Electric pulse heating device for the analysis of solid/solid phase transformations.

Ohmic pulse heating is applied to investigate diffusion and interface controlled solid-state phase transformations. The developed device uses extensive solid-state electronics providing a high current, low voltage approach that overcomes the limitations of existing setups, most notably the use of sample geometries that allow for the reliable measurement of local temperatures and their assignment to microstructures. Power for heating is supplied by a capacitor array with adjustable voltage, and the process is controlled by microcontrollers and a solid-state relay, which allows for controlled pulses that are adjustable in microseconds. Electric currents of up to 22 kA at 90 V can be realized by the setup. Electric data are monitored and collected during the experiments, and temperature data are captured using a high-resolution infrared camera at high frame rates (1200 fps). The capabilities of the setup are demonstrated by rapid heating (106 K/s) and subsequent cooling of a brass sample. Two distinct areas of the sample are analyzed in detail, showing similar heating, but different cooling curves with rates of 104 and 102 K/s. Local microstructure analysis shows that different phase transformation mechanisms were dominant, and thus, the setup fulfills its purpose.

Results of 115 Rubis II reverse thumb carpometacarpal joint prostheses with a mean follow-up of 10 years.

The aim of this study was to assess the clinical and radiological results of the Rubis II thumb carpometacarpal joint reverse prosthesis, at a mean follow-up of 10 years. Between 1997 and 2008, 253 prostheses were implanted in 199 patients; 115 were reviewed. The survival after a mean of 10 years was 89%. At the last follow-up, 70% of prostheses were painless; the others reported moderate or intermittent pain. The satisfaction rate was 98%. The mean opposition was 9 on the Kapandji scale; the mean QuickDASH score was 30. Wrist, key and tip pinch strengths were comparable with the non-operated side. Of the 115 implants, one was radiologically loose (1%) and 15 had suffered dislocations (13%), 12 of which were caused by an injury. Eleven thumbs had revision surgery. This study confirms that the good clinical results of the Rubis II prosthesis are maintained in the medium and long term, and represents a useful alternative to trapeziectomy for selected patients. LEVEL OF EVIDENCE: IV.

[Recruitment for general practice - relationship between practice-based curriculum and career choice]. / Gewinnung hausärztlichen Nachwuchses - Zusammenhang zwischen praxisorientierter Lehre und Karriereentscheidung.

BACKGROUND: Demographic change and recruitment problems in general practice are increasingly threatening an adequate primary care workforce in many countries. Medical schools play an important role in attracting young physicians to this field. The influence of the general practice curriculum on the career choice of graduates has not yet been sufficiently investigated. METHODS: The present study combines continuously collected data of medical students concerning the participation in miscellaneous general practice courses with data of a later graduate survey. RESULTS: Response rate was 64.2%. Although only 4.7% of the participants preferred a career in general practice at study entry, this specialty was, at 12.3%, the second most frequent career choice. Among the future general practitioners, only 18.5% had initially planned this career. The future general practitioners took part significantly more frequently in all facultative general practice courses. They reported more frequently to have met role models in general practice and to have gained experience in rural areas. Future general practitioners would more often prefer to work in rural areas in the future. CONCLUSIONS: Overall, the present results indicate that a broad and practice-oriented general practice curriculum has the potential to attract medical students to the specialty.

The association between changes in household firearm ownership and rates of suicide in the United States, 1981-2002.

OBJECTIVE: To explore whether recent declines in household firearm prevalence in the United States were associated with changes in rates of suicide for men, women, and children. METHODS: This time series study compares changes in suicide rates to changes in household firearm prevalence, 1981-2002. Multivariate analyses adjust for age, unemployment, per capita alcohol consumption, and poverty. Regional fixed effects controlled for cross sectional, time invariant differences among the four census regions. Standard errors of parameter estimates are adjusted to account for serial autocorrelation of observations over time. RESULTS: Over the 22 year study period household firearm ownership rates declined across all four regions. In multivariate analyses, each 10% decline in household firearm ownership was associated with significant declines in rates of firearm suicide, 4.2% (95% CI 2.3% to 6.1%) and overall suicide, 2.5% (95% CI 1.4% to 3.6%). Changes in non-firearm suicide were not associated with changes in firearm ownership. The magnitude of the association between changes in household firearm ownership and changes in rates of firearm and overall suicide was greatest for children: for each 10% decline in the percentage of households with firearms and children, the rate of firearm suicide among children 0-19 years of age dropped 8.3% (95% CI 6.1% to 10.5%) and the rate of overall suicide dropped 4.1% (2.3% to 5.9%). CONCLUSION: Changes in household firearm ownership over time are associated with significant changes in rates of suicide for men, women, and children. These findings suggest that reducing availability to firearms in the home may save lives, especially among youth.

Insomnia: therapeutic approach.

Insomnia is a common complaint. Transient and short-term insomnias usually result from stress or the use of certain pharmaceuticals or drugs and may be managed by reduced caffeine use, behavioral means, and/or pharmacologic treatment. Long-term insomnia is often a symptom of a medical or psychiatric condition or a primary sleep disorder. A diagnostic workup is expected; treatment should focus on the causative condition, as well as addressing the sleep problem itself. Established medications for the symptomatic treatment of insomnia include benzodiazepines, zolpidem, zaleplon, and certain antidepressant or occasionally antihistaminic drugs.

Delirious mania in the elderly.

Delirious mania is a clinical syndrome in which the signs and symptoms of delirium manifest themselves in the context of a manic episode. Though there have been numerous descriptions and case reports of this syndrome, all have described mania as the presenting feature, with signs of delirium developing subsequently, and none of the vignettes have involved elderly patients. We report two cases of elderly individuals with mania who initially presented as in a delirium. Both of them experienced clear manic episodes, which were confirmed by their psychiatric histories and clinical responses to mood stabilizers. Mania needs to be in the differential diagnosis of elderly people presenting with confusion, disorientation, and perceptual changes, particularly in those with a history of bipolar disorder.

ECT for major depression and mania with advanced dementia.

Two patients with advanced dementia and severe affective disorders were successfully treated with electroconvulsive therapy (ECT) without significant adverse effects. These reports illustrate that ECT can be effective for depression and mania even when complicated by moderate or severe dementia.

Midazolam attenuates ketamine-induced abnormal perception and thought process but not mood changes.

PURPOSE: To determine the effects of midazolam, 30 ngxmL(-1), on altered perception, mood, and cognition induced by ketamine. METHODS: After ketamine was administered to achieve target concentrations of 50, 100, or 150 ngxmL in 11 volunteers, perception, mood, and thought process were assessed by a visual analog scale. Mini-Mental State examination (MMSE) assessed cognition. Boluses of midazolam, 30, 14.5, and 12 microgxkg(-1), were injected every 30 min to maintain the plasma concentration at 30 ngxmL(-1), which was reached 30 min after each injection. RESULTS: Ketamine produced changes in perception about the body (P < 0.01, 0.001, and 0.0001 at 30, 60, and 90 min), surroundings (P < 0.01 and 0.0001 at 60 and 90 min), time (P < 0.002 and 0.0001 at 60 and 90 min), reality (P < 0.001 and 0.0001 at 60 and 90 min), sounds (P < 0.002 at 90 min), and meaning (P < 0.05 at 90 min). Subjects felt less energetic and clearheaded (P < 0.02 and 0.05) during ketamine, midazolam, and their co-administration. Ketamine impaired thought process (P < 0.003 and 0.0001 at 60 and 90 min). Ketamine and midazolam decreased mean total MMSE and recall scores (P < 0.001 for both). Co-administration reduced the number of subjects with perceptual (body, P < 0.01 and 0.001 at 30 and 60 min) and thought process abnormalities. Within the range of observation, co-administration did not affect the changes in mood or recall. CONCLUSION: Midazolam attenuates ketamine-induced changes in perception and thought process.

Hair loss in psychopharmacology.

Medication-induced alopecia is an occasional side effect of many psychopharmaceuticals. Most of the mood stabilizer and antidepressant drugs can lead to this condition. Some antipsychotic and antianxiety agents induce alopecia. Hair loss is also related to hypothyroidism, which can be induced by lithium and other agents. Alopecia might not be reported by some people, but physicians should be aware of this potential problem which may contribute to noncompliance. Lithium causes hair loss in 12-19% of long-term users. Valproic acid and/ or divalproex precipitates alopecia in up to 12% of patients in a dose-dependent relationship. Incidences up to 28% are observed with high valproate concentration exposures. These pharmaceuticals also can change hair color and structure. The occurrence of carbamazepine-induced alopecia is at or below 6%. Hair loss is less common with other mood stabilizers. Tricyclic antidepressants, maprotilene, trazodone, and virtually all the new generation of antidepressants may on rare occasions lead to alopecia. The same applies to haloperidol, olanzepine, risperidone, clonazepam, and buspirone, but not to other neuroleptics, benzodiazepines, or barbiturates, selected antihistamines, and antiparkinsonians. Discontinuation of the medication or dose reduction almost always leads to complete hair regrowth. The therapeutic value of mineral supplements remains unclear.

Electroconvulsive therapy in the acute poststroke period.

A depressed patient was successfully treated with electroconvulsive therapy approximately 7 to 14 days after a cerebellar stroke. This report documents an uncomplicated use of electroconvulsive therapy that was well tolerated and effective in a course of eight treatments in the acute poststroke period.

Psychiatric aspects of parathyroid disease.

Parathyroid diseases can present with psychiatric symptoms and can be recognized through determinations of serum electrolytes, especially the calcium level. Psychiatric evaluations should include a serum calcium concentration test, which is also essential in reassessment of patients poorly responsive to mental illness treatment. A magnesium and a phosphate assay may also be diagnostically helpful. Abnormality of divalent cation levels may provide evidence for consideration of, or ruling out, parathyroid disorders. Determinations of parathyroid hormone are performed if clinically indicated, and if abnormal divalent cation quantifications are confirmed. If parathyroid disease is identified, corrective endocrine therapies may diminish or even cure psychiatric aspects of parathyroid pathology. Failure to recognize a parathyroid disorder leaves an endocrine-induced mental dysfunction without proper treatment.

Prompt differentiation of Addison's disease from anorexia nervosa during weight loss and vomiting.

An 18-year-old white woman had nausea, vomiting, weight loss, and a diagnosis of anorexia nervosa. Copper-colored skin was noted on physical examination, and serum chemistry values were normal. Subsequent fever, disorientation, and confusion led to the discovery of Addison's disease, which responded well to corticosteroid replacement therapy. Addisonian and anorexic patients exhibit clinical similarities, including nausea, vomiting, weight loss, abdominal pain, cold intolerance, hypothermia, and orthostasis. Other commonalities include prolongation of electrocardiographic PR and QT intervals and generalized slowing on electroencephalogram. Important differences include a brown color to the skin in Addison's disease instead of a yellowish color in anorexia. Addisonian patients also display hypocortisolism, hypoglycemia, and hyperkalemia, in contrast to the hypercortisolism, hyperglycemia, and hypokalemia seen in anorexia.

Divalproex: a possible treatment alternative for demented, elderly aggressive patients.

Elderly, demented people often exhibit behavioral dyscontrol. Divalproex appears to be safe and effective in the management of this presentation. Twelve cases treated with divalproex all responded with improved emotional control. Patients became less verbally and physically disruptive and much more socially appropriate. Divalproex was well tolerated in this population with none of the subjects experiencing significant medicinal side effects. This uncontrolled report suggests that divalproex should be considered as a pharmacotherapy for aggressivity in cognitively impaired, elderly people.

Dying, death, and grief. Helping patients and their families through the process.

When a patient has terminal illness and death is imminent, grief is a normal reaction. Primary care physicians can help patients and their families by talking with them about the five stages of grief (denial, anger, bargaining, depression, and acceptance), providing grief counseling and appropriate pharmacotherapy, and being supportive. Grief often manifests with features similar to those of depression, and it is critical for the clinician to distinguish between the two. One distinguishing feature is that self-esteem in the grieving person is usually uncompromised, whereas a depressed person often has decreased self-esteem. Physicians should also watch for signs of mood disorders or abnormal grief. When grief is present more than 2 months after a loss, a diagnosis of major depression should be considered. Dysfunctional grief accompanied by severe depression and suicidal intent generally calls for psychiatric referral, hospitalization, or both.