The fitness of the mental patient to be a witness.

The determination of whether a patient has criminal responsibility or is able to stand trial is routine psychiatric work. Cases in which we- psychiatrists- are asked to express our opinion on whether a patient can testify, however, are quite rare. We shall attempt to clarify some of the issues relating to the testimony of mentally ill patients through a case presentation. In this case, the Court agreed to consider our patient's testimony, only after receiving our expert opinion. We find that the Court's reversal of its original decision and its willingness to consider the testimony of a mental patient in the same trial in which he was initially found unable to stand trial, marks an important precedent. The question of the credibility of the mental patient as a witness has significance beyond this case concerning mental patients' rights in regard to the judicial system. We believe there is a need for further discussion between psychiatrists andjurists regarding the fitness of the mental patient to testify as a witness.

Microscope objectives.

The objective is the most crucial image-forming component of a microscope. A knowledge of the many types of objectives available and their characteristics is critical to the selection of appropriate objectives for image cytometry. This unit discusses aberrations in image formation and their correction, construction and types of objectives, and objectives for other microscopy applications, explaining the advantages and limitations of each one.

Microscope alignment.

In order to obtain good images using any microscopic imaging modalities, it is necessary to understand the microscope thoroughly and set up properly. This unit should be required reading for all students and staff using a light microscope. It clearly defines the types of illumination used in microscopes and details the correct set up and operation.

[New psychopharmacological approaches in mental health as applied by the Israel Defense Forces].

In the past decade there have been far-reaching developments in psychopharmacology. Previously, only a few classes of medication were at the disposal of psychiatrists, as many had serious side effects that limited their use. Now our psychopharmacological armamentarium has grown considerably, allowing for greater choice of treatment in the military. We review these developments, and discuss the special considerations to be taken into account when treating soldiers with psychiatric medication. We discuss suitable medication for ongoing outpatient treatment, as well as the standard list of medication currently used by units deployed in the field. Advances in psychopharmacologic treatment should enable more soldiers to serve safely in the military with fewer restrictions on their duties.

Adaptation of immigrant psychiatrists from the former Soviet Union in the Department of Mental Health of the Israel Defense Forces.

Psychiatrists from the former Soviet Union serve in the Department of Mental Health of the Israel Defense Forces. The new immigrant psychiatrists confront a wide range of difficulties during the process of integration to the military system and adaptation to the specifically military aspects of psychiatry. These include unfamiliarity with the military system, cultural clashes with the different groups of soldiers representing the various subgroups of the absorbing society, the psychopathology of soldiers, which is different from that seen in civil psychiatry, and the change in focus in the military mental health service, which emphasizes the importance of evaluating ego strength. Arbitrarily, one can describe four stages of adaptation that the immigrant psychiatrist has to pass through before recruitment and during service until adaptation and integration in the new role take place. Individual and group supervision are the main means by which the assimilation process is eased. The military service smooth the acculturation process and has an important role in helping the immigrant's adaptation to Israeli society and in building his or her professional identity.

Interaction of peptides with sequences from the Newcastle disease virus fusion protein heptad repeat regions.

Typical of many viral fusion proteins, the sequence of the Newcastle disease virus (NDV) fusion protein has several heptad repeat regions. One, HR1, is located just carboxyl terminal to the fusion peptide, while the other, HR2, is located adjacent to the transmembrane domain. The structure and function of a synthetic peptide with a sequence from the region of the NDV HR1 region (amino acids 150 to 173) were characterized. The peptide inhibited fusion with a half-maximal concentration of approximately 2 microM; however, inhibition was observed only if the peptide was added prior to protease activation of the fusion protein. This inhibition was virus specific since the peptide had minimal effect on fusion directed by the Sendai virus glycoproteins. To explore the mechanism of action, the potential HR1 peptide interaction with a previously characterized fusion inhibitory peptide with a sequence from the HR2 domain (J. K. Young, R. P. Hicks, G. E. Wright, and T. G. Morrison, Virology 238:291-304, 1997) was characterized. The results demonstrated an interaction between the two peptides both functionally and directly. First, while the individual peptides each inhibit fusion, equimolar mixtures of the two peptides had minimal effect on fusion, suggesting that the two peptides form a complex preventing their interaction with a target protein. Second, an HR2 peptide covalently linked with biotin was found to bind specifically to HR1 peptide in a Western blot. The structure of the HR1 peptide was analyzed by nuclear magnetic resonance spectroscopy and found to be an alpha helix.

[Quality assurance in the mental health department of the Israel Defense Forces].

A review of quality assurance in the mental health department of the Israel Defence Forces allowed the examination of certain unique elements of quality control which pertain to the military. These include the psychiatric medical board, the computerized documentation of appointments and sessions with soldiers, the psychiatric hospitalization database, control systems implemented in the draft boards, peer-review boards and supervision, and a special officer in charge of handling outside consultations and queries. There were other components of quality assurance and control as well. These instruments are vital in a dynamic system constantly striving to improve clinical performance. Future plans include the continued use and expansion of quality control boards, the inclusion of quality assurance in the curriculum of mental health officers, and the use of clinical guidelines in working with soldiers. All of this is in keeping with the principle of continuous quality improvement, with the aim of viewing the soldier in need of help as a client.

Pleural effusion as a predictor of severity in acute pancreatitis.

Our objective was to determine whether pleural effusion is a predictor of severity in acute pancreatitis and, if so, whether it is an independent predictor. One hundred ninety-six consecutive cases of acute pancreatitis from October 1, 1994, to September 30, 1995, were reviewed. Medical records were analyzed for evidence of pleural effusion by chest radiograph and severe acute pancreatitis by identification of pancreatic necrosis or organ system dysfunction. Data were analyzed to determine if identification of pleural effusion provided an early sign of severity. Among 135 patients who underwent chest radiography, pleural effusion was seen in 16 of 19 (84.2%) with severe pancreatitis and 10 of 116 (8.6%) of patients with mild pancreatitis (p < 0.001). Pleural effusion was noted in severe pancreatitis prior to clinical or computed tomography evidence of severity in only 20% of cases. Pleural effusion is strongly associated with severity in acute pancreatitis but provides independent information on severity in only a minority of cases.

Assessment of PTSD: validation of the revised PTSD Inventory.

The PTSD Inventory, a self-report diagnostic questionnaire based on DSM-III criteria, was revised to meet the more recent DSM-III-R criteria. This study examined the validity of the revised inventory relative to a structured clinical interview (SCID) and the Impact of Events Scale (IES). Results showed a high degree of concordance between the instruments, supporting the use of the more standardized, easy to administer and economical PTSD Inventory.

The role of linguistic and visual information in spelling: a developmental study.

This study investigated the processes that elementary school children use for spelling. Good and poor spellers in grades 3 through 6 spelled words and nonwords that differed in the types of information (phonological, orthographic, morphological, or visual) that could be used to produce their correct spelling. A multiple choice spelling recognition task was also administered. Error rates on words and nonwords were related to the type of information that could be used to determine the correct spelling. Words that could be spelled on the basis of linguistic information were easier than words that could be spelled only on the basis of visual information. While children were sensitive to the linguistic properties of the stimuli, their use and knowledge of various sources of linguistic information was not uniformly developed. Children had the most difficulty with spellings based on morphological information and the least difficulty with those based on invariant sound-spelling relationships. On the dictation and the nonword tasks, younger children and poorer spellers differed from older children and better spellers in the overall level of their knowledge, but all children showed a similar pattern of results suggesting that they did not use different processes to spell words. However, the data from the recognition task suggested that poor spellers may rely more on visual information than good spellers.

Rectal methohexitone induction in pediatric outpatients: physostigmine does not enhance recovery.

Rectal methohexitone (25 mg X kg-1) was used to induce anaesthesia in 15 unpremedicated children scheduled to undergo bilateral myringotomies as outpatients. Induction time ranged from 4 to 11 minutes. In the recovery room, all children received a slow intravenous injection of physostigmine (60 micrograms X kg-1), or saline in a double blind randomized fashion. The use of physostigmine did not significantly decrease the recovery room stay as compared to placebo (34 vs. 43 minutes). Vomiting and soiling were two side-effects associated with the use of physostigmine.

Nitrous oxide and air-filled balloon-tipped catheters.

The differential solubilities of gases permit nitrous oxide (N2O) diffusion into air-filled body cavities, increasing their size and/or pressure. An air-filled balloon-tipped catheter represents a body cavity that may be affected by the diffusion of N2O, and could account for the authors' clinical observation that more gas was aspirated than injected during insertion of Swan-Ganz (S-G) catheters in patients receiving N2O anesthesia. An accompanying increase in balloon diameter could conceivably account for difficulties in floating the tip into the pulmonary outflow tract. To help substantiate these observations, balloon volumes of three S-G catheters were measured at 0.5, 1, 2, 3, 4, 5, 10, 20, and 30 min in various N2O and oxygen mixtures, and the diameters of the balloon were compared with published diameters of pulmonary outflow tracts. The volume changes were near maximum between 5-10 min, increasing to 30 to 150 per cent depending on the N2O concentration. The increases in balloon diameter, when compared to pediatric pulmonary outflow tract diameters, could account for difficulties in passage of the catheter tip through the pulmonary outflow tract. These findings suggest that manipulation of S-G catheters under N2O anesthesia sould be done with intermittent deflation of the balloon every few minutes.