From competition to complementarity. Legal issues and their clinical implications in custody.

In the 1970s, the "best interests of the child" doctrine focused custody litigation away from parental competition and toward meeting each child's needs. Yet, artifacts of the parental preference doctrine remain entrenched in custody law and practice. The evolving "best interests" paradigm requires redefining "custody" as development, implementation, and adaptation of individualized plans that provide a structure for complementary parenting. This article explores this paradigm shift while providing an introduction to the realities of child custody proceedings and family law courts. The article also identifies the ways in which mental health professionals can work most effectively with the legal system for the benefit of children of divorce and separation.

Community youth development: learning the new story.

Community youth development is a challenging approach to youth work that focuses on the incorporation of new values at the practice, management, and community levels. This article explores the implementation of a community youth development approach within the context of learning organization theory, and describes the experiences of three youth-focused agencies making the transition to a community youth development approach.

Uremia with low serum creatinine-an entity produced by marked creatinine secretion.

Two patients are presented who were uremic requiring dialysis despite steady state serum creatinine levels (Cr) of 4.0 and 4.4 mg percent. Their blood urea nitrogen/creatinine (BUN/Cr) ratios of 54 and 44 were shown to be due to excessive creatinine secretion and urea reabsorption. Evaluation of serum creatinine alone may occasionally give misleading information regarding the level of renal function. If clinical evidence of uremia is present while serum creatinine value is relatively low, measurement of glomerular filtration rate (GFR) by Na-iothalamate 125I (OIT) or inulin is essential.

Effects of renal nerves on renal hemodynamics. I. Direct stimulation and carotid occlusion.

Renal nerves were stimulated either directly (loop electrodes) or indirectly (bilateral carotid occlusion with maintenance of control blood pressure) in anesthetized dogs to determine the effects on renal blood flow (RBF), glomerular filtration rate (GFR), sodium excretion (UNaV), and intrarenal distribution of blood flow (microsphere method). Direct nerve stimulation decreased RBF 20% in 9 of 10 dogs; but GFR, UNaV, and intrarenal distribution of blood flow did not change significantly. Carotid occlusion decreased RBF in 9 of 10 dogs. There was a 22% fall in RBF for the whole group, GFR decreased 33%, and UNaV decreased from 0.39 to 0.17 muEq/min/g (p smaller than 0.05). A small (8%) decrease in midcortical fractional flow (p smaller than 0.05 after carotid occlusion was the only distributional flow change observed. The results disclosed no relationship between changes in sodium excretion and changes in total RBF, GFR, or intrarenal distribution of blood flow following nerve stimulation. These studies also indicate that the renal effects of carotid occlusion are probably not mediated by renal nerve stimulation alone.

Effects of renal nerves on renal hemodynamics. II. Renal denervation models.

The effect of acute renal denervation on renal blood flow (RBF) and intrarenal distribution of blood flow (microsphere method) was studied in dogs using three standard denervation models. Surgical denervation, by stripping renal vascular nerves and autoperfusing the kidney through a large bore plastic catheter, caused RBF and glomerular filtration rate to decrease. Also, intrarenal distribution of blood flow became asymmetric, that is, perfusion changes in the two halves of the kidney were not similar. Denervation by stripping away the neural tissue and infiltrating the hilum with 0.5% procaine and 50% ethanol produced no adverse effects on RBF, but distributional changes were asymmetric. Denervation by this method was probably incomplete as evidenced by decreased RBF following bilateral carotid occlusion. Intrarenal arterial infusion of 10 mug/kg/min phenoxybenzamine caused renal perfusion to change asymmetrically and did not abolish the decrease in RBF normally seen following nerve stimulation. Present results demonstrate denervation studies must be interpreted cautiously; because the denervation model may cause renal damage and asymmetric perfusion, and denervation may not be complete.