The MATRIX: A deliberate practice approach for clinical supervision in the public sector

Clinical supervision is an essential component of psychotherapeutic practice. However, the literature suggests that the provision of supervision in the public sector has been declining significantly over the past two decades, suggesting that many health care professionals are receiving neither the guidance nor support needed to deliver safe and effective care. Identifying the distinct challenges of supervision in the public sector and proposing prospective solutions is, therefore, a burning issue. In this article, we introduce a novel analytical framework for clinical supervision-the MATRIX-striving to address the unique demands of psychotherapy in the public sector. Various applications of this framework are thoroughly presented and further exemplified using a case illustration. We conclude by discussing the contribution of MATRIX-aided supervision to the acquisition of expert performance in psychotherapy, while also addressing its limitations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The critical current of disordered superconductors near 0 K

An increasing current through a superconductor can result in a discontinuous increase in the differential resistance at the critical current. This critical current is typically associated either with breaking of Cooper-pairs or with the onset of collective motion of vortices. Here we measure the current-voltage characteristics of superconducting films at low temperatures and high magnetic fields. Using heat-balance considerations we demonstrate that the current-voltage characteristics are well explained by electron overheating enhanced by the thermal decoupling of the electrons from the host phonons. By solving the heat-balance equation we are able to accurately predict the critical currents in a variety of experimental conditions. The heat-balance approach is universal and applies to diverse situations from critical currents to climate change. One disadvantage of the universality of this approach is its insensitivity to the details of the system, which limits our ability to draw conclusions regarding the initial departure from equilibrium.

Sensitivity of the superconducting state in thin films

For more than two decades, there have been reports on an unexpected metallic state separating the established superconducting and insulating phases of thin-film superconductors. To date, no theoretical explanation has been able to fully capture the existence of such a state for the large variety of superconductors exhibiting it. Here, we show that for two very different thin-film superconductors, amorphous indium oxide and a single crystal of 2H-NbSe₂, this metallic state can be eliminated by adequately filtering external radiation. Our results show that the appearance of temperature-independent, metallic-like transport at low temperatures is sufficiently described by the extreme sensitivity of these superconducting films to external perturbations. We relate this sensitivity to the theoretical observation that, in two dimensions, superconductivity is only marginally stable.

Processes in Psychotherapy and the MATRIX: The Case of Projective Identification

The MATRIX is a tool designed to analyze psychoanalytic sessions. It is composed of two axes: focus (patient, therapist, and dyad) and dimension (space, content, and order). The MATRIX was found to be a reliable tool, and valid for identifying the therapist's theoretical inclinations in psychoanalytic-oriented psychotherapy sessions. In the present study, we suggest that the MATRIX can identify different (Kleinian, Bionian, and relational) approaches to projective identification, thus providing therapists and supervisors an easy-to-use tool for monitoring, and better managing, projective identifications during psychoanalytically oriented psychotherapy.

Instability of Insulators near Quantum Phase Transitions

Thin films of amorphous indium oxide undergo a magnetic field driven superconducting to insulator quantum phase transition. In the insulating phase, the current-voltage characteristics show large current discontinuities due to overheating of electrons. We show that the onset voltage for the discontinuities vanishes as we approach the quantum critical point. As a result, the insulating phase becomes unstable with respect to any applied voltage making it, at least experimentally, immeasurable. We emphasize that unlike previous reports of the absence of linear response near quantum phase transitions, in our system, the departure from equilibrium is discontinuous. Because the conditions for these discontinuities are satisfied in most insulators at low temperatures, and due to the decay of all characteristic energy scales near quantum phase transitions, we believe that this instability is general and should occur in various systems while approaching their quantum critical point. Accounting for this instability is crucial for determining the critical behavior of systems near the transition.

The MATRIX, a novel tool exploring dynamic psychotherapy: Preliminary psychometric properties

Most measures in the field of psychodynamic psychotherapy are bound to a specific theory, and usually focus only on patient processes or therapist interventions. The MATRIX is a newly developed research tool that focuses on events within both the patient and the therapist individually, as well as on dyadic events, and provides the simple and meaningful coding of content for therapy session transcripts in psychotherapy. The present study describes the inter-rater reliability and construct validity of the MATRIX. Reliability of the MATRIX was assessed by applying it to 805 fragments of psychodynamic-oriented psychotherapy sessions. Three independent experts coded fragments, and the tool was examined for reliability. Validity in identifying the theoretical inclinations was assessed by applying the MATRIX to 30 segments (containing 1309 fragments) of sessions that reflect different theoretical orientations. Findings evinced high inter-rater reliability for all dimensions. The MATRIX was found to have high degree of validity for differentiating the theoretical inclinations of segments of sessions. The MATRIX is a reliable and valid measure that may enable moment-to-moment, quantitative, analysis of psychodynamic psychotherapy.

Nonequilibrium Second-Order Phase Transition in a Cooper-Pair Insulator

In certain disordered superconductors, upon increasing the magnetic field, superconductivity terminates with a direct transition into an insulating phase. This phase is comprised of localized Cooper pairs and is termed a Cooper-pair insulator. The current-voltage characteristics measured in this insulating phase are highly nonlinear and, at low temperatures, exhibit abrupt current jumps. Increasing the temperature diminishes the jumps until the current-voltage characteristics become continuous. We show that a direct correspondence exists between our system and systems that undergo an equilibrium, second-order, phase transition. We illustrate this correspondence by comparing our results to the van der Waals equation of state for the liquid-gas mixture. We use the similarities to identify a critical point where an out of equilibrium second-order-like phase transition occurs in our system. Approaching the critical point, we find a power-law behavior with critical exponents that characterizes the transition.

Enhancing the use of institutional ethics committees in mental health care in Israel

Institutional ethics committees were established and functioned in Israel prior to the application of the Patients Rights Act of 1996. These committees were voluntary and comprised of multidisciplinary teams in order to obtain numerous viewpoints stemming from various different fields. This intent was based on an understanding that the issue of ethics and the process of making ethical decisions inherently address moral and social considerations which are beyond the realm of medical practice. In contrast to the voluntary institutional ethics committees, the Patients Rights Act of 1996 instituted statutory ethics committees. These committees were mandated to investigate defined areas and, in contrast to the former committees that were considered to be valuable as advisory and enlightening entities, their decisions are binding. However, it appears that the utilization of these ethics committees within the domain of mental health facilities is limited in scope and their use varies greatly between institutions. The employment of these committees in mental health institutions focuses mainly around issues that relate to information management and mentally ill patients' refusal of medical treatment. Several explanations exist for this phenomenon. Suggestions as to how the situation may be remedied are addressed as well as the complementary role that these ethics committees may play in modern day clinical practice.

Voting rights for psychiatric patients: compromise of the integrity of elections, or empowerment and integration into the community?

BACKGROUND

Participation of the mentally-ill in elections promotes integration into the community. In many countries, individuals with compromised mental incompetence who have legal guardians are denied the right to vote. In Israel, mental health consumers are eligible to vote. We evaluated the capacity of psychiatric inpatients with and without legal guardians to understand the nature and effect of voting.

METHODS

Fifty-six inpatients with/without legal guardians were recruited to the study. Participants completed the Competency AssessmentTool for Voting (CAT-V), Brief Psychiatric Rating Scale and the Mini-Mental State Exam.

RESULTS

Cluster analysis determined voting capacity using CAT-V as a continuous variable. Subjects who scored >1.6 on the CAT-V (59%) had high capacity to vote. Subjects without guardians revealed significantly higher capacity to vote. Voting capacity positively correlated with cognitive state and negatively correlated with severity of illness. Among patients with legal guardians those who scored >1.6 on the CAT-V maintained the capacity to vote.

CONCLUSIONS

The right to vote is an important basic right for individuals coping with mental disorders.However, it is important to evaluate the capacity to understand the voting process among individuals with mental disorders who have legal guardians. Thus, the integrity of the elections would be preserved by eliminating the risk of undue influence or manipulation of individuals who lack the capacity to understand the nature and meaning of voting, while preserving the right to vote for those with the capacity to do so, whether or not they have guardians.

Culturally sensitive mental health care: a study of contemporary psychiatric treatment for ultra-orthodox Jews in Israel

BACKGROUND

The literature describes psychiatric treatment of ultra-orthodox Jews as complex and challenging, in light of this community's unique characteristics and the ideological gap between ultra-orthodox patients and secular professionals. Recent data indicate that patient-centred culturally sensitive care contributes to the treatment outcomes among cultural minorities.

AIMS

To examine the effect of the level of a physician's religiosity and cultural sensitivity, as perceived by ultra-orthodox Jewish psychiatric patients, as well as the treatment venue (i.e. the distance of the treatment facility from the patients' community) on treatment outcomes (working alliance, medical adherence and the patients' social adaptation).

METHODS

The sample included 38 ultra-orthodox Jewish men and women receiving psychiatric treatment at the Lev Hasharon Mental Health Centre. The participants completed questionnaires about the physician's religiousness and cultural sensitivity, working alliance, medical adherence and social adaptation.

RESULTS

Working alliance was positively related to the treatment location, meaning that patients were more committed and involved in the treatment when it took place in a facility distanced from their community. Working alliance was also correlated with medical adherence. Regression analysis revealed that the doctor's acquaintance with religion and cultural sensitivity predicted patients' reported social adaptation level.

CONCLUSIONS

In contrary to common perceptions, ultra-orthodox patients are not necessarily reluctant to be treated by secular physicians. These patients prefer a discreet treatment far from their community's public eye. Their perception of a doctor who acknowledges and respects their religiosity positively affects the way that they perceive their social functioning. Culturally sensitive treatment enables patients to feel respected and acknowledged through their sociocultural affiliation, and not only through their disorder. It seems essential to train physicians about the importance of culturally sensitive treatment with this population.

Internalization of stigma and self-esteem as it affects the capacity for intimacy among patients with schizophrenia

The study examines the relationship between internalization of stigma, self-esteem, and the ability of people diagnosed with schizophrenia to form intimate attachments with loved ones. The study included sixty patients with schizophrenia, ages 18-60, men and women. After providing informed consent, all participants completed four questionnaires: Demographics Questionnaire, Self-Esteem Scale, Internalized Stigma of Mental Illness Scale and the Intimacy Attitude Scale-Revised. Internalization of social stigma was found to be a statistically significant core factor that affects self-esteem and the ability to create intimacy among patients with schizophrenia. There was statistically significantly less internalization of stigma of mental illness among hospitalized patients than among individuals with schizophrenia who live in the community.

A multicenter, add-on randomized controlled trial of low-dose d-serine for negative and cognitive symptoms of schizophrenia

BACKGROUND

Observations that antagonists of the N-methyl-d-aspartate (NMDA) receptor of glutamatergic neurons can mimic symptoms of schizophrenia have raised the hope that NMDA agonists can improve symptoms. On the basis of encouraging results of trials in which NMDA agonists were added to antipsychotics, we conducted an adequately powered randomized controlled trial adding d-serine, an NMDA modulator, to antipsychotics.

METHOD

This study was a 195-patient, multicenter, double-blind, randomized, placebo-controlled, 16-week trial of d-serine 2 g/d as an add-on treatment to antipsychotics. Subjects had DSM-IV schizophrenia or schizoaffective disorder and were inpatients or outpatients stabilized on antipsychotics, with persistent negative symptoms. The primary outcome measures were changes in negative symptoms and cognition as measured by the Scale for the Assessment of Negative Symptoms (SANS) and the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) battery, respectively. The study was performed between 2003 and 2007.

RESULTS

Mean total Positive and Negative Syndrome Scale scores at baseline were 75.5. Subjects receiving d-serine and placebo improved in scores on the SANS and MATRICS, but no significant differences were observed between groups: improvement on SANS was 11.4% for d-serine vs 14.8% for placebo, F1,147=1.18, P=.32; and improvement on MATRICS was 6.8% for d-serine vs 6.1% for placebo, F1,125=0.96, P=.39, respectively. d-Serine was well tolerated.

DISCUSSION

This study did not find a significant difference between drug and placebo. However, the results are limited by a relatively large placebo response and somewhat lower-achieved doses than in prior studies. Future studies will administer higher doses and will attempt to affect the NMDA receptor using other mechanisms, such as agonists of the presynaptic metabotropic glutamate 2/3 receptor or glycine reuptake inhibitors.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT00138775.

Ethical and Scientific Perspectives of Placebo-controlled Trials in Schizophrenia

Clinical trials for development of new medications are essential in all fields of medicine. The requirement for a placebo arm in pharmaceutical trials presents ethical and clinical dilemmas that are especially complicated with regard to mentally ill persons whose free choice and ability to provide informed consent may be questionable. On the other hand, we do not believe that this predicament justifies unconditional rejection of placebo use in psychiatry, when the investigational drug may ultimately provide substantial benefit for some patients. At the same time it is the psychiatrist's responsibility to insure that investigators are adequately trained to conduct clinical trials and that stringent regulatory committees supervise the scientific, clinical and ethical aspects of the trials.

KEYWORDS

Placebo-control; Schizophrenia; Medical ethics; Clinical trials.

Appendectomy in familial Mediterranean fever: clinical, genetic and pathological findings

BACKGROUND

Abdominal attacks of familial Mediterranean fever (FMF) may simulate acute appendicitis and bring about considerable uncertainty. The similar presentation of the two clinical entities often leads to an unnecessary appendectomy.

METHODS

182 consecutive FMF patients were retrospectively reviewed for this study. Clinical and genetic data was compared between those who had undergone an appendectomy (n=71) and those who had not (n=111).

RESULTS

The frequency of appendectomy found in FMF was far above the reported rate in the general population (40% vs. 12-25%). The rate of non-inflamed appendectomies was extremely high (80% vs. 20%) and remained constant over time. Tertiary hospitals and improved therapeutic and diagnostic measures that have evolved over the years did not reduce misdiagnosis of acute appendicitis in FMF. Severe phenotype and homozygosity for M694V were identified as risk factors for appendectomy in FMF. A change from the regular diffuse involvement to right lower quadrant abdominal pain was found to be the best predictor of inflamed appendix in FMF patients undergoing appendectomy for suspected acute appendicitis.

CONCLUSION

Reliance on clinical parameters should improve diagnostic accuracy of acute appendicitis in the FMF patient population.

[Decision-making concerning guardianship--who is the "person that no longer has the capacity to make decisions regarding personal matters"?]

Appointment of a guardian is a complicated and important process, when necessary. It is a paternalistic intervention in the life of an individual, which aims to protect those who require that protection. Appointment of a guardian significantly impedes the rights and autonomy of the individual and should therefore remain a last resort. Alternatively, not appointing a guardian for one who needs protection could potentially expose that person to financial or physical harm, exploitation and neglect. The law allows for appointment of a guardian for a person that no longer has the capacity to make decisions regarding some or all of his/her personal matters. The law and the ruling have not defined who is considered a person that no longer has the capacity to make decisions. The criteria for financial capacity should include whether or not the patient knows the extent of his property, his income, expenses, and demonstrates ability to make logical decisions concerning these issues? The criteria for personal capacity [physical wellbeing] should include whether or not the patient can independently take care of his personal needs and care for himself in terms of: nutrition, housing, clothing, general security, and a safe living environment? We suggest that the expert opinion should specifically relate to the issues of guardianship for physical wellbeing and/or property and should provide the following: 1) Reason: What is the disorder/diagnosis that the patient suffers from? 2) Cognitive impairment: What cognitive impairment results from the patient's illness? 3) Functional impairment: What functional impairments resulting from illness affect the life of the patient?

Dying in the psychiatric ward

General hospital staff is experienced in dealing with the death of a patient. However, aside from cases of sudden death among psychiatric inpatients, psychiatric medical staff faces such situations considerably less frequently. Many chronic psychiatric patients do not have a family or home, a situation which may become even more painful if the patient is dying of a physical illness. Coping with a terminally-ill oncology patient is a difficult task for the multidisciplinary staff and for fellow patients in chronic care psychiatric departments. The authors describe the slow deterioration of two psychiatric inpatients who were also diagnosed with advanced cancer, and present the dilemmas involved with continued treatment of terminal oncology patients in a psychiatric ward when the psychiatric status no longer warranted inpatient psychiatric care.

Israeli psychiatric inpatients go to the polls

In 1996, mobile polls were introduced in Israel, enabling physically and emotionally ill inpatients to vote. We surveyed the rate of participation of inpatients at Lev-Hasharon Mental Health Center in parliamentary elections, their feelings regarding voting, and the nature of their vote, compared with the general population. One hundred eighteen of 306 (38.6%) patients voted compared with 63.8% of the general population. Forty-nine more patients (16%) wanted to vote but were unable to for technical reasons. More patients voted in the open than the closed wards (chi=14.5; df=1; p=.001). Most patients reported positive subjective feelings, a sense of responsibility (39%), belonging to the general community (28%), and pride (22%) after voting. Psychiatric inpatients voted similarly to the general population, though their percentage of voters was significantly lower. This discrepancy can be accounted for by lack of concern and ineligibility due to lack of identification documents that may reflect fundamental illness-related problems.

[Ethical considerations of psychiatric treatment in chronic post traumatic stress following multiple casualty attacks]

Israeli society has been repeatedly exposed to traumatic stress following terrorist attacks with multiple casualties. Individuals who are subjected to these incidents experience various mental reactions, including traumatism, fear, loss and bereavement. Unfortunately, evidence based medical knowledge is lacking regarding natural methods for dealing with incidents that may precipitate traumatic stress, ways of identifying people who are more likely to develop post traumatic symptoms, or suggestions on early interventions that may avert the onset of these symptoms. Ethical problems may arise, especially in situations involving mass traumatic stress, when there are insufficient therapeutic resources. In such cases, the issues of whether to intervene, who to treat, and how, will often be influenced by conflicting personal and social interests. Another concern involves the principle of autonomy - the individual's right to decide whether he/she wants treatment. Should "latent" victims be identified in the community and referred to therapy? Diverse ethical issues emerge in situations of traumatic stress, and may potentially evoke dilemmas among health policy makers and among the therapists who work in the field. This type of discussion may enhance the understanding, help formulate key principles and assist in making reasonable and appropriate decisions when dealing with such difficult and complex situations.

Attitude of general practitioners towards psychiatric consultation in primary care clinic

Fifty general practitioners (GPs) were surveyed about their attitudes towards psychiatric liaison-consultation services. The questionnaire differentiated among GPs' attitudes towards the liason-consultation model and towards the various possible roles of the psychiatrist who visits the GP's practice. These attitudes were analyzed in relation to the level of post-graduate training of the GPs, and to their psychological sensitivity as measured by the PMI scale. GPs with specialist registration certificates in family medicine were more interested in working together with psychiatrists and rated themselves as more sensitive to psychological issues. The largest group (39%) among the GPs thought that the main task of the visiting psychiatrist is to advise them on psycho-social issues, while leaving clinical responsibility in their hands. Less frequent responses included: diagnosis and treatment within the primary care clinic (17%), facilitating referrals (15%), and update teaching of psychiatry (12%). The predominant attitude was consistent with the finding that 96% of the GPs thought that they had good abilities at recognizing patients in distress, and 92% rated their doctor-patient relationship skills as high.

Brain viability and function analyzer: multiparametric real-time monitoring in neurosurgical patients

We have developed the Brain Viability (BVA) and Brain Function (BFA) Analyzers for monitoring the following parameters from the human cerebral cortex cerebral blood flow: (CBF), NADH redox state, Electro corticography (ECoG), brain temperature, extracellular K+, DC potential and intracranial pressure (ICP). The BVA monitors the first 4 parameters only. The Brain viability probe (BVP) and Brain function multiprobe (BFM) were used during 11 operations and in 18 ICU patients, respectively. Preliminary results from the OR showed that 5 patients exhibited a typical increase in CBF in response to changes in end-tidal CO2 without a significant change in the NADH redox state. In 4 other patients no changes in CBF and NADH were observed. Two patients exhibited a "steeling response", i.e., a decrease in CBF and an increase in NADH. In 18 comatose patients monitored in the ICU, the ICP, CBF and ECoG were measured correctly in most patients, whereas NADH and K+ were more problematic. One patient exhibited a typical response, may be due to repeated cortical spreading depression cycles and an ischemic depolarization event. Continuous realtime multiparametric monitoring in neurosurgical patients is feasible and practical in the OR and the ICU. The information provided could be used as a diagnostic tool to guide the procedures or treatment given to the patients.

Increased apoptosis in patients with major depression: A preliminary study

Apoptosis is a programmed cell death that can be observed in normal cells. Major depression poses a combination of a depressed and destructive autoimmune reaction. We measured apoptosis in the PBLs of seven patients with major depression and in age- and sex-matched controls. We observed significantly increased apoptosis in the PBLs of depressive patients (p < 0.05). These preliminary results could contribute to an understanding of the interactions of the CNS with the immune system, which could lead to the increased vulnerability of the CNS in depressive disorders. Further studies are needed to establish these results.

Increased Apoptosis in Patients with Major Depression: A Preliminary Study

Apoptosis is a programmed cell death that can be observed in normal cells. Major depression poses a combination of a depressed and destructive autoimmune reaction. We measured apoptosis in the PBLs of seven patients with major depression and in age- and sex-matched controls. We observed significantly increased apoptosis in the PBLs of depressive patients (p &lt; 0.05). These preliminary results could contribute to an understanding of the interactions of the CNS with the immune system, which could lead to the increased vulnerability of the CNS in depressive disorders. Further studies are needed to establish these results.

Immune activation in non-treated suicidal major depression

In the following study we have analyzed cytokine secretion of T-cells of suicidal and non-suicidal depressed patients and healthy controls. It was found that T-cells of suicidal depressed patients have Th1 characteristics, while T-cells of non-suicidal depressed patients have Th2 characteristics. Th1 environment is associated with most of autoimmune diseases. It is thus speculated that Th1 activation in suicidal depression may reflect a unique form of autoimmune suicide.

Characteristics of patients with schizophrenia successive to childhood attention deficit hyperactivity disorder (ADHD)

The goal of this study was to investigate the characteristics of schizophrenic patients with a history of childhood attention deficit hyperactivity disorder (ADHD). The study was performed on 37 adolescent patients meeting the DSM-III-R criteria for schizophrenia and ADHD and 40 controls with schizophrenia only. Schizophrenic patients who were diagnosed in childhood as suffering from ADHD had more prominent developmental disturbances in infancy, more insidious course of schizophrenia, failed to respond to neuroleptics and had poorer outcome as compared to patients with schizophrenia only. The results of this study indicate that schizophrenia subsequent to childhood ADHD has a poor prognosis as compared to schizophrenia only.

Physiological reactions to a suicide film: suicide attempters, suicide ideators, and nonsuicidal patients

A film about two teenagers who commit suicide was shown to three groups of psychiatric inpatients: 17 who had attempted suicide, 20 who had expressed suicidal thoughts, and 10 who were not suicidal. Anxiety before and after the film was evaluated with psychometric (anxiety rating scale) and physiological tools (heart and respiration rate, blood pressure, electromyogram). Values noted before and after screening, and the degree of change in these values, were compared. In addition, psychomotor agitation was rated at several points during the film. Most results were negative. The suicide attempters had significantly lower postscreening heart rates and a significantly lesser change in heart and respiration rates than the other two groups. The suicide attempters revealed an increase in psychomotor agitation until the discovery of the suicide and a decrease thereafter, whereas the agitation of the nonsuicidal patients continued to increase from the start to the end of the film. The study suggests that on some parameters, suicide attempters reveal less anxiety than nonsuicidal psychiatric patients following exposure to a simulated suicide. The reaction of suicide ideators falls somewhere between the two groups.

Real-time multiparametric monitoring of the injured human cerebral cortex--a new approach

Intracranial pressure (ICP) is currently the main parameter monitored following severe head injury or during the post operative period in neurosurgical patients. The normal cerebral cortex depends upon a continuous supply of O2, and direct coupling exists between adequate cerebral blood flow (O2 supply) and ion homeostasis as well as electrical activities. We have developed a new "Brain Function Analyzer-BFA" which enabled monitoring of the following parameters continuously in real time from the surface of the cortex: ICP; tissue blood flow & volume; intramitochondrial NADH redox state; DC steady potential; electrocorticography; tissue temperature. The probes were assembled in a Brain Function Multiprobe (BFM) which was connected to the brain via the burr hole procedure used for ICP monitoring. Measurements were performed in 18 comatose patients after severe head injury (GCS < or = 8) who were monitored in the ICU for 48-72 hours. The basic concept of the multiparametric monitoring approach was proven to be practical in neurosurgical patients. Clear correlations were recorded between hemodynamic, metabolic, ionic and electrical activities under various treatments administered to the patients or after pathological events. Responses similar to cortical spreading depression and ischemic depolarization were recorded from a severely head injured patient.

Short note: can depressive patients exploit the immune system for suicide?

It is suggested that patients with depression can exploit their immune system for suicide. This could be done passively by reducing the ability of the immune system to overcome factors threatening the integrity of the body, or actively by directing the immune system towards self constituents.

Cortical spreading depression recorded from the human brain using a multiparametric monitoring system

The number of parameters (i.e., EEG or ICP-intracranial pressure) routinely monitored under clinical situations is limited. The brain function analyzer described in this paper enables simultaneous, continuous on-line monitoring of cerebral blood flow (CBF) and volume (CBV), intramitochondrial NADH redox state, extracellular K+ concentrations, DC potential, electrocorticography and ICP from the cerebral cortex. Brain function of 14 patients with severe head injury (GCS < or = 8), who were hospitalized in the neurosurgical or general intensive care unit was monitored using this analyzer. Leao cortical spreading depression (SD) has been reported in many experimental animals but not in the human cerebral cortex. In one of the patients monitored, spreading depression was observed. This is the first time that spontaneous repetitive cortical SD cycles have been recorded from the cerebral cortex of a patient suffering from severe head injury. Typical SD cycles appeared 4-5 h after the beginning of monitoring this patient. During the first 3-4 cycles the responses of this patient were very similar to the responses to SD recorded in normoxic experimental animals. Electrocorticography was depressed whereas extracellular K+ levels increased. The metabolic response to spreading depression was characterized by oxidation of intramitochondrial NADH concomitant to a large increase in CBF. During brain death, an ischemic depolarization, characterized by decrease in CBF and an irreversible increase in extracellular K+, was recorded.

Continuous multiparametric monitoring of brain activities following fluid-percussion injury in rats: preliminary results

Severe head injury can result in a high mortality rate or irreversible brain damage. One technique used to induce traumatic brain injury (TBI) is exposure of the brain to fluid percussion pressure while monitoring the increase in intracranial pressure (ICP). Since brain injury is a multifactorial, pathological, time-dependent state, the multiparametric monitoring approach was adopted for studying fluid percussion effects on the rat brain. A multiprobe assembly (MPA) connected to the brain in vivo (right hemisphere) enabled the simultaneous monitoring of CBF, NADH redox state, extracellular K+, Ca2+, H+ levels as well as DC potential, ECoG and ICP. The animal was connected to the monitoring system and exposed to TBI after a recuperation period of at least 3 hours after the end of the operation. Two typical responses to TBI were recorded in our preliminary experiments. When severe injury was induced, ischemic depolarization (ID) developed, whereas mild or moderate injury led to repetitive spreading depression (SD) cycles. The relationship between the ID and SD observed under TBI is important to the understanding of the mechanism of brain injury. ICP before injury was between 2-6 mm Hg and increased to 20-22 mm Hg 2-3 minutes after the ID. After severe head injury, ICP remained high and in some cases increased to critical values causing death of these animals. Some animals developed seizures at various stages after the TBI. Hyperbaric oxygenation was used as a therapeutic tool to treat severely injured animals. These preliminary results suggest that it is feasible and practical to use the MPA approach for monitoring the brain after TBI.

The Politics of Immigration Policy in Israel

"This article examines the policies adopted by the former Likud government--and largely continued by the present Labour-led coalition government which took office in the second half of 1992--to absorb the 400,000 new immigrants (most from the former Soviet Union) who arrived in Israel between 1989 and 1992. As part of that examination, we will critically review the major features of current absorption policies, such as the policy of 'direct absorption', the 'basket of absorption services' provided as a right to new immigrants, and immigration-related housing policies. In addition, we will explore the effects of employment policy on the new immigrant population." (SUMMARY IN FRE AND SPA)

Morphological response of injured adult rabbit optic nerve to implants containing media conditioned by growing optic nerves

Adult rabbit retina can express regeneration-associated characteristics after optic nerve injury, provided it is supplied with appropriate diffusible substances originating from media conditioned by regenerating fish optic nerves or by optic nerves of a newborn rabbit [Hadani et al., Proc. Natl. Acad. Sci. U.S.A., 81 (1984) 7965; Schwartz et al., Science, 228 (1985) 600]. This was shown by applying the active substances to the injured axons in the form of 'wrap-around' implants, consisting of collagen-coated silicone tubes which had been soaked in the conditioned media (CM). The regeneration-associated response was manifested biochemically and by sprouting of nerve fibers in culture. The present work provides morphological evidence that the implantation prolongs survival of ganglion cells and optic nerve fibers and induces new growth. Light microscopic analysis (using horseradish peroxidase (HRP) for labeling the fibers) revealed, 1 week following optic nerve injury, labeled fibers and ganglion cells in both the implanted and control (injured only or injured and implanted with collagen-coated silicone tubes free of CM) nerves. However, from the second week after the injury, distinct differences in the appearance of viable ganglion cells and labeled fibers, were seen between experimental and control preparations. In sections taken through the optic nerve, at the region distal to the site of injury, HRP-labeled fibers were seen in the experimental nerves 1 week, 2 weeks and to a significantly lesser extent 1 month after injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of low-energy He-Ne laser irradiation on posttraumatic degeneration of adult rabbit optic nerve

Axons of the mammalian peripheral and central nervous systems degenerate after nerve injury. We have recently found that He-Ne laser irradiation may prevent some of the consequences of the injury in peripheral nerves of mammals. In the present study, the efficacy of the laser in treating injured neurons of the mammalian CNS was tested. Optic nerves of adult rabbits were exposed daily for 8-14 days to He-Ne laser irradiation (14 min, 15 mW) through the overlying muscles and skin. As a result of this treatment, the injured nerves maintained their histological integrity, which is invariably lost in injured mammalian CNS neurons.

Age related decline in aluminum-activated human platelet adenylate cyclase: post-receptor changes in cyclic AMP second messenger signal amplification in normal aging and dementia of the Alzheimer type

Low, micromolar concentrations of aluminum (in the presence of NaF) were shown to strongly activate human platelet adenylate cyclase and provided a useful probe for evaluating cyclic AMP second messenger function distal to the receptor: The effect of normal aging and disease state on second messenger activity in man was studied by measurements of the aluminum-activated enzyme. A significant decline in aluminum-stimulated platelet adenylate cyclase activity in older, healthy subjects was observed. An age-associated decline in NaF-stimulated cyclic AMP synthesis was also demonstrated for normal, non-demented subjects. These findings suggest an age-associated lesion at the level of the guanine nucleotide regulatory protein/catalytic subunit of the adenylate cyclase complex. However, for patients with Alzheimer's disease no such decline in platelet adenylate cyclase activity was detected, and increased sensitivity to both aluminum and NaF was demonstrated.