Anthropology and cultural neuroscience: creating productive intersections in parallel fields.

Partly due to the failure of anthropology to productively engage the fields of psychology and neuroscience, investigations in cultural neuroscience have occurred largely without the active involvement of anthropologists or anthropological theory. Dramatic advances in the tools and findings of social neuroscience have emerged in parallel with significant advances in anthropology that connect social and political-economic processes with fine-grained descriptions of individual experience and behavior. We describe four domains of inquiry that follow from these recent developments, and provide suggestions for intersections between anthropological tools - such as social theory, ethnography, and quantitative modeling of cultural models - and cultural neuroscience. These domains are: the sociocultural construction of emotion, status and dominance, the embodiment of social information, and the dual social and biological nature of ritual. Anthropology can help locate unique or interesting populations and phenomena for cultural neuroscience research. Anthropological tools can also help "drill down" to investigate key socialization processes accountable for cross-group differences. Furthermore, anthropological research points at meaningful underlying complexity in assumed relationships between social forces and biological outcomes. Finally, ethnographic knowledge of cultural content can aid with the development of ecologically relevant stimuli for use in experimental protocols.

Inadequate treatment of ventilator-associated pneumonia: risk factors and impact on outcomes.

Initial antibiotic therapy is an important determinant of clinical outcomes in ventilator-associated pneumonia (VAP). Several studies have investigated this issue, with conflicting results. This study investigated risk factors of inadequate empirical antimicrobial therapy and its impact on outcomes for patients with a clinical diagnosis of VAP. The primary outcome was adequacy of antimicrobial therapy. Secondary outcomes were duration of mechanical ventilation, hospital and intensive care unit (ICU) lengths of stay, and mortality due to VAP. Mean age was 62.9+/-15.2 years, mean APACHE (Acute Physiological Assessment and Chronic Health Evaluation) II score was 20.1+/-8.1 and mean MODS (Multiple Organ Dysfunction Score) was 3.7+/-2.5. Sixty-nine (45.7%) of 151 patients with a clinical diagnosis of VAP received inadequate antimicrobial treatment for VAP initially. There were 100 (66.2%) episodes of VAP caused by multidrug-resistant pathogens, of which 56% were inadequately treated, whereas the rate of inadequate antimicrobial therapy for VAP caused by susceptible-drug pathogens was 25.5% (P<0.001). Multiple logistic regression analysis revealed that the risk of inadequate antimicrobial treatment was more than twice as great for patients with late-onset VAP [odds ratio (OR), 2.93; 95% confidence interval (CI), 1.30-6.64; P=0.01], and more than three times for patients with VAP caused by multidrug-resistant pathogens (OR, 3.07; 95% CI, 1.29-7.30; P=0.01) or with polymicrobial VAP (OR, 3.67; 95% CI, 1.21-11.12; P=0.02). Inadequate antimicrobial treatment was associated with higher mortality for patients with VAP. Two of three independent risk factors for treatment inadequacy were associated with the isolation and identification of micro-organisms.

Functional assessment of internal mammary artery bypass grafts: case reports and review of the literature.

The utility of intra-arterial Doppler flow in assessing internal mammary artery (IMA) bypass grafts has infrequently been reported. Two patients are described in which Doppler evaluation of the IMA graft provided valuable diagnostic information prior to intervention. Also provided is a review of the available literature concerning evaluation of pathology in IMA grafts.

Mental health care in an adolescent medical setting.

Two hundred sixty-four troubled adolescents referred to a medical adolescent clinic were randomly assigned to one of three therapies and to one of four conditions defined by whether treatment was delayed for 6 weeks or not, and whether or not the case was presented to a psychiatrist. Patients were assessed by parents and self-reports at intake and at 6, 12, and 24 weeks, using the Adolescent Life Assessment Check List (ALAC). This 40-item instrument yielded a total and six subscores. Patients in all treatment conditions showed improvement across time as measured by the ALAC (patient or parent). Improvement was noted for each race--sex group, for each of the four conditions, and for patients assigned to each therapist. Differences in outcome were noted for immediate vs. delay groups and for groups given psychiatric consultation. By 6 months, scores on the adolescent ALAC approximated those of a matched normative sample tested. Although successful, the program should be replicated before its findings are generalized.

Parents view their adolescents' mental health.

A 40-item behavioral checklist was devised for use with adolescent patient and nonpatient samples. A comparable form is used to obtain information about the offspring from the parent or guardian. This report presents the responses of parents and compares them with those of their offspring in two samples. Parents of disturbed adolescents reported a significantly greater frequency of emotional-behavioral problems in their offspring than did parents of a medical sample, whereas the two samples of adolescents reported equivalent frequency of problems. Parental responses to items were clustered into six subscales. Effects of race and sex of the adolescent on subscale scores were investigated. Black parents in both samples reported fewer and less frequent problems than did white parents; in contrast, the black teenagers' reports were similar to the white except for the Affective Distress subscale. Parents and adolescents in both samples reported higher scores for girls than boys on this subscale.

Social alienation-personal disorganization assessment in disturbed and normal adolescents.

Two groups of adolescents seeking psychotherapy (N = 91 and N = 198) and a normative group (N = 112) provided 5-minute verbal behavior protocols which were content analyzed for social alienation-personal disorganization (SA-PD). The data supported the hypothesis that adolescents applying for help in 1974 to 1975 showed greater pathology than those seen in 1972 to 1973. The normative adolescents were significantly healthier than either of the two Adolescent Clinic groups. In the clinic samples, older adolescents were more disturbed than those in the younger ranges. The SA-PD scale is a useful addition to tools available for the assessment of emotional states of adolescents. The data support the idea that there appears to be an increasing severity in the problems presented by adolescents in very recent years.

Content scaling of affect in adolescent speech samples.

Data are reported which extend the applicability of the Gottschalk-Gleser scales for the content analysis of speech samples to adolescents. The data were gathered on 112 youngsters aged 11-18 stratified by age, race, and sex in a balanced design. Girls had higher Anxiety scores and relatively lower scores on Hostility Directed Inward, Ambivalent Hostility, and Social Alienation and Personal Disorganization than did boys. Blacks spoke less words and expressed more Overt Hostility Outward than did Whites. These latter scores increased with age, as did Hostility Directed Inward. The affect scores for this normative group are also compared to those for "normal" adults and to an adolescent clinic and a juvenile delinquent population. Correlations with three paper-and-pencil inventories (Adolescent Life Assessment Checklist, Defense Mechanisms Inventory, and Rotter I-E scale) are presented.

[Pharmacokinetic study of intravenous furosemide in nephrotic syndrome in children]. / Etude pharmacocinetique du furosemide intraveineux dans les syndromes nephrotiques de l'enfant.

The pharmacokinetics and pharmacological effect of intravenous furosemide (F) (2 mg/kg body weight) were studied in 12 children with the nephrotic syndrome with or without renal failure (R.F.). The concentration of F in blood and urine was determined by a new spectrophotometric method. In the nephrotic syndrome alone, the rate of renal excretion was increased (increased slope of the pharmacokinetic curve, decreased t 1/2), which may be due to a decrease in the fraction bound to plasma albumin. In children with the nephrotic syndrome and renal failure, the decrease in the renal excretion of F was related to the degree of renal failure. In normal children the mean F clearance is 296. In patients with N.S. alone the clearance is greatly increased (X = 377) and in N.S. with R.F. it is reduced (0.17-90). The possible mechanisms and therapeutic implications of the results are discussed.

Adolescents view their mental health.

A new 40-item behavioral checklist, the Adolescent Life Assessment Checklist (ALAC), was devised to be used with patient and nonpatient samples. A comparable form obtains information from a parent or guardian. Responses of 356 adolescents from three sources were analyzed for differences attributable to race, sex, age, sample source, and their interactions. A factor analysis was carried out on the average within-race-sex-source subgroup correlation matrix, resulting in seven meaningful and six usable oblique factors. Subscales were developed and corrections were computed to remove estimated differences due to race, sex, and age. Corrected scales significantly differentiate the three samples.