Emotionally focused family therapy for bulimia: Changing attachment patterns.

This article provides an overview of an emotionally focused family therapy intervention for bulimic adolescents referred to an outpatient hospital clinic. The article attempts to integrate theory, practice, and preliminary research results. Bulimia is viewed from the theoretical perspective of attachment theory as described by Bowlby (1969). The emotionally focused approach to creating more secure attachment in families is described, outcome on a small number of adolescents is noted, and the implications of these theoretical and empirical points are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of heart failure on muscle capillary geometry: implications for 02 exchange

There is strong evidence that chronic heart chronic heart failure (CHF) impairs skeletal muscle function independent of blood flow and bulk O2 delivery. Purpose: This investigation sought to determine whether alterations in muscle capillary geometry and surface area that are thought to be primary determinants of the efficacy for blood-tissue 02 exchange might be altered in CHF and contribute to these changes. Methods: Plantaris (fast twitch) and soleus (slow twitch) muscles from control (C) and 6- to 7-wk post myocardial infarcted (CHF) rates were perfusion-fixed in situ. These muscles were analyzed using morphometric techniques that facilitated determination of muscle sarcomere length fiber cross-sectional area, capillary tortuosity and branching coefficient (c(K,0)), capillary length, volume, and surface area. Results: Normalized to a sarcomere length of 2.1 microns, plantaris fiber cross-sectional area decreased by 21% (P < 0.05), and capillary-to-fiber ratio decreased from 2.05 +2- 0.07 in C to 1.79 +2- 0.04 (P < 0.05) in CHF, but these variables were unchanged in soleus. These was no change in c(K,0) or capillary diameter in either muscle, and thus capillary length and surface area per fiber volume remained unchanged. From the measured fiber atrophy and capillary involution in plantaris reductions of total muscle capillary length, volume, and surface area of 11%, 9% and 17%, respectively, are estimated. Conclusion: These changes, coupled with reduced blood flow may impair the effective matching of muscle fiber 02 delivery to 02 requirement during repeated muscle contractions (i.e. exercise). The scenario is expected to reduce intramyocyte 02 partial pressure and thereby contribute to the greater fatigability characteristic of the CHF condition.     

Postinjury multiple organ failure: a bimodal phenomenon

To better define the epidemiology of postinjury multiple organ failure (MOF), we prospectively evaluated 457 high-risk trauma patients who survived more than 48 hours. Overall, 70 (15%) developed MOF. In 27 (39%) patients, the occurrence was early, while in 43 (61%) patients the presentation was delayed. At presentation, early MOF had more cardiac dysfunction, while late MOF had greater hepatic failure. Indices of shock were more critical risk factors for early MOF, while advanced age was more important for late MOF. While early and late MOF had a similar high incidence of major infections, these appeared to be more important in precipitating late MOF. Finally, while mortality is similar, early MOF patients appear to succumb faster. In conclusion, postinjury MOF remains a significant challenge and appears to present in at least two patterns (i.e., early versus late). Better understanding of the relative roles of the dysfunctional inflammation and infections in early MOF versus late MOF may facilitate the development of new strategies for the prevention and treatment of morbid syndrome.     

On the heat transfer from a permeable sphere in stokes flow

The heat transfer from a permeable sphere in a uniform, low Reynolds number flow is examined. In our analysis we consider the case when conduction is the dominant heat transfer mechanism in the exterior fluid, i.e. small Péclet number, and the case when convection is dominant, i.e. large Péclet number. Thermal boundary conditions at the surface of the permeable sphere are discussed. At small Péclet numbers the heat transfer rate from a permeable sphere is found to differ at leading-order from that found for an impermeable sphere, whereas, for large Péclet numbers permeability has only a weak or second-order effect on the heat transfer rate.     

Accomodation of external disturbances in linear regulator and servomechanism problems

Modern linear regulator and servomechanism theories (of the deterministic type) either ignore system disturbances altogether or assume they can be represented by initial conditions on the plant state vector. Controllers designed by such theories may fail to meet performance specifications when the system is subjected to persistently acting disturbances. In this paper, we show how one can modify existing regulator and servomechanism theories to take into account the presence of persistent fluctuating disturbances. By this means one can design a deterministic controller which consistently maintains set-point regulation, or servotracking, in the face of a bread class of realistic external disturbances. In addition, we show how one can systematically exploit any useful effects that may be present in the action of external disturbances.