The Impact of the Sibling in Clinical Practice: Transference and Countertransference Dynamics.

For many years, the impact of sibling relationships on psychological development has been neglected in the literature, overshadowed by the role of the parent-child relationship. As a result, attention to sibling dynamics and sibling transference as valuable information for case formulation and treatment interventions has not been used to its maximum potential. The authors demonstrate how deliberate consideration of sibling dynamics as well as the transferences and countertransferences associated with those dynamics can facilitate treatment. Several important sibling dynamics are discussed, including siblings' influences on identity development; sibling rivalry, jealousy, envy, guilt, and resentment; and sibling attachment. The impact of sibling dynamics on adult love relationships is discussed, as are potential effects of sibling abuse and sibling bereavement. Examples of how these dynamics can manifest themselves in transference and countertransference reactions and suggestions for working with those dynamics are illustrated with clinical examples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Memory-a new era of fast dynamic RAMs [for video applications]

Innovative circuit designs intended to bring inexpensive dynamic memories up to speed are discussed. The features of video DRAMs, the high-data-rate application that spurred the development of application-specific DRAMs that utilize wide on-chip buses, are described. Several new chips use the wide data buses within DRAMs to advantage; on most of them 1024 to 4096 memory locations may be accessed in parallel. Examples are cache DRAMs, enhanced DRAMs, synchronous DRAMs, and Rambus DRAMs, all described in this report     

Evidence for cooperation between TCR V region and junctional sequences in determining a dominant cytotoxic T lymphocyte response to herpes simplex virus glycoprotein B

TCR repertoire availability has the potential to influence the immune response to foreign antigens. Here we have analysed how changes in V region availability influence the H-2b-restricted cytotoxic T lymphocyte (CTL) response to a dominant peptide determinant derived from the herpes simplex virus glycoprotein B (gB). We have previously shown that C57BL/6 mice mount a gB-specific, Kb-restricted CTL response which is dominated by a TCRBV10+ population and a TCRBV8S1+ subpopulation, both containing highly conserved CDR3 elements. We find that this dominant gB-specific CTL pool is lost in C57/L mice which have a different TCRBV haplotype. A population of CTL with diverse TCRBV and junctional sequence usage, which otherwise represents a minor subset in the gB-specific response, appears to emerge as a consequence of this TCRBV gene variation. The loss of preferential V region-encoded complementarity determining regions (CDR) 1- and/or CDR2-ligand interactions in this emerging population also results in a change in CDR3 sequence usage and a corresponding focusing of an otherwise promiscuous pattern of cross-reactivity with a panel of gB498-505 substitution analogues. This suggests that the difference between the two distinct TCR populations is the relative contributions of the CDR towards ligand recognition. Therefore, preferential V region-ligand interaction, at the expense of CDR3 peptide recognition, appears to control the dominant TCR selection in the C57BL/6 response to this peptide determinant.     

Aging, dementia and care: setting limits on the allocation of health care resources to the aged

This article explores the ethical dimensions behind care of the elderly and considers whether younger people should be given priority over the aged in the provision of health care resources. It is argued that age is a relevant consideration in decisions concerning the allocation of health care. The notions of a 'natural life span' and a 'tolerable death' are discussed and on this basis I conclude that while the interests and claims of the elderly must be protected, the use of unlimited resources in the pursuit of life extending measures cannot be justified. When traditional ethical principles are applied to care of the aged they have to be viewed in a modified fashion. The nature of dementia is such that integrity in caregiving has to take account of the patient's premorbid self. I argue that the morally appropriate response to demented patients excludes acute-care, life-extending medicine, but neither does it advocate active euthanasia. The aim is to find a middle ground between treating the demented too aggressively and failing to give them sufficient treatment.     

Randomized study of prophylactic platelet transfusion threshold during induction therapy for adult acute leukemia: 10,000/microL versus 20,000/microL

PURPOSE: We designed and conducted a randomized single-institution trial comparing two common prophylactic platelet transfusion thresholds in patients undergoing induction therapy for acute leukemia. PATIENTS AND METHODS: Seventy-eight patients undergoing induction therapy for acute leukemia were randomized to receive prophylactic apheresis platelet concentrates when the platelet count was either < or = 10,000/microL or < or = 20,000/microL. RESULTS: There was no significant difference in the total number of bleeding episodes per patient with a median of four in the < or = 10,000/microL arm and two in the < or = 20,000/microL arm (25th to 75th percentiles of 2, 7 and 1, 5, respectively; P = .12). Patients randomized to the < or = 10,000/microL arm received more platelet transfusions for bleeding [one (0, 2) v zero (0, 0); P = .0003]. In contrast, patients on the < or = 20,000/microL arm received more platelet transfusions for prophylactic indications [10 (5, 14) v six (3, 8); P = 0.001], as would be expected, but less for bleeding. Nevertheless, the total number of platelet transfusions given to patients on the < or = 20,000/microL arm was higher and nearly significant [11 (6, 15) v seven (5, 11); P = .07]. There were no statistically significant differences between the groups with regard to RBC transfusion requirements, febrile days, days hospitalized, days thrombocytopenic, need for HLA-matched platelets, remission rate, or death during induction chemotherapy. No patient in either group died from hemorrhage or underwent major surgery for bleeding complications. CONCLUSION: Giving prophylactic platelets at a threshold of < or = 10,000/microL compared with < or = 20,000/microL can decrease the total utilization of platelets with only a small adverse effect on bleeding, and no statistically significant effect on morbidity.     

Mutation of the htrB gene in a virulent Salmonella typhimurium strain by intergeneric transduction: strain construction and phenotypic characterization

The htrB gene product of Haemophilus influenzae contributes to the toxicity of the lipooligosaccharide. The htrB gene encodes a 2-keto-3-deoxyoctulosonic acid-dependent acyltransferase which is responsible for myristic acid substitutions at the hydroxy moiety of lipid A beta-hydroxymyristic acid. Mass spectroscopic analysis has demonstrated that lipid A from an H. influenzae htrB mutant is predominantly tetraacyl and similar in structure to lipid IV(A), which has been shown to be nontoxic in animal models. We sought to construct a Salmonella typhimurium htrB mutant in order to investigate the contribution of htrB to virulence in a well-defined murine typhoid model of animal pathogenesis. To this end, an r- m+ galE mutS recD strain of S. typhimurium was constructed (MGS-7) and used in inter- and intrastrain transduction experiments with both coliphage P1 and Salmonella phage P22. The Escherichia coli htrB gene containing a mini-Tn10 insertion was transduced from E. coli MLK217 into S. typhimurium MGS-7 via phage P1 and subsequently via phage P22 into the virulent Salmonella strain SL1344. All S. typhimurium transductants showed phenotypes similar to those described for the E. coli htrB mutant. Mass spectrometric analysis of the crude lipid A fraction from the lipopolysaccharide of the S. typhimurium htrB mutant strain showed that for the dominant hexaacyl form, a lauric acid moiety was lost at one position on the lipid A and a palmitic acid moiety was added at another position; for the less abundant heptaacyl species, the lauric acid was replaced with palmitoleic acid.     

A comparison of the trap properties and locations within GaAs fieldeffect transistors measured under different bias conditions

The activation energy and capture cross section of traps found in GaAs field effect transistors (GaAs FETs) have been measured with both ohmic channel and current saturation bias using a variety of transient, frequency dispersion, and noise spectroscopy techniques. With current saturation bias these effects have been seen in both the transconductance and the output conductance. The results for all methods and bias conditions are compared with those found by others. The relative sensitivity of the techniques and the location of the traps are discussed     

Local refinement of three-dimensional finite element meshes

Mesh refinement is an important tool for editing finite element meshes in order to increase the accuracy of the solution. Refinement is performed in an iterative procedure in which a solution is found, error estimates are calculated, and elements in regions of high error are refined. This process is repeated until the desired accuracy is obtained.Much research has been done on mesh refinement. Research has been focused on two-dimensional meshes and three-dimensional tetrahedral meshes ([1] Ning et al. (1993) Finite Elements in Analysis and Design, 13, 299–318; [2] Rivara, M. (1991) Journal of Computational and Applied Mathematics 36, 79–89; [3] Kallinderis; Vijayar (1993) AIAA Journal,31, 8, 1440–1447; [4] Finite Element Meshes in Analysis and Design,20, 47–70). Some research has been done on three-dimensional hexahedral meshes ([5] Schneiders; Debye (1995) Proceedings IMA Workshop on Modelling, Mesh Generation and Adaptive Numerical Methods for Partial Differential Equations). However, little if any research has been conducted on a refinement algorithm that is general enough to be used with a mesh composed of any three-dimensional element (hexahedra, wedges, pyramids, and/or retrahedra) or any combination of three-dimensional elements (for example, a mesh composed of part hexahedra and part wedges). This paper presents an algorithm for refinement of three-dimensional finite element meshes that is general enough to refine a mesh composed of any combination of the standard three-dimensional element types.