Decisions to treat critically ill patients: a comparison of social versus medical considerations.

A questionnaire survey shows that physicians in four medical specialties evaluate chronically and terminally ill patients not only in terms of the physiological aspects of illness but also in terms of the extent to which they are capable of interacting with others. A patient's potential capacity to perform his social roles depends upon his "salvageability," i;e., the likelihood that he will be able to resume his roles and the degree of irreversible physical or mental damage which indicates his capacity for resuming them. The priorities in terms of treatment are the following: (1) salvageable patients with physical damage; (2) salvageable patients with mental damage and unsalvageable patients with physical damage; (3) unsalvageable patients with mental damage. Within these catagories variables such as patient attitude, family attitude, age, and social class, which define the social environment of the patient, also influence the physician's decision to treat him. Studies of hospital records of cases in two of the specialties were consistent with they survey findings. The findings suggest that there is a disparity between the traditional ethic concerning the treatment of such patients and the actual behavior of many physicians. As a solution to the inconsistencies between ideal and actual behavior, the development of medical guidelines for the withdrawal of treatment with respect ot certain specifically defined conditions is recommended.


The development of ambiguous federal policy: early and periodic screening, diagnosis, and treatment (EPSDT).

This paper examines why Congress's first major program for comprehensive health care to needy children took five years to begin even partial operation. An examination of the 1967 program's legislative history reveals that Congress paid little attention to EPSDT's implications: it was left ambiguous whether health (Title V) or welfare (Title XIX) would administer; costs were never clearly stated; eligibility and scope of services to be provided were left vague. Despite pressure from welfare rights interest groups, these ambiguities delayed the preparation of regulation and guidelines which never did succeed in resolving the question of overlapping jurisdiction and costs. In addition, many states' resistance to paying for the program further held up implementation. The paper concluded that: (1) Congress's and HEW's unwillingness to face up to the real costs of health programs threatens long-term public and state support for such programs; (2) division of responsibility between health and welfare lessens the impact of a program; (3) grant-in-aid programs give states the power to distort the intent of federal health policies; and (4) where states fail to implement such policies, initiatives may pass to consumer advocacy groups.


New organizations out of old ones: teaching group practices out of private practice and outpatient departments.

A private group practice and a traditional hospital medical clinic are joined together as a teaching group practice for primary care (Internal Medical Associates). Responsible for revenues as well as costs, the practice is administered by a board of managers composed of physicians, nurses, and administrators in the practice. This decentralization of practice from the clinical department and hospital administration has resulted in (1) a reduction in the numbers of physicians needed for the practice, (2) a greater visit census with increased physician productivity, and (3) a reduced operating deficit and better understanding of transient and educational costs. The matrix organization of the board of managers has resulted in better communication and a commitment of the staff to common goals. Public demand for a single standard of care for patients of all backgrounds, professional aspirations to work in groups, and educators' interest in training outside the hospital converge to make such reorganizations of practical necessity.


Teamwork in health care in the U.S.: a sociological perspective.

Reactions to teamwork, whether in health care, science and research, or in other areas, are seldom neutral. While some see in it a panacea that will help solve many stubborn organizational problems, others condemn it on a variety of grounds. Impetus to the development of team approaches to the delivery of health care and concern over their performance have been tied to a number of trends: a marked increase in specialization and division of labor as a result of expansion in health-related knowledge and technology, a corresponding emphasis upon coordination, a broadening concept of health and an increase in the types of activities included under its rubric, and a manpower shortage especially in the highly trained professions. This paper reviews current studies, important findings, and points out neglected dimensions. Themes prominent in the literature include: (a) status, power, authority, and influence; (b) roles and professional domains; and (c) decision making and communication. A number of important dimensions seem to be neglected, such as the effectiveness of teams as an approach to the delivery of services, the modes of organization and the dilemma of gate-keeping decisions, and the relations of team approaches to the manpower problems.


The school nurse practitioner.

Whatever the specific details of their practices, SNPs have shown themselves able to function effectively in their expanded roles because they have assumed more responsibility, initiative, interdependence, and independence in caring for children.  Specifically, they have learned to be confident of their decision-making abilities, to adapt themselves to an expanded framework of nursing, and to regard themselves as highly qualified professionals.  What this means to the individual nurse practitioner, the parent and--most important--the child is well summed up in these remarks from Larea Younkman, SNP in the Denver Public Schools: "Previously," she writes, "my recommendations to the parents as to what to do and when, such as seeking medical attention, were frequently too general and consequently not heeded by the parent.  Now when I talk to a parent, I am not only confident of my findings but I'm also much more convinced that what I suggest is necessary.  As a result, parents are looking at SNPs differently, trusting our judgment, and, I think, following through on the advice we offer to a greater extent than previously."  Thus the SNP could well be the vital bridge between this country's traditional system of health care delivery and those children who are deprived of the care they need through reluctance, ignorance, parental apathy, or lack of available health care facilities.


A conceptual framework for curriculum development.

A conceptual framework provides boundaries within which facts, concepts, theories, and propositions from three theoretical sources interact with clarity, coherence, and consistency. From the framework objectives are derived. The framework gives direction to the curriculum design. Finally, the conceptual framework serves as a background against which objectives can be tested. A conceptual framework for curriculum encourages systematic curriculum evaluation that will eventually allow us to more accurately describe, explain, predict, and control the work of curriculum.


Differences in susceptibility of Enterobacteriaceae and penicillin-resistant Staphylococcus aureus to tetracycline and minocycline.

Two hundred strains of penicillin-resistant Staphylococcus aureus and 311 isolates of Enterobacteriaceae were compared for their susceptibility to tetracycline and minocycline. Thirteen and one-half percent of the staphylococcal isolates were resistant to tetracycline but susceptible to minocycline. Similarly, 24% of the enterobacterial isolates were found to be tetracycline resistant but susceptible to minocycline. Of a total of 511 recent clinical isolates, 14.5% were susceptible to minocycline but were tetracycline resistant.


An evaluation of the use of intraventricularly administered [3H]5-hydroxytryptamine as a marker for endogenous brain 5-hydroxytryptamine.

Following the intraventricular injection of a small amount of [3H]5-hydroxytryptamine ([3H]5-HT), the amount of radioactivity in telencephalic structures on the injected side was 6--7 times larger than that in corresponding areas on the opposite side. Moreover, a multiphasic disappearance of [3H]5-HT from whole brain or midbrain was found after the intraventricular injection of the labeled amine. However, after the intraventricular injection of [3H]tryptophan, the levels of [3H]5-HT in midbrain declined in a monophasic manner. A significant portion of the labeled amine derived from intraventricularly administered [3H]5-HT was resistant to the depleting effect of Ro4-1284 or to that elicited by destruction of the midbrain raphe nuclei, both of which caused an almost complete loss  of endogenous 5-HT and labeled 5-HT formed from tryptophan. It thus appears that the intraventricular injection of [3H]5-HT leads to the formation of artifactual pools which are not present if the amine is synthesized in vivo. Studies with 6-hydroxydopamine suggested, however, that uptake of [3H]5-HT into adrenergic neurons did not occur to any great extent.


Minocycline sensitivity related to the phage type of multiply resistant staphylococci.

Clinical isolated of multiply antibiotic-resistant strains of Staphlococcus aureus were divided into three  groups by phage typing. The most prevalent type, which is usually cloxacillin resistant, was found to be moderately sensitive to minocycline. Unfortunately the degree of sensitivity is not sufficient to warrant the use of the antibiotic in severe staphlococcal infection.


Further evolution of a strain of Staphylococcus aureus in vivo: evidence for significant inactivation of flucloxacillin by penicillinase.

A strain of Staphylococcus aureus (no. FAR4) has been isolated at intervals, for 32 months, from the sputum of a patient with cystic fibrosis of the lung. Changes in the properties of isolates of this strain over the first 18 months have been reported previously (Lacey et al., 1973 and 1974). During the last 14 months (May 1973 to July 1974), further evolution has occurred to produce a total of 31 distinct phenotypes. Recent changes are as follows. 1. The ability of isolates to produce penicillinase in vitro was closely correlated with flucloxacillin therapy. Inactivation of flucloxacillin by penicillinase was demonstrated by diffusion testing (but not MIC determination) in vitro and may have occurred to a significant extent in vivo. 2. Lincomycin-resistant mutants slowly disappeared from the sputum after the termination of clindamycin therapy. 3. All of the recent isolates were resistant to erythromycin, possibly because of the linkage of the genes coding for erythromycin resistance with those coding for the production of delta-haemolysin; delta-haemolysin may be an important "virulence factor".


A comprehensive approach to dental health in a school population.

A program to provide school children with dental health education and preventive services was initiated by the Boston University School of Graduate Dentistry. This program utilized several generally untapped resources. The emphasis was on classroom education using teachers who were motivated by special workshops as well as students of dental auxiliary training programs. These dental auxiliary students under the supervision of a dental health educator were used to educate the classroom teachers as well as to teach children in the classroom. Direct dental services were also provided in the program in the form of preventive services utilizing an unused dental chair available at a school.


Antibiotic sensitivity of two Aeromonas and nine Pseudomonas species.

An agar dilution method was used to determine the in vitro sensitivity of different Pseudomonas and Aeromonas species to sulphonamide, tetracycline, colistin, gentamicin, tobramycin, amplicillin, carbenicillin, and cephalothin. P. aeruginosa was generally sensitive to carbenicillin, colistin, tobramycin, and gentamicin. P. putida and P. fluorescens were generally resistant to beta-lactam antibodies but sensitive to gentamicin and tobramycin. P. cepacia and P. maltophilia were mostly resistant to colistin, gentamicin and tobramycin. Other Pseudomonas species were usually more sensitive to the antibodies tested. Strains of Aeromonas hydrophila were mostly resistant to beta-lactam antibiotics but sensitive to other antibiotics, while strains of A. shigelloides were very sensitive to all antibiotics tested.


On paying the fiddler to change the tune: further evidence from Ontario regarding the impace of universal health insurance on the organization and patterns of medical practice.

This paper compares the findings from a 1973 community household interview survey conducted in Sault Ste. Marie, Ontario, with the findings from a similar study conducted in 1968 in the same city by a research team from the World Health Organization. Sault Ste. Marie is the site of the first Canadian consumer-sponsored prepaid group practice. Opposition by the private, solo practice sector of this community to this new modality of medical practice was considerable. Since 1969, with the introduction of universal health insurance in Ontario, the cost and benefit differences between solo and group practice medical care have been eliminated. By comparing the findings from the 1973 study with similar data from the 1968 WHO survey, observations can be made about the impact of universal health insurance on the organization and patterns of medical practice. Implications for the United States are important in view of the recent passage of the Health Maintenance Organization Act of 1973 and the expected enactment of some form of national health insurance.


Factors affecting the choice between prepaid group practice and alternative insurance programs.

This paper examines the basis for the selection of prepaid group practice in a dual-choice situation, and the social, attitudinal, and health characteristics of populations choosing prepaid programs in contrast to other plans. When asked in an open-ended way why they made the decisions they did, those selecting prepaid group practice most frequently referred to the more comprehensive coverage provided and to the fact that at the time of choice they lacked a continuing or adequate relationship with a physician. Enrollees in the prepaid program were better educated and, contrary to previous research, more likely to be unmarried. There was little evidence that enrollees in the prepaid plan brought with them distinctive kinds of attitudes and orientations toward illness and medical care. Enrollees in the prepaid program were also comparable to those retaining an alternative health insurance option on a number of indicators of health status. However, prepaid practice enrollees tended to report more chronic conditions than persons who declined to enroll in the prepaid program. Although the overrepresentation of persons with chronic illnesses is not large, data drawn from a related study suggests that persons with several chronic conditions tend to be heavy users of medical services.


Dental care and the health maintenance organization concept.

The principal dental diseases, caries and periodontal disease, affect almost the entire population and result in considerable pain and discomfort, with eventual tooth loss, if untreated. These disorders can either be prevented or their effects minimized through dental intervention so that intact functioning dentitions can be maintained. Despite the fact that enough practicing dentists probably exist in the United States to achieve these results, the majority of the population lose all of their natural teeth if they live out their normal life spans. The solo-practice fee-for-service system, even with third-party payment, may reduce the difficulties somewhat but cannot solve the problem. Prepaid dental group practice, either independently or as part of a general health care system, has the potential of virtually eliminating edentulism in populations for which it has responsibility. At present, it is possible to project costs and resource needs with sufficient accuracy to start viable entities. The "health maintenance organization" concept, therefore, applies to dental care.


The pricing behavior of medical groups.

This study discusses a model of the pricing behavior of medical groups. Using data collected, by a mail survey, from medical groups in North Carolina, an empirical test of the model is performed. The results suggest that the prices charged by medical groups are positively influenced by the per capita income of the county in which the group is located, and the per physician utilization of medical, technical, and office personnel. They also suggest that for groups in the sample, a non-physician manager and a non-salaried system of remuneration to member physicians are negatively related to the price of medical services. The results of this study also indicate that the managerial structure of group practice is an important area for further research.


On the development and classification of diagnoses.

Nurses, as noted earlier, always have and are now using the five steps of the diagnosis process. This utilization is a valuable and essential element of a profession. On the other hand, conceptual analysis of the process suggests that all ten steps are necessary conditions for a natural history of nursing. Such a natural history would constitute a taxonomy of nursing diagnoses and would identify and codify essential concerns and associated nomenclatures which have been agreed upon by members of the profession. In turn, such an agreement would lead to a common universe of discourse for the clinicians, the students, the teachers, the administrators, and the researchers in nursing. A workable taxonomy would provide potential points of reference, purpose, and direction and would facilitate communication and collaboration in nursing practice, nursing education, and nursing research. Such a taxonomy would constitute a systematic ordering of the unique body of knowledge of nursing and would provide a foundation of level-one theory. On this basis could be built higher-level theories that are grounded in observable phenomena. This development, in turn, would create a bridge across the knowledge-practice gap and would allow more effective application of scientific knowledge to specific clinical patient-care and nursing problems. A workable taxonomy of nursing diagnoses would articulate areas of unique concern to nurses and nursing and would allow more unequivocal communication of the focus, limits, and nature of the realm of nursing to other professions, third-party payers, governmental agencies, and the public. Without the development of such a framework, nursing research will continue to flounder, nursing education will continue to lack articulation of ordered body of knowledge of nursing concerns and related cognitive and other competencies, and nursing practice will continue to drift toward the use of medical terminology and to focus on dependent and technical nursing functions and the extension of the role of the nurse in the domain of medicine. In short, the lack of a sound taxonomy of nursing diagnoses endangers the realm of independent functions of nursing--its care, comfort, and compassion for the person who suffers from illness, and its focus on increased patient self-help ability, self-determination, and health promotion.


Utilization of amino acids by the isolated perfused sheep liver.

To test Elwyn's suggestion [1970], that high concentrations of amino acids supplied to the liver from the hepatic artery do not stimulate protein synthesis, substrates containing amino acids have been infused into either the hepatic artery or portal vein of isolated sheep livers. The livers received highly oxygenated blood from the hepatic artery and partly deoxygenated blood from the portal vein. There were no significant differences in amino acid uptake (81 +/- 4% of input), urea output (69 +/- 6% of uptake) or 'protein synthesis' as assessed by N accumulation in the liver. Amino acids were actively extracted from the plasma by both routes of infusion and , when the concentrations simul-ted those occurring in the portal vein of fed sheep, the uptake was very similar to that in vivo. When an amino acid mixture based on that absorbed in dogs was infused, the extraction of individual amino acids was similar except for a negligible uptake of valine, leucine and isoleucine. In these experiments protein synthesis was also very low.


Lacoferrin in rabbit bile: its relation to iron metabolism.

The relation of biliary lactoferrin concentration and the iron status of the body was studied in normal, anaemic and iron-loaded rabbits. In anaemic rabbits lactoferrin concentrations rose to two to three times the original values. Loading with iron resulted in a return to normal values. Mobilization of iron with desferrioxamine also gave a rise in lactoferrin concentration in bile. Lactoferrin may have a regulatory function in situations of enhanced iron absorption or mobilization of iron from depots.


The influence of phentolamine on the hyperglycaemic and lipolytic effects of ammonia in sheep.

Intravenous infusion over 30 min of ammonium chloride [10-1 g/kg b.w.] caused a significant increase of blood glucose and free fatty acids levels, and a similar effect was observed with adrenaline. Phentolamine [1 mg/kg b.w.] abolished the hyperglycaemic action of ammonium chloride but only slightly diminished the lipolytic effect. It is concluded that the ammonium ion influences carbohydrate metabolism chiefly by way of catecholamines and stimulation of alpha-adrenergic receptors, while tissue lipids are mobilized by ammonia by another route, possibley directly.


[The bacteriological diagnosis of vibrio fetus infection in man (author's transl)].

A synopsis of the present classification of Vibrio fetus is given (tab. 1, 2). Besides the presentation of the importance of these bacteria in veterinary medicine, 97 human infections have been published up to now. The geographic, age and sex distribution of these cases and the material out of which the pathogens were isolated is presented (tab. 3, 4). The clinical picture is summarized. For the culture of Vibrio fetus liver broth as described by TAROZZI incubated for at least 3-4 days was suitable as enrichment medium. The necessity of a prolonged incubation period was shown by results of continous registration of the optical density of growing Vibrio fetus cultures (fig. 1). If specimen is plated out on solid culture media before enrichment, the suitable media are chocolate agar, brain-heart infusion and Bacto-tryptose agar. For subcultures the DST-agar is also useful. Solid media cultures should be incubated microaerobically with 10% CO2 added. The resistance to Cephalothin of Vibrio fetus can be applied for selection on solid culture media. The metabolic activities of different Vibrio fetus biotypes were compared. A hitherto not reported metabolic activity, the hydrolysis of palmitic acid ester, is described (tab. 5). In the tube dilution test Vibrio fetus strains were sensitive to Gentamycin, Streptomycin, Ampicillin, Ciclacillin and Carbenicillin. They were resistent to Penicillin G, Cephalotin and Sulfonamid and showed borderline sensitivities to Tetracyclin, Kanamycin and Chloramphenicol (tab. 6).


Transversal and longitudinal lecithin-sphingomyelin ratios in amniotic and lung fluids of fetal lambs.

Lecithin-sphingomyelin (L/S) ratios were measured in both amniotic and in lung fluids of fetal lambs. Around Day 130 of fetal age sudden increase of L/S ratio appeared in lung fluid. The amniotic L/S ratio increased only slowly as a consequence of which false negative values were obtained. A respiratory distress syndrome is to be expected when the lung fluid shows a L/S ratio less than 2. The L/S ratio of lung fluid is preferable to amniotic L/S ratio. In comparison with those of amniotic fluid the L/S ratios of lung fluid were significantly higher. Lung fluid secretion was measured daily. Large differences were seen among the lambs. Two days before delivery a striking decrease in the quantity of lung fluid production was noticed in all aminals.


In vitro activity of penicillins against anaerobes.

The in vitro susceptibility of 162 anaerobic isolates from clinical material were tested to pencillin G, BL-P1654, and carbenicillin. Penicillin G and BL-P1654 showed good activity against Bacteroides fragilis, but only 60% of strains were susceptible to carbenicillin at achievable blood levels (128 mug/ml).


BL-P1654: a bacteriostatic penicillin?

In tube dilution studies, large discrepancies between inhibitory and bactericidal concentrations of BL-P1654 against Pseudomonas were observed. To explain these discrepancies which were not observed with carbenicillin, the kinetics of bacterial killing by these two penicillins were evaluated and compared. The kinetics of bacterial killing by both antimicrobial agents were characteristic of a penicillin, with killing initiating simultaneously with growth. Kill curves revealed the presence of a small number of cells resistant to BL-P1654 which were not detectable macroscopically. Studies on microbial resistance also showed the presence of a small but consistent number of cells resistant to BL-P1654 over a broad range of concentrations above its minimal inhibitory concentration. This pattern of resistance was not observed with carbenicillin. Thus, the discrepancies between inhibitory and bactericidal concentrations of BL-P1654 were not due to any unusual bacteriostatic activity but rather due to a small number of resistant cells whose presence could be detected only by sensitive subculturing techniques.


Assessment of susceptibility of ampicillin-resistant enterobacteria to cephalosporins.

The susceptibility of 103 ampicillin-resistant strains of enterobacteria to two cephalosporins was assessed by turbidimetric monitoring and disk diffusion tests. The results obtained suggest that in most cases a correlation exists between the suppression of growth of a dense bacterial culture for a therapeutically acceptable period by a fixed, high concentration of cephalosporin and a large zone of inhibition (>/=24 mm) using a high potency disk. This correlation was found to hold good when a moderate, subconfluent inoculum and commercially obtained blood-agar plates were used for the disk test, but not when the stringent conditions required by the Kirby-Bauer test (which demands a dense inoculum on Mueller-Hinton agar) were employed. Better correlation was obtained with cephaloridine than with cephalothin. This approach to the interpretation of disk diffusion tests gives a grossly different picture of the susceptibility of ampicillin-resistant enterobacteria to cephalosporins than do conventional minimal inhibitory concentration-based correlations.


In vivo protection of Fusobacterium necrophorum from penicillin by Bacteroides fragilis.

A mixed infection of Bacteroides fragilis and Fusobacterium necrophorum was resistant to treatment with penicillin even though a pure F. necrophorum infection could be successfully treated with penicillin. Since B. fragilis alone did not produce infection, these results indicate that B. fragilis can protect F. necrophorum from penicillin in vivo. The extent of protection afforded by a strain of B. fragilis was related to its level of resistance to penicillin. Only a few cells of B. fragilis were required in the initial bacterial injection. Moreover, protection was demonstrated when B. fragilis cells were injected as late as 24 h after the F. necrophorum cells. Protection of F. necrophorum from penicillin by B. fragilis was also demonstrated in vitro.


Minocycline in staphylococcal soft-tissue infections.

Fifteen patients who had severe Staphylococcus aureus infections were treated with minocycline for 6 to 24 days; all responded satisfactorily. Where possible, posttherapy cultures were taken, and in all instances, the pathogen was eradicated. There was no adverse reactions. Minocycline proved to be an acceptable and effective alternative for staphylococcal soft-tissue infections. It has the following advantages: (1) it is administered orally on a twice-daily dosage schedule, which facilitates patient compliance; (2) its toxicity is well defined and is not troublesome during short-term therapy; and (3) it penetrates tissues in therapeutic amounts and yields serum levels that are well above the minimum inhibitory concentrations of most staphylococci.


Structural equivalents of latency for lysosome hydrolases.

1. Structure-linked latency, a trait for most lysosome hydrolase activities, is customarily ascribed to the permeability-barrier function performed by the particle-limiting membrane, which shields enzyme sites from externally added substrates. 2. The influence of various substrate concentrations on the reaction rate has been measured for both free (non-latent) and total (completely unmasked by Triton X-100) hydrolase activities in rat liver cell-free preparations. The substrates were: beta-glycerophosphate, phenolphthalein mono-beta-glucuronide. p-nitrophenyl N-acetyl-beta-D-glucosaminide and p-nitrophenyl beta-D-galactopyranoside. The ratio (free activity/total activity) X 100 is called fractional free activity at any given substrate concentration. 3. The fractional free activity of beta-glucuronidase and beta-N-acetylglucosaminidase were clearly independent of substrate concentration, over the range examined, in both homogenates and lysosome-rich fractions. The fractional free activity of acid phosphatase appeared to be either unaffected (homogenate) or even depressed (lysosome-rich fraction) by increasing the beta-glycerophosphate concentration. The fractional free activity of beta-galactosidase consistently showed a non-linear increase with increasing substrate concentration in both homogenates and lysosome-rich fractions. 4. Procedures such as treatment with digitonin, hypo-osmotic shock and acid autolysis, although effective in causing varying degrees of resolution of the latency of lysosome hydrolase activities, were unable to modify appreciably the pattern of dependence or independence of their fractional free activities on substrate concentration, as compared with that exhibited by control preparations. Ouabain did not affect the free beta-N-acetylglucosaminidase activity of liver homogenates at all. 5. Preincubation of control preparations with beta-glycerophosphate or p-nitrophenyl beta-galactoside did not result in any significant stimulation of the free hydrolytic activity toward these substrates. 6. The results consistently support the view that the membrane of "intact" lysosomes is virtually impermeable to all the substrates tested, except for p-nitrophenyl beta-galactoside, for which the evidence is contradictory. Moreover the progressive unmasking of the hydrolase activities produced by these procedures in vitro reflects the increasing proportion of enzyme sites that are fully accessible to their substrates rather than a graded increase in the permeability of the lysosomal membrane.


The ionic channels in excitable membranes.

The ionic channels in excitable membranes are of two classes: those that open and close when the membrane potential alters and those that respond to the release of an appropriate chemical transmitter. The former are responsible for the conduction of impulses in nerve and muscle fibres and the latter for synaptic transmission. It is now clear that the sodium and potassium channels in electrically excitable membranes are functionally distinct, since each can be blocked without affecting the behaviour of the other. It has recently proved possible to study, in the voltage-clamped squid giant axon, the movements of the mobile charges or dipoles that form the voltage-sensitive portion of the sodium channels, which give rise to the so-called 'gating' current. Detailed comparisons can now be made between the kinetics of the ionic conductances as described by Hodgkin & Huxley, and the steady-state distribution and kinetics of the charged controlling particles, which should lead to useful conclusions about the intramolecular organization of the sodium channels and the conformational changes that take place under the influence of the electric field. There is as yet little information about the chemical nature of the electrically excitable channels, but significant progress has been made towards the isolation and characterization of the acetylcholine receptors in muscle and electric organ.


How does ATP act as an energy source?

Two misleading conclusions drawn from the classical treatment of thermodynamics are, first, that single molecules cannot be treated thermodynamically and, second, that all real processes must be irreversible. The first conclusion has meant that the disruptive effect of thermal motions has been ignored, the second has meant that dynamic forces which cannot exist without stored energy, have been left out of account. The effect of these beliefs is demonstrated by analysis in detail of a simple electrostatic model of muscle. It is shown that the necessity of protecting each step against decay of the stored energy, and the requirement that each should be specific, has the effect of stopping the model actually working. Moreover, the character of static forces, which are strongest after their stored energy has been used up, precludes their use in cyclic processes because as much stored energy is required to undo them later in the cycle. Covalent intermediates are also examined from a quantum mechanical viewpoint and it is shown how these store energy which can be transferred by resonant transitions in the ground state when groups like phosphate are transferred chemically between molecules. But this analysis shows that, necessarily, the energy remains stored and therefore not available for muscular contraction. Then it follows naturally both that bond vibrations are produced in exothermic chemical reactions and that, because the force disappears when the energy has been used up, resonant exchange of stored energy in the excited state should solve the difficulties of previous approaches to these problems.


Muscle as a thermodynamic machine.

Three main problems in the energetics of muscular contraction confront us at the present time:- (1) Thermodynamics. This is a labyrinthine subject in the sense that there are often several equally correct ways (that may appear different) of arriving at the same result. The recent advances in the kinetics of the reactions of muscle proteins have increased still further the need for understanding among muscle physiologists-and other biologists-of those parts of thermodynamics that concern them directly, notably those relating work and chemical change. (2) Energy balance. Over the whole cycle of contraction, relaxation and oxidative recovery, the observed energy output (heat + work) can be accounted for by the chemical processes currently believed to operate in the cycle. In contrast, during contraction and relaxation alone, the energy output is greater than can be accounted for by the extent of known chemical reactions combined with their heats of reaction (measured calorimetrically). The physical and chemical methods cross-check one another-hence the usefulness of the method. The details of this discrepancy may vary from species to species but it is seen in all the experiments known at this time. The general problem will be resolved only when we know more about the chemical reactions that have occurred and reliable measurements have been made of their heats of reaction in vitro. (3) Work balance. Work and heat differ thermodynamically and, since the production of work is a primary function of muscles, the question naturally arises whether the observed splitting of ATP (combined with estimates of the change in free energy of this reaction) is sufficient to account for the work observed. On present information, which is imperfect in several respects, the chemical change is sufficient to account for the work. Estimates of the efficiency of transduction vary in different laboratories from 45 to 66%.


Mechanical and biochemical cycles in muscle contraction.

The current biochemical approach to understanding the mechanism by which chemical energy is converted into mechanical energy in muscle is by investigating the kinetics of the reaction of ATP with the isolated contractile proteins in solution with stopped and quenched flow techniques. The results are interpreted in terms of a cycle of hydrolysis of ATP. The current mechanical approach lies through the kinetics of force production or length change in preparations with the contractile proteins intact, by following step changes in length or tension. The results are usually interpreted in terms of mechanical cycles of activity of cross-bridges, in which a cross-bridge progresses through a series of states with different mechanical properties. If the biochemist's and the mechanist's cycles are one and the same, a problem arises over the correspondence between states in the two cycles. One approach to answering this question is through the determination of the effect of pH and of such substances as ATP, ADP and inorganic orthophosphate on the mechanical response. We hope that these will act at known points in the biochemist's cycle and their influence upon the mechanical cycle should enable their location here to be ascertained. The paper deals with the effects of phosphate, ATP and magnesium ions on the mechanical response of insect flight muscle.


[Psychoses in epilepsy--classification and EEG-studies (author's transl)].

It is necessary to classify the epileptic psychoses before starting a comparative study between psychopathological and electroencephalographic findings. The knowledge of the epileptic psychoses is at the moment too incomplete for a systematic order following aetiological or topic aspects. The traditionally system of epileptic psychoses distributes in chronic and episodic, phasic, especially circular, reversible and irreversible psychopathological manifestations. We differentiate psychotic states with or without disturbances of consciousness. Well-known in EEG studies of symptomatic and endogenic psychoses is, that in these psychoses the same clinical syndrom can be related to normal and to pathological electroencephalographic findings. This contradiction could often be explained when the activity of the psychoses was taken into consideration. The activity of the psychoses is to be determined by the duration, number, intensity and variability of the psychopathological symptoms. From his own investigations from 30 patients with schizophreniform epileptic psychoses, episode affective disorders and both depressive and manic psychoses, it could be shown, that normal EEGs are markedly infrequent. Most often they occur in subacute schizophreniform epileptic psychoses. The EEG of active and particularly of schizophreniform epileptic psychoses is most often characterized by simultaneous appearance of sharp waves, paroxysmal dysrhythmias and abnormal rhythm formations. Active schizophreniform psychoses correlate usually with abnormal rhythms. These abnormal rhythms ("parenrhythmien") diminish parallel with loss of activity of the psychotic process, are correspondingly seldom seen in subacute psychoses, and are not demonstrable in inactive psychoses. The experience of an alternating correspondence between epileptic psychoses and frequency of seizures could be confirmed.


[Methods for recording and quantitative measurement of rigidity and spasticity (author's transl)].

First pathophysiological aspects of rigidity and spasticity are described with special regard to the possibilities of errors during the measurement of muscle tone in man. The following methods are explained and discussed: Psychometric techniques, physical analysis of movements (kinesiology, photobadismography, kinetometry), pendulousness tests, investigations of reflexes (T-reflex, H-reflex, H/M-ratio), electromyographic methods (after-activity, silent period, unloading-reflex, stretch-reflex, release-phaenomen), and torque measurements. In the main we discussed these techniques with the view-point of diagnosis and drug effects. Furthermore we expressed our opinion on the relevance of the different methods. Last the most important sources of errors are tabulated.


[Occlusion of sinus sagittalis superior by infiltration of a tumor metastasis (author's transl)].

As a casuistic contribution to differential diagnosis of thrombosis of cerebral veins and sinuses a case of occlusion of sinus sagittalis superior by infiltration of an intracerebral metastasis from a teratoma of testis is reported. The leading symptoms - epileptic seizures, progressive hemiplegia, choked papilla and clouding of consciousness - gave rise to the tentative diagnosis of a cerebral tumor; in carotis angiography however, the metastasis was not detected, merely the occlusion of the sinus was demonstrated. Therefore the progress of the syndrome was misinterpreted as caused by an advancement of a venous thrombosis. Only autopsy showed the symptomless primary tumor and its formation of metastases.


[Drug abuse in Norway (author's transl)].

The author gives a review of the problems of drug dependences in Norway. The rate of use of and dependency to drugs is discussed with special reference to adolescent drug habits, as registered yearly since 1968. About 18 percent of adolescents in Oslo have tried cannabis once or several times (1972, 1973). Although, the situation seems to have stabilized during the last two or three years. In other big towns in Norway the percentage is about half of that in Stockholm and Copenhagen. The attitude of young people to the use of drugs, including cannabis, is strongly negative. Tendencies in adolescent use of and dependency on drugs are described. In adults dependency on benzodiazepines seems to be the most common type of dependency. The methods used in treatment of drug dependents in Norway are described, as are also the prophylactic measures.


[A conceptual model of the long-term configuration of manic-depressive illness (author's transl)].

A theoretical approach to manic-depressive illness is developed which explains the fundamental connection between psychopathologic symptoms and their arrangement in the course of time by means of one argument, i.e. the special variation of the diurnal organization of the drive and mood system. Elements of the model are a periodicity in a stringent sense, the hypothesis of the principal independence of the rhythmic organization of the drive system and the mood system which is postulated. In some special cases of different infradian rhythms there is a desynchronization of mood and drive which results both in a psychotic state and in rapid deformation of diurnal rhythms as well as slow interference cycles. This concept generates an interpretation of endogenity which uses only chronobiological terms; the hypothesis of somatogenesis is not implied but the physiologic systems involved are deemed to be intact, and the basic process is seen as a disturbance of the time structure of these functions. Thus, further investigation defines four fields: the depressive sleep disorder, the diurnal variation of mood, the chronobiology of the so-called mixed states and the time structure of the life-long sequence of phases and intervals. A new therapeutic concept works with artificial and fast sleep and wake periods and their transformation in order to achieve a resynchronization of the drive and mood system.


Trends in continuing education in the United States.

Developments in continuing education are closely related to professional and societal trends, developments in medicine and other health professions, scientific advancement, the state of the economy, and other factors.  It is safe to predict that in the future, increasing recognition will be given to continuing education as a necessity for professional practice.


[Multiple drug resistance of Enterobacter-Serratia group isolated from clinical materials (author's transl)].

We determined the drug susceptibility of Serratia-Enterobacter group isolated from clinical materials between October 1973 and May 1974 by disk method and agar plate dilution method, and compared the drug susceptibility and multiple resistance among pigment-producing Serratia, pigment non-producing Serratia and Enterobacter. We used following drugs for susceptibility tests; ampicillin, carbenicillin, sulbenicillin, cephaloridine, streptomycin, kanamycin, dibekacin, gentamicin, chloramphenicol, tetracycline, colistin, nalidixic acid, nitrofurantoin and erythromycin. Above one half of strains of Serratia and Enterobacter was isolated from sputa and pharyngeal swabs. Almost all strains of Serratia and Enterobacter wer resistant to ampicillin, cephaloridine and erythromycin, but sensitive to gentamicin and dibekacin. Resistant strains were more found in Serratia than in Enterobacter. Pigment non-producing strains of Serratia were more sesistant to chemotherapeutics than pigment producing strains. There were many multiple resistant strains in Serratia and Enterobacter, especially in pigment non-producing strains of Serratia, and the strains isolated from urine were resistant to more drugs compared with the strains from other materials.


[Clinical experiences of lividomycin on respiratory tract infections (author's transl)].

Clinical effects of a newly developed aminoglycoside antibiotic lividomycin, were investigated in 13 patients suffering from respiratory infections. 1. A total of 13 patients with the following infectious diseases was treated with 1 g/day of lividomycin for 3 to 11 days (average 6.7 days): Acute pneumonia 3 cases, bronchiectasis 3 cases, acute bronchitis 5 cases, suppurative diseases of the lung 1 case, and pyothorax 1 case. As the results, the antibiotic was effective in 5 patients, moderately effective in 4 patients and ineffective in 4 patients, and thus the global effective rate was 62.9% (9/13). 2. As in the case of kanamycin, lividomycin indicated fairly good sensitivity against a total of 17 strains comprising Staphylococcus aureus (7 strains), alpha-Streptococcus (2 strains), beta-Streptococcus (3 strains), gamma-Streptococcus (1 strain), Neisseria (2 strains) and Haemophilus (2 strains) which were isolated from sputum. 3. No side effects attributable to lividomycin were observed.


[Urinary uropepsin activity in patients with closed cranial trauma].

The authors determined uropepsin activity in 24-hour urine in 30 cases of mild craniocerebral trauma. The determinations were done on the 1st, 3d and 7th days after trauma. The control group consisted of 15 healthy subjects. The activity of the enzyme was raised only on the 1st day after trauma and it may be explained as a result of stress.


The effect of potassium chloride infusion of parotid salivary flow and composition in conscious sheep.

The composition and flow of parotid saliva in conscious sheep was measured before, during and after the intravenous infusion of 0-43 M-KCl or 0-43 M-NaCl at 2 ml./min for 2 hr. The salivary flow rate was depressed during the infusion of potassium chloride into both intact sheep and adrenalectomized sheep. As the salivary flow was unchanged by sodium chloride infusion it was concluded that the potassium ion was responsible for the decrease in flow and that this effect was not mediated through any of the adrenal hormones. The highly significant negative correlation between plasma potassium concentration and salivary flow throughout all potassium infusions indicated that the extent to which the salivary flow was depressed varied with the degree of hyperkalaemia. Except for situations where mineralocorticoid levels were likely to be elevated the concentrations of sodium and potassium in the saliva were positively correlated with the plasma concentrations of these ions. The salivary bicarbonate concentration of the saliva was negatively related to flow. The chloride concentration of the saliva was negatively correlated with salivary flow during all potassium chloride infusions.


Flow in glass models of arterial bifurcations and berry aneurysms at low Reynolds numbers.

Using the dye injection technique, flow at low Reynolds numbers was studied in glass models which simulated arterial bifurcations of varying angles and had varying bluntness of the apex or crotch. Forks bearing small saccular evaginations simulating berry aneurysms were investigated similarly.. At quite low Reynolds numbers in all the models small wave motion was observed at the forks. At higher Reynolds numbers and below the critical values for turbulence, larger Vortices akin to a Kármán vortex street were shed from most of the forks. The disturbances were attributed to boundary layer separation and a jet-edge effect.


Changes in renal haemodynamics and electrolyte excretion during acute hyperkalemia in conscious adrenalectomized sheep.

The p-aminohippurate (PAH) clearance, inulin clearance and the excretion of electrolytes by 10 adrenalectomized sheep were measured before, during and after the infusion of 0-43 M-KCl at 2 ml./min for 2 hr. The PAH clearance increased as the plasma potassium concentration increased up to approximately 6-0 m-mole/l. Further increases in plasma potassium were associated with a progressive return of the PAH clearance to or below the pre-infusion levels. At its maximum the PAH clearance was 1-228 +/- 0-032 (S.E. of mean) times the pre-infusion levels. The inulin clearance increased to reach a mazimum coincident with or subsequent to the maximum PAH clearance. The maximum level of inulin clearance during the hyperkalaemia was 1-158 +/- 0-020 times the pre-infusion clearance. The increments in the clearance of potassium and of bicarbonate rose rapidly to exceed the increment in inulin clearance during the hyperkalaemia in all experiments. The increments in the clearance of sodium and of chloride exceeded the increment in inulin clearance in more than half the experiments. It was concluded that although hyperkalaemia was associated with increased glomerular filtration much of the increased excretion of sodium, chloride and bicarbonate was derived from depressed tubular reabsorption of the ions. When the infusion experiments were repeated on the same animals the sheep demonstrated an improved ability to control the rise in plasma potassium concentration which was similar to potassium adaptation described in other species. There were no apparent differences between sheep maintained on 1-5 mg and 5 mg deoxycorticosterone acetate daily in their adaptation to potassium loading and the effect was tentatively attributed to the level of steroid maintenance being chronically high. The toxicity of hyperkalaemia was not lessened by this adaptation to potassium loading.


Plasma iron transport during egg laying and after oestrogen administration in the domestic fowl (Gallus domesticus).

The concentrations of 59Fe and of radioiodinated transferrin and albumin were measured in the blood, liver, spleen, bone marrow and ova at different times after the injection of transferrin-bound 59Fe and the labelled proteins into non-laying, laying and oestrogen treated chickens. In the egg-laying and oestrogen-treated birds the 59Fe of the plasma was rapidly transferred from transferrin to another component with the properties of th phosphoprotein, phosvitin. Radioactive iron, and labelled transferrin and albumin to a lesser extent, entered the ova only while they were in the ovary. Relatively more labelled transferrin than albumin was found in all the tissues studied except in the ova, in which the two labelled proteins were present in the same relative concentration as in the plasma. It is concluded that, during egg laying and after oestrogen treatment, plasma iron bound to transferrin is taken up by the liver, incorporated into phosvitin and is then secreted into the plasma leading to elevation of the plasma iron concentration and transfer of iron to the ova.


A subchronic study of the toxicity of an orally administered benzoquinolizinyl derivative in the rat and dog.

The subchronic toxicity of the trans isomer of N-(1,3,4,6,7-hexahydro-11bH-benzo[a] quinolizin-2-yl) propionanilide hydrochloride (TR2379), a new antihypertensive agent, was studied in rats and dogs. TR2379 was well tolerated for 13 weeks at daily p.o. doses up to 200 mg/kg in the rat and 70 mg/kg in the dog. However, severe toxic manifestations, including death, were elicited in the rat at 820 mg/kg and in the dog at 160 mg/kg. Toxicity in both species was characterized by a reduction in body weight gain and an increase in the weight of several organs, (liver, heart, kidneys, adrenals, and thyroids). Serum alkaline phosphatase, which was not assayed in the rat, was markedly increased in the dog. Microscopic examination of the various tissues revealed no evidence of organ pathology in either species.


Influence of a benzoquinolizinyl derivative on serum and hepatic alkaline phosphatase activity in the dog and rat.

Oral administration of 100 mg/kg of TR2379, N-(1,3,4,6,7-hexahydro-11bH-benzo[a]quinolizin-2-yl) propionanilide hydrochloride, for 20--29 days to 6 dogs resulted in significant elevations of alkaline phosphatase (AP) activity in serum and in liver microsomes. Results of biochemical and histochemical experiments revealed that the liver was the sole source of the increased AP activity but there was no evidence of liver damage. The subchronic (7-35 day) p.o. administration of TR2379 at 820 mg/kg to 20 rats did not produce elevation of AP activity in serum or liver. Relative liver weights (g/100 g body wt) of rats receiving TR2379 were significantly increased during the 2nd week and thereafter. The results of these studies suggest that high doses of TR2379 induce protein synthesis in dog and rat liver and induce AP activity in the dog but not in the rat. The elevation of AP in the dog is not considered to have toxicologic implications.


Bilateral deep brachial vein thrombophlebitis due to vibrio fetus.

A patient had bilateral deep brachial vein thrombophlebitis in which Vibrio fetus was recovered from six blood cultures of the six drawn. Fever and phlebitis continued with treatment with intravenous doses of heparin and oxacillin but rapidly improved with treatment change of oxacillin to clindamycin. In vitro antibiotic disk susceptibility testing confirmed resistance to oxacillin and susceptibility to clindamycin. Vibrio fetus infection is associated with the vascular endothelium in this and previously reported cases


A computer study of bacterial resistance patterns to antibiotics.

The study of resistance patterns of strains of bacteria to antibiotics in different regions of a country and, if possible, comparing them at international level appears to be a useful exercise. The patterns of resistance during 1968-71 revealed an increasing resistance for most antibiotics with an unexpected increase for chloramphenicol. Notable is a decreasing resistance, not only of coagulase-positive strains of Staphylococcus aureus but also of other micro-organisms towards doxycycline. For practical purposes there was no difference between the sensitivy of the isolates from hospitalized patients and from out-patients, though less pronounced in the latter. The incidence of resistance among strains isolated from the paediatric ward was low. Comparatively small changes in molecular structure may result in relatively large differences in the sensitivity pattern; for example, between tetracycline and doxycycline (Vibramycin, Pfizer), the greatest activity is seen with doxycycline.


[The EEG during post-traumatic coma (author's transl)].

With traumatic coma, the underlying pathomorphology may vary and it may not always be possible to establish it. Possible organic lesions are contusions of brain, oedema, intracranial haematoma, fat embolism, or an open brain injury. On the other hand there may be no organic lesions, as for instance in concussion. In every case, the leading clinical symptom is alteration of consciousness. This arises through interference, at some point, with the reticulo-thalamocortical system which is responsible for the regulation of consciousness. Concurrently with the alteration of consciousness, the EEG also shows changes. At the same time, the EEG is affected by the other effects of trauma upon the brain. Becuase of this, this EEG is not exclusively determined by the degree of unconsciousness. The possible causes of traumatic unconsciousness, and of the pathological waves seen in such cases, cannot always be established in clinical medicine, and experimental studies particularly with regard to neurophysiology are required to explain them....


[The clinical picture and psychopathology of the XYY constitution].

It is reported on 2 cases of the XYY chormosomal constitution. The patients were comparable only with respect to some somatic deviations. Age at manifestation of psychic abnormalities as well as the degree of deviation of behaviour were rather different. One patient got his psychic traumatization mainly in early childhood where as the other suffered from a more puberal conflict. Genetic disposition may be the basic cause of the psychological abnormalities. Yet, the degree of deviation seems to be influenced mainly by environmental factors.


["Fatiguability" in myasthenic syndromes].

Neuromuscular disorders accompanied by a "myasthenic reaction", but without other symptoms of myasthenia gravis and no therapeutic response to cholinergic drugs may be called myasthenic syndromes. The abnormal fatigability can be shown in the electromyogram. Lasting voluntary contraction of a muscle shows a rarefication of the EMG-pattern. Sometimes during repetitive stimulation of the motor nerve a decrease in the amplitude of the muscle potential may occur. This decrease is poorly influenced by cholinergic drugs. Often this observation was present in patients with myositis and myotonic dystrophy, sometimes in other myopathies and seldom in neurogenic disorders. A failure in the neuromuscular transmission is discussed not only in myasthenia gravis, but also in myasthenic syndromes. But there may be another explanation. A decreased number of intact muscle fibers during lasting innervation will cause a more rapid fatigation of the muscle fibers and in this way there will be an exhaustion. It is discussed, whether the symptoms in myasthenic syndromes can be explained by an abnormal "fatigability".


[Neurological aspects of nerve transplantation].

Neurological aspects of nerve-grafting are discussed. Methods designed for quantification of the pre-and the postoperative neurologicalsyhdromes ("index of integral function") and for the selective description of sensory impairment ("index of sensibility") are presented. These methods may facilitate the comparison of results of different investigators. The rate of positive results could possibly be raised if patients could be operated earlier. Considerable improvement can be expected only, when nervegrafting takes place as soon as possible, at the latest six months after injury. Grafting is no longer recommendable, when 12 months or more have passed even when only sensory recovery is aimed at. The reason is that reduction of sensory functions usually causes less impairment than vegetative and trophic changes which may occur as sequelae of the operation.


Resistance categories of enterobacteria to beta-lactam antibiotics.

The activities of cephaloridine, cephalothin, and ampicillin against dense cultures of 103 ampicillin-resistant gram-negative bacilli were compared in a turbidimetric system. The organisms were divided into two groups according to their behavior in conventional minimal inhibitory concentration titrations: those fully resistant to ampicillin at a concentration of 500 mug/ml and those inhibited by 32-500 mug of ampicillin/ml. Of the 83 strains in the first group, most were more sensitive to cephalothin than to cephaloridine, whereas the 20 strains in the second group exhibited a number of interesting properties peculiar to them. On the basis of these and previous results, six distinct categories of resistance to beta-lactam antibiotics have been detected among enterobacteria.


Do boys with a low-average I.Q. actually have a low self-esteem?

The purpose of this study was to gain an understanding of the needs, fears, aspirations, and attitudes of the low-average elementary and junior high age boy. The settings were two schools, a junior high (grades 9-12) and an elementary school (grades 5-6), located in a working class community. Two separate groups involving boys ages 11 and 12 years, and boys ages 14 and 15 years, met for five consecutive meetings. The structured interview in a group setting was chosen to increase the likelihood of a spontaneous, open interchange, as opposed to a more restricted response pattern. All subjects had failed at least one year, had maintained a stable I.Q. of 80-90 during their school years and were level in one or more subjects. The findings suggest caution in automatically equating low-average intelligence in boys with low self-concept, lack of career plans, family problems, and other similar stereotypes.


Assessment of the cognitive effect of a prototype health education unit on sixth grade students.

The purpose of this study was to assess the cognitive effects of a prototype health education teaching model on the cardiovascular health knowledge of selected sixth grade students. The level of significance for the study was set at .05. No significant differences between pre-test mean scores, experimental to control group were found. Significant differences between post-test mean scores, experimental to control group were noted. No significant differences between control group pre-test to post-test mean scores were found. Although significant experimental group pre-test to post-test mean scores were found in all four locations, no significant differences were found between the experimental post-test mean scores by geographic location.


The sick role and the role of the physician reconsidered.

The main substance of this paper was presented orally at a meeting of the Sick Role, organized and chaired by Andrew Twaddle. It was a commentary on four papers and the oral discussion of them. In response to these the paper first discusses the relation of the sick role to deviant behavior and the motivation to become and remain ill. The position was taken that the author never had meant to confine the category of illness to deviant behavior, though its negative valuation should not be forgotten. Nor had he confined it to cases of acute illness, omitting consideration of chronic and other types. The most important issue, however, concerned the structure of the relation between physician and patient. Though insisting that interaction between them is two-way, not one-way, the author insisted that the relation is basically asymmetrical because of the physician's expertise in health matters, gained through training and experience, and his special fiduciary responsibility for the care of the sick. In this respect the relationship is different from others such as the competitive market or the democratic association, but is comparable to the relation of teacher and student in higher education.


The longevity and mortality of American physicians, 1969-1973.

This paper analyzes the mortality experience of male and female physicians during the five-year period 1969 through 1973 in terms of age, sex, geographic location, and medical specialty. Physician mortality and longevity are then compared with the experience prevailing among the U.S. white population of the same age and sex. Relationships between socioeconomic status and mortality suggest that physicians should have a better mortality experience than the general population and as such have a greater overall expectation of life. Previous studies of physician mortality in the United States using data from the records of the American Medical Association, have examined physician mortality relative to comparable groups of white males. No studies of physician mortality utilizing a population-based approach have been reported since that of the 1949 to 1951 population of physicians, and previous studies may have been subject to certain limitations in the data. Empirical findings are presented which demonstrate the improvement in physician longevity since 1925. The relationship between age- and sex-specific mortality and geographic location and medical specialization is also discussed.


Renal excretion of monovalent cations during functional adrenalectomy in conscious sheep.

In sheep with both adrenals removed and one re-implanted in the neck, functional adrenalectomy was produced in conscious undisturbed animals by occluding the blood supply to the transplanted gland. Functional adrenalectomy caused a fall in potassium excretion and a very large increase in sodium excretion and was reversed by aldosterone. Hydrocortisone infusions slightly increased potassium excretion and reduced solute-free water reabsorption. Preliminary evidence suggests that potassium secretion into urine was still occurring during the 8 hr period of adrenal occlusion and functional adrenalectomy.


Antibiotics in the treatment of chronic staphylococcal osteomyelitis.

Fourteen patients with chronic osteomyelitis were treated with oral penicillin, oxacillin, or cloxacillin at a dose of 5 gm/day, plus 0.5 gm of probenecid (Benemid) three or four times per day. Treatment was continued for 2 1/2 to six months. In ten patients, evidence of osteomyelitis disappeared and there has been no recurrence during follow-up periods varying from six months to 2 1/2 years. Significant hepatotoxicity was encountered in two patients; one similar patient, not in this series but receiving a similar regimen of antibiotic, developed leukipenia. Thus, patients with chronic osteomyelitis appear to benefit from such a therapeutic program, but they must be monitored closely for hepatic or hematologic toxicity.


Postcardiotomy psychosis: indications and interventions.

Aberrant psychological behavior has become a frequent occurrence in the intensive care unit (ICU). In specifically considering postcardiotomy psychosis, health professionals puzzle whether the manifestations are motivated by physiological problems imposed by surgical considerations (cardiac status, pump perfusion) and/or by pre- and postoperative psychological factors. Current literature attempts to isolate elements which may predispose patients to develop these aberrant behaviors. This paper attempts to identify important areas and suggest concrete nursing interventions to decrease, delay, and assimilate these behaviors in the cardiotomy patient.


Emotional response and clinical severity as early determinants of six-month mortality after myocardial infarction.

The literature relating psychic factors to pathogenesis, onset, and complication of acute myocardial infarction was selectively reviewed. A study which suggests that psychic factors affect six-month mortality rate after myocardial infarction was described. Specifically, patients showing a trend toward emotional adjustment early in their hospitalization had a far smaller mortality rate than those who did not show early adjustment trends. Severity of the heart attack, measured by the extent of complication, proved also to be predictive of six-month mortality. The findings were discussed with an emphasis on the acute-care staff's potential for changing patient behavior patterns, and hence, improving eventual patient mortality rates.


Psychosocial influences on heart rhythm in the coronary-care unit.

This report is an extension of previous studies which have shown that significant heart rate and rhythm changes can occur in coronary-care patients during a variety of socio-clinical interactions. Results of continuous day-long observations and concurrent monitoring of one such coronary-care patient disclosed that twice as many ectopic beats occurred during routine nursing interactions compared to resting periods, even though such interactions accounted for less than half of the total observation period. These results are similar to previous studies that have shown that the frequency of ectopic beats can be significantly altered in coronary-care patients by such routine interactions as pulse palpation. Combined with other clinical and animal studies, these data suggest that psycho-social interactions can have major effects on cardiac functioning.


Evaluation of the pathotec Rapid I-D system for identification of Enterobacteriaceae.

The PathoTec Rapid I-D System for identifying Enterobacteriaceae was evaluated with 471 cultures. In 4,910 individual test comparisons, 95.5% of the results agreed, with results of only two test strips, those for esculin hydrolysis and urease production, agreeing with conventional tests in less than 94% of the trials. The PathoTec system exhibited 94.3% accuracy in identifying these cultures in a double-blind study with conventional media and procedures as the alternate system. Two newly developed test strips, for 0-nitrophenyl-beta-D-galactopyranoside and ornithine decarboxylase, were found to be highly reliable.


Arrhythmias in the coronary-care unit. II. Physiologic bases of paroxysmal bradycardia-dependent A-V block.

Bradycardia-dependent A-V block during acute cardiac ischemia or injury is best explained by applying knowledge of basic cellular electrophysiology. Spontaneous diastolic depolarization during phase 4, plus a reduction in the magnitude of the transmembrane action potential are the pathophysiologic changes responsible for "phase-4 block".


Evaluation of nursing care in terms of process and outcome: issues in research and quality assurance.

Approaches to patient care evaluation (process, outcome, and process-outcome) are placed in perspective and organized into a framework which clarifies the need for working toward the goal of process-outcome evaluation. Some issues of interest to researchers and to quality control programs are discussed, and recommendations are made.


Role insufficiency and role supplementation: a conceptual framework.

A theoretical basis for the diagnosis of nursing problems, centered on the concepts of role insufficiency and role supplementation, is offered. Role insufficiency is anticipated and experienced by clients during role transitions with developmental, situational, and health-illness implications. The conceptual basis of nursing intervention is role supplementation, and components, strategies, and processes of role supplementation are described. Conditions that predispose clients in the health setting to undergo role transition, conditions under which aspects of role transition may become nursing problems, and the role of the nurse in dealing with clients' role transition problems are described. A predictive and prescriptive paradigm, showing the interaction of construct components, is presented.


The impact of a professional baccalaureate degree program.

Results of a five-year investigation at the University of San Francisco of the impact-as measured by the students' perceptions of their collegiate experience-of an innovative four-year curriculum, leading to a bachelors degree and professional preparation in nursing, are summarized.


Factors contributing to child abuse.

Medical data of 48 children up to six years of age who were hospitalized at a public children's hospital for battering between 1965 and 1973 were compared with a random sample of comparable data of 50 nonbattered children. The average age of the battered children was 15.5 months. No differences were found between abused and nonabused children on study questions.


Developing a computer program to assist the nursing process: phase I-from systems analysis to an expandable program.

In a three-stage project, a computer program was devised to assist in the nursing process. As Stage I, a definition of nursing was developed upon which a systems model of the nursing process was constructed. In Stage II, the computer program was written to collect patient data and formulate nursing diagnoses related to functions of the skin, mucous membranes, nails, and hair. The program was designed to serve as a model for the development of a more comprehensive program that would include other functional areas, suggest patient objectives and nurse interventions, and help to evaluate nursing care. In Stage III, initial trials were conducted to obtain feedback from nurses. Nurses found the program took too long but agreed that with modification it could help them give better care.


Patient attitudes toward nursing interventions.

When attitudes toward nursing interventions of 103 psychiatric inpatients studied over a 28-month period, in three different ward phases, were correlated with demographic, psychiatric, and psychologic test variables, attitudes varied premirily and almost exclusively with ward administrative phase. Within the differing ward phases the nursing interventions most valued by patients did not focus directly upon the individual patient.


Direct tape access as an adjunct to learning.

In a study to ascertain effect of direct tape access as an adjunct to learning, junior nursing student in a course in epidemiology were divided into control and experimental groups. The study extended through three quarters--fall, winter, and spring. Experimental students in the winter and spring quarters were given access to 15-minute taped summaries of each week's lecture. When midterm and final examination scores were analyzed according to study group, no statistically significant differences between control group scores and experimental group scores were computed, so that the tapes were found to have no effect on learning; however, student satisfaction with the course showed a significant increase.


A hospital stress rating scale.

When 261 medical and surgical patients at a community hospital were asked to rank order 49 events related to the experience of hospitalization from most to least stressful, results indicated the subjects were capable and willing to order the events. Moreover, they showed a high degree of consensus as to how the events should be ordered. The rank order of these events provides a tool that can be used to quantify the measurement of psychosocial stress experienced by hospital patients.


Effect of simulation gaming on attitudes toward mental illness.

Sixty nursing students were administered the Opinions about Mental Illness (OMI) scale. Students whose scores fell above the median on authoritarianism and social restrictiveness were randomly assigned to experimental and control groups. The experimental subjects' scores on authoritarianism and social restrictiveness decreased significantly (p greater than .001), wheras the control  groups' scores on these two factors remained essentially the same.


Measurement of Nursing Work Load Using Head Nurses' Perceptions.

A methodology for measuring and  predicting work load on nursing units utilizes perceptions of head nurses as measured by a specially designed questionnaire. The data were collected in a 300-bed shortterm general hospital over a seven week period. The results indicated that head nurses' perceptions of need on nursing units were predominantly influenced by unit census and available staff on the unit. Other patient load affecting variables, such as patient classification, number of new admissions, or postoperative patients, did not play a major role in shaping head nurses' perceptions.


Extra tactile stimulation of the premature infant.

To ascertain whether touch, in the form of extra tactile stimulation, would result in more rapid physical and social development and a greater degree of social development of the premature infant, 48 minutes of extra tactile stimulation, defines as a gentle, nonrhythmic stroking of the greatest possible area of skin surface of the infant's body by the nurse's hand, was given to eight experimental group premature infants daily for a minimum of two weeks while they were confined to an isolette. Six infants formed a control group. Regain of birth weight was used to assess physical development. Scores on the applicable portions of the Gesell Development Schedule and Bayley Scales of Infant Development and plasma cortisol levels were used to measure rate and degree of social development. Data were analyzed in terms of the total group and for pairs of infants matched for gestational age, birth weight, and Apgar score. No significant difference was found between control and experimental groups in rate of physical development as measured by regain of birth weight. Analysis of the relationship between weight gain and gestational age, sex, and Apgar scores indicated that none was a substantial indicator of the rate at which infants gained weight while in the hospital. There was no significant difference in the degree of social development between experimental and control infants, but, as hypothesized, there was significant difference in rate of social development. Plasma cortisol levels as an indication of the infant's adrenocorticol development as evidenced by his ability to respond to stressful situations, and hence indirectly his social development, revealed no significant difference between the two groups.


Current trends in diet and drug therapy for the dialysis patient.

It is virtually impossible to discuss diet and drug therapy separately in the treatment of the hemodialysis patient. Drugs and dialysis techniques often necessitate changes in dietary care, just as dietary indiscretions call for changes in drug therapy and dialysis. In order to coordinate the various facets when ordering diets, several factors must be considered. The physician plans the drug therapy with input from the dialysis nurses, especially for dialysis effects on salt, water, K+, and protein balance, and the dietitian coordinates the diet with drug and dialysis therapy. It is therefore essential that all personnel must interact as a team if the patient is to receive the maximum benefit of hemodialysis. To maintain this delicate, constantly changing approach, a balance of teamwork is essential.


Large surface area dialysis; innovations and patient management.

The analysis of the middle molecule theory has provided a means for reduced time and large surface area dialysis. Increasing the time-surface area product for the dialysis patient has provided a challenge for the dialysis staff. Rapid ultrafiltration necessitates careful and constant monitoring of these patients to prevent complications such as hypotension and cramping. The use of multiple dialyzers to accomplish large surface area dialysis also increases the cost. However, reuse has become a practical and safe way of decreasing the cost without jeopardizing the efficacy of dialysis. Developing a dialysis prescription to meet the particular needs of each patient, based on middle molecule clearance and residual renal function, appears to be an important factor in the future of large surface area dialysis and its adequacy.


Comparing the body-systems and conceptual approaches to nursing education.

This study compared the teaching effectiveness of two approaches to curriculum organization-the body-systems approach (which organizes the nursing curriculum in terms of the different systems of the body) and the conceptual approach (which organizes the nursing curriculum in terms of overarching principles or concepts). It was hypothesized that the conceptual would be more effective than the body-systems approach to nursing education, as measured by National League for Nursing (NLN) achievement tests and state board examinations for nursing licensure. The study, conducted in a small three-year diploma program in San Francisco, compared the Classes of 1970, 1971, and 1972 (N equals 70), which were taught on a body-systems curriculum, with the Class of 1973 (N equals 26), which was taught on a concept-oriented curriculum. No statistically significant differences were found among graduates of the four classes on the basis of either entering I.Q. scores or high school grade point averages. Statistically significant differences were found, however, on later NLN achievement test and state board examination results. Although the Class of 1973 did not perform as well as the classes of the three preceding years, it was not possible to attribute the performance of the Class of 1973 to changes in curriculum. The results of the study, therefore, did not sustain the hypothesis, but were instead inconclusive.


Nursing assessment and care plan statements.

Scope, specificity, and interrelatedness of patient problem and nursing intervention statements on nursing care plans were studied in relation to the introduction into the nursing assessment process of an objective observation checklist and a nursing history form. Ninety nursing care plans from six inpatient units in a Veterans Administration hospital were studied over an 11-month period. Results indicated that significant increases in the numbers of both types of care plan statements occurred only following the introduction of the nursing history, as did the numbers of nursing interventions related to the identified patient problems. The degree of specificity among the problem statements increased, but nursing interventions tended to become less explicit. The scope of focus of both types of statements continued to be primarily physical in orientation. The findings also suggested that, since the care plans reflected less than half the patient problems identified on the nursing histories, care plan studies alone might not be appropriate for evaluating the breadth of nursing care planning.


Sexual health education and counseling.

In the past decade, there has been a concentrated effort to develop much needed advances in human sexuality, but many sexually misinformed or troubled members remain in our society. As more information is disseminated and people become sophisticated, there will be many people requesting help with sexual problems in primary and secondary health settings. Nurses need to equip themselves in this important aspect of health care. First, one's own values, attitudes, and knowledge must be carefully examined. Desensitizing, and incorporatin experiences have been used effectively to help get in touch with feelings and attitudes about the sensitive area of sexuality. Second, the nurse must be aware of the wide range of feeling and attitudes on specific sexual issues that have proved troublesome to our society. Third, the nurse must take advantage of educational opportunities to gain knowledge of psychosexual growth and development during the entire life span. Fourth, if the nurse desires to become involved in sexual conseling further education with concentration on the various innoviative techniques and approaches will be necessary to help clients with specific problems and concerns. Finally, sexual health programs need to be affiliated with a reputable health agency with prefessional supervision. All programs and new approaches must be evaluated to determine their effect on sexual health care.


Development of a patient-completed admission questionnaire and its comparison with the nursing interview.

To compare the effectiveness of a patient-completed paper-and -pencil questionnaire with the nursing interview in obtaining the admission history, 30 patients newly admitted to a Veterans Administration hospital were asked to complete a questionnaire and were given the routine nursing interview. Data were compared for accuracy and nursing time required. The nurses made significantly more errors of omission in an unstructured interview than the patient made in completing the questionnaire (p greater than .001). The nurse spent an average of 11.5 minutes on her interview while the investigator used an average of 0.9 minute to explain the reason for the questionnaire to the patient and obtain his consent to its completion. Study findings are discussed as a means of providing an accurate, systematic, recorded data base for planning nursing care.


Myths in human sexuality; a social-psychological perspective.

Human sexuality, as a field of interest as well as a human experience, is inundated with myths, falacies, and dead beliefs. These outdated notions are instrumental in failure to gain an accurate and factual knowledge base about human sexuality, its nature, function, and its regulation. Myths have served to create an aura and mystery around the expression and experience of human sexuality. It is that aura that has contributed to ignorance, abuse, and misunderstanding. It is imperative, therefore, to examine the existence of myths in everyday living and to explore the meaning in our personal lives as well as in our prefessional encounters.


Sexuality in later life.

Aging produces changes in sexual organs, in the strength of the secual urge, and in physiologic responses and psychologic tensions. While sexual interest ans sexual thought decline, they do not disappear. Availability of partners and retention of youthful attitudes are important elements of sexual interest and activity at older ages. All authorities seem to agree that regularity of sexual activity is the essential factor in maintaining sexual capacity and performances for both males and females. Older persons who are sexually inactive and comfortable with that adjustment should not be made to feel inadequate, but those who are struggling with sexual problems should be helped to overcome them. Nurses should be prepared to take an active role in sexual conseling of the elderly and in agitating for social, political, legal, and attitudinal change.


Pressure volume curves of lamb lungs and the lecithin-sphingomyelin ratios of lung fluid.

Pressure-volume curves were made of lungs from non-distressed, from asphyxiated and from distressed lambs. The curves of the non-distressed animals differed from the curves of the asphyxiated and of the distressed group. Eleven stability indices were calculated and the summation of these in situ surfactant characteristics was used for individual respiratory distress syndrome diagnosis. Low values (less than 2) of lecithin/sphingomyelin (L/S) ratios in lung fluid were found before the 130th day of gestation, but a steep increase of the L/S ratio was present after that period. Postnatal RDS was found in low L/S ratio cases, whereas normal lung stability was noticed in animals with L/S ratios greater than 2. It is concluded that the prenatal L/S ratio in lung fluid of lambs is of predicting value in RDS experiments and fits well with lung stability characteristics.


Kinetic studies of mold alpha-galactosidase on PNPG hydrolysis.

The kinetic properties of alpha-galactosidase of Mortierella vinacea were investigated in detail using PNPG (p-nitrophenyl-alpha-D-galactopyranoside) as a substrate. Consequently, the enzyme was markedly inhibited not only by the substrate, but also by the galactose hydrolized. The initial rate of reaction at sufficiently high substrate concentrations, however, did not fall to zero and did approach a finite value. Galactose behaved as a mixed inhibitor and was neither totally competitive nor totally noncompetitive. A rate equation was obtained from a generalized equation derived from a kinetic model which took both the inhibitions into consideration. The constants used in the equation were appropriately estimated. The calculated rate agreed fairly well with the observed initial rate. Moreover, the PNPG hydrolysis progressing in a batch system was found to be approximately representable by simple first order kinetics in which the rate constant was dependent on the initial substrate concentration.


Thebaine variations between germplasm sources within one collection of Papaver bracteatum Lindl.

Plants of Papaver bracteatum Lindl. derived from different germplasm sources within one Iranian collection were grown for 18 and 37 weeks in the greenhouse and controlled environment chambers. Gas-chromatographic analyses showed significant differences between thebaine concentrations of root tissue for 18-week-old plants, but not for 37-week-old plants. The two age groups did not differ in thebaine yield per unit of dry weight of root tissue. However, due to more profuse root growth, the total yield of thebaine from roots of the older plants was about four times that of the younger plants. Shoot thebaine concentrations differed significantly for 18- and 37-week-old plants. The over-all mean thebaine concentration for shoots of older plants was nearly twice that of younger plants. The variation in thebaine concentrations in these plants suggested genetic differences between the germplasm sources. Thus, domestication of P. bracteatum will require selection of germplasm from within and between collections, for plants of the greatest economic potential.


[The acute visual hallucinosis in infancy. Clinical, neurophysiological and psychodevelopmental aspects and differential typology (author's transl)].

By introducing the definition "hallucinosis" (Wernicke) it has become possible to confine the psychoses of organic origin more closely. Therefore, this term should also be used in pediatry and pedopsychiatry in order to designate cases with corresponding clinical aspects. Thus, accordance to the phenomenological characteristics of such syndromes as described in this paper, it is justified to emphasize that the acute hallucinosis in children is a special type of disease as compared to other psychoses caused by exogenic influences in this age group. The 10 case reports deal with visual hallucinoses which turned out to be characteristically different compared to those in adults. Hallucinating children at the age of 3 to 9 years predominantly visualized animals and legendary beings. Contrary to findings in adults, scenic and systematized visions were scarcely noticed, which psychodevelopmentally may be attributed to the fact that creative power in children is still little pronounced. Etiologically intoxications and infectious diseases were the cause for the visual hallucinations of the 10 children described. In the development of visual hallucinations somatic and psychic factors are significant. They have been discussed on the basis of today's knowledge. As today, however, there exists no satisfactory theory concerning the conditions favoring the development of hallucinations. To explain the somatogenesis of visual hallucinations three theories have been outlined, based on the present neurophysiological findings. It has been worked out that especially in children emotion plays an essential role in the origin of hallucinations. In infancy and early school age, while rational control of reality is still suppressed to a great extent, domination of emotional life goes along with lack of differentiation. At the same time the difference between imagination and perception is still little precise; therefore, phenomena, impressing as hallucinations in the adult, occur with greater facility in children.


[Transient global amnesia - a paroxysmal amnestic syndrome (author's transl)].

The Syndrome of Transient Global Amnesia is clinically characterized by a disorder of the ability to form memory engrams, appearing suddenly and lasting for several hours. Since the first papers on this syndrome by Bender (1956) and Fisher and Adams (1964) approximately one hundred cases of transient global amnesia have been described. Symptomatology, course, somatic findings and differential diagnosis are discussed with consideration of the literatur and three own observations. Regarding the etiology most authors discuss a transitory localized ischemia in the circulatory area of the vertebral-basilar artery system. Relapsing episodes occur less frequently than single episodes. In connection with this disorder characterized by the paroxysmal occurence and the episodic course, possible ways of genesis of amnesic syndromes are discussed. Theoretically three types of amnestic syndromes of organic origin may be differentiated: (1) amnesia in the frame of "function psychosis", i.e. of global mental deterioration caused by various diffuse brain function disorders; (2) amnesia caused by a combination of diffuse (function psychosis) and local brain function disorder; (3) purely local type of amnesia without function psychosis. In the combined type of amnesia a dissociation between the severity of memory disorders and relatively mild function psychosis is to be found. The importance of psychopathometric investigations, i.e. of quantitative determination of other mental dysfunctions besides memory disorder, for the interpretation of an amnesic syndrome is emphasized. Unfortunately these have not been possible in the cases described in this paper.


Antibacterial activity of combinations of cefazolin and semisynthetic penicillins.

The antibacterial activity of cephalosporin (CS) and semisynthetic penicillins was studied using CS-resistant strains of Escherichia freundii and Proteus morganii. A synergistic growth inhibitory action toward these microorganisms was demonstrated by a qualitative method and confirmed by a quantitative determination.


Nursing's contribution to social psychiatry: a holistic approach to personhood.

The expanded role of the nurse in social psychiatry involves building upon the conventional role of the nurse to include a focus on health promotion and prevention as well as on the detection and treatment of illness. Nursing is strategically located and uniquely prepared to take on such a challenge. Nursing has long recognized the holistic nature of families and communities. Nursing assumes that families have rights and responsibilities which include participation in the solution to problems which they helped to create. Nursing has been sensitive to the interrelationship between social expectation and dysfunctional behaviour. In the expanded role, nurses have accepted the mandate to transform society, to act as social change agents, as family advocates, as champions of minorities and as facilitators of mental health, i.e., the promotion and maintenance of mental health as well as disease detection and restoration of health. With a focus on mental health teaching, mental health promotion and prevention, nursing has the potential for providing an essential, holistic, now missing, link in the delivery of mental health services.


Pneumothorax as a function of gestational age: Clinical and experimental studies.

Infants with respiratory distress syndrome are especially prone to pneumothorax and pneumomediastinum as a complication of their disease. In a retrospective clinical analysis of a consecutively delivered population of infants with RDS the data suggested that the less premature infant with RDS was apparently more at risk to develop pulmonary rupture. This clinical observation was confirmed in postmortem studies in premature rabbits. The most immature group of lungs were relatively resistant to pulmonary rupture, owing to high surface forces. Toward term, surface forces were decreased as were lung tissue elastic forces, which predisposed to rupture at lower pressures.


Treatment of aspiration pneumonia and primary lung abscess. Penicillin G vs clindamycin.

Aspiration pneumonitis and lung abscess generally involve anaerobic bacteria, which normally colonize the upper respiratory passages. The therapeutic response of these infections to parenteral penicillin G (49 patients) and parenteral clindamycin (35 patients) was compared to determine relative efficacy. No difference was discerned between these two agents in terms of time required for defervescence, roentgenographic clearing, and ultimate outcome. Seven patients with infections including Bacteroides fragilis were treated with penicillin G, and all responded well. These data indicate that penicillin G is the preferred agent for pulmonary infections involving anaerobic bacteria. Clindamycin is a suitable alternative for patients in whom penicillin G is contraindicated.


The effect of the teachers smoking behavior on their involvement in smoking education in the schools.

The smoking behavior and attitudes of public school teachers were studied to determine if the teachers' smoking behavior is related to their attitudes and behavior regarding students' smoking practice and smoking education in schools. The Northampton, Massachusetts, School System was studied, where 162 of the 194 teachers randomly selected from various schools in the district completed the close-ended questionnaires administered and collected by the researcher. The study yielded a return rate of 83 percent. The results of the study showed that the general climate in school is one conducive to the establishment of a comprehensive smoking education program. It also indicates that the teachers' attitudes and behavior towards smoking education were closely related to their smoking  behavior. The ex-smokers were the most active group in attempting to initiate student smoking behavior change, while the smoking teachers were  the least active in this respect. Furthermore, pre-service and in-service teacher training programs in relation to smoking education were shown to be extremely sparse and ineffective in the past. This study suggests the need to strengthen pre-service and in-service teacher training programs in smoking education and to make smoking cessation programs available to those teacher who want to stop smoking.


[Position of cyticholine in pneumologic therapy].

The position of cyticholine in lung lipid metabolism and hence in pneumological therapy (the subject of a personal hypothesis) is discussed. A summary is given of personal experimental work and papers read at the 1974 Padua meeting (11th December) held by the Societas Europae Physiologiae Clinicae Respiratoriae. It is shown that cyticholine may: 1) prevent the onset of acute neonatal respiratory distress; 2) improve chronic pneumogenous respiratory insufficiency; 3) prevent postoperative hypoventilation; 4) improve ventilation mechanics in hyperelastic lung syndromes; 5) increase the gas permeability of the air-blood barrier; 6) counterbalance the loss of surfactants caused by endobronchial aspiration in patients with tracheal tubes.