A review and critique of the process approach in neuropsychological assessment.

This paper surveys the process approach literature with an emphasis on higher level cognitive functions like attention and concentration, learning and memory, and problem solving and executive functioning. In particular, it discusses organizational strategies and kinds of errors found on a variety of tests as well as behavioral, situational, and interpersonal issues as they relate to test procedures. It critiques the process approach and suggests future directions.

Use of pulse oximetry to monitor venous saturation during extracorporeal life support.

OBJECTIVE: To assess the ability of two different pulse oximeters to display continuous venous oxygen saturation through an extracorporeal bypass circuit with a degree of accuracy comparable to direct in-line oximetry. DESIGN: Prospective, comparison study of pulse oximeters (test oximeter 1 or test oximeter 2) and an in-line oximeter (test oximeter 3). SETTING: A tertiary care neonatal intensive care unit. PATIENTS: Sixty-five consecutive neonates with severe cardiorespiratory failure undergoing extracorporeal life support. INTERVENTIONS: The accuracy of the oximeters was determined by simultaneously comparing the saturation displayed by the pulse oximeters (test oximeters 1 and 2) and/or the in-line oximeter (test oximeter 3) with the measured fractional venous oxygen saturation obtained at regular intervals from the extracorporeal circuit. MAIN OUTCOME MEASURES: Venous oxygen saturation was the criterion standard used to determine accuracy. Bias was defined as the mean difference between observed pulse oximeter or in-line oximeter values and the measured venous oxygen saturation. Mean biases were calculated for venous oxygen saturation measurements between 55% and 99% at intervals of 10%. Precision (the standard deviation of the bias) was calculated for low (55% to 75%), medium (76% to 81%), and high (82% to 99%) venous oxygen saturation values. A total of 983 venous oxygen saturation measurements were made and compared with simultaneous oximeter readings from test oximeter 1 (n = 600), test oximeter 2 (n = 478), and test oximeter 3 (n = 587). RESULTS: Test oximeter 1 was the most precise instrument at each level of venous oxygen saturation (SD, 4.0 to 4.8). Test oximeter 3 demonstrated the most consistent mean bias (range, 8), but was the most inaccurate oximeter across all levels of venous oxygen saturation. CONCLUSIONS: In addition to its known clinical usefulness, pulse oximetry may serve as an adequate substitute for in-line oximetry during extracorporeal life support.

Serving the needs of persons with chronic mental illness: a neglected ministry.

Argues that the present disarray in services for persons with chronic mental illness opens the door for the Church to provide important and needed ministries. Describes various misconceptions and prejudices and the services church people can provide to meet the challenge.

A sensitive bioassay for teicoplanin in serum in the presence or absence of other antibiotics.

A teicoplanin bioassay has been developed that is accurate, sensitive, and reliable. A linear relationship is obtained between the diameter of the zone of inhibition and log10 teicoplanin concentration in human serum over the range of 0.15 or 1.25 to 96 micrograms/ml using wells or paper filter disks, respectively. The assay medium devised consists of 50 g BBL Mueller-Hinton II Agar, 30 g NaCl, 8 g CaCl2, and 1.0 g citric acid (monohydrate) per liter of deionized water (resulting pH 5.1 +/- 0.1) and the assay organism Bacillus subtilis ATCC 6633. This system allows the assay of teicoplanin in the presence of commonly used aminoglycosides and in the presence of beta-lactams after inactivation by beta-lactamase. Additionally, it has the potential to be used in the presence of rifampin by using a rifampin-resistant strain of B. subtilis.

Applications of cognitive testing to group therapies with the chronically mentally ill.

Appreciation of the various cognitive deficits displayed by many chronic patients offers an alternative way of understanding each patient's predicament and an alternative way of approaching group and milieu therapies with chronic patients. Case examples taken from a test protocol based on neuropsychological testing procedures illustrate the clinical information that can be obtained in this important, but relatively unexplored area.

Compassion without illusion.

This paper describes the present crisis in the mental health system relative to the chronically mentally ill. It asks how we can apply our usual social contract with the sick to noncompliant mental patients. The paper identifies some American assumptions about freedom and individualism that undermine a more effective response and offers alternative assumptions based on the Judeo-Christian tradition that may help resolve some difficulties.

Spirituality and depth psychology.

The resurgence of interest in spiritual and religious matters and in the depth psychology of C.G. Jung is examined relative to the work of spiritual direction and pastoral counseling. It is suggested that the risks of muddled thinking, narcissism, gnosticism, and credulity are increased when one attempts to combine spiritual disciplines with depth psychology.

Cognitive deficits among functionally psychotic patients: a rehabilitative perspective.

Psychological and neuropsychological assessments of psychiatric patients are usually designed to contribute to or document psychiatric diagnoses. The present article suggests that reframing the task to focus on cognitive rehabilitation issues can contribute significantly to the treatment of the chronic patient. A test protocol is proposed and exemplary tests suggested.

Acute and chronic implantation of coiled wire intraneural electrodes during cyclical electrical stimulation.

The posterior tibial nerves of 18 rabbits were intraneurally implanted with coiled wire electrodes for up to 9 weeks to evaluate their usefulness for neuromuscular electrical stimulation. In one group an electrode was implanted and removed in one leg while the other leg was chronically implanted. A second group was chronically implanted without electrical stimulation in one leg and implanted with cyclical electrical stimulation applied through the electrode in the other leg. No significant changes in nerve conduction velocities between the time of implantation and up to 9 weeks post-implantation were observed in either the stimulated or the non-stimulated nerves. Little change in motor current threshold was observed beyond 10 days post-implantation. The nerves showed little or no histologic demyelination or denervation in most specimens, although in about 40% of the nerves, a bulbous formation of connective tissue was observed at electrode entry and exit sites with some demyelination in these regions. The spinal cords showed no histologic abnormalities in either group. The gastrocnemius and soleus muscles showed only occasional signs of denervation. One cat was implanted in both the posterior tibial and peroneal nerves of each leg for a 4-year period. Threshold current showed very little change during the implantation period. The nerves showed minimal focal demyelination at the electrode site and the muscles showed normal fibers.

In vitro and in vivo evaluation of MDL 19,592, an oral cephalosporin.

MDL 19,592 is a new semisynthetic cephalosporin with a good therapeutic potential against Gram-positive bacterial infections when administered orally or parenterally. In the oral treatment of benzylpenicillin-resistant Staphylococcus aureus infections in mice, MDL 19,592 was superior to cephalexin, cephradine, cefaclor, cefadroxil and cefroxadine. These in vivo results reflect the in vitro superiority expressed by MDL 19,592 over the other oral cephalosporins against staphylococci. Additionally, MDL 19,592 orally was superior to cefazolin and cephalothin administered subcutaneously and to a number of penicillinase-resistant penicillins given orally or subcutaneously in the treatment of S. aureus mouse infections. MDL 19,592 killed S. aureus cells at the same or faster rate than did cephalexin or cephradine. As compared to cephalexin, MDL 19,592 was marginally superior in vitro against Streptococcus pyogenes and Streptococcus pneumoniae. In vivo, MDL 19,592 was significantly the more effective of the two against S. pyogenes and marginally more effective against S. pneumoniae. Against Gram-negative organisms, with the exception of Haemophilus influenzae, cephalexin was the more potent of the two antibiotics both in vitro and in vivo. Administered orally to mice, MDL 19,592 was absorbed as rapidly as cephalexin with both drugs attaining similar concentrations in the blood. MDL 19,592, like cephalexin, was minimally bound by mouse serum.

Psychotherapy and the locus of control.

Underlying various actions of both the therapist and the patient are expectations about the measure to which an individual's experiences are the product of powerful external forces or of the person's own actions and decisions. While most of our anthropological theories support the notion that a person's experience is subject to an external locus of control, neither that view nor the opposite emphasizing freedom and autonomy is adequate for the therapeutic enterprise. THere are elements of truth in both positions that ned to be incorporated in therapeutic expectations if the enterprise is to proceed in an orderly fashion.

Reconsidering three dichotomies.

Certain dichotomies that are built into modern medical and psychiatric care-mind versus body, the individual versus the group, and "sin" versus sickness-are discussed and criticized. Judeo-Christian views regarding these issues are presented as helpful alternatives that can help set limits on the distinctions made.

Semisynthetic cephalosporins. IV. Synthesis and structure activity relationships of parenterally active 7-[4-(substituted methyl)phenyl]-acetamido-3-cephem-4-carboxylic acids.

A group of novel 4-substituted phenylacetic acids were prepared and coupled with several 7-amino-delta-3-cephems to afford a family of parenterally active cephalosporins. A compound designated 13I had the broadest spectrum of activity and the highest potency of the group against both Gram-positive and Gram-negative bacteria. The activity of 13I included high potency against penicillinase-producing staphylococci and activity against anaerobes, including Bacteroides fragilis.

Small-group psychotherapy with patients on a short-stay ward: an opportunity for innovation.

The principles of small-group psychotherapy have been developed largely from experience with groups of outpatients and long-term inpatients. Group therapy in short-stay settings is distinguished by a number of features--chiefly the transience of group membership--that make the application of the standard principles of group therapy problematic. The author suggests that these difficulties can be viewed as an opportunity for adapting group therapy to better serve the needs of short-stay patients. Therapists can allow groups to serve a variety of functions--administrative and humanitarian as well as the primary treatment function--while being specific about the goal or goals of each group. Therapists should be flexible about group format, keeping group membership open, departing from the standard group discussion format when necessary, and accommodating disruptive patients.

beta-lactam antibiotics derived from nitrogen heterocyclic acetic acids. 2. Cephalosporin derivatives.

Three cephalosporin derivatives were prepared from 1,4-dihydro-4-oxypyridine-1-acetic acid. These were the 7-aminocephalosporanic acid (7-ACA) derivative and the compounds with 5-methyl-1,3,4-thiadiazol-2-thiol and 1-methyl-1,2,3,4-tetrazole-5-thiol at C-3 of the cephalosporin nucleus. The antibacterial activity of the 7-ACA derivative was comparable to cephalothin, and that of the other two derivatives was comparable to cefazolin. The 7-ACA derivative, compared to cephalothin, was significantly less metabolized, was less protein bound, and had a longer half life.