Review: Mitigating the risks posed by intensification in livestock production: the examples of antimicrobial resistance and zoonoses

Major shifts in how animals are bred, raised and slaughtered are involved in the intensification of livestock systems. Globally, these changes have produced major increases in access to protein-rich foods with high levels of micronutrients. Yet the intensification of livestock systems generates numerous externalities including environmental degradation, zoonotic disease transmission and the emergence of antimicrobial resistance (AMR) genes. Where the process of intensification is most advanced, the expertise, institutions and regulations required to manage these externalities have developed over time, often in response to hard lessons, crises and challenges to public health. By exploring the drivers of intensification, the foci of future intensification can be identified. Low- and middle-income (LMICs) countries are likely to experience significant intensification in livestock production in the near future; however, the lessons learned elsewhere are not being transferred rapidly enough to develop risk mitigation capacity in these settings. At present, fragmentary approaches to address these problems present an incomplete picture of livestock populations, antimicrobial use, and disease risks in LMIC settings. A worldwide improvement in evidence-based zoonotic disease and AMR management within intensifying livestock production systems demands better information on the burden of livestock-associated disease, antimicrobial use and resistance and resources allocated to mitigation.

ESTABLISHMENT OF A NATIONAL DOSE REGISTER AND A DOSIMETRY SERVICE APPROVAL SYSTEM IN IRELAND

Until the end of 2012, the Radiological Protection Institute of Ireland (RPII) operated a personal dosimetry service for workers in the medical, industrial, education and research sectors in Ireland. The data recorded by the RPII service were used to generate national dose statistics and as such acted as a National Dose Register (NDR). In preparation for the closure of the RPII dosimetry service in 2012, a formal NDR was introduced for the first time in Ireland and data on all monitored workers are now supplied to it annually by Approved Dosimetry Services. A new system for approving dosimetry services operating in Ireland was also introduced in 2012. The criteria for approval are based on the recommendations given in the European Commission's publication, 'Radiation Protection No. 160'. This paper describes the steps involved and the operational experience gained in establishing both the NDR and the system for approval of dosimetry services.

Early childhood OCD: preliminary findings from a family-based cognitive-behavioral approach

OBJECTIVE

To examine the relative efficacy of family-based cognitive-behavioral therapy (CBT) versus family-based relaxation treatment (RT) for young children ages 5 to 8 years with obsessive-compulsive disorder (OCD).

METHOD

Forty-two young children with primary OCD were randomized to receive 12 sessions of family-based CBT or family-based RT. Assessments were conducted before and after treatment by independent raters blind to treatment assignment. Primary outcomes included scores on the Children's Yale-Brown Obsessive Compulsive Scale and Clinical Global Impressions-Improvement.

RESULTS

For the intent-to-treat sample, CBT was associated with a moderate treatment effect (d = 0.53), although there was not a significant difference between the groups at conventional levels. For the completer sample, CBT had a large effect (d = 0.85), and there was a significant group difference favoring CBT. In the intent-to-treat sample, 50% of children in the CBT group achieved remission as compared to 20% in the RT group. In the completer sample, 69% of children in the CBT group achieved a clinical remission compared to 20% in the RT group.

CONCLUSIONS

Results indicate that children with early-onset OCD benefit from a treatment approach tailored to their developmental needs and family context. CBT was effective in reducing OCD symptoms and in helping a large number of children achieve a clinical remission.

Human Embryonal Carcinoma Stem Cells Expressing Green Fluorescent Protein Form Functioning Neurons In Vitro: A Research Tool for Co-culture Studies

Neural differentiation is controlled by complex molecular mechanisms that determine cell fate and diversity within the nervous system. Interactions between developing tissues play an important role in regulating this process. In vitro co-culture experiments offer a method to study cell differentiation and function under controlled conditions, with the additional benefit of investigating how interactions between populations of cells influence cell growth and behavior. However, it can often be difficult to distinguish between populations of co-cultured cells. Here we report the development of a human embryonal carcinoma (EC) stem cell line (named TERA2.cl.SP12-GFP) that expresses the genetic marker, green fluorescent protein (GFP). Here, we demonstrate that TERA2.cl.SP12-GFP stem cells stably express GFP and that this remains detectable during retinoic acid-induced differentiation. Regulated expression of neural markers during cell development correlated with the formation of morphologically identifiable neurons. Populations of post-mitotic GFP-positive neurons were readily purified and electrophysiological characterization confirmed that such neurons were functionally active. Thus, cultured TERA2.cl.SP12-GFP cells can be readily distinguished from alternative cell types in vitro and provide an amenable system for live cell imaging to study the development and function of human neurons in isolation, and in co-culture with other tissue types.

The analgesic effect of odour and music upon dressing change

Vascular wounds may require frequent dressing changes over a long period of time, often involving pain, which may not be adequately controlled with conventional analgesia. Complementary analgesia may be beneficial as an adjunctive therapy. This pilot study presented eight patients with two odour therapies, lavender and lemon, two music therapies, relaxing and preferred music and a control condition, during vascular wound dressing changes. Although the therapies did not reduce the pain intensity during the dressing change there was a significant reduction in pain intensity for the lavender therapy and a reduction in pain intensity for the relaxing music therapy after the dressing change. This supports the use of these complementary therapies, which are inexpensive, easy to administer and have no known side effects, as adjunctive analgesia in this patient population. Earlier administration before dressing change may enhance these effects. Further research is required to ascertain why certain complementary therapies are more effective than others at relieving pain.

Sodium channel inhibition by anandamide and synthetic cannabimimetics in brain

Anandamide is a prominent member of the endocannabinoids, a group of diffusible lipid molecules which influences neuronal excitability. In this context, endocannabinoids are known to modulate certain presynaptic Ca(2+) and K(+) channels, either through cannabinoid (CB1) receptor stimulation and second messenger pathway activation or by direct action. We investigated the susceptibility of voltage-sensitive sodium channels to anandamide and other cannibimimetics using both biochemical and electrophysiological approaches. Here we report that anandamide, AM 404 and WIN 55,212-2 inhibit veratridine-dependent depolarization of synaptoneurosomes (IC(50)s, respectively 21.8, 9.3 and 21.1 microM) and veratridine-dependent release of L-glutamic acid and GABA from purified synaptosomes [IC(50)s: 5.1 microM (L-glu) and 16.5 microM (GABA) for anandamide; 1.6 microM (L-glu) and 3.3 microM (GABA) for AM 404, and 12.2 (L-glu) and 14.4 microM (GABA) for WIN 55,212-2]. The binding of [3H]batrachotoxinin A 20-alpha-benzoate to voltage-sensitive sodium channels was also inhibited by low to mid micromolar concentrations of anandamide, AM 404 and WIN 55,212-2. In addition, anandamide (10 microM), AM 404 (10 microM) and WIN 55,212-2 (1 microM) were found to markedly block TTX-sensitive sustained repetitive firing in cortical neurones without altering primary spikes, consistent with a state-dependent mechanism. None of the inhibitory effects we demonstrate on voltage-sensitive sodium channels are attenuated by the potent CB1 antagonist AM 251 (1-2 microM). Anandamide's action is reversible and its effects are enhanced by fatty acid amidohydrolase inhibition. We propose that voltage-sensitive sodium channels may participate in a novel signaling pathway involving anandamide. This mechanism has potential to depress synaptic transmission in brain by damping neuronal capacity to support action potentials and reducing evoked release of both excitatory and inhibitory transmitters.

A therapeutic nursery evaluation study

The object of this prospective study was to evaluate the effectiveness of a therapeutic nursery program for troubled preschoolers attending the Preschool Day Treatment Center of The Menninger Clinic. Thirty-eight seriously disturbed preschoolers were assessed both at admission and at 9 months or at discharge (if before 9 months) in a pre-post design. Commonly used assessment instruments were collected by independent research clinicians. Significant gains were found in both internalizing and externalizing behaviors on the Child Behavior Checklist (CBCL). The Kohn Social Competence Scale showed significant improvement in learning, pleasurable play activities, and peer interactions. The socialization domain on the Vineland Adaptive Behavior Scale also indicated improvement beyond expectable maturation. In the Behavioral Observations test, both the capacities of the child and the qualities of the relationship were shown to be improved. As measured by the Epidemiologic Studies of Depression Scale (CES-D), mothers also became less depressed. Overall, the researchers conclude that a therapeutic nursery with a comprehensive program is an effective way to help seriously troubled preschoolers make gains in behavior, as well as in social and emotional growth.

Changing patterns of inpatient care for children and adolescents at the Menninger Clinic, 1988-1994

The authors describe trends in inpatient psychiatric length of stay (LOS) and admissions for the population of children and adolescents (N = 784) at the Menninger Clinic from 1988 to 1994. During this period. median LOS declined dramatically from 7 months to 3 weeks, whereas admissions increased 4-fold. The diagnostic case mix changed substantially, with a crossover in modal principal diagnosis from personality disorder to affective disorder. Use of medications became almost universal. Diagnosis and medication use became less important determinants of LOS over time. The practical implications of these patterns include higher patient turnover, fewer inpatient clinical contact hours, and heightened importance of continuity with outpatient care. Research should center on the impact of declining LOS on clinical and functional outcomes for children and adolescents.

Changing patterns of inpatient care for children and adolescents at the Menninger Clinic, 1988-1994

The authors describe trends in inpatient psychiatric length of stay (LOS) and admissions for the population of children and adolescents (N = 784) at the Menninger Clinic from 1988 to 1994. During this period. median LOS declined dramatically from 7 months to 3 weeks, whereas admissions increased 4-fold. The diagnostic case mix changed substantially, with a crossover in modal principal diagnosis from personality disorder to affective disorder. Use of medications became almost universal. Diagnosis and medication use became less important determinants of LOS over time. The practical implications of these patterns include higher patient turnover, fewer inpatient clinical contact hours, and heightened importance of continuity with outpatient care. Research should center on the impact of declining LOS on clinical and functional outcomes for children and adolescents.

Course of illness following specialized inpatient treatment for women with trauma-related psychopathology

The authors report findings from repeated assessments of 101 women who received intensive inpatient treatment focused on trauma-related disorders. All patients were assessed at admission and discharge, and half were reassessed at 1-year follow-up. Measures included the Global Assessment Scale, Brief Psychiatric Rating Scale, Brief Symptom Inventory, Role Functioning Scales, Follow-up Adjustment Scale, and Client Satisfaction Questionnaire. As a group, patients improved substantially during hospitalization and maintained gains at follow-up, although they showed a trend toward relapse in some symptom areas. However, a substantial minority of patients continued to show severe impairment at follow-up. In light of continual need for changes in clinical programs in the face of declining reimbursement, there is a pressing need for future outcome research on specialized trauma programs to relate subsequent clinical course to specific treatment interventions.

Evaluation of intensive inpatient treatment of patients with severe personality disorders

OBJECTIVE

The purpose of this study was to determine whether severe personality disorders improve or deteriorate with intensive inpatient treatment.

METHODS

Overall 216 patients diagnosed as having personality disorders by DSM-III-R criteria were prospectively monitored at two private psychiatric hospitals from admission through discharge to one-year follow-up.

RESULTS

Substantial positive change in the sample was recorded at discharge, and the improvements held up at one-year follow-up. The proportion of patients with scores of 50 or more on the Global Assessment Scale was 3.7 percent at the time of admission. By discharge the proportion had increased to 55.1 percent, and by one-year follow-up it had risen to 66.3 percent.

CONCLUSIONS

These results suggest that patients with severe personality disorders benefit from intensive inpatient treatment. We found no evidence that hospitalization of such patients is associated with regression or deterioration of function.

Which treatments help? The patient's perspective

In an effort to determine which specific aspects of treatment might account for patient satisfaction, the authors developed the Components of Treatment Questionnaire. This measure, which was administered to 500 adult inpatients along with the Client Satisfaction Questionnaire (CSQ-8; Larsen, Attkisson, Hargreaves, and Nguyen, 1979), asked patients to assess the helpfulness of their treatment. Convinced that patient input is pertinent to program design, the authors later surveyed 46 patients on treatments that they perceived as helpful and would like to receive. Respondents identified individual relationships and problem-focused therapies as the most helpful aspects of treatment.

Trauma pervasively elevates Brief Symptom Inventory profiles in inpatient women

The Brief Symptom Inventory was administered to 228 women (M age: 37) consecutively admitted to specialized inpatient treatment for trauma-related disorders. Subsamples of patients were administered different posttraumatic stress disorder scales, the Impact of Events Scale-Revised, the Posttraumatic Stress Diagnostic Scale, and the PTSD scale of the Millon Clinical Multiaxial Inventory-III, as well as a measure of child abuse and neglect, the Childhood Trauma Questionnaire. In this severely traumatized group, every scale of the Brief Symptom Inventory was significantly more elevated than the inpatient female norms, with the five most highly elevated scales being Depression, Obsessive-Compulsive, Anxiety, Interpersonal Sensitivity, and Psychoticism. Different indicators of trauma (Childhood Trauma Questionnaire, PTSD scales, and PTSD diagnosis) show different patterns of relationships with the individual scales of the Brief Symptom Inventory. There is no simple relationship between trauma and BSI symptoms, but clinicians should consider severe interpersonal trauma to be one pathway to pervasively elevated profiles of the Brief Symptom Inventory.

Complex posttraumatic stress disorder in women from a psychometric perspective

Herman's (1992a) formulation of complex PTSD was not incorporated into the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994), but finds ample confirmation in personality assessment of women in inpatient treatment for trauma-related disorders. This study relates MCMI-III and Adult Attachment Scale scores to a self-report measure of childhood abuse and neglect, the Childhood Trauma Questionnaire. Consistent with Herman's formulation, the data reveal a wide array of symptoms coupled with two facets of relationship disturbance: (a) enmeshment in ambivalence (depressive, dependent, and self-defeating personality as well as ambivalent attachment), and (b) more profound isolation (avoidant and schizoid personality coupled with profoundly insecure attachment). We present a model for using such psychometric findings in patient education and diagnostic evaluations.

Dissociative detachment relates to psychotic symptoms and personality decompensation

Previous studies have addressed the prominence of psychotic symptoms in conjunction with multiple personality disorder (now dissociative identity disorder). The present study examines the relation between psychotic symptoms and a more pervasive form of dissociative disturbance, namely dissociative detachment. Two hundred sixty-six women in inpatient treatment for severe trauma-related disorders completed the Dissociative Experiences Scale (DES), and 102 of these patients also completed the Millon Clinical Multiaxial Inventory (MCMI-III). A factor analysis of the DES yielded two dimensions of dissociative detachment: detachment from one's own actions and detachment from the self and the environment. Each of these DES dimensions relates strongly to the thought disorder and schizotypal personality disorder scales of the MCMI-III. We propose that severe dissociative detachment, by virtue of loosening the moorings in inner and outer reality, is conducive to psychotic symptoms and personality decompensation.

Patterns of utilization of medical care and perceptions of the relationship between doctor and patient with chronic illness including chronic fatigue syndrome

To what extent do personal constructs affect the relationship between doctor and patient when the ill patient does not readily recover with treatment? Questionnaires were returned anonymously by 609 patients with a self-reported diagnosis of chronic fatigue syndrome, who were considered chronically ill. Findings were compared with those of an earlier study of a population of 397 general medical patients. The chronically ill patients lost an average of 65 days of work per year due to illness compared to general medical patients who missed six or fewer days per year because they were ill. The chronically ill patients also reported a 66% higher frequency of iatrogenic illness, spent more money on health care, took more medication, saw more specialists, and were more litigious than the general medical population. Research suggested several patterns of relationships between doctors and patients, and attitudes to health and illness, which may alert doctors to patients' perceptions, beliefs, encoded constructs, and patterns of relating that affect responses to treatment. More attention by doctors to patients who are experiencing the stress of chronic illness is indicated.

Tailoring the psychotherapy to the borderline patient

Views still differ as to the optimal psychodynamic treatment of borderline patients. Recommendations range from psychoanalysis and exploratory psychotherapy to an explicitly supportive treatment aimed at strengthening adaptive defenses. The authors contend that no single approach is appropriate for all patients in this wide-ranging diagnostic category, which spans a continuum from close-to-neurotic to close-to-psychotic levels of functioning. Careful differentiations based on developmental considerations, ego structures, and relationship patterns provide the basis for the optimal treatment approach.

Dissociation and vulnerability to psychotic experience. The Dissociative Experiences Scale and the MMPI-2

Prior research on the MMPI has cautioned against misdiagnosing schizophrenia in patients with dissociative identity disorder. The present study examined the full spectrum of the dissociative experience in relation to MMPI-2 profiles. Ninety-eight women in treatment for trauma-related disorders completed the Dissociative Experiences Scale and the MMPI-2 in routine inpatient diagnostic evaluations. Consistent with prior research, severe dissociation was associated with high elevations on MMPI-2 scales typically associated with psychotic symptoms. Contrary to hypotheses, the ostensibly most benign form of dissociation, absorption and imaginative involvement, was somewhat more strongly related to MMPI-2 scores than the more pathognomonic forms of dissociation, depersonalization and amnesia. Although it should not be misdiagnosed, severe impairment on the MMPI in conjunction with dissociation should be taken seriously as suggesting vulnerability to psychotic experience. The dissociative retreat from the stressors of outer reality opens the door to the inner world of traumatic images and affects, along with compromised reality testing and disorganized thinking.

Some interpersonal and attitudinal factors characterizing patients satisfied with medical care

This research investigated the extent to which interpersonal and attitudinal factors affect the doctor-patient relationship. A questionnaire survey of people living in northeastern Kansas who had experience with medical care was conducted. Dependent measures were over-all patient satisfaction, patient's attitude toward death of self or others, causality orientation, attitude toward health and disease, and perception of the doctor-patient relationship. The majority of test subjects (92%) reported satisfaction with their medical care. A significant correlation between fear of death of significant others and scores on causality scales reflects feelings of not being in control of one's life. Other associations indicate that people who do not feel in control of their lives depend on traditional and folk remedies. Scores showing low fear of own death correlated significantly with the rated greater sense of responsibility for own health and treatment. Patients who rated themselves as more needy were unsatisfied with their care and those whose doctors called them by first name tended to be more content. Even in populations satisfied with their medical care, we suggest that the quality of care could be improved by attention to interpersonal and attitudinal factors.

Age and sex modulate effects of stress on the immune system: a multivariate analysis

Multivariate analyses indicate that both age and sex can modulate examination stress effects on immune factors. Stress lowered eosinophil counts in females but raised them in males. Age modulated stress effects on CD4 and CD8 cells, hemoglobin, and erythrocytes. CD4 decreased more in older subjects; CD8 increased in older and decreased in younger subjects; hemoglobin decreased in younger but not older subjects; erythrocytes increased in older and decreased in younger subjects. Initial age and/or sex differences in levels of neutrophils and lymphocytes were not statistically altered by stress. Stress effects not modulated by age or sex increased serum IgA and IgM, CD19, and stimulated phagocytic activity but decreased serum IgG, CD3, basophils, and unstimulated phagocytic activity. The immunological effects of stress are multiple and are influenced by variations in age and sex of the person.

Transference interpretation in the psychotherapy of borderline patients: a high-risk, high-gain phenomenon

The effectiveness of transference interpretation in the psychodynamic psychotherapy of patients with borderline personality disorder has been highly controversial. Both highly expressive approaches that stress the value of transference interpretation and supportive strategies that eschew transference work have been advocated in the literature. We review this literature and identify three emerging trends in thought: (1) Primarily interpretive approaches should be reserved for patients with greater levels of ego strength. (2) Whichever technique is used, a strong therapeutic alliance is the foundation of treatment. (3) Expressive and supportive techniques should not be juxtaposed as polarized opposites; supportive interventions often pave the way for transference interpretation. Our psychotherapy process study revealed that transference interpretations tended to have greater impact--both positive and negative--than other interventions made with patients with borderline personality disorder. We conclude that such factors as neuropsychologically based cognitive dysfunction, a history of early trauma, patterns of object relations involving interpersonal distance, masochistic tendencies, and anaclitic rather than introjective psychopathology are among the patient characteristics that influence the impact of transference interpretation on the therapeutic alliance. Bias toward expressive technique and countertransference issues appear to be relevant to the therapist's difficulty in shifting to a more supportive approach when indicated.

Child abuse and treatment difficulty in inpatient treatment of children and adolescents

This study examined the associations between abuse and staff perceived treatment difficulty in sixty-nine hospitalized children and adolescents. Subjects were rated on a treatment difficulty scale, and clinical charts were reviewed for evidence of physical abuse, sexual abuse, abuse between parents, and parental history of abuse. Subjects with histories of abuse were not rated as more difficult or less responsive to treatment than other patients. Physically abused youngsters were rated as more self-destructive and more accessible to treatment than non-abused children, while sexually abused youngsters were self-destructive and demanding, and their families were seen as more distant and unavailable.

Comorbidity in an inpatient eating disordered population: clinical characteristics and treatment implications

Data are presented that describe the clinical characteristics of 96 patients treated at the C.F. Menninger Memorial Hospital, Topeka, Kansas, from November 1983 to June 1989. Their Axis I eating disorder diagnoses were as follows: 53 had diagnoses of bulimia; 21 had anorexia nervosa; 2 had both diagnoses; 17 had atypical disorders or eating disorders not otherwise specified; and 2 had a diagnosis of psychological factors affecting physical conditions. Seventy-three percent of the cohort were found to have either Axis I or Axis II disorders or both, comorbidity. Borderline personality disorder was found in 46% of the sample, although 20% of the patients with borderline disorders were diagnosed retrospectively. Depression was the largest comorbid Axis I diagnosis. Patient variables for sexual abuse, drug and alcohol addiction, purgative behaviors, and interpersonal relationships are also described. The authors conclude that a substantial subpopulation of eating disordered patients are significantly comorbid for other psychiatric illnesses. This high incidence of comorbidity may help explain the frequency of refractoriness of many eating disordered patients who do not respond to outpatient or short-term inpatient hospitalization. The authors recommend that additional research studies address the problems of the comorbid eating disordered patient and suggest that the findings be taken into account by clinicians and payers.

The effect of attention/information processing impairment of tardive dyskinesia and neuroleptics in chronic schizophrenics

In this article we report the results of a test of the hypothesis that a form of attention/information processing dysfunction, attentional set impairment, is exacerbated by facial-oral tardive dyskinesia in schizophrenics. This hypothesis was tested in the context of a study that was aimed at determining whether the Reaction Time Crossover Effect, a well-established form of attentional set impairment in schizophrenia, was "affected" by neuroleptic treatment. Our results indicate that the crossover effect is resistant to modification by neuroleptics, but that it is exacerbated by facial-oral tardive dyskinesia. We speculate that neurophysiological mechanisms underlying tardive dyskinesia interact with or are similar to those underlying attentional set impairment.

Assessing need for extended psychiatric hospitalization

The authors developed a set of rating scales to assess a wide range of variables believed by clinicians to influence the optimal length of hospital stay. They report the results of interrater reliability studies, a factor analysis of the scales, and a correlational study of the factors with actual length of stay. They describe the potential applications of the scales to clinical practice and research.

Alterations in EEG amplitude, personality factors, and brain electrical mapping after alpha-theta brainwave training: a controlled case study of an alcoholic in recovery

A controlled case study was conducted of effects of EEG alpha and theta brainwave training with a recovering alcoholic patient who experienced craving and fear of relapse after 18 months of abstinence. Training consisted of six sessions of thermal biofeedback to increase central nervous system (CNS) relaxation. Effects were documented with pretreatment and post-treatment personality testing, 20-channel digitized EEG evaluations both under relaxed conditions and under stress, minute-by-minute physiologic recordings of autonomic and EEG data during each training session, blood pressure, and heart rate indications taken both during relaxation and under stress, and by clinical observation. Results replicated those of a previous controlled study with chronic alcoholic patients not abstinent prior to treatment. New findings include post-treatment indications of more relaxed CNS functioning under stress, and of reduced autonomic activation both during relaxation and under stress. Brain-mapping indications of anxiety associated with painful cold-pressor stimulation were seen only in the pretest readings; at post-test the brain map indicated pain-associated EEG activity in the contralateral somatosensory area, but no apparent anxiety-associated EEG activity. At 4 months post-treatment the patient's wife and colleagues report the patient appears to function in a more relaxed way under the impact of stress, and he reports no longer experiencing craving for alcohol. Overall, support is provided for the possibility that alpha and theta brainwave training may be a useful intervention for the abstinent alcoholic experiencing stress-related craving and fear of relapse.

Air oxidation of hydrazine. 1. Reaction kinetics on natural kaolinites, halloysites, and model substituent layers with varying iron and titanium oxide and O- center contents

Air oxidation of hydrazine was studied by using a group of kaolinites, halloysites, and substituent oxides as models for the tetrahedral and octahedral sheets. The rate was found to be linear with oxygen. The stoichiometry showed that oxygen was the primary oxidant and that dinitrogen was the only important nitrogen-containing product. The rates on kaolinites were strongly inhibited by water. Those on three-dimensional silica and gibbsite appeared not to be. That on a supposedly layered silica formed from a natural kaolinite by acid leaching showed transitional behavior--slowed relative to that expected from a second-order reaction relative to that on the gibbsite and silica but faster than those on the kaolinites. The most striking result of the reaction was the marked increase in the rate of reaction of a constant amount of hydrazine as the amount of clay was increased. The increase was apparent (in spite of the water inhibition at high conversions) over a 2 order of magnitude variation of the clay weight. The weight dependence was taken to indicate that the role of the clay is very important, that the number of reactive centers is very small, or that they may be deactivated over the course of the reaction. In contrast to the strong dependence on overall amount of clay, the variation of amounts of putative oxidizing centers, such as structural Fe(III), admixed TiO2 or Fe2O3, or O- centers, did not result in alteration of the rate commensurate with the degree of variation of the entity in question. Surface iron does play some role, however, as samples that were pretreated with a reducing agent were less active as catalysts than the parent material. These results were taken to indicate either that the various centers interact to such a degree that they cannot be considered independently or that the reaction might proceed by way of surface complexation, rather than single electron transfers.

Do clinicians agree about who needs extended psychiatric hospitalization?

This report examines the level of agreement among 194 staff members of The Menninger Clinic and Harding Hospital about the optimal length of stay for 71 types of patients selected on the basis of hypothesized suitability for various lengths of hospitalization. There were differences of opinion associated with hospital affiliation and professional discipline, but there was sufficient consensus to enable the development of comprehensive criteria for predicting required length of hospitalization. The validity of these criteria will be tested in a future treatment outcome study.

Outcome at discharge for patients in an ongoing follow-up study of hospital treatment

Methodological and practical difficulties have limited the growth of knowledge about outcome of psychiatric hospital treatment. The authors report on outcome at hospital discharge for 103 long-term and 93 short-term patients treated at the C. F. Menninger Memorial Hospital, part of an ongoing follow-up study of hospital treatment. Discharge outcome is based mainly on ratings of symptoms, global functioning, and therapeutic alliance as well as on patients' reports of satisfaction. At discharge both long- and short-term patients were found to have low levels of symptoms (based on the Brief Psychiatric Rating Scale) and a relatively adequate level of functioning (in the 51-to-60 range on the Global Assessment Scale) and to have been highly satisfied with treatment.

Fine needle aspiration cytology of talc granulomatosis in a peripheral lymph node in a case of suspected intravenous drug abuse

A fine needle aspiration (FNA) specimen of an epitrochlear lymph node from a 22-year-old suspected intravenous drug abuser was submitted for cytologic examination, which revealed numerous granulomatous tissue fragments, histiocytes, lymphocytes and giant cells. Polarizing microscopy revealed strongly birefringent material of varying shapes and sizes, including anisotropic crystals with the Maltese cross configuration characteristic of starch. A cytologic diagnosis of talc granulomatosis in the lymph node was made. This case emphasizes the value of FNA biopsy in the differentiation of inflammatory versus neoplastic processes; this appears to be the first case of peripheral talc granulomatosis diagnosed by FNA biopsy.

Skin-conductance orienting response in chronic schizophrenics: the role of neuroleptics

The primary aim of this study was to determine whether there is an association between neuroleptic treatment and skin-conductance orienting response (SCOR) nonresponding in chronic schizophrenics. In a design adapted to this purpose, we were unable to demonstrate a relationship between neuroleptics and nonresponding. Although inability to prove the null hypothesis precludes a claim that neuroleptic treatment and SCOR nonresponding are unrelated, internal evidence and prior studies strongly suggest that such a dissociation exists in most chronic schizophrenic nonresponders. We also found stable nonspecific and toxic skin conductance activity differences between SCOR "responders" and "nonresponders" on three occasions of testing. We interpret our results as bearing on state and trait issues in chronic schizophrenics.

An analysis of home practice patterns for non-drug headache treatments

Regular home practice of non-drug training techniques is assumed essential for improved headache control. In numerous research studies on non-drug treatment efficacy, subjects have been routinely required to practice daily self-regulation techniques. This paper examines the relationship between amount of home practice and treatment outcome, and the extent to which subjects adhere to training requirements. A total of 42 subjects completed daily home practice records for 32 weeks. Fourteen subjects had randomly been assigned to an autogenic phases group, 17 to an electromyographic biofeedback group, and 11 to a thermal training group. All subjects charted frequency of practice, change of feeling in the target area, time required to bring about the change, and general body relaxation. Relationships between subject compliance and 11 selected variables including demographics, headache activity components, treatment group, and treatment outcome were evaluated. Results support home practice, but place greater emphasis on its quality rather than its quantity.

Rorschach correlates of treatment difficulty in a long-term psychiatric hospital

There are no studies of the use of the Rorschach test to predict possible treatment difficulties with hospitalized psychiatric patients. To explore this area, the authors assessed the Rorschach protocols of 114 patients using 19 example-anchored rating scales. They conducted a factor analysis of the scales and correlated the resulting factor scores with the extent and type of treatment difficulty. Although there were few significant findings, the Rorschach factors of Dysphoric Affect, Mirroring, and Depreciation may warrant further investigation of their predictive value for treatment difficulty. Rorschach measures of severity of psychological disturbance, inability to represent aggression in ideation, and depreciation may help treaters anticipate types of treatment difficulty.

Skin-conductance orienting response in chronic schizophrenics: The role of neuroleptics

The primary aim of this study was to determine whether there is an association between neuroleptic treatment and skin-conductance orienting response (SCOR) nonresponding in chronic schizophrenics. In a design adapted to this purpose, we were unable to demonstrate a relationship between neuroleptics and nonresponding. Although inability to prove the null hypothesis precludes a claim that neuroleptic treatment and SCOR nonresponding are unrelated, internal evidence and prior studies strongly suggest that such a dissociation exists in most chronic schizophrenic nonresponders. We also found stable nonspecific and toxic skin conductance activity differences between SCOR "responders" and "nonresponders" on three occasions of testing. We interpret our results as bearing on state and trait issues in chronic schizophrenics.

Indications for extended psychiatric hospitalization: a study of clinical opinion

The authors previously developed a conceptual model of factors bearing on length of stay from clinicians' vignettes describing patients considered ideal candidates for various lengths of stay. The previous study was conducted at The Menninger Clinic, the present study at Harding Hospital. The two hospitals provide a worthwhile contrast because Menninger specializes in long-term (LT) stays (averaging 1 year) and Harding in intermediate-term (IT) stays (averaging 2 to 3 months). The Harding findings generally replicated and complemented the Menninger results, and the authors used the combined data to generate a hypothesized set of general indications for various lengths of stay in these private psychiatric hospitals.

The effect of neuroleptics and tardive dyskinesia on smooth-pursuit eye movement in chronic schizophrenics

We sought to determine whether such state-related factors as neuroleptic treatment and facio-oral tardive dyskinesia (TD) influence smooth-pursuit eye movement (SPEM) in chronic schizophrenics. The design involved 100 schizophrenics, 64 of whom showed "abnormal" eye tracking. Experimentally drug-withdrawn patients, some of whom were clinically relapsed, were compared with control patients who continued taking medication in prewithdrawal and postwithdrawal SPEM tests. All groups showed a slight worsening in eye-tracking performance on two postwithdrawal tests, but significant group-by-test session "interactions" were not demonstrable. We also determined that patients with TD tend to substitute large, nontracking saccades for SPEM to a significantly greater extent than nondyskinetic patients. Our findings strengthen the supposition that impaired SPEM is a trait in many schizophrenics but suggest that patients with TD be excluded in future studies of SPEM addressed to trait issues.

Scales to assess the emphasis of psychiatric hospital treatment

There are few studies of psychiatric hospital treatment that include measures of the treatment process. Perhaps the greatest neglect exists in the failure to collect from the clinicians their observations about the treatment interventions they most emphasize in each patient's treatment. The purpose of this paper is to report the development of a set of rating scales that call on hospital clinical staff to assess the relative prominence of various forms of interventions, namely, degree of restriction, vocational and avocational activities, therapeutic and community groups, medication, degree of supportive versus expressive emphasis and individual psychotherapy. We present a study of interrater reliability in a variety of hospital settings and results of a factor analysis of a portion of the scales.

Assessment of therapeutic alliances in the psychiatric hospital milieu

The authors developed scales to assess long-term hospital patients' collaboration in milieu treatment and their working relationships with various staff members. A factor analysis of patients' ratings of their collaboration in several areas of treatment yielded three dimensions: Goal Orientation, Involvement, and Use of Structure. While each dimension of collaboration correlated positively with working relationships and progress, Goal Orientation was the most substantial contributor. Patients' and staff members' perceptions of their working relationships corresponded to a statistically significant-but modest-degree. Only nurses' ratings of progress related significantly to patients' ratings. The authors highlight divergent perceptions of the treatment process, and advocate that different perspectives be openly discussed and clarified in the service of improved collaboration.

The effect of therapist interventions on the therapeutic alliance with borderline patients

The authors draw attention to the problems of establishing and maintaining a therapeutic alliance in the psychotherapy of the borderline patient. They elaborate an extensive methodology designed to study the manner in which shifts in collaboration occur in response to therapist interventions. This report demonstrates how one particular borderline patient increased his ability to collaborate with the therapist in response to a transference focus in the psychotherapy. Methodological problems are noted as are directions for future research. Only a series of patients studied with this or with similar methodology will allow for a sophisticated and empirical rationale for choosing a particular form of psychotherapy for a particular kind of borderline patient.

Predictors of response of antisocial patients to hospital treatment

Although clinicians generally agree that patients with antisocial personality disorder should not be treated on general psychiatry units, little is known about the response to hospital treatment of personality disorder patients who have antisocial features or traits. In a study to identify predictors of positive and negative response to hospitalization, charts of all patients discharged from a private hospital with diagnoses of antisocial personality disorder or antisocial features over 52 months were reviewed. As a group the 33 patients did not respond well to treatment, and 70 percent left treatment prematurely. Significant predictors of negative response were histories of felony arrest and conviction; a history of repeated lying, aliases, and conning; and an unresolved legal situation at admission. Positive response was related to the presence of anxiety and an axis I diagnosis of depression. The authors believe that antisocial personality disorder is often underdiagnosed and that countertransference can present a significant obstacle to treatment of antisocial patients.