Health needs of the elderly.

Elderly residents in two high-rise apartments in Erie, Pennsylvania, were surveyed to identify health needs in this type of congregate dwelling. Responses to a 20-item structured questionnaire were analyzed in relation to health condition, physical functioning, and access to medical care. When the elderly surveyed were divided into subsamples of males living alone, females living alone, and pairs, some differences were found. For example, females living alone had most difficulty in ambulatory activities (physical functioning) and 24.3 percent of the total elderly surveyed were not well in health condition. Recommendations included: A nurse practitioner could assess their health status at a specified health center or in their own apartments. Community groups or a home health aide could provide assistance for the 32 percent of the elderly surveyed who indicated difficulty with physical functioning activities. For the 11.7 percent who reported no access to medical care, a counseling or referral service monitored by a health professional could be provided.


Children's retention of dental hygiene instruction. Report of a pilot study.

Following three days of instruction in dental hygiene regarding correct brushing, plaque control, and nutrition, 23 hospitalized children between 4 and 13 significantly (p less than .05) improved practices in plaque control and brushing.


Empathy training as the major thrust of a staff development program.

The purpose of the study was to develop a human-relations-modeled staff development program and obtain an objective measure of the level of empathy of registered nurses who practiced in an acute- and chronic-care hospital. The short-term human-relations-modeled staff development program was designed specifically to assist nurses who scored low in empathy to increase their abilities to perceive and respond with greater empathy. The study indicated that all nurses tested possessed an extremely low level of empathy, that the staff development program significantly raised their levels of empathy, but that more training was needed to enable all or the majority of subjects to reach at least the minimal facilitative level necessary to help another person successfully.


Effect of nursing reassurance on patient vocal stress levels.

To compare effect of two types of nursing reassurances on patient anxiety or stress, as measured vocally by the Psychological Stress Evaluator, 23 subjects with confirmed pregnancies were interviewed by two registered nurses regarding their concerns about hospitalization. Each subject served as her own control. Vocal stress was measured from audiotapes of the nurse-subject interactions. Fourteen subjects; received "knowledgeable" (R2) reassurance; nine received "superficial" (R1) reassurance. Both types of nursing reassurances seemed to be effective with regard to vocal stress patterns. Three subjects who received knowledgeable reassurance showed decreased vocal stress: no subjects who received superficialreassurance showed decrease. There were no significant differences in the interaction length among the three groups of vocal stress patterns of subjects who received knowledgeable reassurance or between the two groups who received superficial reassurance. The data suggested that differences in vocal stress did not result from more or less talking by the subjects. Distribution of vocal stress changes observed in both types of reassurance led to investigation of the patient variable of denial as a possible explanation for the reason why knowledgeable reassurance was associated with increases in vocal stress for some subjects. The results that knowledgeable reassurance may be more beneficial regarding the reduction of stress than superficial reassurance, but only for subjects who do not utilize denial or avoidance as a coping mechanism. The study indicated that, for the majority, one of the benefits of academically promulgated knowledgeable reassurance is probably not the immediate reduction of subject anxiety or stress.


The chronotherapy of corticosteroids: practical application of chronobiologic findings to nursing.

In this paper evidence is presented pointing to the significance of when to treat along with why, what, and how much. Because of the circadian organization of the pituitary-adrenal axis, the long-term management of steroid-dependent patients must recognize and take into consideration the advantages of chronotherapy with corticosteroids. Thus, when corticosteroids are administered either daily or on alternate days, adrenal suppression and possibly growth disturbance can be minimized by timing to the circadian crest in adrenocortical function. As more findings are accumulated from ongoing and planned investigations, it can be expected that in the near future chronotherapeutics will become established in the practice of clinical and hospital nursing.


Amputation: two views.

It has been over one year now since his surgery, and Allen has returned to school and work, ambulating on his prosthesis most of the time. As his phantom limb pain decreased and his proficiency in walking increased, his acceptance of his amputation has been demonstrated in his comments and references to himself and his relations with others. As he states, the more comfortable he is about his amputation, the easier it is for others to accept and relate to him. This, I think, is the key to approaching that final stage of acceptance mentioned earlier. The more we can help our patients accept their amputation initially by supporting them through this crisis period, the easier it will be for them to relate to others and grow emotionally from these relationships.


Rehabilitation of the patient with a lower extremity amputation.

Preservation of life is an incomplete and inadequate objective for the lower extremity amputee. A comprehensive rehabilitation program must be designed to meet his individual needs. This is the responsibility of the professional community that purports to treat disease and maintain the health of the population. The multidisciplinary team functions in a coordinated effort to identify and resolve the amputee's problems, and to establish realistic goals during each phase of his rehabilitation program. The rehabilitation process begins when the prospective LE amputee is identified and continues until he has achieved optimal independence; that is, he has learned to cope with his disability within the boundaries of his normal environment.


Nursing care of the patient in a cast brace.

To establish realistic outcomes and formulate workable nursing care plans for the patient in a cast brace, the nurse must understand the concept of cast bracing, the patient's response to the injury and previous treatee is often the most persistent problem, and vigilant observations along with supportive care may prevent the skin from breaking down and the patient from becoming discouraged. Since the purpose of cast brace treatment is to hasten healing, maintain knee and hip joint function, and shorten the rehabilitation period, the smooth progression of activity and prevention of problems due to the cast brace are priorities.


Ultrastructural studies of the placenta of the ewe: phagocytosis of erythrocytes by the chorionic epithelium at the central depression of the cotyledon.

Extravasated maternal blood, which escapes from capillaries and larger blood vessels within the tips of the maternal septa, is responsible for the characteristic pigmentation of the central depression of the ovine cotyledon in the last third of pregnancy. The chorionic epithelium of this region is actively engaged in the uptake and subsequent breakdown of maternal erythrocytes, which may represent an important source of iron for the foetus during the period of maximum intra-uterine growth.


Changes in arterial blood pressure, heart rate and haematocrit during acute hyperkalaemia in conscious sheep.

The systolic, diastolic and mean arterial blood pressures, heart rate and haematocrit were measured at 15 minute intervals before, during and after 2 hour infusions of 0-4 mol.l-1 NaCl at 2-2 ml min-1 into conscious intact sheep and 0-4 mol. l-1 KCl at 2-2 ml. min-1 into conscious sheep which were either intact or adrenalectomized. The haemotocrit was also measured in splenectomized sheep receiving 0-4 mol. l-1 KCl. The NaCl infusion had no significant effect on blood pressure(BP), heart rate and haematocrit. Both intact and adrenalectomized sheep were able to withstand an increase in plasma potassium concentration in excess of 50% of the preinfusion concentration before any substantial fall in BP occurred. In intact and adrenalectomized sheep, heart rate and haematocrit increased rapidly and progressively throughout the potassium infusions and at maximum plasma potassium concentration the mean increments in these parameters for both groups of sheep were 21-6+/-2-69 beats/min and 7-5+/-0-47% respectively. Heart rate and haematocrit were more closely correlated with the plasma potassium concentration than with any other variable measured in these experiments. Adrenalectomy did not reduce the ability of the sheep to maintain their BP or to increase their heart rate and haematocrit. As the mean increase in haematocrit during potassium infusion into splenectomized sheep was 1-3+/-0-45% most of the increase in haematocrit observed in the potassium-infused intact and adrenalectomized sheep was caused by ejection of red cells from the spleen into the circulation.


The effect of intravenous infusion of hyperosmotic sodium and potassium chloride solutions on cephalic blood flow in conscious sheep.

The rate of flow of plasma and blood through the head of conscious sheep was measured before, during and after the intravenous infusion of 1 mol. 1(-1) NaCl and 1 mol. 1(-1) KCl at 0-8--1-0 ml. min-1 for 2 hours. The plasma flow was estimated by indicator-dilution technique using sodium para-aminohippurate which was shown to be a satisfactory indicator substance. Short periods of rumination were found to cause marked increases in cephalic blood flow. The infusion of hyperosmotic sodium chloride caused no consistent changes in the rates of cephalic plasma flow and blood flow. During potassium infusion plasma and blood flows increased as the plasma potassium concentration increased up to approximately 6 mmol.1(-1). Further increases in plasma potassium concentration were associated with a progressive return of these flow rates to or below the pre-infusion levels. This pattern of change in the rate of plasma flow through the head of the sheep was very similar to that previously reported for renal plasma flow during hyperkalaemia in conscious sheep. At its maximum the cephalic plasma flow was 1-163+/-0-029 (S.E. of mean) times the pre-infusion flow rate. Cephalic blood flow tended to reach maximum rates at slightly higher plasma potassium concentrations and thereafter, to fall more slowly than the plasma flow due to concomitant increases in haematocrit. Maximum cephalic blood flow was 1-176+/-0-032 times the pre-infusion flow rate. The lowest rates of cephalic plasma and blood flow occurred during the first 30 minutes following cessation of potassium infusion.


Stomach motility in insulin-treated sheep.

The effect of insulin-induced hypoglycaemia on the motility of the reticulum, rumen and abomasum of sheep was investigated using small lightly inflated balloons connected to transducers and a multichannel recorder. The principle response recorded was an inhibition of reticulo-ruminal and abomasal motility, occurring in 'resting' cycles only, and not during eating or rumination. The only hypermotility recorded was that shown by the abomasum just before the onset of inhibition. Ruminating cycles were recorded as frequently during hypoglycaemia as in control periods, and showed no abnormality. The inhibition was reversed by intravenous glucose or adrenaline and by feeding or ruminating.


A search for the factors responsible for absence of recovery of the normal vascular response to oxytocin following sympathetic nerve injury.

In dogs following crush injury to the lumbar sympathetic trunk, reflex vasoconstriction reappears in 4-6 months but the normal vasodilator response to oxytocin does not return even 12 months after crush. Histochemical examination of the walls of the blood vessels shows that division or crush of the lumbar sympathetic trunk or removal of terminal ganglia leads to decentralization, not denervation of the blood vessels. True denervation follows division or crush of the sciatic and femoral nerves. Following recovery from sciatic or femoral crush the pattern of peripheral innervation appears histochemically normal. However, there is no return of the normal vasodilator response to oxytocin. It is concluded that a normal response to oxytocin does not return even after long-term recovery from sympathetic injury, nor does its effect depend on a normal pattern of peripheral adrenergic innervation, but on an unknown more central activity of the sympathetic nervous system.


The effect of the anions, phosphate and sulphate, on normal rates of excretion of potassium in dogs.

Small doses of (NH4)2HPO4 or KH2PO4 by stomach tube caused increase in plasma PO4 and PO4 excretion. Above a threshold of 0-8 mmol. 1(-1), increase of plasma PO4 by 0-5 mmol. 1(-1) caused PO4 excretion to increase by about 35 mumol. min.-1 After KH2PO4 this relationship was not altered by the concurrent increases in plasma K and K excretion. After doses of (NH4)2SO4 or K2SO4, excretion of SO4 was similarly related to plasma SO4 and was independent of plasma K and K excretion. An effect of PO4 on K excretion was observed after doses of (NH4)2HPO4, when increased excretion of PO4 was accompanied by increased excretion of K without change in plasma K. There was also increased excretion of NH4 and a small increase in Na excretion. The changes were similar to those produced by (NH4)2SO4 [O'Connor and Summerill, 1976]. KH2PO4 and K2SO4 produced increase in plasma K and increased excretion of K not significantly different from the changes produced by KCl or KHCO3 [Baylis and O'Connor, 1976]. After KH2PO2 or K2SO4, the urinary anion was PO4 or SO4, instead of Cl and HCO3. Any effect of anions on K excretion was much less than the effect of increase in plasma K. At low rates of excretion of K, increased urinary excretion of impermeant anion can determine increased excretion of K. However, the effect of anion is small in comparison with the effect of increase in plasma K.


The projection of the retina, including the 'red area' on to the optic tectum of the pigeon.

The optic tectum of the pigeon has been mapped physiologically, including much of the inferior surface. There are two separate regions of high magnification factor, the projection areas of the fovea and the middle of the red area in the retina, each of which has a correspondingly high density of neurones in the ganglion cell layer.


Staphylococcus aureus strains isolated in Danish hospitals from January 1st, 1966, to December 31st, 1974.

During the years 1966-1974, 167,297 strains isolated from 167,297 patients or staff members in Danish hospitals were registered at Staten Seruminstitu. All the strains were phage-typed and examined for production of a 'Tween'-80-splitting enzyme and resistance to mercuric chloride. 158,236 strains were examined for resistance to antibiotics. Since 1968, a steep decrease in the number of strains resistant to three or more antibiotics (multiple-resistant) and in strains of the 83A complex was noticed. In recent years an increase in strains belonging to phage-group I and in those referred to as miscellaneous and non-identified was registered. The increase in the non-typable strains might be explained by the shift of the concentration of the typing phages from 1000 X RTD to 100 X RTD. It is concluded that at least two factors may have contributed to the reduction of the multiple-resistant strains: an altered antibiotic policy, restricting the use of streptomycin and tetracyclines, and an improved hospital hygiene, diminishing the spread of identical strains within the various departments. However, it is emphasized that the consumption of methicillin is still increasing.


[Effect of antibiotics on the resistance of white mice to infection caused by antibiotic-resistant Staphylococcus strains].

The effect of benzylpenicillin, streptomycin and tetracycline on the animal resistance to infection caused by the antibiotic resistant staphylococci was studied. It was found that the effect of the antibiotics on the infectious process outcome was not limited by their antibacterial properties. Changes in the natural resistance of the host under the effect of the antibiotics were not always the same and depended on both the antibiotic type and the moment of its administration.


[Study of the L-transforming action on Brucella cells of tetracycline, streptomycin, rifampicin and their combinations with penicillin in in vitro experiments].

The in vitro study of the possible formation of L-forms of Brucella under the effect of tetracycline, streptomycin, rifampicin or their combinations with penicillin showed that passages of various Brucella species on media containing increasing concentrations of the antibiotics resulted in insignificant morphological changes in the cells. Passages of the same cultures on media containing combinations of the above antibiotics with penicillin resulted in more significant changes in the cell morphology, up to formation of spheroplasts. No L-transformation was observed under the experimental conditions.


Antibiotic susceptibilities of streptococci from the mouth and blood of patients treated with penicillin or lincomycin and clindamycin.

Patients undergoing dental extractions were non-randomly allocated to three groups, one of which received no antibiotic, one benzylpenicillin followed by oral penicillin for 5 days, and the third intramuscular lincomycin followed by oral clindamycin. Dental extraction was performed at the beginning of the course of chemotherapy. Streptococci were isolated from the extracted teeth, from blood cultures collected before and immediately after dental extraction, and from sutures removed from the gums 5-7 days after the operation. The species of these organisms was determined, and their susceptibilities to penicillin, clindamycin, cephaloridine, erythromycin and tetracycline were assessed. The majority of streptococci isolated from teeth belonged to the species Streptococcus sanguis, S. mitior, S. mutans and S. milleri. Occasional isolates of each of these organisms collected before the antibiotic could take effect were resistant to penicillin. Three of these species, but not S. mutans, were the commonest streptococci to be isolated from the blood after dental extraction. Penicillin completely suppressed dental bacteriaemia under the conditions of our investigation, and lincomycin reduced the incidence by about 60 per cent. The commonest streptococci from sutures were also S. sanguis, S. mitior, S. mutans and S. milleri. S. faecalis was also isolated, but only in patients who had received antibiotics. Among the non-faecalis organisms, penicillin resistance was significantly more frequent among isolates from patients given penicillin than from patients not given this antibiotic, and clindamycin resistance was significantly more frequent among isolates from patients given lincomycin and clindamycin than from patients not given these antibiotics.


The school nurse as a health counselor.

It is difficult for school nurses to meet the many and varied demands of students, school personnel, and parents. This is especially true since the expectations of each may differ in different circumstances. However, if the school nurse has a clear perception of her own role and its inherent limits, if she takes every opportunity for staff development through inservice education or graduate work in counseling and human development, then she is in a unique and invaluable position to assume a role of major importance in the pupil personnel team within the school.


The effects of study abroad on health educators' attitudes toward international health efforts.

The major hypothesis of this study was that graduate level course work about internationl health matters carried out in an international setting would reduce hostility and increase cooperativeness in attitudes toward international relations. An eight week program of this type was executed and a comparison of pre- and post-program measurements of these attitudes confirmed the hypotheses. However, it was noted even though statistically significant shifts occured, there were many students who reported negative changes or no change at all. It was also found there were moderately strong correlations between hostility and cooperation. The implications of these findings are that programs of this nature can have a positive impact on attitudes such as these, but that there may be mediating variables tied closely to participant receptiveness to the message of the program; variables which might be important to consider in selection and screening. However, if this were true, it might also be true that those individuals capable of greatest gains may be in least need of such a program and vice versa.


[Factors of multiple resistance to antibiotics in nodule bacteria].

Multiple resistance to antibiotics (penicillin, levomycetin, neomycin, tetracycline) was found in 15% of collection strains of nodule bacteria and in strains isolated from natural environment.


Comparison of the epidemiology of bacterial resistance to mecillinam and ampicillin.

Mecillinam is a new type of beta-lactam antibiotic (an amidinopenicillanic acid) that is particularly active against Enterobacteriaceae and is taken orally as in the form of an ester, pivmecillinam. Assessment of any new antibiotic should include a survey of levels of bacterial resistance and investigation of its capacity to select resistant organisms or harm the commensal flora. Antibiotic resistance patterns of 2,000 Enterobacteriaceae isolated from the urine of patients with significant urinary tract infections were therefore determined. Mecillinam-resistant Enterobacteriaceae were found to be much less common than ampicillin-amoxycillin-resistant organisms both in the community and in hospital patients. Most ampicillin-resistant Enterobacteriaceae from infected urines were susceptible to mecillinam, but the relatively rare mecillinam-resistant organisms were usually resistant to ampicillin and cephaloridine. The fecal flora of 26 healthy volunteers who served as controls or were given repeated courses of therapeutic doses of either ampicillin or pivmecillinam was studied. Pivmecillinam had only a transient effect on the aerobic fecal flora and in contrast to ampicillin did not increase populations of resistant Enterobacteriaceae, which would be a potential hazard to the patient and contaminate the environment.


[Effects of lithium chloride administered in combination with methamphetamine or a reserpine- like drug on brain norepinephrine and dopamine metabolism in rats].

Lithium chloride (LiCl) was injected acutely (2.4 mEq/kg, i.p.) or subacutely (2.5 mEq/kg X 2/day for 4.5 days, i.p.) in rats treated concurrently with methamphetamine (MAPT) or a reserpine-like drug (Ro4-1284), and effects of LiCl on behavior as well as metabolism of brain norepinephrine (NE) and dopamine (DA) were investigated. Acute administration of LiCl suppressed the MAPT-induced hyper-locomotor activity but did not affect the Ro4-1284-induced behavioral depression. LiCl administered subacutely increased the MAPT-induced stereotyped behavior, and it reduced the Ro4-1284-induced initial transient excitation in spontaneous locomotor activity and tended to facilitate the recovery from behavioral depression. As for NE and DA metabolism, LiCl administered subacutely inhibited the MAPT-induced decrease of the deaminated NE metabolites and Ro4-1284-induced decrease of DA metabolism and the Ro4-1284-induced alterations in NE metabolism. From these results, it is likely that the inhibitory effect of LiCl on the MAPT and Ro-1284-induced changes in NE and DA metabolism may to some extent be involved in the therapeutic effects on manic-depressive illness.


[Differential diagnosis and syndrome-genetic problems and aspects of drug-induced psychoses in juveniles (author's transl)].

Acute and chronic psychotic states in juvenile drug addicts demand careful observation of syndrome-genetic and differential diagnostic factors. Not only the diagnosis of a schizophrenic or affective juvenile psychosis and their differentiation from phase-specific developmental crises may often be difficult. A further problematic field are special aspects of symptomatic psychoses and particularly states due to drug addiction with hashish, LSD and amphetamines and the effect of drugs on already existing endogenous psychoses. This demands subtile phenomenologic description and syndrome-genetic assessment. One will have to take into account the complexity of drug effects and whether a psychosis existed already before addiction, whether drugs have provoked a latent psychosis, whether a purely symptomatic psychosis mimics a schizophrenia or whether irreversible personality changes with secondary psychotic behavior have developed.


[Neuropsychiatric disorders of the diseases of exocrine pancreas (author's transl)].

Neuropsychiatric and psychosomatic disorders occurring the exocrine pancreatic diseases are not rare, nevertheless didn't it seem to be very interesting in research and there exists no summarizing work of this disorders. Therefore we tried to give a comprehensive representation of those neuropsychiatric problems which are connected with the function of this organ. At first we give a description of psychopathology and pathogenesis of the functional pancreatic psychosis. The problematic of the reciprocal relationship of nervous system and pancreatitis, alcoholism and pancreatitis are demonstrated as well as the psychic disorders occurring the pancreas insufficiency, cystes of pancreas and congenital pancreatic diseases. Psychosomatic and mental disorders of pancreas carcinoma and mucoviscidosis are shown in detail. The question of the interrelation between pancreatic function and amyotrophic lateral sclerosis or parathyreotic diseases are discussed just as themes of neuropsychiatric pharmacotherapie and pancreatic function and mental disorders in pancreatic treatment.


[Arteriovenous malformation of the dura and spontaneous intracerebral hematoma (author's transl)].

The rare arterio-venous angiomas of the dura may accompany other pathologic conditions of the brain and meninges without producing signs of their own. When combined with intracranial hemorrhage, angiographic analysis of venous drainage of the malformation may solve the question whether there is a connection or not. This is shown on a case of unusual combination of an arterio-venous angioma of purely dural type with intracerebral hemorrhage.


[Sciatic and gluteal nerve lesions during coma and anesthesia (author's transl)].

We observed 5 patients with sciatic nerve lesions after coma or general anesthesia; in 2 cases there were also the gluteal nerves involved. These lesions are probably caused by direct nerve pressure. In 4 cases axonotmesis with a delayed and incomplete recovery was seen.


[Fundamental studies on combination of antibiotics; especially on pharmacokinetics. I. Combination of gentamicin with sulbenicillin or cephacetrile (author's transl)].

1. When gentamicin (GM) and sulbenicillin (SBPC) or cephacetrile (CEC), in combination with pre- or post-treatment, were injected intravenously to the rat, their pharmacokinetics were investigated. 2. The antibiotics in the samples were separated by paper electrophoretic technique and their concentrations were determined by cup thin layer plate method using Bacillus subtilis as the test organism. 3. The biological half-life of SBPC in the serum was shortened in pretreatment with GM and prolonged in posttreatment with GM, while that of GM did not vary in pre- or post-treatment with SBPC. 4. The half-life of CEC was prolonged in treatment with GM, while that of GM did not vary. 5. These phenomena may be considered to be produced as the results of a concentration ratio of SBPC and GM or of CEC and GM, and protein binding of these antibiotics, as far as plasma initial levels, tissue distribution, urinary excretion and protein binding of these antibiotics are concerned.


Narcolepsy. Diagnosis and treatment.

Narcolepsy may affect as many as 200,000 Americans. The illness involves a neurologic defect in the regulation of sleep and wakefulness. The chief symptoms are sleepiness, inappropriate sleep episodes, and cataplexy. A characteristic history of cataplexy establishes the diagnosis. Narcoleptic patients also frequently complain of hypnagogic hallucinations, sleep paralysis, blackouts (or automatic behavior), and disturbed nocturnal sleep. Narcolepsy usually develops in adolescence and is a life-long illness. Symptoms may also appear in young children who may be misdiagnosed as hyperactive or psychotic. No completely satisfactory treatment is available at the present time. The current treatments of choice are methylphenidate (for sleepiness and sleep episodes) and imipramine (for cataplexy). Medication dosages must be adjusted for individual patients. A careful history of the illness can rule out hypothyroidism, hypoglycemia, and epilepsy. Sleep apnea is a serious complication of narcolepsy and may be life threatening.


Prenatal genetic counseling.

Current medical practice is using an increasing number of new and sophisticated techniques to deal with the fetus during pregnancy and not focusing exclusively on the immediate perinatal period. Some of these techniques deal with the occurrence or risk of serious genetic disease in the newborn. These procedures, which offer alternatives to the birth of seriously defective children, pose new problems in critical decision-making for contemporary parents. Proper medical care for the mother in such situations requires an understanding of the psychological as well as the medical and genetic aspects of each situation. It includes careful and caring communication of this information to the parents early in the gestational period, supportive care during the pregnancy and the procedures, and supportive counseling and follow-up afterwards. Properly applied, current genetic counseling diagnostic techniques as used by the physician can be extremely helpful to his patients in achieving the healthy family they desire.


Reactions to hysterectomy: fact or fiction?

Elective hysterectomy has become culturally patterned as a normal part of the life cycle with more than half of all American women destined for hysterectomy if current rates continue. In keeping with this widespread acceptance, both women and their doctors frequently express satisfaction with the operation. The sequelae that do occur appear to be serious in only a few women, though more minor disturbances do appear in a sizable number. Repeated or controlled studies indicate that hysterectomy may yield problems for some women in the following areas: rejection by male partners,  hot flushes after conservation of ovarian tissue, severe hot flushes after ovariectomy, long-term psychourinary problems, weight changes, lingering fatigue and prolonged convalescence, painful intercourse, depression, sleep disturbances, and other psychiatric symptoms. Prospective studies using matched control groups are needed which follow patients at least 2 years postoperatively, as repeated studies have shown "sleeper effect" after hysterectomy with sequelae developing after the first 6 months or even after 1 year. The impact of varying surgical techniques and the long-term endocrine impact of hysterectomy need to be detailed as well as further study undertaken on the psychosomatic sequelae.


[Pathogenicity of methicillin resistant Staphylococcus aureus. In vitro study].

Pathogenicity of methicillin-resistant (MR) strains of S. aureus is difficult to determine from clinical or epidemiological data. The degree of their pathogenicity has been tested in an in vitro phagocytic assay using isolated polymorphonuclear leukocytes (PMN), since PMN are considered to be the main defense mechanism against infections by S. aureus. In the phagocytic assay, survival of MetR strains was measured simultaneously with that of a methicillin-sensitive (MetS) control strain. After 30 and 60 min of incubation, MetR strains survived the phagocytic action of PMN better than the MetS strain. Amplification of resistance towards the antibiotic in three MetR strains did not modify their survival in the phagocytic assay. In conclusion, MetR strains have a definite pathogenic potential and this potential is not affected by the level of resistance towards methicillin.


The incidence of drug use and associated factors in two small towns: a community survey.

The article reports the results of a 1974 drug survey in two rural municipalities in the Pacific Northwest. Drug use in these towns was found to be similar to drug use in urban areas. It appears that towns size 2,500 to 50,000 have been absorbed into the national drug culture while only farmers and people living in very small towns still experience relatively low rates of drug use. Other findings include attitudes toward and needs met by drug use, the effect of parental drug use on perceived children's drug use, and the relationships between drug use and age, sex, and general health. In the past few years, articles have appeared describing adult drug use in the United States as a whole, or in selected urban populations. The most comprehensive study is a national survey of a representative sample of 2,552 adults completed in 1971 (1-3). Among the regional reports are studies carried out in California (4,5) and New York (6,7). What these studies have in common is the absence of data on rural or small town drug use as compared with urban drug use. A national study by Cahalan, Cisin, and Crossley (8) does analyse rural-urban differences, but only for alcohol use. No comprehensive treatment of this topic exists in the literature. The research reported in the present article represents an attempt to begin to fill in this void data on small town drug use in a rural setting.


A note on the cannabinoid content of Jamaican ganja.

There has been considerable recent interest in the study of Jamaican ganja users as a potentially valuable source of information on the effects of long-term cannabis consumption. However, reported data on the cannabinoid content of Jamaican material have been limited to those of Rubin and Comitas for a small number of samples of unknown representativeness. In the present study, the cannabinoid content was determined on 36 samples purchased from various ganja dealers at two different periods, derived from crops treated differently with respect to fertilization, and representing the range of types locally considered to differ in quality or potency. The analytical results agreed well with those of Rubin and Comitas, and indicated that samples with a delta9-THC content of 4.0% or more were apt to be comparatively rare. The median value was 2.3% by weight. Some of the variation in the THC content of the samples was clearly attributable to the different seasons in which they were purchased, and some may have been due to differences in the type of fertilizer used in cultivation. Local judgement as to the potency of samples proved generally sound, although by no means infallible.


Separation of cannabinoids.

The three main cannabinoids--cannabidiol (CBD), tetrahydrocannabinol (THC) and cannabinol (CBN)-can be isolated from purified extract of cannabis by preparative gas chromatography in satisfactory amounts and with a degree of purity similar to that of the sample substances provided by the United Nations Narcotics Laboratory.


Metal ion content of specific areas of the rat brain after 1600 MHz radiofrequency irradiation.

Rats were exposed to a hyperthermal environment or 1600 MHz radiation for 10 minutes to achieve equivalent rectal temperature increase (4 degrees C). Brain areas were quantitatively assayed for changes in magnesium, calcium, copper, zinc, iron, sodium, and potassium. Iron was increased in several brain regions of both hyperthermal and irradiated animals. Copper content of the cortex was also increased in both experimental groups, whereas zinc was decreased in the hypothalamus. Magnesium was increased in the cortex and medulla of the irradiated rats.


Structuring the black family for survival and growth.

The options presented in this article provide an additional frame of reference for understanding some of the relationships between the parts, the whole, and the environment in which they exist, on the assumption that a "holistic" view may give a more accurate picture of the problem, as well as suggest some possible solutions. The black family, as the primary unit of socialization for the black community, must maximize the survival and facilitate the growth of its members. From a social systems persepctive, the relationship of the black family's internal structure to the external environment provides important insights. Internal boundaries must be firm but permeable to maximize both survival (firm boundaries) and growth (permeable boundaries). Assaults from the external environment must be managed to provide psychic relief for family members. What becomes clear, in structuring the black family to cope with boundary intrusions, is the way in which family members can organize, prepare, and preserve the integrity of the family system without losing sight of the task.


Sexuality in the baccalaureate nursing curriculum.

One hundred and fifty-one baccalaureate nursing programs responded to a survey indicating how and to what extent concepts of human sexuality were incorporated into the nursing curricula. A majority of programs provided for all topic areas listed on the questionnaire with those related to reproduction being most prevalent in the curricula. Most respondents believed that baccalaureate graduates should be able to provide sex education for youth, counsel regarding healthy sex function, minimize the incidence of sexual dysfunction by educating adults, and counsel clients regarding sexual problems after illness or surgery. In nearly every instance, there was a perceived gap between what the curriculum provided and between the graduates' knowledge and competencies.


Secretory and structural effects of 6-hydroxy-dopamine on normal parotid glands of rats, and at different times after surgical sympathectomy.

The effects of i.v. 6-hydroxydopamine (6-OHDA), 100 mg/kg, have been studied on parotid glands of rats at 12, 24, 48, 72 hr and 3 weeks after avulsion of the right superior cervical sympathetic ganglion. The salivary flow from normal left control glands and from right glands 12 hr after ganglionectomy were similar, but at longer times after ganglionectomy the secretory response from the test glands was greatly reduced. Morphological assessment showed that 6-OHDA induced a massive depletion of secretory granules from all control glands and also at 12 hr after ganglionectomy but at 48 and 72 hr there was considerably less depletion of granules on the ganglionectomized side. It is thought that at the longer times after ganglionectomy the secretion from the test glands is caused by circulating catecholamines released by the action of 6-OHDS on adrenergic nerves elsewhere, plus a possible small direct secretogogue effect oomy are thought to be attributable to the release of catecholamines from adrenergic nerves within the gland.


Divergent changes in the rate of development of pressure in the left ventricle and in the performance of the heart as a pump.

Dog hearts were prepared in situ so that heart rate (HR), left ventricular end diastolic pressure (LVEDP) and mean aortic pressure (MAP) could be controlled separately during computation of left ventricular dP/dt max and external stroke work (SW). Progressive increases in HR consistently raised dP/dt max over a wide range, and consistently lowered SW except at low rates. Progressive increases in LVEDP or MAP consistently raised both dP/dt max and SW. Infusion of noradrenaline consistently raided both dP/dt max and SW, except at very high HR when only dP/dt max was consistently raised. Our results lead us to question the validity of equating changes in pre-ejection measurements with changes in performance of the heart as a pump under abnormal conditions and in the assessment of inotropic agents.


The effect of cholesterol oleate treatment of mice on the rosette forming cell response against sheep erythrocytes.

Mice injected with a single dose of 60 mg cholesterol oleate emulsion showed substantial blockade of the monoclear phagocyte system measured by the rate of vascular clearance of radio-labelled sheep erythrocytes. The labelled rythrocytes, in lipid treated mice, localized mainly in the spleen, contrasting with control mice in which localization was mainly in the liver. Treatment with this lipid, 24 hr before the intravenous of two different doses of sheep erythrocytes, resulted in significant depression of the rosette forming cell response in the spleen, whereas the responses in the lymph nodes of both control and lipid treated mice were at a low level and not significantly different. Intravenously administered cholesterol oleate emulsion is known to localize mainly in the Kupffer cells and in splenic red pulp macrophages. Cultured macrophages treated with this lipid show inhibition of antigen-binding and depressed phagocytosis of heterologous erythrocytes. The lipid does not affect lymphocytes. These findings are in keeping with the hypothesis that macrophages play a direct role in the induction of an immune response against a particulate antigen.


Changes in urinary water and electrolyte excretion in sodium-loaded sheep in response to intravenous infusion of arginine vasopressin.

Mature sheep receiving supplements of sodium chloride into the rumen were given intravenous infusions of arginine vasopressin at rates varying from 4-6-23 pmol/min (2-10 mU/min). Infusion of the hormone led to an increase in urine flow and to increases in the amounts of sodium and chloride excreted, the effect on flow was, however, the greater so that the osmolality of the urine fell during the infusions. In sheep given intravenous infusions of a hypertonic sodium chloride solution addition of vasopressin to the infusate led to the formation of a larger volume of urine containing a higher proportion of the infused salt load compared to when the salt solution alone was given. As before the effect on flow was the greater and hence the osmolality of the urine was lower when the hormone was given. In other experiments intravenous infusion of a hypertonic sodium chloride solution at rates providing 2-8 mmol NaCl/min led to increases in urine flow and increases in sodium and chloride excretion, the size of these increases being proportional to infusion rate. Plasma vasopressin levels markedly increased during these infusions, the levels seen being similar to those seen in sheep given vasopressin in amounts which increased both urine flow and electrolyte excretion. This suggests that during hypertonic salt loading vasopressin probably contributes directly to the increases in urine flow and the increases in electrolyte excretion which are seen. Further evidence in support of this was obtained in experiments in which a greater natriuretic response was seen in sheep given a hypertonic sodium chloride solution into the carotid artery as opposed to the given a hypertonic sodium chloride solution into the carotid artery as opposed to the jugular vein and where it was shown that plasma vasopressin levels were indeed higher when the solution was given into the artery.


[The cephalosporins and their clinical value].

Up to now cephalothin was the only parenteral and cephalexin the only oral cephalosporin for clinical use in the GDR. The paper deals with several newer cephalosporins. Of these cephazolin shows some advantages, especially in antibacterial activity and serum levels.  There is no metabolization and a better local tolerability compared with cephalothin. Cephapirin has no and cephacetril only inessential advantages. The antibacterial activity of the also well tolerated cephradin is less than that of cephalothin. Certain favourable pharmacokinetic properties such as high lymph and tissue levels, related to serum levels, slight protein binding, high distribution volume and a better stability against beta-lactamases lead to a superiority over cephalothin and diminish the disadvantages compared with cephazolin. The oral form of cephradin very equals to cephalexin.


[Purification and properties of beta-galactosidase from fungus, Curvularia inaequalis].

Highly purfied beta-galactosidase from fungus Curvularia inaequalis cultural fluid with a specific activity of 50 units per mg of protein was obtained by 2-fold purification of the enzyme, using chromatography on DEAE-cellulose and on hydroxylapatite. The enzyme was found to hydrolyze o-nitrophenyl-beta-D-galactopyranoside (pH optimum of 3.7--4.5) and lactose (pH optimum 3.9--5.3). The isoelectric point was observed at pH 4.4 the temperature optimum was 60 degrees C. The molecular weight (115 000--126 000) and the amino acid composition of the enzyme were determined. Km values for o-nitrophenyl-beta-D-galactopyranoside and lactose were 0.55-10(-3) M and 4.5-10(-3) M respectively. Disc-electrophoresis in polyacrylamide gel revealed a single band with a specific activity. The homogeneity of the enzyme was found in ultracentrifuge.


Transferrin: physiology and function in iron transport.

Since its identification about 30 years ago transferrin has attracted the interest of many investigators concerned with its structure, metal-binding properties, genetic polymorphism, and especially its role in the transport of iron within the body. Transferrin's two iron-binding sites appear to be structurally identical with equivalent iron binding after addition of iron in vitro. However, since the experiments of Fletcher and Huehns, the functional homogeneity of transferrin-bound iron has been questioned. Understanding of the precise mechanism of iron release from transferrin to receptor sites on reticulocytes and other tissues active in iron exchange is incomplete. Considerable evidence has been assembled from rats to support the Fletcher-Huehns hypothesis of selective release of A-site iron to erythrocyte precursors and placenta while B-site iron is delivered to hepatocytes. Results of experiments in rabbit and human systems remain controversial. Reasons for this controversy include: variations in the technique of iron addition to transferrin with the possibility of non-specific binding; variations in reticulocytes used in preparing selectively labelled transferrin and in its biological assay; and artifacts introduced in mixed-species experiments. Until methods are more refined and the transferrin-iron receptor interaction is better understood, the controversy about transferrins's iron transport function will persist.


Control of iron delivery to haemoglobin in erythroid cells.

This paper reviews and reports the results of experiments on the mechanism by which iron is delivered from extracellular transferrin to reticulocyte mitochondria in which haem is synthesized. It is suggested that transferrin donates the iron directly to mitochondria. Transferrin seems to be bound to mitochondria during the process of iron release. When the release of iron from transferrin is blocked by haem, the iron-transferrin complex remains bound to mitochondria so that the total amount of transferrin molecules associated with mitochondria increases in haem-treated reticulocytes. This also leads to an increase in the number of transferrin molecules in the cytosol. In haem-deficient reticulocytes, the rate of dissociation of iron from transferrin is accelerated and the uptake of iron by mitochondria is increased. When the synthesis of haem is inhibited, the non-haem iron in the cytosol (i.e. mainly low-molecular-weight and ferritin iron) comes from mitochondria. Greater amounts of non-haem iron can also be induced in reticulocytes incubated with highly saturated transferrin but, in this case, iron does not seem to be accumulated in mitochondria. These results represent an experimental basis for the elucidation of the excessive non-haem iron accumulation in erythroid cells observed in various clinical conditions.


Iron status, immune response and susceptibility to infection.

Nutritional factors can modulate immune responses. The concentration of iron, amongst other nutrients, influences host defence mechanisms. In experimentally induced iron deficiency in animals, morbidity and mortality on bacterial challenge are increased several-fold. Cell-mediated immunity and intra-cellular bacterial killing by polymorphonuclear leucocytes are impaired in iron-deficient individuals. This impairment is likely to be mediated by the effect of iron lack on cell proliferation, DNA synthesis and activity of iron-containing and iron-dependent enzymes involved in killing and elimination of microbes. Conversely, the availability of the free iron is a critical determinant for bacterial multiplication. It is not surprising then that epidemiological and clinical data on the frequency of infections--bacterial, fungal and others--in iron-deficient, iron-overloaded and healthy groups differ so widely. Vulnerability to infection based on the individual's iron status must be the net result of the effect of iron, or the lack of it, on microbial growth on the one hand and on immunocompetence of the host on the other. The key to keeping these interactions within physiological bounds is 'optimal iron nutrition'.


Lysosomal disruption in the pathogenesis of hepatic damage in primary and secondary haemochromatosis.

The disruption of lysosomes with release of their content of lytic enzymes was an early concept for the possible role of these organelles in the pathogenesis of tissue damage. Many examples are known of primary lysosomal storage diseases due to a congenital deficiency of certain acid hydrolases. It is suggested that iron overload due to either primary haemochromatosis or transfusional siderosis is a form of acquired secondary lysosomal storage disease. Subcellular fractionation experiments and electron microscopic studies have shown that liver tissue from patients with iron overload has iron-laden lysosomes. Similar results have been found in iron-overloaded rats. In patients, but not in experimental animals, enzymic analyses have shown increased activities of acid hydrolases and strikingly enhanced lysosomal fragility in liver homogenates. When it has been possible to deplete the patients of the excessive iron, these parameters have returned to normal. The possible mechanisms by which the iron compounds disrupt lysosomes, including distension with ferritin or haemosiderin or free-radical-mediated membrane damage, will be discussed.


The liver in thalassaemia major: ultrastructural observations.

During a study of pathogenetic mechanisms in the hepatic cirrhosis of thalassaemia major, 16 liver biopsies were examined by electron microscopy. Previous ultrastructural studies of liver cells during iron overload have shown electron-dense iron as lysosomal haemosiderin, and as lysosomal and cell-sap ferritin. In this study, all biopsies, regardless of the patient's age, showed ferritin molecules within lysosomes in a specific pattern in relationship with regularly arranged lamellae. This membrane-associated lysosomal ferritin is considered to be a stage in the segregation of iron seen in iron overload. The dimensions and electron density of individual ferritin molecules indicate differences between cell sap and lysosomal ferritin. Intracellular ferritin transport and iron-seclusion mechanisms are reconsidered in view of these findings. The liver biopsies of thalassaemic infants also provide information about the causal relationship between iron overload and collagen deposition. Since the collagen deposition precedes any morphological evidence of cellular injury (other than the increased iron content), the primary cirrhotogenic factor in thalassaemia is apparently not cell necrosis but possibly excessive collagen deposition induced by iron.


Iron centres and rate-limiting spans in the respiratory chains of mitochondria from adult and fetal rats.

The respiratory chain is a mosaic of complexes functionally linked through the mobile intermediates ubiquinone and cytochrome c. Changes in content of complexes that are not rat-limiting might not be reflected in the overall respiratory rate but may be revealed by titration with specific inhibitors. Oxidation of succinate by membranes of liver mitochondria from fetal, adult and starved rats was titrated with antimycin. Initial respiratory rates were similar but antimycin-titration curves were markedly different. The results indicate that the content of Complex III (cytochrome b-c1 span) is much lower in mitochondria from fetal and starved adult rats than in controls. In no case however is Complex III initially rat-limiting, and in fetal and starved adult rats it seems that a much lower content of functional Complex III is required to sustain a given respiratory rate. A possible explanation is a compensatory optimization of the pool function of ubiquinone, through increases in its content or its mobility in the mitochondrial membrane.


An intracellular transit iron pool.

It seems likely that iron which has crossed the cell membrane and has been released from transferrin enters a labile intermediate pool from which it is available for haem synthesis, for the activation of iron-dependent enzymes, for incorporation into ferritin or for a return to extracellular transferrin. Enlargement of this pool stimulates ferritin synthesis. Iron probably enters the transit pool not only from transferrin but also as a result of endogenous haem breakdown and the mobilization of ferritin iron. Evidence for the occurrence of the transit pool has been obtained for reticuloendothelial cells, red cells precursors, cultured Chang cells and liver. It is suggested that the transit pool consists of a low molecular weight complex and that this is a major source of the iron chelated by agents such as desferrioxamine. No more precise characterization has been possible up to the present time.


The development of agricultural antibiotics in Japan.

Agricultural antibiotics are very hopeful biodegradable pesticides which are expected to be from environmental pollution. The outline of the present status of agricultural antibiotics used or tested at present for practical application in Japan is presental in this paper.


Ferritin phenotypes: structure and metabolism.

Recent advances in our understanding of the biochemistry of ferritin have provided new insights into its role in iron metabolism. Findings of multiple structural forms in many tissues may have important consequences for ferritin's function and metabolism. This article reviews the molecular basis of apoferritin heterogeneity and discusses mechanisms operating in the phenotypic expression of ferritin in normal and malignant cells.


The new mother's view of herself.

A woman's attitude to breast-feeding is usually determined more by feeling than by rational thought; it is built on her adolescent views of the development of secondary sexual characteristics and subsequently on the breasts' part in sexual attraction. Early in pregnancy a mother is aware that fixed advice is more often offered than explanatory discussion. When birth is imminent, disinclination to breast-feed may be part of an unrecognized reluctance to submit to the changes which motherhood will bring. After the birth of her first child a mother finds herself enduring the discomforts of heightened moods and only too ready to interpret difficulties as signs of her inadequacy. Yet at the same time she is likely to discover her delight in her baby's repose and her own tranquillity at times of feeding.


Lactation education: the learning of the 'obvious'.

As far as the human mother is concerned, breast-feeding is hardly an instinctive act. Its success is based on the transmittal of accumulated experience in how to tackle breast-feeding problems. In rural societies where this experience is still intact and the mothers are well supported in the period just after the birth of the child, the best policy is non-interference. In transitional and urban societies, however, the traditional know-how and support is often lost, and failure to breast-feed usually results; here, lactation education is in its place. The knowledge of health personnel about how to teach mothers to breast-feed is often scanty. Medical text-books are weak on this point--more often than not, the information given is a mere extrapolation of bottle-feeding techniques to breast-feeding. Re-education is necessary, so that the advice given to mothers is simple, uniform and based on experience and insight. 'Moralizing' is unnecessary and should be avoided. There are several channels for the spreading of information about breast-feeding: mothers' groups, health services in general, mass media and schools. The importance of the policy makers should not be overlooked: at least in urban areas, several of their decisions will finally affect the method of infant feeding.


The response of the hospital doctor to the health requirements of a changing society.

Before the advent of the National Health Service in 1948 most hospital doctors were in close contact with the primary care of, at least, a section of the community both by their continuing close contacts with general practitioners and as a result of often having spent some part of their careers as general practitioners. Since 1948 this awareness of the health aspirations of the community has weakened as a result of advances in the care of disease which have made the hospital doctor increasingly dependent on sophisticated facilities and, thus, focused his attention on hospital care rather than on the community. Hospital staff must re-establish their link with primary care and must perceive clearly the ways in which they contribute to the health of their community. They must be conscious of the proportion of available resources that are used in hospital and be prepared to regulate demands so that there is equality in the distribution of resources in the health field. Hospitals are not only expensive but have become extravagant; it is the responsibility of the hospital doctor to curb extravagance. If private practice is to continue, it must be integrated into the health service, not excluded from it. Finally, the patient must be recognized as a member of a family and of a community that is both curious and concerned about health. The hospital doctor must communicate with patience, understanding and clarity. In this relationship he also has a part to play in health education and prevention of disease. He must remove the mystery from his art and enter into useful discussions with government and community.


The place of academic research.

The medically qualified academic research worker under university aegis but within the National Health Service has recently been subjected to frightening forces. His traditional role of being allowed and financed to do what he wants is questioned in an age of economic crisis and of concern about how to spend limited resources. The call for 'relevance' in academic research makes sense when looked at from society's viewpoint but nonsense when looked at from the research worker's viewpoint. Recent personal experience has generated a proposal for the resolution, in part, of these conflicting claims; namely, the university hospital. Unless academic research continues to flourish within our present framework, the quality of the practitioners of medicine and paramedical subjects will drop slowly over the next 20 years as the spirit of enquiry dies!


Health education, cancer and postgraduate training.

Cancer as a term encompasses a multitude of diseases and is consequently misunderstood. Today, it is still considered sinister and, too often, synonymous with death. It is a complex subject, exciting and challenging, yet the myths associated with cancer are perpetuated even by professionals in the health service. This can be attributed to the scant knowledge of its nature and prognosis, the progress made and the services available. When one considers the breadth of basic training needed to prepare both doctors and nurses to practise it is understandable. In a health service based on disease it is difficult to consider prevention as a priority. Financial implications are enormous and inhibit this aspect of the work in thefield of cancer and allied diseases. However, it is estimated that 80--90% of cancers are caused by environmental influences and can, in theory, be prevented. Efforts to promote health and prevent disease are costly and too often ineffective. Early diagnosis is another contentious subject; efforts are being directed to the establishment of clinics for patients presenting with symptoms rather than detection of symptom-free subjects. Improved approaches to prevention, recognition and acceptance through an understanding of cancer will alleviate the task of those directly involved in the cure and control of the disease. Health education in relation to cancer needs to be directed equally at health service professionals and the public. It would be unacceptable and inaccurate to describe the cancer services anywhere as incapable of further improvement. Research and therapy must go hand in hand and depend on the participation of the patient as a knowledgeable member of the team, rather than as a passive recipient of care. Death should not be considered failure, rather the completion of care. We face constantly the risk of despondency and the efforts of the team must be sustained with optimism and encouragement. Achievements have been made and will be made, however slowly, and the end justifies the effort. The need for postgraduate training is greater now than ever before. Adaptability to rapid change, vision and continuity are vital in our technologically orientated society. This should be considered a prerequisite to ensure improved standards of patient care at home and in hospital.


The difficulties of changing.

In general, our psychological equipment develops in such a way that we get information of predictive value through the senses; we tend to record constancies and consistencies of events and behave as though these are persistent. We are mostly unaware of the power of the stores of relevant experience (assumptions, expectations, attitudes) that condition our perceptions and therefore cannot question them, nor in many circumstances is there need to do so. In fairly constant conditions they are useful in helping us to see, quickly and effortlessly, what we expect to see. But in rapid changes this is not so; we can no longer rely on our psychological equipment and we become uncertain, confused and, in extreme cases, antagonistic, fearful and impotent. Examples of assumptions that influence medical education and medical treatment are given. Ability to respond effectively to change requires confidence to examine and restructure basic assumptions. The value of interaction in small groups in helping to achieve this is indicated.


Implications of shortening the time spent in hospital.

The decision to shorten the time spent in most areas of hospital care is extremely complex and hinges on the balance of numerous resulting credits and debits, which are largely unknown. The length of stay in hospital can be stabilized for many categories of medical care but the likely benefits may be disappointingly small in the face of unchanged demand for health care. Furthermore, a sustained reduction in length of stay could bring with it logistic contractual and personal problems, the costs of which could outweigh the benefits of stabilization. The best delivery of health care in a closed financial system seems to depend on a joint consideration of output per unit time and a provision of a service that comes near to satisfying the true need for that service. The appropriate level of service will be decided from a study of the true prevalence of the need and the ability of the service to satisfy it. The enthusiastic pursuit of traditional efficiency without adequate information may be counterproductive--by increasing demand, by demoralizing the health personnel and by diverting some of the demand into private practice. Our first priority is the rationalization of demand; this will need the combined efforts and goodwill of the consumer and the supplier. Only when demand has been rationalized may we expect a net benefit from shortening length of stay.


The nurse's contribution to care.

The concept of health needs as envisaged by the nurse and the challenge of the changing setting to nursing are explored with regard to the nurse's contribution to care against the background of change. Advances in medical science and technology tend to result in increasing specialization in health care and a complex organizational structure for its delivery. These and other factors tend towards fragmentation of care. Care is the concern of all health workers and needs collaboration based on mutual trust and respect. The nurse makes not the only but a unique contribution to care. In the primary care team she has information about the patient as a 'whole' person and about his or her family on the basis of which she can assess total needs and make appropriate arrangements for these to be met. She communicates with the medical and other members of the health professions in the interest of coordinated and total care, including continuity of care between home and hospital, where appropriate. In hospital, nurses are the only professional workers providing a continuous and direct caring service. Care is a concept implying a measure of constancy and continuity. These two aspects, reinforced by communication, coordination, explanation, education and empathy, are some of the main components in the nurse's contribution to care.


Some quandaries facing the health visitor in these times of change,.

Several dilemmas face personnel in the National Health Service as they endeavour to provide quality care while both costs and the level of consumer expectation rise. Amongst the specific aspects of concern to the health visitor are, in particular, role perceptions and role expansion, the problems consequent upon the integration of preventive workers within traditionally curative settings, the perplexities of those concerned with the rightful deployment of skills and resources within the primary health care team, and the need to create group cohesion and efficiency against a background of different professional cultural heritages. The changing pattern of disease raises several issues, in particular the contribution that health visitors might make to the total health care system. The overall aim is to examine a few of the areas where there may be conflict and to look at the way in which such conflicts could be harnessed for further cooperation and communication, so improving group harmony and community health care.


Commitment and concern in the health service.

As part of a general review of the use of local health services resources, a specific enquiry was mounted to examine the recurring complaint of a lack of identity or sense of belonging made by staff working in the largest district of the Grampian Health Board. The investigation pointed to clearly identifiable sources of confusion and concern: (a) a need to identify with and feel committed to the health service; (b) a sense of purpose and direction; (c) satisfaction with the conditions of service; (d) an understanding of an individual's role and its relationship to others'. It is relatively easy to list the problems, such as friction between occupational groups, lack of commitment, uncertainty over duties and authority, reluctance to delegate and resistance to, or even outright rejection of, decisions apparently at variance with professional advice. In addition to these internal stresses the health service is perpetually beset by two other external problems, namely what it is expected to achieve and the finance allowed to attain its goals. The various groups within the service are in no way agreed on roles and responsibilities, Without agreement goals cannot be defined. Without goals, use of resources cannot be rationalized. Without a demonstrably fair distribution of resources, neither the public nor health service staff will feel confident or committed. Somewhere this cycle must be broken.


French medical research: the risk of 'demedicalization'.

French medical research is at present financed almost entirely by INSERM (Institut National de la Santé et de la Recherceh Médicale). The INSERM budget (286 million francs in 1975) supports research in laboratoreis in university hospitals by doctors who have both clinical and teaching commitments and, especially, by more than a thousand 'statutory research workers' employed by INSERM. Research in INSERM laboratories now tends to be fundamental biological research rather than directed towards pathological problems. Among the reasons for this are (i) the mode of recruitment of staturtory research workers; (ii) the difficulties of clinical investigation, which are due mainly to the way the hospitals function and to lack of interest by the hospital administration in medical research; (iii) the small number of university doctors actively involved in research. Research on fundamental biological problems in INSERM laboratories is making excellent progress, due to the quality of the research workers, and it may pay in the long run. But medical research is now tending to become an 'ivory tower' for the victorious researchers, who sometimes scorn the clinicians. Medical research will, if no measures are taken, 'demedicalize.' Institutes of pure biological research could soon be isolated within the medical faculties and doctors may become even less scientific and investigative than they are today. This situation could be modified by: (i) re-evaluating the role of research in a university hospital career, making it impossible for a doctor to attain high levels of promotion unless he does some research (this could be done by asking doctors interested in such a career to work for several years in an INSERM laboratory after their training and before they take up clinical responsibilities); (ii) awarding clinicians, exceptionally, the status of research worker; (iii) increasing considerably the participation of the universities in financing medical research, a participation which at present is absurdly low and is every decreasing.


Client-oriented medicine.

Both weak (Illich) and strong (Kerr White, Cochrane) cases have been made for radical changes in medical education and medical practice. The real needs of patients and of the community are considered to be incompletely served by the prevailing emphasis on acute hospital medicine, to the comparative neglect of primary care in the community and of the needs of particular 'client groups', e.g. the mentally and physically handicapped, and the elderly. Inherent in this approach are emphases on information systems related to morbidity rather than to mortality; on 'care' rather than on 'cure'; on quality control relating to 'outcomes' rather than to 'structure' or 'process' of practice; and on controlled trials of both new and accepted forms of treatment. Difficulties in this approach include the taxonomic incongruity of 'client-group' statistics and the 'disease-system' categories of biomedicine; the therapeutic expectations of the consciously ill; the intellectual interest and the immediacy of specialized clinical practice; and the necessary and profitable links between medical science and the general corpus of science. Nevertheless, and in the full recognition that what is socially desirable may not be scientifically feasible, there is a need in the research context to explore methods of assessing the 'health service priorities' to be attached to biomedical categories. However, these priorities are in themselves multiple, and their relative weighting involves value judgements which are not completely quantifiable.


Government needs and public expectations.

The priorities for research which emerge from looking at the health needs of patients collectively are examined here. Priorities, however imperfect, are discernible when the five indices of where the main burdens on the health services lie are examined; those indices are inpatient days, outpatient referrals, general practitioner consultations, sickness-benefit days, and loss of life expectancy. Housing, employment, nutrition, etc., are equally relevant to health and to the question of priorities in medical research. It is important in dealing with government needs and public expectations to be clear what health and social services cannot do and what people must do for themselves.


International coordination of biomedical research.

Recent efforts at international coordination in biomedical research have taken place at two levels. At the level of the working clinician and scientist, European regionalism has become increasingly manifest in such organizations as the European Society for Clinical Investigation, the European Organization for Research into the Treatment of Cancer, the European Molecular Biology Organization and many others. These have developed largely, though not entirely, independently of government funding. At the level of science policy, i.e. of bodies supporting biomedical research mainly from public funds, the major developments have been the Comité de la Recherche Médicale of the European Community and the much wider association of European Medical Research Councils, based on the whole of Western Europe; in October 1975 the latter group became incorporated into the new European Science Foundation as the first Standing Committee of that body. Wider, interregional, cooperation presents greater problems, though there have been some modest successes, and the multinational drive on research into six of the major health problems of the Third World now being proposed by WHO holds further promise for the future.


Delineation of clinical conditions: conceptual models of 'physical' and 'mental disorders.

The dysfunctional consequences of the Cartesian dichotomy have been enhanced by the power of biomedical technology. Technical virtuosity reifies the mechanical model and widens the gap between what patients seek and doctors provide. Patients suffer 'illnesses'; doctors diagnose and treat 'diseases'. Illnesses are experiences of discontinuities in states of being and perceived role performances. Diseases, in the scientific paradigm of modern medicine, are abnormalities in the function and/or structure of body organs and systems. Traditional healers also redefine illness as disease: because they share symbols and metaphors consonant with lay beliefs, their healing rituals are more responsive to the psychosocial context of illness. Psychiatric disorders offer an illuminating perspective on the basic medical dilemma. The paradigms for psychiatric practice include multiple and ostensibly contradictory models: organic, psychodynamic, behavioural and social. This mélange of concepts stems from the fact that the fundamental manifestations of psychosis are disordered behaviours. The psychotic patient remains a person; his self-concept and relationships with others are cental to the therapeutic encounter, whatever pharmacological adjuncts are employed. The same truths hold for all patients. The social matrix determines when and how the patient seeks what kind of help, his 'compliance' with the recommended regimen and, to a significant extent, the functional outcome. When physicians dismiss illness because ascertainable 'disease' is absent, they fail to meet their socially assigned responsibility. It is essential to reintegrate 'scientific' and 'social' concepts of disease and illness as a basis for a functional system of medical research and care.


Clinical science.

The most obvious achievements of clinical science have been in the elucidation of symptoms and signs and the patterns of disordered function due to failure of the organs or to nutritional disturbances. The benefits of clinical research are both direct--through improved practice--and indirect--through improved teaching and contributions to biological science. It is suggested that the clinical scientist, experienced in both clinical and research work, has a potential not to be expected from collaboration between non-scientific clinicians and non-clinical scientists. Problems which particularly affect clinical research include: ethics; difficulty in being experimentally rigorous; the need to be opportunistic; dependence on transient workers; excessive conern with the end stages of irreversible disease; triviality; uncritical and premature imitation of research in practice. Clinical science is always threatened by a tendency for its problems to be regarded simply as applied problems of basic science. The roles of the clinical scientist should include: elucidating clinical phenomena, about most of which we remain very ignorant; collaboration with basic scientists on the one hand and with community scientists on the other; and clarifying the description and analysis of illnesses.


The value to medical practice of basic and applied medical research done twenty years ago.

Research can be justified in many ways besides the improvement of clinical practice--for example, by providing the intellectual excitement necessary for teachers and students. The value of present-day research cannot be assessed; but that of twenty years ago can be, at least in respect of current medical practice. An analysis has been made of all the papers published in 1956 in the American Journal of Physiology, the Journal of Physiology (London), the Journal of Clinical Investigation, and Clinical Science. This shows an overwhelming impact on current medical practice coming from clinical departments, and a comparatively very small influence of work coming from preclinical departments. If this conclusion is correct and generally applicable, it has some relevance to the funding of medical research.


Problem-solving in science.

Problem-solving is a characteristic activity of scientists, Theoretical problems are formulated as a consequence of scientists' thirst for knowledge, and their solutions take the form of general propositions, termed hypotheses, which are consistent with, and provide provisionally satisfactory explanations of, empirical observations. Practical problems appear as the result of feedback from the extra-scientific world of everyday life, industry and professional practice. Their solutions provide an improved basis for decision-making in terms of existing options or increase the number of options from which a choice may be made. The categories theoretical and practical are not mutually exclusive: practical problems often generate interesting theoretical problems, and the solution of a theoretical problem may entrain the solution of a host of practical problems. All hypotheses are provisional because it is impossible to establish the truth of a generalization by rigorous deduction from any number of particular instances, though a single instance may suffice to refute it. This asymmetry forms the basis of Popper's analysis of scientific methodology. This analysis, though acceptable in the main, is open to criticism in the following respects; (1) it ignores the contribution to scientific progress made by unplanned perceptions; (2) it ignores the contribution of hypotheses which do not generate testable predictions; (3) it does not do justice to the extra-logical component in knowing (Polanyi's tacit dimension); and (4) its treatment of practical problems in inadequate.


[GSP--a polypeptide from the pancreas with gastrin-like effect].

A peptide has been extracted from porcine pancreas which is capable to stimulate gastric acid secretion in the rat. This peptide consists of 13 aminoacids, it's molecular weight is about 1300. In comparison with antral gastrin there are several biochemical differences: GSP (gastrosecretagogue pancreatic polypeptide) reacts differently in gel filtration, ion exchange chromatography and electrophoreses and has a different aminoacid composition. The 4 amino acids of the C-terminal tetrapeptide of gastrin are not all present. GSP does not react with gastrin antibodies in radioimmunoassay. GSP may be a new gastrointestinal hormone by means of which the pancreas takes part in the regulation of gastric acid secretion.


Variation in karyotype in Hemerocallis.

Fifty two taxa have been studied, out of which forty five, including the species; H. citrina, H. dumortierii, H. multiflora, H. forrestii and H. thunbergil are diploid with 22 chromosomes in the somatic complement. H. fulva var. Europa, H. fulva var. cypriana, H. kwanso "Flore Pleno" and H. disticha "Flore Pleno" are triploid with thirty three chromosomes in the somatic complement. One cultivar "Mrs. David Hall" is tetraploid with forty four chromosomes. Besides this two aneuploid clones "Garden Lady" and cv. "29" with 2n=23 and 2n=29 chromosomes respectively were also encountered. Essentially four basic karyotypes are recognizable; A(IV + 8L + 1J + 1I), B(IV + 7L + 2J + 1I), C(9L+ 1J + 1I) and d(8L + 2J + 1I), where V stands for median, L for submedian, J for subterminal and I for terminal centromere. Thirty two taxa could be relegated to these four types and 17 can be resolved as combinations of these four types. These fall under AB, AC, AD or BC, BD and CD classes. The number of nucleolar chromosomes does not show any correlation with the grade of ploidy, whereas 2, 3 or  telocentric chromosomes were consistantly found in diploid, triploid and tetraploid taxa respectively. The possible origin of telocentric chromosomes and aneuploid taxa has been discussed.


The existential plight in cancer: significance of the first 100 days.

The Existential Plight in cancer is a poorly recognized but significant period. It starts with the definite diagnosis and continues for two to three months into the illness, approximately 100 days. The chief signs are the predominance of life/death concerns, e-en over worries about health or physical symptoms. One hundred and twenty newly diagnosed cancer patients were interviewed, tested, and followed from about ten days after diagnosis at four to six week intervals until three to four months had elapsed. Plight was analyzed from the viewpoint of coping strategies, resolution of problems, vulnerability, total mood disturbance, and predominant concerns. Patients who had higher emotional distress during this period had many regrets about the past, were pessimistic, came from a multiproblem family, and had marital problems. The widowed or divorced had higher vulnerability, as did patients who anticipated little or no support from significant others. Although vulnerability increased with advanced staging and many symptoms, at the time of diagnosis psychosocial distress crossed diagnostic and prognostic boundaries, enabling investigation to predict within limits those patients who will cope effectively or fail to cope with cancer and its ramifications.


Psychosocial and medical effects of vasectomy in a sample of health plan subscribers.

The effects of vasectomy on psychosocial adjustment assessed by interviews, and on physical health assessed by physicians and other medical personnel, were examined by comparing 33 vasectomized men with a matched group of 33 non-vasectomized men in a pre-paid health plan. Consistent with favorable self-reports in earlier studies, the vasectomized men experienced no greater marital, job, or general living stress than the non-vasectomized men. In fact the psychosocial adjustment of the vasectomized men appeared superior to that of the non-vasectomized men, perhaps because of reduced anxiety about unwanted pregnancy. The hypothesis advanced by some investigators that vasectomized men exaggerate their masculinity in an overcompensating maneuver to reduce a perceived threat to their masculinity was not supported; instead, men volunteering for vasectomy exhibited as many masculine traits prior to the operation as after it. There was no evidence that vasectomy led to either impairment or enhancement of medical health.


Psychoanalysis applied to medicine: a personal note.

The psychoanalyst has much to contribute to medicine, more through the teaching of observational skills and an appreciation of relationships than through the teaching of psychoanalytic technique or languate itself. The analyst can promote tolerance in the physician of the unusual, an examination of the impediments of habitual ways of working and seeing, and a facility in the patient to "be himself". Attention to the unusual, as illustrated through experience in training-cum-research seminars, can enhance the doctor's satisfaction with his professional life while offering improved care to his patients. When psychoanalyst, physician and patient interact in their roles as people, there is hope of an improved quality of human existence for all.


Teamwork: a multidisciplinary pediatric-liaison service.

Psychiatrists, psychologists and social workers are often consulted about the same hospitalized patient. Since each may differ in their training, orientation and experience, the opinions expressed by them to the consultee may differ. The authors have described a multidisciplinary liaison team operating within a pediatric teaching hospital. The consultants work as a team in close collaboration with each other and with the psychiatric nurse clinician and an occupational therapist. The team approach has specific advantages. It allows for a concise and unified approach to the emotional and social needs of the patients. It presents a forum for informal consultations and interdisciplinary meetings. In addition, teaching opportunities are many as each discipline learns from the other.


The relationship between language and disease concepts.

The Sapir-Whorf hypothesis, well-known in anthropological linguistics, postulates that language may not only describe the world we inhabit but also mould the way we experience it. This paper argues that an individual's language may similarly determine his conception of disease. Possible relationships between linguistic features and disease concepts are cited for the Eskimo, the Navaho, and the Chines, and it is suggested that, in European languages, the extensive use of spatial metaphors to express abstract concepts may encourage a more rigid categorization of disease and inhibit the ability to conceive of multiple factors in disease causation. The use of nouns rather than verbs to express the idea of illness could lead to a static view of disease and tends to separate illnesses as distinct entities rather than defining them as aspects of bodily functioning. The bipolar structure of Indo-European languages, setting subject against predicate and noun against verb, may play a part in the persistence of the mind-body dichotomy and restrict the holistic perception of man with nature. These linguistic features, in leading to a conception of disease as a rigidly defined, unchanging, unicausal thing, may encourage an over-use of surgery and lead to difficulty in perceiving social and psychological factors in disease.


Consultation in the intensive care nursery.

The paper describes a group-oriented mental health consultation program which was established for the staff of a pediatric special care nursery. The initial phase of consultation was designed 1) to deal with work stresses in providing acute medical care for premature infants who are at high risk for later emotional and developmental disturbances; and 2) to facilitate intrastaff communication in an atmosphere of strenuous physical demands from patients, and moral dilemmas raised by infants' life-threatening conditions. Also discussed are problems experienced by staff in providing psychological support to families of hospitalized infants. The author reviews implications for crisis intervention to help mitigate families' mental stress and to facilitate the emotional attachment to their infants.


Interpersonal resistance to change: a study of a fat woman who became thin.

The paper reports on the psychoanalytically-oriented psychotherapy of a very obese woman who, after a rather prolonged therapy, "decided" to reduce. During the weight loss process, significant reactions were noted from her son, daughter, brothers, sisters-in-law, customers, employees, husband, and therapist, which became crucial interferences with the continuing weight loss and specific resistances in the therapy. The identification of and the working through of these resistances significantly increased and consolidated her self-understanding. In that the response to major psychological changes was minimal as compared to the response to her physical change, it is hypothesized that physical change is more basically related to sense of self-continuity and hence more threatening to experience and observe.


Psychiatric day hospital treatment of terminally ill patients.

The psychiatric Day Hospital offers a forum for working out bereavement issues of terminally ill patients. Through individual and group psychotherapy, patients and their families are assisted in coping with the issues of death and dying. Coordination of medical, surgical, and psychiatric treatment of dying patients is enhanced by Day Hospital educational and treatment programs which afford continuity of care at the interface area between treatment specialties.


Psychiatric status of diabetic youth in good and poor control.

Two groups -- identified as "good control" and "poor control" -- of 40 diabetic youth, between 6 years and 18 years, matched for age, sex and duration of diabetes, were interviewed by a child psychiatrist who was not aware of the status of their diabetic control. After each interview psychiatric diagnoses, interpersonal conflicts and noninterpersonal conflicts were determined. At the same time, mothers completed a children's behavioral-emotional symptom checklist. Six psychiatric diagnoses were made (7 1/2 per cent occurrence): four in the poor control group and two in the good control group, not a significant difference. Fifty per cent of the psychiatric diagnoses were found in the prepubertal girls who had the earliest onset of diabetes. A significantly greater number of patients in poor control had interpersonal conflicts compared with patients in the good control group. Mothers of patients in poor control had checked significantly more behaviors as slight and considerable-severe problems compared to mothers of patients in good control. Five per cent of the patients in good control and fifteen per cent of the patients in poor control stated that they experienced a "different" self-image because of their diabetes. The frequency of psychiatric diagnoses (7 1/2 per cent) for the entire group was not higher than literature reports of serious psychiatric disorders in normal population studies.


The psychiatrist as teacher in primary care residency training: the first year.

Increasing development of postgraduate primary care training programs to meet manpower needs is supported by flexibility in the Boards of Internal Medicine and Pediatrics to include experience in psychiatry; with this change, liaison psychiatrists will become progressively more involved and closely integrated into such training. This report outlines the first year experience of a psychiatrist in one innovative three year program in pediatrics and medicine, and describes some common problems and issues, along with teaching goals and some developing methodologies. Although the number of trainees in this first year cohort is small, preliminary results reported by a feedback component of an independent evaluation team attached to the program suggest that the interns are receptive to the psychiatric input and that they consider the initial contribution by psychiatry to have as much usefulness to their training in primary care as the more traditional pediatric and medical components.


An unusual adverse reaction to self-medication with prednisone: an irrational crime during a fugue-state.

During five years of self-medication with Prednisone, a forty-one-year old asthmatic businessman experienced periods of euphoria, psychomotor hyperactivity, and poor judgement; a period of depression and anxiety during temporary steroid withdrawal; and finally, with resumption of Prednisone, episodes of grandiosity and bizarre fugue-like behavior, with adoption of a second identity and culminating in an irrational crime. Steroids were then withdrawn, and the patient resumed his premorbid personality, but had amnesia for much of his previous behavior. The literature on hysterical fugues and corticosteroid-induced mental disturbance is reviewed. The patient's reactions are analyzed in terms of his premorbid neurotic conflicts, the psychological stresses acting upon him, and the effects of Prednisone on his central nervous system.


On the subsarcolemmal localization of phenazine ethosulfate-linked alpha-glycerophasphate dehydrogenase activity in pigeon pectoralis white muscle fibres.

In this study frozen sections of avian striated muscles were incubated for mitochondrial alpha-glycerophosphate de hydrognease (alpha=GPD) reaction, and the effect of menadione, phenazine methosulfate (PMS) or phenazine ethosulfate (PES) as intermediate electron acceptors was evaluated. Under histochemical conditions, PMS or PES-linked alpha-GPD reaction was poor in the chicken posterior latissimus dorsi and chicken pectoralis muscles. However, PMS or PES-linked alpha-GPD reaction was present characteristically in the subsarcolemmal mitochondria of the "broad white" fibres of the pigeon pectoralis muscle only; the subsarcolemmal mitochondria of the narrow red fibres lacked such a reaction pattern. The above reaction pattern, however, differed when compared with the menadione-linked alpha-GPD reaction. The present histochemical evidence suggests the existence of an inherent heterogeneity in the mitochondrial populations of the different avian striated muscle fibres studied.


Pharmaco-histochemical studies on a specific monoamine in the gustatory epithelia of the rabbit.

The foliate, vallate and fungiform papillae of the rabbit's tongue were studied fluorescence-histochemically under normal and experimental conditions. In normal animals a yellow fluorescence suggesting the presence of a serotonin-like monoamine was demonstrated only in taste bud cells of the foliate papilla, though its intensity was very weak. The fluorescence disappeared completely following reserpine treatment, while it was significantly enhanced by the treatment with nialamide. The fluorescence of taste bud cells could be clearly distinguished from that of catecholamines by the treatment with alpha-MMT followed by nialamide. When 5-HTP, 5-HT and 5,6-DHT were administered separately, each of these drugs was selectively taken up in taste bud cells of the foliate and vallate papillae, but no fluorescent cells were observed in the fungiform papilla. From the present results, it seems reasonable to conclude that the fluorigenic amine of taste bud cells may be 5-HT (serotonin), or at least an indoleamine derivative. Also, it is suggested that the taste bud of the vallate papilla contains a cell type which can potentially synthesize a biogenic amine in situ, or is actually synthesizing it in a very small amount just like in the case of the taste bud of the foliate one.


Absorption cytophotometry: evaluation of three methods for the determination of DNA in Feulgen stained nuclei.

Three methods for the evaluation of the relative amount of DNA per nucleus by absorption cytophotometry are compared. A combination of the two-wavelength method (Patau, 1952; Ornstein, 1952), the one-wavelength two-area method (Garcia, 1965) and the determination of transmission through nuclear plugs is proposed in order to estimate systematic errors made by absorption cytophotometry.


Polyacrylamide gel technique for the histochemical demonstration of soluble enzymes.

Soluble enzymes were immobilized and visualized by polyacrylamide gel slabs, impregnated with the incubation medium including auxiliary enzymes. The method has several advantages over existing techniques which make use of gel films or a semipermeable membrane. The diffusion of tissue compounds is effectively limited, while auxiliary enzymes may be operative. Moreover the viscosity of the medium is temperature-independent so that the incubation temperature can be varied. To demonstrate the suitability of the method glycerol-3-phosphate dehydrogenase, lactate dehydrogenase, glucose-6-phosphate dehydrogenase, hexokinase, phosphoglucomutase and aldolase were visulaized in human or rat skeletal muscle. Cytosolic and mitochondrial glycerol-3-phosphate dehydrogenase were both visualized in the absence of added NAD+ and menadione. For the visualization of ATP producint enzymes, like creatine kinase and pyruvate kinase, the method is not suitable.


A new approach to building social work knowledge.

A vehicle such as an information reporting and summarization system (IRSS) is needed to assist social workers in building social work knowledge. The IRSS moves toward this goal in two important ways: (a) by requiring that social workers strive to formulate unambiguously detailed categories and classifications for use in making descriptive generalizations of their individual cases; and (b) by enabling social workers to generate descriptive generalizations extending over a multiplicity of cases. In this way it provides social workers with the kinds of empirical data necessary to verify and build thier knowledge.


Consultation with community care facilities.

An innovative application of consultation to community care facilities, also known as board and care homes, is presented in order to improve services to chronically mentally ill persons. An extended Caplanian model for establishing an effective consultant-consultee relationship with administrators is described with reference to the following tasks: (a) understanding the setting; (b) recognizing an unmet need; (c) resolving problems of entry; and (d) negotiating a contract for case consultation and for program consultation. Interventions that reduce theme interference with work efficiency are described by examining realistic conflict resolutions utilizing problem clarification, expressing understanding, sharing feelings, and exploring solutions. The results include development of a climate of responsibility among the chronically mentally ill residents and more effective use of community resources.