The need to express and the compulsion to confess: Reik's theory of symptom-formation.

The present article offers a close reading of Reik's theory of symptom-formation. Drawing on two-person aspects of Freud's work, Reik argues that human beings have a basic need to express ourselves to others. The child's expressions develop as compromises between the urge to express and the internalized responses of caregivers to expressions, which are consolidated into the superego. When others repeatedly reject the child's expressions, the child comes to reject its own expressions through repression. Repressed expressions return as composites of the need to express and the internalized prohibitions against expression. These composites emerge as unconscious confessions in which the patient both communicates repressed material and punishes herself for doing so. Reik proposes that neurotic symptoms comprise such unconscious confessions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Plasmablastic morphology--an independent prognostic factor with clinical and laboratory correlates: Eastern Cooperative Oncology Group (ECOG) myeloma trial E9486 report by the ECOG Myeloma Laboratory Group

We studied the prognostic significance of plasmablastic (PB) multiple myeloma (MM) in Eastern Cooperative Oncology Group Phase III trial E9486. Two reviewers independently reviewed 453 cases. They agreed on 37 PB (8.2%) cases and 416 non-PB cases, achieving an 85% concordance (P < .0001). These PB cases had significantly lower hemoglobin and serum albumin levels, higher calcium and beta 2-microglobuin levels, and higher percentage BM plasma cells (PC) by immunofluorescence. They had higher bone marrow PC labeling indices, higher serum soluble interleukin-6 receptor (sIL-6R) levels, and a higher probability of ras mutations. Three treatment regimens were used: vincristine, bis-chloro-ethyl nitrosourea (BCNU) melphalan, cyclophosphamide, and prednisone (VBMCP) alone; VBMCP with added cyclophosphamide (HiCy); or recombinant interferon alpha 2 (rIFNalpha2). Although the numbers are low, patients with PB had a significantly lower response rate versus non-PB MM when treated with VBMCP (treated, 47.1% v nontreated, 66.5% [P = .015]). Patients with nonresponding PB had a significantly higher progression rate than non-PB cases (30.6% v 11.8% [P < .0001]), especially with VBMCP alone (35.3% v 15.8% [P = .002]), and with added HiCy (37.5% v 9.8% [P < .0001]), but not with added rIFNalpha2. Event-free and overall survival of PB MM was shorter (median years, 1.1 v 2.7 and 1.9 v 3.7, respectively [P < .0001 for both]). In multivariate analysis, PB classification was also highly prognostic. There is no survival difference between the patients who were classified as PB by both reviewers versus patients classified as PB by only one reviewer. We conclude that PB MM is a discrete entity associated with more aggressive disease and shortened survival. Tumor cell ras mutations and increased sIL-6R may contribute to a higher proliferation rate and reduced survival. There were significant improvements in response and progression with the addition of HiCy and rIFNalpha2 to VBMCP, but the numbers were small and improved survival could not be shown.     

Lack of effects of recombinant growth hormone on muscle function in patients requiring prolonged mechanical ventilation: a prospective, randomized, controlled study

OBJECTIVE: To evaluate the benefit of recombinant human growth hormone administration on muscle strength and duration of weaning in critically ill patients undergoing prolonged mechanical ventilation. DESIGN: Prospective, randomized, controlled, single-blind study. SETTING: Intensive care unit. Patients: Twenty patients requiring > or = 7 days of mechanical ventilation for acute respiratory failure. INTERVENTION: Random assignment to receive either 0.43 IU (approximately 0.14 mg) recombinant growth hormone/kg body weight/day (treated group), or saline (nontreated group) for 12 days. MEASUREMENTS AND MAIN RESULTS: Nutritional support was guided by indirect calorimetry. Cumulative nitrogen balance was positive throughout the study period in the treated group 17.3 (44.9 +/- 17.3[SEM] g/12 days) vs. the nontreated group (-65.8 +/- 11.8 g/12 days) (p<.0001). Despite similar initial plasma concentrations, recombinant growth hormone supplementation resulted in marked increases in growth hormone, insulin like growth factor-1, and insulin concentrations (p<.05, .02, and .0001, respectively, vs. nontreated group). Body impedance determined net fat-free mass increased in the treated group (0.8 +/- 0.6 kg) vs. the nontreated group (-1.1 +/- O.5 kg) (p<.03). Initial peripheral muscle function, assessed by computer-controlled electrical stimulation of the adductor pollicis, was similarly lower in treated and nontreated groups than sex and age-matched normal controls, and decreased further during the study period. Arterial blood gases, cumulative total mechanical ventilation time, and number of hrs/day of mechanical ventilation during weaning were similar in both patient groups. Only three of the ten patients in each group were weaned from mechanical ventilation by day 12. CONCLUSIONS: Daily administration of recombinant growth hormone in mechanically ventilated patients with acute respiratory failure promotes a marked nitrogen retention. However, this reaction is accompanied neither by an improvement in muscle strength nor by a shorter duration of ventilatory supports.     

Intramolecular excimer formation and energy migration in head-to-head polystyrene

Head-to-head polystyrene (HH-PS), in which the phenyl rings are separated by either two or four carbon atoms, displays predominantly fluorescence from monomeric units. No excimer emission is observable even when the polymer is dissolved in increasingly thermodynamically poorer solvents. This is strongly suggestive that excimer formation in normal head-to-tail polystyrene (HT-PS) occurs primarily between nearest-neighbouring chromophores. Intramolecular energy migration is shown to be negligible in both fluid and solid solutions of HH-PS. This is in direct contrast to the case with HT-PS in fluid solutions in which an energy migration coefficient of 7.5 × 10^?5 cm²s^?1 and an energy migration frequency of 4.1 × 10¹¹s^?1 were determined.     

Ethical issues facing school psychologists working with families.

Explores the place of assessment and interventions with families in terms of the psychologist's role and school policy. As school psychologists increase family involvement, there is a need to examine potential ethical issues. Ethical concerns related to school psychologists working with families are considered in relation to the American Psychological Association Ethical Principles of Psychologists (1981). Topics discussed include responsibility and welfare of the consumer, competence, confidentiality, intrafamilial issues, extrafamilial or privileged information, research with human participants, and stereotypes and values. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Applying virtual reality in medical communication education: current findings and potential teaching and learning benefits of immersive virtual patients

The purpose of this paper is, first, to summarize a theoretical perspective toward the development of a virtual reality innovation in education. Next, we will describe a virtual character project that is impacting the training of medical students in two institutions. In doing so, we will present a summary of three studies completed over the last 2 years, highlighting specific results from the research. Finally, we conclude with a discussion of the impact of these findings on the development and implementation of virtual reality systems for teaching and learning. It is our hope that through providing this study of a virtual reality scenario—experienced by over 100 end-users—from an educational concepts perspective will help others aiming to apply virtual reality to education.     

Full-Scale Field Testing of Colloidal Silica Grouting for Mitigation of Liquefaction Risk

This paper reports results of a full-scale field test to assess the performance of dilute colloidal silica stabilizer in reducing the settlement of liquefiable soil. Slow injection methods were used to treat a 2-m-thick layer of liquefiable sand. Eight injection wells were installed around the perimeter of the 9-m-diameter test area and 8% by weight colloidal silica grout was slowly injected into the upper 2?m of a 10-m-thick layer of liquefiable sand. A central extraction well was used during grout injection to direct the flow of the colloidal silica towards the center of the test area. Details of the field injection are described. Subsequently, the injection wells were used to install explosive charges and liquefaction was induced by blasting. After blasting, approximately 0.3?m of settlement occurred versus 0.5?m of settlement in a nearby untreated area. The mechanism of improvement is thought to be bonding between the colloidal silica and the individual sand particles; the colloidal silica gel encapsulates the soil structure and maintains it during dynamic loading.     

Effects of Particle Size on Soft Lithography Process,the Green and Sintered Micro Alumina Parts

Alumina micro parts were fabricated using powders in particle sizes of 1 μm, 2.0 μm, and 12.0 μm. The effects of particle size on soft lithography process, green bodies, and sintered characteristics were investigated, including process parameters affecting homogeneous and smooth surface. The effects of particle size were analyzed through suspensions, green, and sintered properties. It was found that the stability of suspensions, sintered density, Vickers micro hardness, surface roughness and edges resolution are significantly improved with the decrease in particle size. On the other hand, suspension viscosity, green density and shrinkage are degraded with the use of finer particles.