Client as colleague. Therapeutic contracting with the seriously mentally ill

This article introduces the therapeutic contracting program as a comprehensive treatment system for persons with serious mental illness. Therapeutic contracting offers a promising framework for integrating medical, psychological, and social therapies in a manner that fosters clients' active involvement in treatment. This article outlines a multistage therapy program that mobilizes clients' adaptational resources through experimental interventions, structured goal-setting exercises, and skills-building experiences. Data illustrate the effectiveness of therapeutic contracting for (a) securing clients' treatment compliance, (b) promoting positive clinical outcomes, (c) reducing overall treatment costs. The therapeutic contracting model is discussed as a potential vehicle for expanding the professional role of psychologists in psychiatric settings, particularly in areas of clinical and administrative decision making.

Client as colleague. Therapeutic contracting with the seriously mentally ill

This article introduces the therapeutic contracting program as a comprehensive treatment system for persons with serious mental illness. Therapeutic contracting offers a promising framework for integrating medical, psychological, and social therapies in a manner that fosters clients' active involvement in treatment. This article outlines a multistage therapy program that mobilizes clients' adaptational resources through experimental interventions, structured goal-setting exercises, and skills-building experiences. Data illustrate the effectiveness of therapeutic contracting for (a) securing clients' treatment compliance, (b) promoting positive clinical outcomes, (c) reducing overall treatment costs. The therapeutic contracting model is discussed as a potential vehicle for expanding the professional role of psychologists in psychiatric settings, particularly in areas of clinical and administrative decision making.

Significance of the epithelial crypts at the bovine utero-tubal junction in the pre-ovulatory phase of sperm regulation

Because polyspermic fertilisation is a pathological condition in mammals, arising from an excess of spermatozoa at the site of initial sperm-egg contact and leading to early death of the embryo, consideration has been given to the manner whereby the utero-tubal junction may contribute to a reduction in the numbers of spermatozoa entering the Fallopian tubes. This seems especially important in cattle since the utero-tubal junction does not exhibit swollen polypoid processes that might act physically to reduce the number of spermatozoa entering the isthmus from the uterus. In tissues prepared from animals close to the time of ovulation, large numbers of simple glands were visible in the uterine surface and throughout the region of the utero-tubal junction and its ridges extending into the isthmus. The glands appeared as crypts, slits or craters. On the basis of a figure of 500 glands situated close to the utero-tubal junction and some 2-10 spermatozoa located within each gland, these conservative estimates suggest a temporary arrest of 1-5x10(3) spermatozoa, thereby contributing to the steeply diminishing sperm gradient before the site of fertilisation. There would thus appear to be a vital physical rôle for the simple glands and clefts that predominate in this region, functioning importantly in the pre-ovulatory interval to pave the way for normal monospermic fertilisation. More subtle forms of sperm regulation by glycoprotein molecules are also considered.

Ovarian regulation of sperm progression in the fallopian tubes

Successful liberation and apposition of gametes are essential components of fertility. Normal fertilisation depends upon the establishment of a pre-ovulatory sperm gradient in the female tract between the site of semen deposition and the site of fertilisation in the Fallopian tubes. As a consequence, sperm: egg ratios may be close to unity at the time of activation of most secondary oocytes under conditions of spontaneous mating. In the absence of a sufficient sperm gradient, newly ovulated eggs would be confronted by an excess of spermatozoa resulting in polyspermic fertilisation. Penetration of the vitellus by more than one spermatozoon is pathological in mammals (Beatty, 1957; Austin, 1963). Accordingly, systems that act to regulate sperm progression and competence before the time of ovulation assume a particular importance. During the 1950s, 1960s and 1970s, there was much controversy as to the rate of sperm transport into the Fallopian tubes. Because observations failed to focus on those spermatozoa that could fertilise eggs, the controversy was largely sterile. Nor were the disagreements well founded since some experiments employed artificial insemination whilst others used natural mating. These two quite distinct approaches to introducing a sperm suspension into the female tract could not reasonably form the basis of disagreements on the physiological events of cellular progression. More recent studies have been set in perspective by Overstreet (1983), Harper (1988), Yanagimachi (1988), Hunter (1988, 1991, 1995) and Drobnis & Overstreet (1992)After mating at the onset of oestrus, ram and bull spermatozoa require a minimum of 6–8 h to reach the Fallopian tubes in sufficient numbers to promote suc.cessful fertilisation (Hunter et al., 1980; Hunter & Wilmut, 1982). Spermatozoa displaced to the tubes in a small number of minutes are moribund or dead, not.

Modulation of gamete and embryonic microenvironments by oviduct glycoproteins

Studies on protein molecules in oviduct luminal fluid are viewed historically, and then in terms of more recent studies on a possible involvement of unique glycoproteins in embryonic development. As a caution, however, it is noted that incorporation of such molecules into the vitellus may be nonspecific. The question is raised as to whether oviduct glycoproteins could be acting primarily in a physical sense to stabilize differing chemical environments along the oviduct. Equally or more importantly, glycoproteins might be acting as carrier molecules to present cations and metabolic substrates at appropriate concentrations to the vitelline membrane. This latter possibility is examined in some detail and could be tested by manipulating the composition of the perivitelline fluid. Glycoproteins may also be critically involved in regulating the physiological competence of spermatozoa in the pre- and peri-ovulatory oviduct, in maintaining a coordinated pattern of cilial beat, and in immunosuppressive functions within the oviduct, not least in those associated with the masking of paternal antigens on both spermatozoa and embryos.

Sperm:egg ratios and putative molecular signals to modulate gamete interactions in polytocous mammals

Reasoning from the premises that 1) the sperm:egg ratio at the time of activation of the secondary oocyte in mammals is close to unity under conditions of spontaneous mating, 2) a majority of eggs within the cumulus oophorus of a polytocous species is fertilized in a reasonably short interval of time, and 3) spermatozoa would find it difficult to reverse their approach to the zona pellucida, it is proposed that molecular gradients exist to divert spermatozoa penetrating the cumulus mass away from eggs already activated and towards eggs as yet unfertilized. Possible sources of such molecular cues are considered, as is the event that triggers their release.

Rate of establishment of a fertilising population of spermatozoa in the sheep cervix after a single mating at the onset of oestrus

In order to study how soon a population of spermatozoa capable of fertilisation could progress into the cervical canal, the vaginal contents were flushed with a detergent solution at different intervals after mating at the onset of oestrus. Eggs recovered 1 or 2 days later from the oviducts were stained and examined by phase-contrast microscopy. Flushing at 3 minutes after mating did not prevent fertilisation in 44% of instances, whereas similar flushes performed at 6 or 9 minutes completely prevented fertilisation in a total of 26 animals. In the groups flushed at 12 and 15 minutes, the proportion of eggs fertilised was 21% and 24%, respectively, and this increased to 37% after flushing at 18 minutes. An explanation is offered for the paradoxical finding at 3 minutes, and it is concluded that at least 30-60 minutes would be required for adequate colonisation of the cervix with a fertilising population of spermatozoa under the conditions employed in the experiment. However, multiple matings or mating closer to the time of ovulation might act to reduce this interval.

Concentrations of energy substrates in oviductal fluid and blood plasma of pigs during the peri-ovulatory period

Large White gilts, 9 to 18 months old, that had exhibited at least two natural oestrous cycles were divided into three groups (phases): unmated pre-ovulatory, unmated post-ovulatory and mated post-ovulatory (n = 16, 20 and 18). Oviductal luminal fluid samples were collected under anaesthesia by micropipette from the ampulla and ampullary-isthmic junction and analysed by an ultramicrofluorometric technique. Glucose concentrations (mmol 1(-1), means combining regions; mean +/- SEM) were significantly higher in blood plasma than in oviductal fluid (4.56 +/- 0.20 versus 0.59 +/- 0.16; P < 0.0001; n = 27), whereas lactate was higher in the oviduct (5.71 +/- 0.53 versus 2.48 +/- 0.24; P < 0.0001; n = 27). No significant differences were found between the ampulla and the ampullary-isthmic junction. However, the concentration of glucose was significantly higher (P < 0.05) in the ampulla of the pre-ovulatory group (0.97 +/- 0.20; n = 13) compared with the mated group (0.25 +/- 0.05; n = 14) and its concentration in the ampullary-isthmic junction in the pre-ovulatory group (1.65 +/- 0.63; n = 13) was significantly greater (P < 0.05) than in the post-ovulatory (0.43 +/- 0.11; n = 11) or mated groups (0.17 +/- 0.02; n = 14). Lactate in the ampulla of mated animals was higher than in the pre-ovulatory group (6.83 +/- 0.70 versus 3.86 +/- 0.38; P < 0.05; n = 15 and 13), but neither was significantly different from the post-ovulatory group. Furthermore, no change was seen at the ampullary-isthmic junction in lactate concentration with phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Sarcoidosis of the breast, central nervous system, and exocrine glands in a patient with sicca symptoms

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Oviduct function in pigs, with particular reference to the pathological condition of polyspermy

Because the exceptionally high incidence of polyspermic fertilisation has been emphasised as a major defect in systems of in vitro fertilisation in pigs, the aetiology of the condition has been analysed in a series of experiments in vivo in the search for a common underlying cause and possible means of mitigation. Whereas the defense mechanism against polyspermy in pig oocytes is classically viewed as zona reaction, more recent evidence suggests a secondary block at the vitelline surface. Both blocks may be compromised in situations leading to polyspermy, although deleterious influences seem to be expressed principally in an inadequate zona block, as judged by the presence of perivitelline spermatozoa. Postovulatory aging of mammalian oocytes prior to sperm penetration leads to polyspermy, as can be demonstrated in pig eggs. The primary lesion may concern the cortical reaction, owing to a delayed and incomplete exocytosis of the vesicular contents. Eggs ovulated after gonadotrophin treatment during the luteal phase of the cycle show a high incidence of polyspermic penetration (60.6%), as do those shed at estrus in animals treated with progesterone systemically (40%) or by local microinjections in the oviduct wall (32.3%). Whereas progesterone may be modifying interactions of the gametes and responses of the egg organelles in all four above experimental situations, enhanced numbers of spermatozoa ascending a more patent isthmus appear to be the principal cause of polyspermy.(ABSTRACT TRUNCATED AT 250 WORDS)

Distribution, morphology and epithelial interactions of bovine spermatozoa in the oviduct before and after ovulation: a scanning electron microscope study

In cows undergoing spontaneous oestrous cycles and mated during the first 6 hours of oestrus, the distribution of spermatozoa in the oviduct isthmus and changes in their surface membranes and neighbouring epithelium have been examined shortly before and after ovulation. In agreement with previous histological studies, relatively few spermatozoa were detected in the oviduct lumen: most were located in the caudal isthmus before ovulation, frequently among folds and in the presence of a viscous secretion. A majority of spermatozoa in this region showed strands and droplets of secretory material distributed over the anterior portion of an intact head before ovulation, whereas distribution of material over the post-nuclear cap of spermatozoa close to vesiculation or already acrosome-reacted was characteristic of the post-ovulatory situation. These changes in sperm head membranes were viewed as an expression of the completion of capacitation, and seemingly permit microvillous engagement with the rostral tip of the head. In conjunction with a narrow lumen and viscous secretions in the caudal isthmus, microvilli may thus serve to regulate periovulatory sperm progression towards the site of fertilisation, and be the basis of intermittent phases of adhesion to the oviduct epithelium as seen by phase-contrast microscopy. Although cilia do not similarly engage the heads of bull spermatozoa (cf. boar spermatozoa), they may act to regulate progression of capacitated spermatozoa by contacting the principal piece of the flagellum. In the light of these observations, changes in the molecular composition of sperm surface domains during the process of capacitation in vivo now require specific definition.

Characterization of ovarian follicular fluids of sheep, pigs and cows using proton nuclear magnetic resonance spectroscopy

Proton NMR spectra were produced for Graafian follicular fluids obtained by aspiration from sheep, pig and cow ovaries. The following low molecular mass, non-protein-bound metabolites were detected at concentrations exceeding 0.1 mM: acetate, alanine, creatinine/creatine, glycine, D-3-hydroxybutyrate, lactate, valine. Glucose was difficult to quantify and N-acetyl sugars gave a broad resonance at 2.06 ppm, presumably representing side-chains of glycoproteins. Ethanol was detected at up to millimolar concentrations in some specimens, though the physiological significance of this finding was not clear. The concentrations of all metabolites were comparable to those of plasma. These results have therefore shown that NMR spectroscopy is useful for gaining a broad and semiquantitative impression of the more abundant metabolites in the fluids of preovulatory Graafian follicles.

Luteinizing hormone response to an oestradiol challenge in 5 intersex pigs possessing ovotestes

After challenge with oestradiol benzoate, the mean maximum LH concentration in 5 XX intersex pigs possessing ovarian and testicular tissue, or only testicular tissue, was 2.10 (+/- 0.41) ng/ml compared with 8.9 ng/ml in mature domestic gilts. These results indicate that exposure of the pig brain to testosterone before Day 30 of gestation is important, or that early testicular secretions other than testosterone are involved in the determination of brain gender. The observation that some intersex pigs show normal oestrous cycles implies that the response to these prenatal factors is primarily quantitative rather than qualitative.

Influence of cell cycle stage at nuclear transplantation on the development in vitro of mouse embryos

Nuclei were transplanted from embryos of mice at different stages of the 1st and 2nd cell cycle to oocytes enucleated at various times after fertilization. After transfer of pronuclei, a greater proportion of embryos developed to blastocysts if donor and recipient embryos were at the same stage of the cell cycle (synchronous transfer = 94%, asynchronous transfer = 76%). By contrast, when 2-cell blastomere nuclei were fused to the cytoplasm of enucleated zygotes, there was a significant effect of both cytoplast and karyoplast cell cycle stage on the development of the reconstituted embryos. Karyoplasts and cytoplasts derived from embryos at later stages of the cell cycle had greater potential to support development to blastocysts in vitro. It is suggested that the secretion of stage-specific messengers and the timing of nuclear membrane breakdown are the main factors causing the karyoplast and cytoplast effects, respectively.

Capacitation potential of the fallopian tube: a study involving surgical insemination and the subsequent incidence of polyspermy

In an attempt to demonstrate limitations in the capacitating potential of the Fallopian tube, ejaculated boar spermatozoa were introduced directly into the isthmus at varying intervals before ovulation. The incidence and degree of polyspermy subsequently observed were taken as indicators of the population of capacitated spermatozoa confronting the newly ovulated eggs: the more extensive the condition of polyspermy, the greater the number of capacitated spermatozoa presumed to have been available at the site of fertilization. Results are based on 673 eggs from 53 animals. When suspensions containing 2.21-3.87 x 10(8) sperm per ml were introduced 36-40 hours and 26-30 hours before ovulation, 85% and 61% respectively of the eggs were polyspermic, such eggs exhibiting mainly dispermy and trispermy. By contrast, when comparable sperm suspensions from the same boar were instilled 17-18 hours before ovulation, 70% of the eggs were polyspermic but the degree of polyspermy had increased dramatically: most eggs contained 40 or more sperm heads in the vitellus, invariably forming swollen chromatin aggregates rather than male pronuclei. Surgical insemination at times closer to ovulation significantly reduced the incidence and degree of polyspermy, reaching a low of 2% with insemination 1-2 hours before ovulation. These results therefore support the concept of a limited capacitation potential of the Fallopian tube. In a separate series of observations, mating animals shortly before surgical insemination with sperm suspensions from the same boar markedly reduced the incidence of polyspermy. This latter observation may be of clinical significance in procedures of laparoscopic or transcervical insemination into the tubes to alleviate human infertility. The manner whereby myosalpingeal physiology could be modified in response to coital stimulation is discussed.

Electrophysiological properties of the follicle wall in the pig ovary

The transmural potential difference and short-circuit current of the porcine Graafian follicle have been measured in an attempt to test whether antral fluid accumulates as a result of active transport of salt. The values obtained by mounting explants of follicle wall in Ussing chambers were close to zero and the specific electrical resistance was only 59 delta.cm2. The elemental composition of the follicular fluid was similar to that of ovarian venous plasma with the exception of follicular Na+ which was slightly more abundant. Bicarbonate concentrations were slightly lower in follicular fluids. These findings were interpreted as evidence that the follicular wall is a leaky epithelium and, therefore, any charge resulting from net ion transport will be shunted along low resistance paracellular pathways.

Human fertilization in vivo, with special reference to progression, storage and release of competent spermatozoa

Whilst very large numbers of spermatozoa accumulate in the cervical mucus and crypts in the hours following coitus, evidence is offered from species with comparable gonadotrophin surge-to-ovulation intervals to suggest that the cervix is not the site of the functional sperm reservoir in women. On the contrary, human spermatozoa involved in the events of fertilization may spend the greater part of the pre-ovulatory interval in the distal portion of the Fallopian tube, that is in the intra-mural segment. This would enable spermatozoa to be arrested within reach of the site of fertilization in the ampullary region of the tube, and to be activated and released close to the time of ovulation by means of a local transfer of high concentrations of ovarian follicular hormones. The clinical importance of confirming this proposed role for the intra-mural segment of the tube is stressed, as is the possibility of specific micro-environments within the lumen of the duct.

Simple measures of progress and outcome in the evaluation of mental health services

There is a tautology regarding the use of progress and outcome measures. Such measures are easy to use in a reliable and valid fashion if the language of the measures is used as an integral part of (a) treatment planning and progress review, (b) clinical supervision, and (c) program management. The paper describes example guidelines and uses of measures in each of these functions. Also included are listings of scales with documented reliability and validity (by target population) and some sources for finding computer software for scoring some of the scales.