disruptions on the DIII-D tokamak. The gas jet penetrates to the central plasma at its sonic velocity. The deposited species dissipates >95% of the plasma by radiation and substantially reduces mechanical stresses on the vessel caused by poloidal halo currents. The gas-jet species-charge distribution can include >50% fraction neutral species which inhibits runaway electrons. The favorable scaling of this technique to burning fusion plasmas is discussed.

Modified lattice Boltzmann method for compressible fluid simulations.

A modified lattice Boltzmann algorithm is shown to have much better stability to growing temperature perturbations, when compared with the standard lattice Boltzmann algorithm. The damping rates of long-wavelength waves, which determine stability, are derived using a collisional equilibrium distribution function which has the property that the Euler equations are obtained exactly in the limit of zero time step. Using this equilibrium distribution function, we show that our algorithm has inherent positive hyperviscosity and hyperdiffusivity, for very small values of viscosity and thermal diffusivity, which are lacking in the standard algorithm. Short-wavelength modes are shown to be stable for temperatures greater than a lower limit. Results from a computer code are used to compare these algorithms, and to confirm the damping rate predictions made analytically. Finite amplitude sound waves in the simulated fluid steepen, as expected from gas dynamic theory.

Personality disorders in primary care.

Managing patients with personality disorders is an unfortunate, yet inevitable, aspect of the primary care practice. The epidemiology and origin of these disorders are briefly discussed. This article discusses both formal criteria for diagnosis and informal indicators that are clues for the physician to consider these disorders. In addition, relevant clinical cases are presented and reviewed. This article also outlines some practical management strategies to help the physician more effectively and efficiently deal with these troublesome patients.

Serum sickness reaction following multiple insect stings.

BACKGROUND: Anaphylaxis is the most common systemic allergic reaction caused by stinging insects. Serum sickness reactions occur much less frequently. OBJECTIVE: To determine the level of venom-specific IgG and IgE antibodies during and after a serum sickness reaction to vespid venom. METHODS: Case report; ELISA determination of venom-specific IgG and IgE; complement levels and tests for immune complexes were performed. RESULTS: We report the case of a 66-year-old woman who developed a serum sickness reaction nine days after receiving multiple vespid stings. She developed urticaria, angioedema, fever, and arthralgias. She had elevated IgG and IgE venom-specific titers which declined during the recovery phase. Complement levels were normal and tests for immune complexes were negative. She was successfully treated with venom-specific immunotherapy without any serum sickness reaction. CONCLUSIONS: A serum sickness reaction with elevated venom-specific IgG and IgE is reported with successful immunotherapy.

Suicide: the interaction of clinical and ethical issues.

Although bioethical principles such as beneficence, nonmaleficence, and autonomy increasingly guide clinical decision making, in good clinical practice none of these principles is absolute. The authors describe how clinical and ethical issues interact in prioritizing principles in the treatment of suicidal patients. For the acutely suicidal patient, beneficence must be given primacy, as it should for the chronically suicidal patient who is unable to control self-destructive impulses. However, some chronically suicidal patients may be capable of resisting these impulses, and in such situations, respecting patients' autonomy facilitates clinical work and prevents the therapist from being drawn into a role that encourages regression. The successful management of the suicidal patient illustrates the need for dynamic, rather than rigid, application of ethical principles.

The East York Health Needs Study. I: Prevalence of DSM-III-R psychiatric disorder in a sample of Canadian women.

BACKGROUND: This study reports the prevalence of psychiatric disorder in women from a Canadian community. The GHQ and the CES-D were compared for their utility. METHOD: A thousand women over the age of 18 were mailed the GHQ and the CES-D. Our return rate was 44.4%; 24% were personally interviewed by interviews blind to screening information. The CIDI was used to establish DSM-III-R diagnoses. Four versions of the GHQ and one version of the CES-D were calibrated against the CIDI. RESULTS: The prevalence of general psychiatric disorder was estimated as between 15% and 19%, anxiety disorders between 10% and 13%, and depression occurring with anxiety between 3% and 4%. The calibrated GHQ was the most reliable instrument. CONCLUSIONS: Prevalence of DSM-III-R psychiatric disorder can be reliably determined with the calibrated GHQ. Anxiety disorders are most prevalent in this community, and were best detected using calibrated versions of the longer form GHQ.

New uses of countertransference for the inpatient treatment of borderline personality disorder.

The author describes the uses of countertransference for the inpatient treatment of borderline personality disorder. Differences from usage in the dyadic outpatient situation are noted. In particular, the countertransference induced in staff may provide a crucial signal function reflecting the patient-ward system. Understanding these feelings provides information not only about the patient's inner world but also about general system features such as the staff's needs, therapeutic capacity and unresolved feelings from previous borderline patients. The signal function may also have diagnostic and treatment implications. A conceptualization of countertransference that encompasses the unique system aspects of inpatient psychiatry is helpful in the care of borderline patients.

The use of contracts in the inpatient treatment of the borderline personality disorder.

This paper reviews and describes the clinical, administrative, and psychodynamic aspects of the use of contracts. The particular focus is on how the characteristic difficulties which borderline personality disorder patients encounter on inpatient services are helped by contracting. The use of contracts facilitates the therapeutic alliance, and aids in the avoidance of excessive regression and acting out. The improved stabilization of the patient permits a more constructive use of transference and countertransference, and facilitates a clearer examination of Axis I diagnosis and the use of medication. The contracting process can be a useful addition to the inpatient treatment of borderline personality disorder patients.

Private practice of periodontics. Past patterns, future prospects.

The private practice of periodontics has grown in a comparatively short time from a handful of clinicians to a significant factor in the overall practice of dentists. Periodontics has matured into a specialty that interfaces with every aspect of dentistry. Patient awareness demands it service. With the changes taking place in the health delivery system, there has emerged insurance and capitation programs that have influenced the private practice of periodontics. Along with these changes have come economic factors that have encouraged many periodontists to seek new avenues of revenue such as implantology. The dental awareness of the public and the continuance of the high standards of periodontics will prevail. If this is the case, then the future prospects of the private practice of periodontics is ensured.

The price of better diagnostic accuracy in suspected appendicitis in Jerusalem.

We studied changes in diagnostic accuracy and in perforation rates in cases of suspected appendicitis at two major Jerusalem hospitals. In females, a major improvement in accuracy was observed over the past decade which was not accompanied by higher perforation rates. In males, on the other hand, the reduction in the rate of negative appendectomies was accomplished at the expense of a large increase in perforations. At the end of the decade of observation, diagnostic accuracy in males was still far better than for females, but the perforation rate in males had become worse than the rate for females. We conclude from our work and that of others that at high baseline negative appendectomy rates much improvement is possible without causing higher perforation rates, whereas at relatively low negative appendectomy rates, further decreases will, perforce, cause more perforations, a poor trade-off in the opinion of most investigators.

The inpatient treatment of the borderline personality disorder: a critical review and discussion of aftercare implications.

The literature on inpatient treatment of adult borderline personality disorder is reviewed. The controversy regarding the use or avoidance of the regression which can accompany hospitalization is discussed. It is suggested that this literature is not specific enough. There is insufficient attention to definition of terms, clinical heterogeneity and the longitudinal course of the illness. As well, the ahistoric approach to the hospitalization of these patients serves to reinforce characteristic ego deficits. Recommendations regarding the use of long or short-term length of hospital stay are not substantiated by formal research. It is suggested that greater emphasis be placed on aftercare issues. The stabilization of the patient, outpatient therapist, and aftercare system are described as important goals of inhospital care.

Assessment, Commitment and motivation in marital therapy.

The importance of a discrete assessment phase in the treatment of people with martial problems is emphasized. The consequence of such phase in terms of clarification of treatment selection and engagement is discussed. Examples are presented which demonstrate the importance of attending to the factors of commitment to the marriage and motivation and capacity to work in therapy. Attention to these issues facilitates proper treatment planning designed to best suit the couple's specific therapeutic needs.