Alan Carr

A synthetic bone implant macroscopically identical to cancellous bone

Macroporous hydroxyapatite (HA) and beta-tricalcium phosphate (beta-TCP) are widely used as synthetic bone replacement materials due to their high biocompatibility and osteoconductive properties. The level of porosity, pore size distribution, pore morphology, and the degree of pore interconnectivity in such grafts significantly influences the extent of bone ingrowth. It has been hypothesised that an ideal implant macrostructure may be similar in morphological characteristics to the inorganic matrix of the bone it is replacing. However, to date, clinically available synthetic materials differ structurally from cancellous bone. A method is described for the macrostructural replication of cancellous bone. Reproduction involves a multistage process requiring the manipulation of positive and negative forms of the inorganic matrix. By infiltration of a wax negative mould of cancellous bone with a ceramic slip, followed by removal of the wax, and firing, it is possible to produce a positive replica of the original cancellous macrostructure. Optimisation of slip preparation conditions (pH and percentage deflocculant addition) and sintering conditions have allowed successful replication of cancellous bone using several bioceramic compositions including HA, beta-TCP, and HA/beta-TCP.

Evidence-based practice in family therapy and systemic consultation II Adult-focused problems

Evidence for the effectiveness of family therapy and family-based interventions from critical literature reviews and controlled trials is considered for families with children and adolescents who present with various difficulties. The evidence supports the effectiveness of family therapy as an effective treatment either alone or as part of a multimodal or multisystemic treatment programme for child abuse and neglect, conduct problems, emotional problems and psychosomatic problems. Implications for practice, training and continuing professional development in the field of family therapy are discussed.

Unawareness of illness and its relationship with depression and self-deception in schizophrenia

Both poor insight and depressive symptomatology are common features of schizophrenia that may be independent of positive and negative symptoms. Forty-six patients with DSM-III-R schizophrenia were evaluated for level of insight (schedule for unawareness of mental disorder), depression (Calgary depression scale for schizophrenia, Beck depression inventory), and self-deception or denial (balanced inventory of desirable responding). Patients with a greater unawareness of their illness had relatively less depressive symptomatology and relatively greater self-deception. This relationship was particularly strong for unawareness of the social consequences of having a mental disorder. These results suggest that the presence of depressive symptomatology in schizophrenia is related to the level of insight, and contingent at least in part on the absence of self-deception as a denial defense.

Minimization of childhood maltreatment is common and consequential: results from a large, multinational sample using the childhood trauma questionnaire

Childhood maltreatment has diverse, lifelong impact on morbidity and mortality. The Childhood Trauma Questionnaire (CTQ) is one of the most commonly used scales to assess and quantify these experiences and their impact. Curiously, despite very widespread use of the CTQ, scores on its Minimization-Denial (MD) subscale—originally designed to assess a positive response bias—are rarely reported. Hence, little is known about this measure. If response biases are either common or consequential, current practices of ignoring the MD scale deserve revision. Therewith, we designed a study to investigate 3 aspects of minimization, as defined by the CTQ’s MD scale: 1) its prevalence; 2) its latent structure; and finally 3) whether minimization moderates the CTQ’s discriminative validity in terms of distinguishing between psychiatric patients and community volunteers. Archival, item-level CTQ data from 24 multinational samples were combined for a total of 19,652 participants. Analyses indicated: 1) minimization is common; 2) minimization functions as a continuous construct; and 3) high MD scores attenuate the ability of the CTQ to distinguish between psychiatric patients and community volunteers. Overall, results suggest that a minimizing response bias—as detected by the MD subscale—has a small but significant moderating effect on the CTQ’s discriminative validity. Results also may suggest that some prior analyses of maltreatment rates or the effects of early maltreatment that have used the CTQ may have underestimated its incidence and impact. We caution researchers and clinicians about the widespread practice of using the CTQ without the MD or collecting MD data but failing to assess and control for its effects on outcomes or dependent variables.

Mechanical stir casting of aluminium alloys from the mushy state: process, microstructure and mechanical properties

Abstract A comprehensive study was carried out to establish the effects of controlled stirring during solidification on the microstructure and mechanical properties of aluminium alloys, in comparison to conventionally gravity chill cast material. A novel device comprising a grooved reaction bonded silicon nitride rod rotating in a tube-like crucible was used to process aluminium alloys in the mushy state. The stir casting device was specially designed to also enable rheometric study of the alloys in this condition. A factorial design of experiments was used to determine the effect of the process variables shear rate ( γ ), shear time (ts), and volume fraction solid during shear (fs) on microstructure and both static and dynamic mechanical properties of the stir cast alloy. Investigation of the microstructure consisted of computer-aided image analysis of the primary phase morphology. A more globular primary phase was achieved at low values of fs, but this was not the optimum morphology for mechanical properties. In all cases, improved mechanical properties and reduced porosity were obtained in the stir cast condition in comparison with conventional casting and in comparison with previous work on stir casting. Comparison with alloy commercially rheocast via electromagnetic stirring, however, showed that the latter had superior mechanical properties. It is proposed that the mechanical stir casting process be considered as an alternative to gravity die casting in cases where very simple and thick walled shapes are required.

Attachment Styles and Psychological Profiles of Child Sex Offenders in Ireland

When 29 child sex offenders, 30 violent offenders, 30 nonviolent offenders, and 30 community controls were compared, a secure adult attachment style was 4 times less common in the child sex offender group than in any of the other three groups. Ninety-three percent of sex offenders had an insecure adult attachment style. Compared with community controls, the child sex offender group reported significantly lower levels of maternal and paternal care and significantly higher levels of maternal and paternal overprotection during their childhood. Compared with all three comparison groups, the child sexual offenders reported significantly more emotional loneliness and a more external locus of control. With respect to anger management, the child sexual offenders’ profile more closely approximated those of nonviolent offenders and community controls than that of violent offenders.

The evidence-base for family therapy and systemic interventions for child-focused problems

This review updates similar articles published in the Journal of Family Therapy in 2001 and 2009. It presents evidence from meta-analyses, systematic literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with various difficulties. In this context, systemic interventions include both family therapy and other family-based approaches such as parent training. The evidence supports the effectiveness of systemic interventions either alone or as part of multi-modal programmes for sleep, feeding and attachment problems in infancy; child abuse and neglect; conduct problems (including childhood behavioural difficulties, attention deficit hyperactivity disorder, delinquency and drug misuse); emotional problems (including anxiety, depression, grief, bipolar disorder and self-harm); eating disorders (including anorexia, bulimia and obesity); somatic problems (including enuresis, encopresis, medically unexplained symptoms and poorly controlled asthma and diabetes) and first episode psychosis.

A quantitative study of the sintering and mechanical properties of hydroxyapatite/phosphate glass composites

Previous work has shown that small additions of a phosphate glass (CaO-P2O5) can significantly enhance the sinterability and strength of hydroxyapatite. However, there are no quantitative phase analyses available for these materials which would provide indicators of biocompatibility and resorbability. Similarly, there is little information available about the mechanical properties, especially with high glass additions. In this study, the effects of sintering hydroxyapatite with phosphate glass additions of 2.5, 5, 10, 25, and 50 wt.% are quantified. Each composition was sintered over a range of temperatures, and quantitative phase analysis was carried out using XRD. In addition, the microstructures were studied using RLOM and SEM, and mechanical properties (Vickers hardness, KIC, and MOR) measured. These results may be used to indicate which compositions and processing conditions may provide materials suitable for use in hard tissue replacement. Composites containing up to 10 wt.% glass additions formed dense HA/TCP composite materials possessing flexural strength and fracture toughness values up to 200% those of pure HA. The HA/TCP ratio was strongly dependent on the percentage glass addition. Higher glass additions resulted in composites containing beta-TCP together with large amounts of alpha- or beta-calcium pyrophosphate, and having similar mechanical strengths to pure HA.

The sintering and mechanical behavior of hydroxyapatite with bioglass additions.

There is increasing interest in the potential of composites of hydroxyapatite with phosphate- or silicate-based bioactive glasses, and certain of these glass additions have been found, in previous work, to aid densification and form a mechanically-reinforced, bioactive material; in particular, large improvements in flexural strength and fracture toughness were obtained through the addition of small amounts of phosphate glass. Less is known about the mechanical behavior of HA/bioglass composites, although in vivo studies by other workers have shown encouraging biological results. In this investigation, the sintering behavior, mechanical properties, and microstructure of composites of HA with up to 50 wt % glass, were analyzed. X-ray diffraction showed the phase composition of sintered composites with up to 5 wt % added bioglass to be non-stoichiometric HA with α-TCP or β-TCP. Phase analysis of composites containing higher glass additions was impracticable due to peak broadening and overlap, although reaction products, at the highest glass additions and sintering temperatures, may include wollastonite-2M and β-Na2Ca4(PO4)2SiO4. Sintered density, and mechanical properties other than fracture toughness, showed no significant improvement over HA.

Thematic review of family therapy journals 2010

There were many creative clinical articles on the use of systemic therapy to address a broad range of child-focused problems, for example, family therapy for inconsolable crying in neonatal infants (Patrick et al., 2010), psycho-educational family therapy for children with bipolar disorder (Leffler et al., 2010), the integration of motivational interviewing into a family-based obesity treatment programme for adolescents (Irby et al., 2010) and letter writing in family therapy with adolescents who engage in non-suicidal self-injury (Hoffman et al., 2010). Particularly noteworthy articles were published evaluating the effectiveness of evidence-based approaches to family therapy for child abuse, adolescent suicide risk and delinquency. There were also important articles on parental alienation. These articles are summarized below. Child abuse In a US community-based controlled trial of interventions for physically abused young adolescents and their families, Swenson et al. (2010) found that multisystemic therapy (MST) was more effective than routine out-patient treatment in reducing out of home placements, adolescent and parent distress, and parenting behaviour associated with child abuse. This study showed that MST can be conducted in community settings to enhance the functioning of families in which young adolescents have suffered child abuse. MST was developed by Scott Henggeler and his team in the USA. It involves helping families and involved