Standardization of the State Board Test Pool Examinations.


Health education or health information: improving our health education talk.


The professional nursing journal in Nigeria: a decade's experience.


Nigerian nursing care and milieu therapy.


Thirty years of computing history.

Thirty years of computing history.


Getting our act together.

Getting our act together.


Changing roles of nurses at birth.

Changing roles of nurses at birth.


Hospice.

Hospice.


The future of nursing.

The future of nursing.


A family nurse practitioner in a rural setting.


Project GAIN: a preventive health program for the elderly at risk of nursing home placement.


A stroke nurse program.

A stroke nurse program.


The expanding role of the nursing service administrator.


Organizational structural changes.

Organizational structural changes.


Labor contracts and negotiations.

Labor contracts and negotiations.


Detection of emotional and behavioural disorders in children.


The nurses' role as a child carer and health educator.


Welfare services for children in Singapore.


The International Year of the Child and the nurses.


Continuation of the Review of the expanded programme on immunization as published in January-March issue.


Prevention of disease in childhood.

Prevention of disease in childhood.


The second national family planning and population survey in Singapore 1977. A survey was conducted to assess current knowledge, attitude and practice pertaining to family planning and population issues and to gauge changes in these respects since 1973 when the 1st National Survey on Family Planning in Singapore was conducted.  Field operations included 3 phases: updating of addresses; preliminary interviewing to identify and collect information on basic characteristics of women eligible for the main survey; and comprehensive interviewing of the selected women in their homes.  2467 women were successfully interviewed.  The rise in the mean age at 1st marriage from 21.6 years among married women of reproductive age in 1973 to 22.1 years among a similar group of women in 1977 was indicative of a slight move towards later marriages.  The mean number of children declined from 3.4 in 1973 to 2.8 in 1977; the mean number of children considered ideal for a married couple in Singapore fell from 3.1 to 2.7 over the same period.  Awareness of the oral contraceptive and female sterilization rose from its high levels in 1973 to almost universal levels in 1977; awareness of the condom, IUD and male sterilization increased from 81% to 88%, 51% to 62% and 50% to 75% respectively.  Contraceptive practice increased from 60% of respondents in 1973 to 71% in 1977.  The ever-users increased from 77% to 86% over the same period.  Awareness of the government policy advocating a 2-child family increased from 75% in 1973 to 93% in 1977.


Smoking and lung cancer.

Smoking and lung cancer.


Rehabilitation of stroke patients.

Rehabilitation of stroke patients.


Speech to conclude Seminar Workshop on the nursing process in family health care.


Continuing education in nursing.

Continuing education in nursing.


A decade of private nursing service to the community.


Senior citizens: their dignity and worth.


Respecting your elders.

Respecting your elders.


Management of the terminally ill patient.


Education for the change in role of nurses in India.


Grief and its manifestation as a psychosomatic disease--hypertension.


Research orientation in nursing-XIII. You mean I am going to analyze data--Part II (analysis of data).


Inaugural address of Mr. Rabi Ray Union Minister of Health & Family Welfare at the Golden Jubilee Conference of the SNA. Oct., 1979 at Panaji, Goa.


Presidential Address. Social changes and student nurses.


Notes on the contribution of nursing to health care.


Social welfare and legislation for the children in India during IYC 1979.


Primary care. Symposium on cerebrovascular disorders. Foreward.


The effect of organizational and group characteristics of faculty's perception of climate in schools of nursing.


The differential diagnosis of stroke.

The differential diagnosis of stroke. Size, shape, location and etiology must all be considered in the differential diagnosis of stroke. A logical sequence of steps will be helpful in the evaluation of individual patients.


Disease of the carotid system.

Disease of the carotid system. Tremendous progress has been made in the investigation of occlusive disease of the internal carotid artery. With the advent of technologic advances such as CT scanning and more highly skilled personnel for the safe performance of cerebral angiography, diagnostic capabilities have been heightened. Carotid endarterectomy and surgical shunts have expanded the surgical armamentarium. Medical treatments have also proliferated.


Sources of stress in university nursing students.


Cardiac embolic cerebrovascular disease. Cerebral emoli may originate in the heart, the carotid arterial system, or the aortic arch. If the source of the embolus can be located, medical or surgical therapy may be able to prevent the occurrence of further strokes.


Subarachnoid hemorrhage.

Subarachnoid hemorrhage. Spontaneous subarachnoid hemorrhage is most frequently caused by rupture of an aneurysm or arteriovenous malformation. Early clinical diagnosis is important to avert fatal hemorrhage. Surgical treatment should be carried out in patients in good neurologic condition.


Treatment of intracranial hemorrhage.

Treatment of intracranial hemorrhage. The acute cerebellar hematoma and the subdural hematoma resent urgent surgical problems and treatment early in the clinical course should result in an excellent outcome. The subdural hematoma may be especially difficult to diagnose early, but may be suspected in patients on anticoagulant therapy or with shunze, and surgery, especially in the acute stage, should be avoided if possible. The CT scan supplemented when necessary by angiography is the diagnostic procedure of choice and will clearly demonstrate the lesions.


Language dysfunction in cerebrovascular disease. Language disorder is often mistaken for confusion, psychosis, or memory loss, and thorough evaluation may require much time. A simple beside examination can often separate aphasic syndromes, and the anatomic location of the lesion can be inferred. Speech therapy, although not entirely satisfactory, is helpful in most patients.


Chronic vascular dementia.

Chronic vascular dementia. Vascular disease is responsible for only a minority of cases of chronic dementia. Vascular dementia can be an end stage of a variety of mechansisms. Correct identification of the cause of the vascular disease is the key to successful treatment.


Formidable: that's the only word for the external fixation device--and for the care it demands.


What to watch for when you give loop diuretics.


ECGs made easier than ever: fast rhythms and early beats.


Breastfeeding works for cesareans, too.

Breastfeeding works for cesareans, too.


Amyotrophic lateral sclerosis. Helping the patient with Lou Gehrig's disease.


How nursing diagnosis helps focus your care. Beyond endocarditis.


Experiences in clinical problem solving. Nursing decisions: quick! What's your first move when a patient chokes?


We've been put down long enough!

We've been put down long enough!


Malpractice is the least of your worries!


The sexually harassed patient.

The sexually harassed patient.


Sex Q & A: frank answers to your most delicate patient-counseling questions.


Warning: don't jump to conclusions when a patient's in shock.


What to watch for when you give cephalosporin.


RN's assertiveness workbook. How to take your assertiveness home.


How nurses rate nursing's shopworn image: how it hurts you... how it helps.


Must nursing squeeze out the rest of your life?


How nursing diagnosis helps focus your care.


A gift of life.

A gift of life.


A frightening new malpractice ruling.

A frightening new malpractice ruling.


Reflections on being in nursing for twenty years.


Presidential address: "Let us face the future with confidence".


Attitudes to death and dying.

Attitudes to death and dying.


The nursing profession and the Medical Council of Rhodesia.


The nurse practitioner's role in the next twenty-five years.


Temperature dependent activation of the alternate complement pathway by an IgG cryoglobulin. A patient with chronic membranoproliferative glomerulonephritis is presented whose serum contains a monoclonal IgG3 cryoglobulin. The presence of persistent hypocomplementemia suggested the possibility that the cryoglobulin, upon cold-induced precipitation, was capable of activating the complement system. Because visible cryoprecipitation commenced in vitro at 30 degrees C, the patient's serum and normal serum had been added the isolated cryoglobulin were repeatedly cooled to 30 degrees C and rewarmed to 37 degrees C. This reproduction of the in vivo counterpart of blood circulating through an extremity exposed to the cold resulted in activation of C3-proactivator (properdin factor B), C3 cleavage, and a 78% reduction in total hemolytic complement. This study demonstrates that IgG is capable of activating complement via the alternate pathway and reveals a mechanism through which this can occur in vivo; namely, by means of temperature dependent polymerization. In addition, we postulate that episodic complement activation initiated by the cryoglobulin contributed to the development of glomerulonephritis in this patient.


Limited proteolysis of complement components C2 and factor B. Structural analogy and limited sequence homology. A method is described for the simultaneous purification of milligram quantities of complement components C2 and Factor B. Both products are homogeneous by the criteria of polyacrylamide-gel electrophoresis and N-terminal sequence analysis. Component C2 is cleaved by serine proteinase C1s at an X-Lys bond to give fragment C2a (approx. mol.wt. 74000) and fragment C2b (approx. mol.wt. 34000). The two fragments can be separated by gel filtration without the need for reducing or denaturing agents. Fragment C2b represents the N-terminal end of the molecule. Similar results were seen on cleavage of Factor B by Factor D in the presence of component C3. Again two non-covalently linked fragments are formed. The smaller, fragment Ba (approx. mol.wt. 36,000),) has threonine as the N-terminal residue, as does Factor B; the larger, fragment Bb (approx. mol. wt. 58000), has lysine as the N-terminal residue. A similar cleavage pattern is obtained on limited proteolysis of Factor B by trypsin, suggesting an Arg-Lys-or Lys-Lys bond at the point of cleavage. Although component C2 and Factor B show no apparent N-terminal sequence homology, a limited degree of sequence homology is seen around the sites of proteolytic cleavage.


Kinin-inactivating enzyme from the mushroom Tricholoma conglobatum. IV. Its effects on the kallikrein-kinin system.


Low urinary kallikrein excretion and elevated blood pressure normalized by orally kallikrein in essential hypertension. 1. Urinary kallikrein was measured in 67 patients with essential hypertension and 25 normotensive subjects variously on unrestricted and low sodium diet. Also, the effect of orally applied hog pancreatic kallikrein on elevated blood pressure and kallikrein excretion was evaluated. 2. Urinary kallikrein was reduced in a large subgroup of patients with sustained essential hypertension. 3. With salt restriction, urinary kallikrein rose markedly in normotensive subjects and patients with borderline hypertension but not in those with sustained hypertension. 4. Oral kallikrein normalized reduced kallikrein excretion and lowered elevated blood pressure. 5. The rise in urinary kallikrein with oral kallikrein was due to an increased formation of endogenous enzyme. 6. A defective kallikrein-kinin system may be involved in both the low urinary kallikrein excretion and the hypertension.


Mode of insertion of the sucrase-isomaltase complex in the intestinal brush border membrane: implications for the biosynthesis of this stalked intrinsic membrane protein. Unlike other intrinsic plasma membrane proteins the sucrase-isomaltase complex is associated with the intestinal brush border membrane through a highly hydrophobic segment located not far from the N-terminal of one subunit (isomaltase). This observation calls for additions and/or modifications to the generally accepted scheme of biosynthesis of plasma membrane intrinsic proteins.


Absorption of di- and tripeptides by the intestine of the guinea-pig. This paper describes a method of quantifying the amount of smaller peptides in physiological fluids and reports the preliminary results of studying the mesenteric blood of adult guinea-pigs during absorption of a partial hydrolysate of casein. Because of the different roles suggested for plasma and erythrocytes in the inter-organ transport of amino acids, both plasma and whole blood have been studied. Whole blood and plasma samples were deproteinized with sulphosalicylic acid, and amino acids and small peptides separated from residual small amounts of protein on a Sephadex G-25 column. Ion exchange chromatography was then performed before and after acid hydrolysis. The concentration of small peptides in blood seems to be much lower than was previously believed. The adult guinea-pig did not absorb small peptides across the intestine into mesenteric whole blood or plasma in our experiments. However, casein hydrolysates are not necessarily representative of all protein hydrolysates, and further studies are required using different proteins and varying degrees of hydrolysis. The possibility of peptide transfer during development, and in conditions involving mucosal damage, should also be investigated. The present investigation confirms the assumption that predominantly plasma, and not red blood corpuscles, carries amino acids from the gut to the liver. It is worth noting, however, that taurine, aspartic acid, glutamic acid, citrulline and arginine were found in higher concentrations in whole mesenteric blood than in plasma.


Gastrointestinal host defence: importance of gut closure in control of macromolecular transport. An important adaptation of the gastrointestinal tract to the extrauterine environment is its development of a mucosal barrier against the penetration of harmful substances (bacteria, toxins and antigens) present within the intestinal lumen. At birth, the newborn infant must be prepared to deal with bacterial colonization of the gut, with formation of toxic byproducts of bacteria and viruses (enterotoxins and endotoxins) and with the ingestion of antigens (milk proteins). These potentially noxious substances if allowed to penetrate the mucosal epithelial barrier under pathological conditions can cause inflammatory and allergic reactions which may result in gastrointestinal and systemic disease states. To combat the potential danger of invasion across the mucosal barrier the infant must develop an elaborate system of defence mechanisms within the lumen and on the luminal mucosal surface which act to control and maintain the epithelium as an impermeable barrier to uptake of macromolecular antigens. These defences include a unique immunological system adapted to function in the complicated milieu of the intestine as well as other non-immunological processes such as a gastric barrier, intestinal surface secretions, peristaltic movement and natural antibacterial substances (lysozyme, bile salts) which also help to provide maximum protection for the intestinal surface. Unfortunately, during the immediate postpartum period, particularly for premature and small-for-dates infants, this elaborate local defence system is incompletely developed. As a result of the delay in the maturation of the mucosal barrier newborn infants are particularly vulnerable to pathological penetration by harmful intraluminal substances. The consequences of altered defence are susceptibility to infection and the potential for hypersensitivity reactions and for formation of immune complexes. With these reactions comes the potential for developing life-threatening diseases such as necrotizing enterocolitis, sepsis and hepatitis. Fortunately, 'nature' has provided a means for passively protecting the 'vulnerable' newborn against dangers of a deficient intestinal defence system, namely human milk. It is now increasingly apparent that human milk contains not only antibodies and viable leucocytes but many other substances which can interfere with bacterial colonization and prevent antigen penetration.


Development of sucrase activity: effect of maternal hormonal status and fetal programming of jejuno-ileal differences. The first part of the paper deals with the effect of changes in the mother's hormonal status on the development of the small intestine of her offspring. Administration of cortisone or triiodothyronine (T3) to pregnant rats evokes a precocious appearance of sucrase activity in the fetal small intestine. Administered to lactating rats, T3 evokes a precocious increase in sucrase activity in sucklings and leads to increased T3 levels and decreased TSH levels in the mother's milk and in sera of mothers and sucklings. These experiments show that (a) sucrase activity can be induced in the fetal period; (b) changes in the mother's hormonal balance during the fetal and suckling period can influence the development of the small intestine; and (c) levels of thyroid hormones in milk can be altered experimentally. The second part deals with jejuno-ileal gradients in villus size and sucrase activity. Both gradients appear in fetal jejunal and ileal implants developing in adult hosts. Our experiments indicate that (a) the gradients are already 'programmed' during the fetal period; and (b) direct contact with food, and proximity of the jejunum to the flow of digesta from the stomach, are not decisive for expression of the jejuno-ileal gradients, but may play a 'tuning' role.


The influence of gestational age and size on the absorption of D-xylose and D-glucose from the small intestine of the human neonate. D-Xylose absorption (using the one-hour blood levels) and active D-glucose absorption (calculated from changes in transmural electrical potential difference) have been measured after intraduodenal infusion of the appropriate sugar, in groups of neonates who were full-term or preterm, and who were in addition either appropriately sized for gestational age, or growth-retarded in utero. The one-hour D-xylose blood levels were significantly lower in preterm infants, and were even lower in the growth-retarded group. In follow-up studies D-xylose absorption rose in all groups of infants over the first three weeks of postnatal life but there was no sign of 'catch-up' in the results of the growth-retarded infants. In the studies of D-glucose absorption the theoretical kinetic parameters 'apparent P.D.max' (equivalent to Vmax) and 'apparent Km' were calculated. Normal full-term infants had values for both parameters that were approximately two-thirds of published adult values. Malnourished neonates had significantly lower P.D.max and apparent Km, and preterm infants had a lower P.D.max, than the values obtained in those infants who were full-term and appropriately grown.


Perinatal changes in the absorption of trace elements. Fetal demands for many of the essential trace elements change markedly during the terminal stages of development. Susceptibility to deficiency during early postnatal life is influenced by the extent of fetal trace element reserves, by inadequacies in the supply of some elements in maternal milk and by postnatal changes in the efficiency of trace element absorption. The efficiency with which essential and some toxic trace elements are absorbed after birth is a function both of age and of diet. Homeostatic mechanisms for the control of iron absorption are poorly developed in the newborn. There are indications that pinocytotic absorption of iron, copper, lead and cadmium may occur at this stage and account for the high efficiency with which these elements are absorbed from a liquid diet. Evidence of developmental changes in the enterohepatic recirculation of such metals is considered and an account is given of our very inadequate understanding of the processes of trace metal absorption in the weaned animal.


Studies on recently isolated cultures of methicillin-resistant Staphylococcus aureus. Of 19 recently isolated cultures of methicillin-resistant Staphylococcus aureus, 18 showed inducible low-level resistance to minocycline, 15 showed high-level resistance to streptomycin, and 4 showed resistance to low levels of streptomycin. Two cultures produced yellow pigment and may have been derived in vivo by loss of a gene(s) determining orange pigment. Treatment of three cultures with serial exposures to N-methyl-N'-nitro-N-nitrosoguanidine resulted in a widening of phage typing pattern that included all reactions in group I, the great majority in group III, but none in group II. The widening in phage lysis was possibly due to the elimination of defective prophages. Transfer of tetracycline resistance occurred from 12 out of the 19 cultures to a recipient in mixed culture; this transfer required either Ca2+ or Mg2+, was abolished by citrate, and enhanced by high cell density. It was probably mediated by defective bacteriophages. No evidence was obtained for the occurrence of recombination within the methicillin-resistant clone in nature. Eleven methicillin-resistant cultures stored for at least 5 years on agar slopes at 20 degrees C had all lost this resistance at high frequency.


The use of antibiotics in childhood diarrhea. A comparative study was undertaken in Indonesia to assess the effect of antibiotic therapy in the treatment of acute diarrheal disease in infants.  120 children, age 2-60 months, suffering form acute gastroenteritis with varying degrees of dehydration who were treated at the Gadjah Mada University Hospital in Yogyakarta, Indonesia, between August and December 1975, were included in the study.  Approximately 1/2 the group was treated with antibiotics; the other 1/2 was not.  Both groups received oral rehydration therapy.  No significant differences were found between the 2 groups as to duration of the diarrhea and duration of hospitalization.  It is concluded that antibiotics are not generally indicated in cases of acute diarrheal disease.  The only requirements in treatment seems to be maintenance of the fluid electrolyte balance.


Absorption of biological amines of bacterial origin in normal and sick infants. This investigation aims at monitoring the formation of diamines in the gastrointestinal tract of human infants, and thereby also the bacterial colonization of the intestine, by studying the urinary excretion of the heterocyclic amine piperidine during development and in different malabsorptive states. A gas chromatographic assay of the dinitrophenyl derivative of piperidine and a mass spectrometric method of identification were worked out and applied. The piperidine excretion was expressed in units of urinary creatinine concentration. Adult women show a greater variation than men, both inter- and intra-individually. The piperidine excretion is very low and mostly undetectable in the first week of life. There is an increase in weaning, with a significant difference between breast-fed and formula-fed infants at 4--6 months. There is a significant difference between infants suffering from untreated coeliac disease and infants without malabsorption. The findings indicate that piperidine excretion is a sensitive biochemical index of changes in the gastrointestinal flora. The high excretion in coeliac disease suggests that piperidine, which is known to have nicotine-like synaptic activity in the CNS, is one of the hitherto unidentified 'auto-intoxicating' substances arising from the bacterial decomposition of protein suggested by Metchnikoff in 1903.


Morphogenesis of the small intestine during fetal development. During the last five days ('last trimester') of the 22-day gestation period of the rat the mucosa of the small intestine changes from undifferentiated stratified epithelium without villi to a mucosa with villi covered with simple columnar epithelium. During this process many secondary lumina form in the primitive stratified epithelium; these lumina enlarge and eventually fuse with the main intestinal lumen as degenerating superficial epithelial cells are exfoliated and as upward growth of mesenchyme towards the main lumen takes place. Proliferation of intestinal epithelial cells occurs along the entire length of the newly formed villi until one or two days before birth, when proliferating epithelial cells become confined to incompletely formed crypts at the base of the villi. In contrast, differentiation of the small intestinal mucosa in human fetuses begins much earlier in gestation. Villi form at 9 to 10 weeks and crypts are well developed by 12 weeks (first trimester). By 17 weeks, all epithelial cells types seen in intestinal crypts of adults are present. Absorptive cells on villi have a prominent apical tubular system, large meconium-filled lysosomes and abundant glycogen between 10 and 22 weeks' gestation. Whereas there is uptake of the macromolecular marker, ferritin, into the apical tubular system after eight or more minutes of in vitro exposure, there is no evidence of transport of ferritin across the absorptive cells after up to 40 minutes of exposure between 11 and 12 weeks' gestation.


Milk lactose: the amount tolerated in post diarrheal children.


Development of mammalian absorptive processes. General discussion.


What is social pediatrics?

What is social pediatrics?


Composition of breast milk beyond one year. The composition of breast milk from 197 mothers lactating for 12-34 months was investigated seeking correlation of composition with maternal and child nutrition and an estimate of nutritional value to be derived from mother's milk in the 2nd and 3rd years of life.  It was found that although the composition of breast milk is not constant from 1 mother to another or at all periods of lactation or even hourly throughout the day, the mean concentration of protein, fat and lactose in milk from women lactating for more than 1 year was the same as milk composition during the 1st year.  Proximate composition was not influenced by the duration or lactation or the nutritional status of the mother.  Even though the lactating mother is undernourished, she continues to provide high quality milk for her child.  In that no mother in this series was below 70% weight for height, severe malnutrition could not be evaluated.  Among children receiving mother's milk, there is no correlation between proximate composition and the nutritional status of the child.  Calculations to show the nutritional value of breast milk in the 2nd year indicate that it may supply 1/3 of all protein needs.  The presence of only 1 severely malnourished child in this group of children supports a protective nutritional effect of the breast milk.


Cell surface components of intestinal epithelial cells and their relationship to cellular differentiation. The surfaces of the epithelial cells of the rat small intestine were studied by fluorescence microscopy using various fluorescein isothiocyanate-conjugated lectins. Throughout most of the adult intestine changes were detected in the luminal surfaces as the cells differentiate and move from the crypts to the villi. These changes in cell surface material depend upon the region of intestine in which the villi are located. By the end of the second week of postnatal development the cell surface components detected by the lectins used in this study have appeared at all levels of the small intestine. The maturational and regional differences begin to appear during the third week of postnatal development, and the adult pattern of distribution of surface components is established by 30 days after birth. By eight weeks after proximal jejunal-ileal resectioning or transposition of ileal segments to the jejunum, the epithelial cell surfaces of the relocated ileum had acquired the surface properties characteristic of the jejunal cells. However, jejunal segments transposed to the ileum maintained their original cell surface characteristics and influenced the properties of ileal cell surfaces distally adjacent to the transposed segment. The cell surface material detected by the Ricinus communis (RCAI) lectin was extracted from crypt cells of adult rat jejunum and isolated by affinity chromatography. The isolated material was found to contain at least two components, and its distribution in the jejunum was examined by fluorescence microscopy using antibodies prepared against the isolated material.


Training course for village nutrition programs. The aims and objectives of a training course to train the trainers for village nutrition programs in Indonesia are described along with the selection and preparation of participants, course syllabus, and the various field and classroom activities.  Certain aspects of both the program and training course are unique to Indonesia, but the principles of community nutrition and education techniques are applicable to many varied situations.  The training course is aimed at workers who will be training villagers and overseeing the initiation and the operation of the various program activities envisioned.  The assumption is that participants will enter the course with a firm background knowledge of nutrition and some grasp of the precepts of public health.  The participants are divided into groups of 6-7 persons in order to ensure a heterogeneous mix of experience, geography and professional background.  The general course objective was to educate persons designated as trainer for specified districts who will be prepared to train village level volunteers to organize and operate the village nutrition programs.  Course content includes the following:  nutrition; anthropometry; village weighing program; supplementary feeding; nutritional first aid; simple curative health services; home gardening; and organization/management.  The specific objectives for each of the course content areas are outlined.  A precourse reading assignment is sent to each participant 6 weeks prior to the training.  The assignment includes 4 concise pamphlets covering basic nutrition, simple anthropometry, a village weighing guide, and a supplementary feeding program guide.  Accompanying these pamphlets is a detailed examination to be used as a self test by the participant to assure an adequate standard of baseline knowledge on entering the course.  Emphasis during the course is on small group (5-7 members) problem solving activities in the classroom and in the field.  All lectures are illustrated with slides and briefly stenciled outlines that provide all necessary information.  This approach encourages participants to interact more freely with the speaker and to grasp concepts rather than trying to record facts.  A set of detailed written guides to provide clear instructions for action on return home is provided to all participants.  A course schedule is outlined in detail.


A classification system for the orthopedic patient.


Discharge planning.

Discharge planning.


The care and handling of air powered equipment.


Soft tissue injuries of the knee.

Soft tissue injuries of the knee.


Pes anserine bursitis.

Pes anserine bursitis.


The prevention of depression in the immobilized patient.


Spica cast care in the infant with a congenital dislocated hip.


Metacarpophalangeal arthroplasty.

Metacarpophalangeal arthroplasty.


Antibiotic therapy.

Antibiotic therapy.


Initial care of the trauma patient.

Initial care of the trauma patient.


Sharing (metatarsus adductus).

Sharing (metatarsus adductus).


Treatment of congenital clubfoot.

Treatment of congenital clubfoot.


The physical aspects of counseling for persons with congenital or acquired spinal cord injuries.


Nursing care of the patient with Roger Anderson Well Leg traction.


Dealing with a casted Legg-Calvé-Perthes diseases child.


Close wound irrigation in orthopedics.

Close wound irrigation in orthopedics.


The pain clinic concept.

The pain clinic concept.


Marfan's syndrome.

Marfan's syndrome.


Shoulder dislocations.

Shoulder dislocations.


Lower extremity torsional evaluation: examination of the child for in-toe gait and commonly presenting foot abnormalities.


Women hold the key to their liberation.

Women hold the key to their liberation.


Nursing issues and challenges.

Nursing issues and challenges.


Relationship between kallikrein release and factor XII in normal persons and carriers of the Hageman trait. In four healthy subjects with Factor XII levels equal to or below 50% (selected at random from 100 persons) the release of Kallikrein was studied in order to establish the relationship between the above data and those found in four Hageman trait carriers showing levels of Factor XII above the lowest normal limits. It was found that for similar amounts of Hageman activity three of the carriers showed significantly less release of Kallikrein than the control subjects in whom it was normal. The conclusion was reached that the additional determination of the amount of Kallikrein released may be of value in the detection of carriers of the Hageman trait.


Nursing, a real apostolate.

Nursing, a real apostolate.


Justice, power and organization.

Justice, power and organization.


Filipino patient's bill of rights.

Filipino patient's bill of rights.


Accountability: issues and solutions.

Accountability: issues and solutions.


Core curriculum outline: the second draft.


RNI update.

RNI update.


A method of program evaluation in rehabilitation settings.


The kallikrein-kininogens-kinins system in the Brown-Norway rat. The Brown-Norway rat is deficient in plasma kallikrein and kininogens, making it particularly useful in studies on the role of the kinins system in some physiological and physiopathological processes.


A nursing challenge: effective patient education.


The nurse as patient advocate in the rehab setting.


Applying systems theory to a view of the skilled nursing facility.


Rehabilitate the patient with ALS?

Rehabilitate the patient with ALS?


Intact heel decubitus: an innovative treatment with a special cleansing sponge.


Learning & teaching-part of every nurse's business. The field work teacher.


Learning & teaching-part of every nurse's business. Breastfeeding--a problem conquered.


UN/Thai programme for drug abuse control in Thailand-A report on phase I:February 1972-June 1979. The paper describes the principal achievements of the UN/Thai programme for drug abuse control which was carried out during the years 1972-1979. The programme was of a pilot nature and covered five selected key villages and 25 satellite villages in the north of Thailand. The major components of the programme were crop replacement and community development, treatment and rehabilitation, and drug information and education. The Royal Thai Government has accepted the achievements of this project as models for greatly expanded programmes for the eradication of the opium poppy cultivation. Two key villages-Ban Mae Tho and Hui Tund Jaw which were included in a pilot programme have provided to be opium free.


Patterns and prevalence of opium use in rural Punjab (India). A household survey of opium use was carried out in three district of Punjab. Of the 1,400 randomly selected households, 1,276 were covered by the study. All members above the age of 15 years were individually interviewed. The survey included 2,064 men and 1,536 women. The percentage prevalence rate of opium use was 5.76, much higher among men than women. Because of the small number of women involved in opium use (0.5 per cent), the data on socio-demographic variables were analysed only for men. The male opium users were classified as past, experimental, regular and seasonal users, with 3.4, 0.8, 3.6 and 1.8 percentage prevalence rates respectively. The relationships between opium use and variables such as age, occupation, religion, education, marital status and per capita income are discussed as well as their implication on drug abuse control policy.


In vitro antibacterial activity of four aminoglycosides and two semisynthetic penicillins on fresh clinical isolates from cancer patients.


The identification of drugs of abuse in the Republic of Ireland during the years 1968-1978. A survey of the composition of 4,933 exhibits submitted for laboratory analysis by the Drug Squad of the Irish police during the years 1968-1978 indicated an increase in the level of non-medical drug consumption in the Republic of Ireland. Cannabis was the most widely encountered drug. Barbiturates constituted a considerable proportion. Amphetamines were rarely found; this was attributed to the unique legislation controlling the storage and sale of amphetamines. Various substances were sold as drugs of abuse. For example, Datura was sold as cannabis which caused a considerable concern because of its toxicity. The recognition of a drug-related problem of some significance in Ireland during 1968 led to the formation of a drug squad in the Irish police. Since that time a total of 4,933 exhibits arising from arrests and drug seizures have been submitted for laboratory analyses. These exhibits ranged from "normal" pharmaceutical formulations (tablets, ampoules, etc.) to unknown powders and a large number of more unusual items (table 1). The drugs were identified using an appropriate combination of microscopic, chromatographic and spectroscopic techniques (1, 2).


Association of socio-economic factors with drug use among college students in an Indian town. The paper examines the association of various socio-economic factors with the use of drugs by college students in a town in central India. Data were collected from a large sample, using a self-reporting questionnaire. It was found that analgesics, tobacco and alcohol were the most commonly used drugs amongst some 30 per cent of the students. Factors such as age, urbanity, sex, marital status as well as the family's educational and economic status were seen to be relevant. Inter-parental and inter-generational tensions in the family also had a bearing. Drug use by one or more members of the family was seen as a highly significant factor. The data thus suggest that an inclination towards drug taking might be embedded in the social matrix itself.


Approval mechanism for continuing education in nursing.


The container size/volume relationship in particulate contamination.


An approach to GMP training.

An approach to GMP training.


Behavioral effects of strong 60-Hz electric fields in rats. Eight individually housed male Long Evans rats were raised, beginning at age 30 days, for six weeks in an electric field exposure apparatus. During five of the six weeks, the animals were exposed to a 25 kV/m, 60-Hz electric field. A similar population of rats housed in an identical environment, except for the absence of the high voltage field, were used as control animals. Differences between the two groups in body mass, food and water intake, and exploratory activity were studied. Statistical analysis shows the high voltage fields to have no significant effects on the above parameters.


Some interpretations of controversial sub-sections in the Current Good Manufacturing Practice regulations for drug products.


Effects of low level microwave radiation on the digestive transit of the rat. The effects of low level microwave radiation (3-4 mW/cm2--2450 MHz) during 4 and 8 h on the WISTAR Rat digestive transit has been studied. The results showed no effect after 4 h radiation and an acceleration of the digestive transit after 8 h of radiation (p less than .001). The acceleration of the digestive transit was still observed after 24 h (p less than .001). 60-90 s after radiation time the rectal temperature of radiated animals did not differ from the controls.


Response to total dosage and instilled volume of pilocarpine nitrate in experimentally induced hypertensive albino rabbits.


Microwave-evoked brainstem potentials in cats. Rectangular pulse-modulated microwave radiation has been shown to produce auditory responses in mammals. It is therefore reasonable to explore the possibility of using microwave pulses to achieve an estimate of sensori-neural involvement in the objective evaluation of human hearing and to assess the presence of tumors or brainstem lesions in patients with neurological disorders. In this paper we shall show that microwave-evoked auditory response of cats closely resembles that evoked by acoustic pulse. We shall also give preliminary results obtained from electrodes fastened to the vertex of the skull after successive coagulative production of lesions in the inferior colliculus, lateral lemniscus, and superior olivary nucleus.


Linac microwave hazards to cardiac pacemaker wearers.


EtO sterilization residual monitor.

EtO sterilization residual monitor.


Preformulation screening of antioxidant efficiency in parenteral solutions.


SCOT (Sterilization Computer Operating Terminal) for sterilization control and monitor.


Middle-ear structures contribute little to auditory perception of microwaves. The contribution of the ossicles (middle-ear bones) to auditory perception of microwaves was evaluated by the brain-stem evoked response (BER). Amplitude and latency of BERs were recorded from guinea pigs that were stimulated at various intensities by acoustic pulses coupled to the auditory canal or via bone conduction, and by microwave pulses. Blocking of the external ear, middle-ear damping, and middle-ear destruction produced little change in the BERs that were elicited by microwave pulses. Results indicate that activity in the central auditory pathway as induced by pulsed microwaves only requires stimulation of the cochlea. Conduction of pressure waves through the bones of the calvarium appears to be the mechanism responsible in perception of pulsed microwaves.


Miniature anechoic chamber for chronic exposure of small animals to plane-wave microwave fields. A system of miniature anechoic chambers for chronically exposing a sizeable number of animals to microwave radiation was developed in which each animal can be individually exposed to microwaves or sham-exposed under controlled environmental conditions. Each animal is supplied with food and water by means designed to eliminate undesirable perturbations of the field. Field patterns in each chamber correspond closely to those made in large anechoic chambers; measurements indicate that a power density of 169 microW/cm2 per watt of input power can be provided, which results in peak SAR levels of 0.37 W/kg in cadavers of exposed rats.


An invasive microwave antenna for locally-induced hyperthermia for cancer therapy. A microwave system has been developed and characterized for delivering heat directly into tumors. This system employs a microwave power source (3-10W) operating in the 500 MHz to 1.3 GHz frequency range, coaxial transmission line, and a monopole antenna. Absorbed power was measured in saline, in tissue equivalent phantoms, and in tumors in live and dead mice. Antennas were designed to operate at 500 MHz and 1 GHz, and the critical design parameters have been identified for this system. Analytical and experimental results obtained in our laboratory suggest that this system is capable of providing controlled temperature distributions appropriate for hyperthermia in animal tumors. Theoretical results predict that 3 GHz may be an optimum choice for this system in animal tumors of approximately 1 cm diameter; the microwave antenna system provides a heat distribution superior to that obtained using a resistance heater of similar dimensions. We propose that further development of this approach may overcome some of the problems associated with other systems which use external radiation sources, and implications for clinical application of this system are discussed.


Parenteral fundamentals. Dynamics of microbial growth and death in parenteral products.


Physiological and behavioral effects of chronic exposure to 2450-MHz microwaves. Long-Evans male adult rats were exposed for sixteen weeks to 2450-MHz CW microwaves at an average power density of mW/cm2. The resulting dose rate was 1.23 (+/- 0.25SEM) mW/g. The animals were exposed eight hours a day, five days a week, for a total of 640 h in a monopole-above-ground radiation chamber while housed in Plexiglas holding cages. Daily measures of body mass and of food and water intakes indicated no statistically significant effects of microwave irradiation. Biweekly stabilimetric tests immediately after exposure revealed a significant depression of behavioral activity by 15 microwave-exposed rats as compared with 15 sham-exposed animals. Measures of locomotor activity based on revolutions of a running wheel, which were obtained during 12-h periods between each 8-h exposure, showed no significant effect of irradiation. Blood sampled after 2, 6, 10, and 14 weeks of exposure indicated slight alterations of sulfhydryl groups, and of red and white blood-cell counts. Measures of levels of 17-ketosteroids in urine at weeks 1, 5, 9, and 12 of exposure, and mass of adrenals, heart, and liver at the end of the sixteen-week period of exposure, revealed no indications of stress.


Preliminary studies: far-field microwave dosimetric measurements of a full-scale model of man. Measurements of microwave heating were made in a full-size, upright human model. The 75-Kg model, composed of electrically simulated muscle, was placed in the far-zone of a standard-gain horn inside an absorber-lined chamber. Pulsed energy at 1.29 GHz was obtained from a military radar transmitter (AN/TPS-1G) and produced radiation at 6-14 mW/cm2 average power density at the location of the model. Microwave heating at the front surface was measured at nine locations on the phantom. Measurements at several depths within the phantom were also made at a central location to gain information on the depth-of-penetration of the microwave energy. Results of the frontal surface measurements and of the penetration study permitted a calculation of the approximate whole-body average specific absorption rate (SAR) when the model's long axis was parallel to the E-field vector. For a normalized power density of 1 mW/cm2 at a frequency of 1.29 GHz, the whole-body average SAR approximated 0.03 W/Kg. This result agrees well with theoretical predictions based on absorption in prolate spheroidal models of man.


Microwave irradiation and ambient temperature interact to alter rat behavior following overnight exposure. Each of twelve male hooded rats was trained to insert its head into a food cup for food pellets on a random-interval schedule of reinforcement. After performances stabilized, the rats were assorted into 3 groups of 4 animals. Groups were matched for response rates. Animals were exposed in groups of 4 for 15.5 h to CW 2450-MHz microwaves once every 6 nights. Animals of each group were exposed to microwaves at only one power density, either 5, 10, or 15 mW/cm2; they were exposed three times at an ambient temperature of 22 degrees C, then three times at 28 degrees C, and then once more at 22 degrees C. The relative humidity was 50% during all exposures. Rats were sham irradiated (at 0 mW/cm2) the night before each microwave exposure. Behavior was tested daily after termination of microwave irradiation or after sham exposures. None of the exposures to microwaves at 22 degrees C altered rates or durations of responding. Exposures at 28 degrees C reduced response rates and increased response durations in direct relation to the power density. The results are interpreted as the transient debilitation of behavior produced by the interaction of a mild elevation of ambient temperature and microwave irradiation.


Carbon-loaded Teflon electrodes for chronic EEG recordings in microwave research. Conventional metal electrodes can cause serious modification and intensification of the rate of energy absorption in tissues during exposure of animals to microwaves. Carbon-loaded Teflon with a conductivity close to that of tissue has been implanted and maintained for four to six months at cortical and subcortical locations in rabbits. The EEG and its spectrum as recorded from the carbon-loaded Teflon electrodes are comparable to those recorded from conventional metal electrodes. Histological examination showed good tissue compatibility. Recordings made during acute exposure of rabbits to microwave radiation (2450-MHz) at 100 mW/cm2 showed no electromagnetic interference. The results indicate that carbon-loaded Teflon electrodes can be implanted chronically to record the EEG in animals during the course of microwave radiation.


International Year of the Child, United Nations, and Declaration of the Rights of the Child.


WHO/UNICEF meeting on infant and child feeding.


Nurses are sick of being treated like bedpans.


Urinary kallikrein excretion, renal kallikrein content and renal plasma flow in the rat.


Florence Nightingales as casualties in their mission of mercy.


Tripartism--an alternative solution to the improvement of life and work conditions?


The PNA's primary health care project--two years after.


The justness of the nurses' cause.

The justness of the nurses' cause.


The avenging angels of wrath.

The avenging angels of wrath.


Position paper of the Labor Panel.

Position paper of the Labor Panel.


The hospital and the nurse--useless each without the other.


The position of the Philippine Hospital Association.


The effect of music on the pain of selected postoperative patients.


Tripartism - work ahead of us.

Tripartism - work ahead of us.


Opium administration to infants in Peshawar region of Pakistan. Use of opium for sedating infants in the North-West Frontier Province of Pakistan causes a grave public health problem. Among the infants hospitalized for opium overdosage, 22 were studied in detail, and their major clinical picture is presented in this paper. The effect of opium use on the nutritional status of these infants, or the relation of infant opium use to addiction in adult life, have not been assessed. It is, however, pointed out that opium overdosage of infants contributed to infant mortality. Despite emergency treatment, the lethality rate of opium overdosed infants was 40 per cent. It is emphasized that a preventive programme should be undertaken to educate parents who are ignorant of the dangers of opium administration to infants.


Distortions in mothering and fathering.

Distortions in mothering and fathering.


Job satisfiers and dissatisfiers among clinical instructors.


The inquiry method.

The inquiry method.


Covalent attachment of amino acids to casein. 1. Chemical modification and rates of in vitro enzymatic hydrolysis of derivatives.


Prevalence and patterns of drug use among high-school students: a replicated study. A survey of high-school students in Delhi, carried out in 1975, revealed that 34.3 per cent of respondents used psychoactive drugs in the preceding year. The percentage of users of psychoactive substances other than alcohol and tobacco was 15.5 per cent. The percentage prevalence rates by substance ranked as follows: tobacco (35.1), alcohol (26.2), cannabis (12.0), tranquillizers (8.9), amphetamines (5.8), sedatives (4.9) and opium (1.3). The survey was replicated in the same classes of students in 1976. It revealed that the non-response vote was slightly lower, as was also involvement with drugs, though the difference between prevalence rates of drug use in the two years was not statistically significant.


Sociocultural differences between former and current users of psychoactive drugs in a sample of college student. The paper present the results of a study on the underlying sociocultural factors which distinguish "former users" of drugs from "current users" among the college youth. Belonging to a similar social milieu, the two sets showed little difference in many respects. There were, however, features on which the two differed. Those who gave up drug use were mostly from the middle or lower strata of society, and had tolerant but drug abstaining family members. They were mostly junior students pursing "professional courses", and had fewer drug-using friends. Also they did not view drugs with favour. Giving up drug use had been mainly their personal decision, perhaps prompted by the influence of their family members and peer-group and by their own experience with drugs. Thus the former users have been found to differ noticeably from the current users.


Kallikrein excretion in parotid saliva in rats with various forms of arterial hypertension. A technique for continuous and quantitative collection of parotid saliva--including salivary flow rate determination--for in vivo experiments in rats is described. Excretion of kallikrein-like activity in parotid saliva of rats with various forms of arterial hypertension (genuine, renovascular and DOCTMA-salt hypertension) was studied. Kallikrein excretion was measured by its esterolytic activity. The levels of kallikrein-like activity in parotid saliva of normotensive control rats ranged between 2.5--4.0 mU/min during salivary flow stimulation with pilocarpine. In all forms of experimental hypertension salivary excretion of kallikrein-like activity was increased 2--4 fold. This increase was not related to the activity of the renin-angiotensin system.


Brain and mind: Chairman's opening remarks.


Do philosophy and the brain sciences need each other?


Neuropsychological evidence for multiple memory systems. Neuropsychological data provide strong support for the existence of multiple memory systems. The distinction between short-term memory and long-term memory has been discussed in the experimental literature for some years. More recently it has been argued that the concept of long-term memory is misleading in that it fails to differentiate between semantic memory and episodic/event memory. The independent and selective impairment of multiple memory systems, each with its own functional and structural properties, has been recorded in patients with cerebral lesions and the evidence for impairment of such systems is reviewed. It is argued that the cerebral organization of short-term memory, long-term (non-individual) semantic memory and long-term (individual) event memory is highly differentiated.


The tasks of consciousness: how could the brain do them? According to Darwin's theory of evolution by natural selection, the existence of mental operations proves their usefulness. Darwin called himself a mental materialist. This is one scientific theory of consciousness. Human consciousness has three useful aspects: awareness, intentionality and sharing with others. All have simple equivalents in animals. The latter two are neglected in neurophysiology and experimental psychology. Developmental, neuroanatomical and neuropsychological evidence shows that the human brain has innate structures of awareness, intentionality and interpersonal sharing. Human life depends on interpersonal cooperation. We may have a conscious self, but consciousness of others is essential in us. Studies of commissurotomy patients demonstrate the elaborate interconnected neural organization of consciousness and provide evidence of underlying and necessary levels of motivation, perception and motor integration below consciousness. Additionally, they show that awareness may be split into two different modes. These regulate one another during development and are complementary in culturally sophisticated adult life. One hemisphere, usually the left, has responsibility for expressing ideas and purposes in language. The other responds to the phenomenal context and the subjective situation. Both have human experiences and purposes. Both still collaborate in a unified intentional system after commissurotomy. Infant studies reveal that language develops out of an interpersonal mental process. This seems to control development of thinking. Thus notions of the newborn as an isolated amoral id, and of the infant as an egocentric discoverer of the object concept, must be rejected. Cultivation of moral awareness and a sense of purpose guided by meanings and values depends on innate organization of the human brain for interpersonal consciousness.


Neurophysiological mechanisms and consciousness. Consciousness may be understood as a behavioural state and thus levels of consciousness may be distinguished. But consciousness as we understand it is an experience. Any critical reasoning about it will lead to a dualistic formula. A neurophysiological mechanism may exist for this. In the neocortex various aspects of the world and of the physical and social relationships of the individuum to the world are represented through thalamocortical projection systems. There is no unified representation of the world in any single cortical area. All neocortical outputs feed into action systems of the brain. The synthesis of the distributed cortical representations of the world is thus realized through the action elicited by their combination. The action systems of the midbrain-cerebellum and the basal ganglia feed back into neocortical areas (internal loops). The action itself changes the relationship of the individual to the outside world and thus its representation in the brain (external loops). The role of the basal ganglia in the normal functioning of processes in consciousness and in the synthesis of cortical representations is described, which further emphasizes the intricate connections between motor performance and consciousness. The function of the reticular substance and related structures is seen as a gating mechanism for the (thalmic) access gates to the cortex and thus to mechanisms of conscious experience. The basis for the experience of consciousness is the symbolic representation of the world and of the individual to that individual's brain. This self-representation is based on the linguistic competence of the brain in a broad sense and is therefore possible only for brains with such a competence. The symbolic self-representation is called the reflective loop and its conditons are briefly discussed.


Three types of consciousness.

Three types of consciousness. It is useful to distinguish three senses of the word 'consciousness'. 'Minimal' consciousness is the occurrence of any mental activity, whether or not the subject is aware of this activity. 'Perceptual' consciousness is perceptual activity. Minimal and perceptual consciousness may be present, yet 'introspective' consciousness be lacking. Introspective consciousness is conceived as it was by Locke and Kant: as perception-like awareness of the subject's own current mental states and activities. It includes introspective consciousness of introspective consciousness itself. A useful model for demystifying and naturalizing introspective consciousness is the subject's proprioceptive awareness of bodily states and activities. Introspective consciousness may be further subdivided into 'reflex' introspective consciousness and 'introspection proper'. The distinction is one of degree: the degree of attention involved. We attach a quite special importance to introspective consciousness and are particularly unwilling to identify it with a purely physical process in the brain. It is suggested, however, that this springs from (a) the fact that what is introspected is taken to be a state or activity of a single thing, the self; and (b) the fact that event-memory is generally only possible if the event remembered was the object of introspective consciousness at the time. Without introspective consciousness, therefore, awareness of a self and the past history of that self is lacking.


Outcome from severe neurological illness; should it influence medical decisions? Most persons now accept the concept that when brain is dead, self is dead, and are willing to act accordingly. Much more difficult is to decide what to do when illness irreparably deprives the brain of cognitive functions. To facilitate less impassioned discussion of this question, 500 consecutive patients in coma from non-traumatic causes have been studied in the USA and Europe and the outcome has been compared against carefully selected early neurological signs. Medical coma was itself a dangerous sign, with only 15% of patients recovering independence within the first month. Within the first six hours, when most medical decisions are made about applying intensive care, neurological signs predicted with 95% confidence between the extremes of favourable and unfavourable outcomes in as many as a quarter of the patients. Only 5% of patients who failed to regain cognition by the end of one week regained any independence. Other more detailed guidelines were equally informative. If prognostic signs that confidently separate potentially favourable from unfavourable outcomes can be identified in severe neurological illness, perhaps society can more easily help medicine in reaching difficult ethical decisions.


Experimental surgery, and predictions of outcome from severe neurological illness: legal and ethical implications.


Three phases of evil: the relation of injury to pain. It is proposed that injury may be followed by three phases of behaviour in human beings and animals. In the immediate phase, pain may not occur and other activities take precedence. Even when the victims are fully aware of their injury, these other activities may include fighting, escaping and obtaining safety and aid. Once relative safety from the source of injury has been achieved, a new form of behaviour related to allowing recovery begins. This is the acute stage. The need for the initiation of this behaviour is signalled by pain. In the transition stage from injury to the beginning of recovery, anxiety is a cardinal feature. The anxiety is directed at assuring safety from the original damage, at assuring the best conditions for the initiation of treatment and recovery, and at the possible future consequences of the damage. This phase merges with the third period, during which quiet inactivity is the optimal tactic to encourage cure and recovery. This third stage associated with pain and depression may appear prolonged far beyond the necessary period for recovery. It is proposed here that pain is associated with the search for treatment and optimal conditions for recovery.


Pain and the senses.

Pain and the senses. There has been considerable philosophical debate over whether pain is a form of perception. A point of controversy is what pain is perception of; the best answer is neither pain-causing stimuli nor pain sensation but injury or the threat thereof. This answers the argument that pain cannot be perception because its 'objects' are private and exist only when perceived. A more potent argument is that pain is too poorly correlated with injury to count as perception of it. This issue is to be settled, in part, by determining the function of pain. The standard view of pain's function has here been contested and the resolution of the controversy will affect our inclination to ascribe to pain the status of perceptual faculty.


Communication and abnormal behaviour.

Communication and abnormal behaviour. In this paper the similarities between normal and abnormal behaviour are emphasized and selected aspects of communication, normal and aberrant, between persons are explored. Communication in a social system may be verbal or non-verbal: one person's actions cause a response in another person. This response may be cognitive, behavioural or physiological. Communication may be approached through the individual, the social situation or social interaction. Psychoanalysis approaches the individual in terms of the coded communications of psychoneurotic symptoms or psychotic behaviour; the humanist-existential approach is concerned more with emotional expression. Both approaches emphasize the development of individual identity. The interaction between persons and their social background is stressed. Relevant are sociological concepts such as illness behaviour, stigma, labelling, institutionalization and compliance. Two approaches to social interactions are considered: the gamesplaying metaphor, e.g. back pain as a psychosocial manipulation--the 'pain game'; and the 'spiral of reciprocal perspectives' which emphasizes the interactional complexities of social perceptions. Communicatory aspects of psychological treatments are noted: learning a particular metaphor such as 'resolution' of the problem (psychotherapy), learning more 'rewarding' behaviour (learning theory) or learning authenticity or self-actualization (humanist-existential).


Commentary on papers by Tim Crow and Sidney Crown.


Brain and mind: Chairman's closing remarks.


Consciousness and the brain: evolutionary aspects. Self-reflective consciousness is distinguished from 'simple' awareness and from conscious awareness. Awareness is a fundamental property of living matter as it reacts to environmental stimuli. A hypothesis is advanced to account for the general phenomenon of decussation of nerve fibres in the central nervous system of vertebrates. This feature, the crossing over of nerve fibres to the opposite side of the brain, is interpreted as exemplifying the inherent caution of living forms. The evolution of increasing complexity of structure in spinal cord and brain is a prerequisite for increasing awareness of the environment and for increasing freedom from its constraints. Conscious awareness is manifested in living forms primarily when they are learning to respond either to new stimuli or to internal demands such as breathing and walking. The relegation of learnt activities to the realm of unconscious reflex allows for concentration on new and more complex responses, which leads to further freedom of action. The seeming simplicity of human thinking rests on the increasing complexity of the evolving brain and of appropriate responses learnt during phylogenetic development. The human brain and its thinking functions are basically trustworthy because they are rooted in biological evolution.


The mine--body problem in an evolutionary perspective. Charles Darwin realized that his theory of evolution, jointly with the psychoneural identity hypothesis, implies the conjecture that behaviour and ideation evolve alongside anatomical and physiological traits. He was therefore the founder of evolutionary psychology. However, this science has not been pursued with vigour: not even its name has attained currency. In fact most psychologists still think in a pre-evolutionary fashion and seldom ask questions about the adaptive value and possible evolution of behavioural and mental traits. One reason for the underdevelopment of evolutionary psychology is that, on the whole, psychology is still separate from biology. In turn, one reason for this estrangement between close relatives is that psychology is still to some extent in the grip of psychoneural dualism, or the prehistoric belief that mind and body are separate entities. This doctrine is bound to block the advance of evolutionary psychology because a dualist must either deny mental evolution or speculate that it proceeds by some mechanism other than genic variation and natural (and social) selection. On the other hand the psychoneural identity hypothesis fits in with biology and, in particular, with evolutionary biology. Moreover, by construing ideation as a brain process, psychoneural monism explains how ideas (via behaviour) can become a motor of evolution as well as an outcome of it. So, it is in the interest of evolutionary psychologists to pay closer attention to the mind-body problem and to adopt the psychoneural identity hypothesis and turn it into a full-fledged scientific theory.


Language: perspectives from another modality. Human languages have been forged in auditory-vocal channels throughout evolution. This paper examines the formal properties of a communication system that has developed in the absence of speech: the sign language of the deaf. The objective is to investigate to what extent the overall form and organization of language is determined by the articulatory and perceptual modality in which it has developed (its transmission system) and to what extent its form and organization represent more fundamental aspects of the human mind (intellect). Experimental and linguistic evidence is brought to bear on the analysis of the sign: studies of coding and processing of signs in memory; of slips of the hand; of historical change in signs over time; the heightened use of language in poetry and wit. American Sign Language differs dramatically from English and other spoken languages in the mechanisms by which its lexical units are modified. For the form of its morphological processes, the mode in which the language develops appears to make a crucial difference. Finally, the issue of cerebral specialization with respect to a visual-manual language is addressed.


The effects of combined action of beta-lactame and aminoglycoside antibiotics on resistant strains of streptococcus group D. The aim of the paper was to study the effect of benzylpenicillin, cloxacillin and ampicillin in combination with streptomycin, kanamycin and gentamicin on antibiotic-resistant strains of Streptococcus group D. Most frequently the synergistic effect was observed when cloxacillin was combined with streptomycin (76%), cloxacillin with kanamycin (63%) and benzylpenicillin with streptomycin (53%). In some cases the synergistic effect was so pronounced that MIC of two antibiotics used in combination was equal or lower than levels of these antibiotics in patients sera. It is assumed that these combinations may have therapeutic meaning.


Similarities between cysteinesulphinate transaminase and aspartate aminotransferase. A method for the purification of two cysteinesulphinate transaminases, A and B (EC 2.6.1), is described. These enzymes catalyse the conversion of cysteinesulphinic acid to beta-sulphinyl pyruvate. The final preparations are homogeneous by polyacrylamide gel electrophoresis, sodium dodecyl sulphate-polyacrylamide gel electrophoresis and isoelectrofocusing. The molecular weight of the subunits is 41 000 for cysteinesulphinate transaminase A and 43 400 for B. Both enzymes are unspecific, as L-asparate, L-glutamate and L-cysteic acid serve as substrates in addition to L-cysteinesulphinic acid. Cysteinesulphinate transaminase A has a Km of 9.8 mM for cysteinesulphinic acid and 0.25 mM for aspartic acid, whereas the B enzyme has a Km of 6.5 mM for cysteinesulphinic acid and 1.4 mM for aspartic acid. The Vmax values of the A and B enzymes are respectively 7.1 and 6.2 mmol h-1 mg-1 protein for aspartic acid and 45 and 9.3 mmol h-1 mg-1 protein for cysteinesulphinic acid. Both enzymes exhibit maximum activity at pH 8.6. A high specific activity is found in optimal conditions for these two transaminases, the pI values being 9.06 and 5.70 for cysteinesulphinate transaminase A and B respectively. These results have been compared with those already obtained for purified aspartate aminotransferase. Similarities in the pathways of taurine and gamma-aminobutyric acid (GABA) metabolism are discussed.


Anticomplementary activity of cornea, vitreous and chorioretina in rabbits. We wished to determine if inhibitors of the complement system are present in different rabbit ocular tissues. Soluble extracts of cornea, vitreous humor and chorioretina in different dilutions were incubated with normal human serum (as source of complement). The ability of the latter to lyse sheep erythrocytes sensitized with antisheep rabbit hemolysin was assessed. The cornea did not show any inhibition of complement. The vitreous humor exhibited very low inhibitory activity. The extracts of the uveo-retinal tissue contained heat-labile and heat-stable factors capable of cleaving C3 and factor B.


Semipermeable membrane techniques in quantitative enzyme histochemistry. Non-structurally bound, partially structurally bound or weakly structurally bound enzymes diffuse out of sections during the histochemical incubation period. Fixation of sections does not help to prevent diffusion since the enzymes may be inactivated by their chemical reaction with the fixative. Moreover watery fixatives cause partial leakage of enzymes into the fixative solution. The inclusion of macromolecular substances in the incubation media only partially prevents the leakage of enzymes. In the technique discussed here a semipermeable membrane is interposed between the incubating solution and the tissue section. Because only molecules with a molecular weight of 20 000 can penetrate the membranes, diffusion of enzymes is prevented, whereas substrate molecules and other components necessary for the staining reaction diffuse through the membrane. This technique is suitable for the histochemical demonstration of activity of oxidoreductases, transferases, hydrolases and isomerases. Particular attention is paid to how far semipermeable membrane methods are suitable for quantitative histochemical studies of enzymes.


Criteria for the validation of quantitative histochemical enzyme techniques. Some practical criteria are suggested for establishing the precision, reproducibility, validity and specificity of quantitative histochemical techniques used for assaying the activities of enzymes in single cells and tissue sections. To be valid, a technique should ideally pass 12 tests. Principally these involve proving that the mean absorbance or fluorescence of the specific final reaction product (FRP) is related to section thickness, incubation time, substrate concentration and the concentration of enzyme in situ. However, the formation of appreciable amounts of non-specific FRP may interfere in the determination of the true enzyme activity. This and other difficulties are illustrated with data obtained from an investigation of Meijer's semipermeable membrane technique for assaying acid phosphatase in unfixed sections of muscle.


Microphotometric determination of enzyme activities in cryostat sections by the gel film technique. Use of the gel film technique in microphotometric determinations of enzyme activity is described. The microscope photometer is computer-controlled. It is programmed to deal with repetitive measurements at up to 12 selected positions within a tissue section and to evaluate recorded reaction rates statistically. Films of polyacrylamide gel with entrapped glucose-6-phosphate dehydrogenase are used as a model to demonstrate the correlation between local enzyme activity and the microphotometrically determined reaction rate. Enzyme activities at different positions in the same tissue section are determined and compared. Activity profiles of five enzymes (glutamate dehydrogenase, lactate dehydrogenase, malate dehydrogenase, succinate dehydrogenase, NAD-dependent tetrazolium reductase) in the liver are presented and show non-uniform intra-acinar distribution patterns. These results are interpreted in the light of the metabolic zonation of the hepatic acinus. Further applications of the method are discussed.


The effect of kallikrein on central effects of acetylcholine in rats receiving indomethacin and prostaglandin E1. Kallikrein given in combination with acetylcholine (ACh) increased the central inhibitory action of ACh as measured in the Lat's test, duration of thiopental sleep and inhibition of electrogenic convulsions. Indomethacin aboished the potentiating effect of kallikrein on these actions of ACh, PGE1 did not play a significant role in the influence of kallikrein on the central action of ACh. However, inhibition of prostaglandin synthesis with indomethacin plays an important role in the interaction of kallilkrein and ACh.


Quantitative cytochemical analysis of (single) cultured cells. Human fibroblasts or amniotic fluid cells can be cultivated in special dishes with a bottom of thin transparent plastic foil. After quick freezing and freeze-drying small groups of cultured cells or single cells can be isolated by dissecting small pieces of plastic foil under the stereomicroscope. These can be incubated in (sub)microlitre volumes of substrate and the absorbance, fluorescence or radioactivity can be measured and expressed per cell. When absorbance is measured with a microscope spectrophotometer in 1-10 microliter, microcuvettes, the minimum amount of coloured product that can be determined is of the order of 10(-11) moles. Incubation under paraffin oil in 0.05 microliter of substrate, followed by fluorescence measurements in 1-5 microliter with a microscope fluorometer, allows down to 10(-14) mol of methylumbelliferone, which is the end-product in many analyses of lysosomal enzymes, to be detected. (Re)cycling procedures have an even greater sensitivity (10(-15)-10(-19)mol) but they are more complicated and limited to NAD(P)(H)-dependent reactions. Several radiometric procedures have also been adapted for the analysis of small numbers of cultured cells but most of them still require 10(4)-10(5) human fibroblasts. These microtechniques allow rapid prenatal diagnosis of at least 20 different genetic metabolic diseases to be made within 7-14 days after amniocentesis at the 14th-16th week of pregnancy. Enzyme assays on single cultured cells have also enabled complementation studies to be done on heterokaryons after hybridization of different types of mutant fibroblasts, as well as investigations of the intercellular exchange of lysosomal enzymes between normal and mutant cells.


Microdensitometry.

Microdensitometry. Microdensitometry, or microspectrophotometry, is the measurement of the concentration or mass of a chromophore in microscopically defined regions, and is governed by well-established laws of physics. Initially it proved of value in Feulgen cytophotometry of the relative amounts of DNA in individual nuclei of isolated cells. It has now achieved wide applicability to the measurement of cellular biochemical activity by means of stoichiometric chromogenic reactions. The validity of some of these measurements has been confirmed by comparative biochemical and microdensitometric assays. Thus microdensitometry, even of heterogeneously distributed chromophores, can be precise, provided that the technique is operated with due regard to its limitations within the laws of physics. The potential errors include: variation in thickness of tissue sections (path-length); scatter; glare; diffraction; occlusion of light by optically dense particles; and the inhomogeneity error. However, under correct conditions for the cytochemical reactions and for operating the microdensitometer, these potential errors become small or negligible. Thus the highly sensitive cytochemical bioassay of thyrotropin exemplifies the precision that can be achieved by controlled use of microdensitometry.


The constant proportion enzyme group concept in the selection of reference enzymes in metabolism. Comparative analyses of enzyme activity patterns reveal groups of enzymes with constant proportions and enzymes with variable proportions of their maximum activities. Constant proportion groups comprise enzymes of unbranched metabolic sequences or functionally related pathways. Ratios of constant proportion groups reflect metabolic correlations, which may be used as discriminative magnitudes of  metabolic specialization. Comparison of closely related muscles reveals that differences in the absolute levels of the constant proportion group enzymes of glycolysis parallel differences in maximum glycolytic flux rates. This holds for near-equilibrium as well as for non-equilibrium enzymes. In any case, maximum enzyme activities are significantly higher than maximum metabolic flux rates. Maximum enzyme activities therefore do not permit conclusions on maximum metabolic capacities to be drawn. They may, however, be compared in closely related tissues or different metabolic conditions of a given tissue as relative magnitudes of maximum flux rates. Reference enzymes of constant proportion groups as well as of other enzymes which are representative of distinct metabolic pathways may be used in this sense for the evaluation of enzyme activity patterns. Selection of appropriate enzymes depends on the aim of the intended study, on a thorough knowledge of their individual properties, and on the possibility of measuring their maximum activity under reproducible conditions.


Use of enzyme activities as indices of maximum rates of fuel utilization. It can be shown theoretically and experimentally that the maximum activities in vitro of enzymes that catalyse near-equilibrium reactions in vivo must be considerably higher than the maximum flux through that pathway. Consequently, the activities of such enzymes cannot provide quantitative information on the maximum possible flux through a pathway. On the other hand, the maximum activity of an enzyme that catalyses a non-equilibrium reaction in vivo may provide quantitative information. Such possibilities must be tested experimentally. Thus the maximum flux through a given metabolic pathway is measured (or calculated) and compared with the maximum in vitro activities of enzymes that catalyse non-equilibrium reactions in that pathway. Catalytic activities similar to the flux suggest that such enzymes may be useful as flux indicators. For example, phosphorylase or phosphofructokinase activities provide a quantitative indication of maximum flux through glycolysis-from-glycogen (i.e. anaerobic glycolysis); hexokinase activities provide a quantitative indication of maximum flux through glycolysis-from-glucose; 2-oxoglutarate dehydrogenase activities provide a quantitative indication of maximum flux through the citric acid cycle. The advamtages of the use of enzyme activities in this manner include simplicity, general applicability to pathways, tissues and animals, and minimum intervention (particularly in larger animals including the human species). One disadvantage is that the properties of the enzyme must be known in detail before an assay that gives maximum activities can be developed, and the properties of enzymes that catalyse non-equilibrium reactions may be complex. These considerations emphasize the dangers of quantitative interpretation of the maximum flux through pathways from 'near-equilibrium' enzymes or from 'non-equilibrium' enzymes whose properties have been inadequately studied.


The place of histochemical techniques in toxicology, pharmacology and pathology. The uses of histochemistry in pathology (experimental and clinical), pharmacology and toxicology are considered and their restrictions are discussed. In time-course studies of drug effects in animals the research worker must choose an appropriate histochemical technique for evaluating the changes seen in the tissues, if any, during the study. Acid phosphatase is shown to be a marker enzyme which may be active in both cell multiplication and tissue necrosis; results obtained with it must therefore be interpreted with caution. The need for histochemical techniques to match experimental conditions is emphasized. The restrictions of fixation and tissue preparation are also emphasized. Histochemical and biochemical techniques should be used together where appropriate, and the results should be analysed carefully. Indiscriminate use of histochemistry and quantitation is deplored.


Symposium on the assessment of quantitative histochemical techniques. Introduction.


Tissue stabilizer methods in histochemistry. Quantitative studies in the 1960s established that the tissue disruption and enzyme loss which occurs when unfixed cryostat sections are incubated could be prevented with high concentrations of polyvinyl alcohol without inhibition of enzyme activity. This use of polymeric stabilizers has been largely confined to studies of 'soluble' dehydrogenases in tissue sections. However, optimum conditions for 'soluble' enzymes in cut sections may not be ideal for membrane-bound enzymes or for whole cells, where an over-stabilization of membranes can lead to restricted entry of reagents and thereby low activities. Lower concentrations, or other stabilizers such as Ficoll (a synthetic polysucrose) and collagen polypeptides, have been used in such cases. Suggested criteria for a tissue stabilizer are: (i) The stabilizer should be chemically inert, of defined and constant composition, and generally available; (ii) The tissue must remain structurally intact during the incubation, and the final preparation should look 'clean' and have the proper morphology; (iii) The component being assayed must remain inside the section, and not diffuse into the incubation medium. Ideally, it and any reaction product should remain at their original loci, although it may not always be possible to verify this; (iv) Recorded activities should be comparable to those found in biochemical systems under similar conditions.


Drug concentrations in neuropsychiatry. Introduction: the rational use of plasma drug levels in clinical medicine.


Drug concentrations in neuropsychiatry.

Drug concentrations in neuropsychiatry.


Clinical significance of monitoring plasma levels of psychotropic drugs. The possible clinical significance of plasma level monitoring of psychotropic drugs in psychotic patients is described. In particular, data obtained with children and 'resistant' psychotic patients are presented. The results in children indicate the existence of a good relationship between side-effects and haloperidol plasma levels as well as between adverse effects and chlorimipramine plasma levels. Furthermore, an age effect on haloperidol clearance could be shown. Relationship between haloperidol and chlorimipramine concentration and effects could be observed for tics and enuresis respectively but not for psychotic reactions. Data in adult patients illustrate on the one hand possible causes of variability in plasma levels of haloperidol and, on the other hand, the fact that poor bioavailability is not the cause of lack of response in 'resistant' schizophrenic patients.


Principles of pharmacokinetics.

Principles of pharmacokinetics. A compartmental representation of the body is often used to explain the principles of pharmacokinetics, where the compartments are purely hypothetical and bear no relationship to real tissues or organs. In recent years a more physiological approach has been emphasized. Differences in derived kinetic parameters, such as elimination half-life, volume of distribution and clearance, as a function of drug, patient and route of drug administration, are more easily understood when related directly to primary physiological variables, such as blood flow, enzyme activity and drug binding. In turn this allows a convenient conceptual framework for describing and predicting both unbound and total drug concentrations in many clinical situations.


Adrenergic and serotonergic mechanisms in depression and their response to amitriptyline. Our investigations into the chemical pathology of the affective disorders have indicated that depressed patients not only have significantly reduced rates of accumulation of 5-hydroxytryptamine (5-HT) into their blood platelets but their peripheral alpha-adrenoreceptors are supersensitive. Investigations into the mode of action of amitriptyline have centred on these abnormal adrenergic and serotonergic mechanisms in depressed patients. We have not detected any significant relationship between blood platelet 5-HT re-uptake inhibition and therapeutic response to amitriptyline in depressed patients, although there is a significant correlation with plasma levels of the drug. It is interesting to note that nortriptyline, the major metabolite of amitriptyline, blocks the alpha-adrenoreceptor but the degree of blocking of this supersensitive receptor is significantly correlated to poor outcome. Amitriptyline does not appear to correct these abnormal mechanisms in depressed patients. These results are discussed with reference to other pharmacological actions of amitriptyline and other antidepressant drugs.


The role of plasma level monitoring of tricyclic antidepressant drugs as an aid to treatment. Use of the tricyclic antidepressant drugs is the most common pharmacotherapeutic approach to the treatment of depression. It is a common clinical experience to find that a fair proportion of patients fail to show a satisfactory response and that others complain of side-effects. Important factors which influence this situation are the diagnostic criteria used to select patients for drug treatment, the dosage prescribed and individual compliance. Measurement of plasma drug concentrations has been proposed as a more rational way of increasing the efficacy of antidepressant medication and avoiding toxicity. A number of studies have shown a correlation between plasma concentrations of these drugs and clinical effects, but the relationship is far from simple. With amitriptyline and nortriptyline there is good evidence for a 'therapeutic window' within which maximum antidepressant action is obtained. Many patients being treated with these drugs have plasma levels outside recommended therapeutic ranges. Experience in our department has shown that there are a number of clinical situations where routine plasma level monitoring of selected antidepressants is of value: (1) inadequate clinical response; (2) side-effects/toxicity; (3) complicating medical conditions; (4) suspected poor compliance; and (5) long-term therapy. Such measurements are a relatively simple and inexpensive way of maximizing the benefits of drug therapy and a means of tailoring drug dosages to suit individual requirements.


Clinical application of the monitoring of anticonvulsant drug levels. The drug treatment of epilepsy poses considerable problems, including the high prevalence and early age of onset of seizures, the relatively poor prognosis in many patients, prolonged polypharmacy, chronic toxicity, and uncertainty of the relative efficacy of individual drugs. The application of recent knowledge of the clinical pharmacology of the major anticonvulsants offers a partial solution to several of these problems. Although there is no therapeutic range for any drug applicable to all patients, a more simple rational and effective approach to treatment is possible with the guidance of serum level monitoring. In new referrals, there is considerable potential for monotherapy, and the avoidance of polypharmacy and chronic toxicity. Reduction in polypharmacy in chronic patients is more difficult, but in many can be achieved with reduction in toxicity, and sometimes improved seizure control. Further studies will provide a clearer picture of the limits to modern anticonvulsant therapy, the relative efficacy of individual drugs, and the potential for improved long-term prognosis.


The logistics of drug monitoring.

The logistics of drug monitoring. Although opinions differ to some extent there is increasing belief in the value of monitoring plasma levels for effective therapy with neuropsychiatric drugs, especially with anticonvulsants. Monitoring should not be on a comprehensive and routine basis, but should be selective and discriminating. In these circumstances the expenditure incurred on the laboratory operations involved might work out for Britain at about pounds 5 million per year. This figure should be compared to a total annual expenditure from the prescribing of neuropsychiatric medication amounting to an estimated pounds 40 million per year. The benefits thus achieved in patient care, together with the possible economies in prescribing, could well merit this monitoring exercise. In terms of personnel and administration, the laboratory facilities could be organized on a regional, or on a district general hospital, basis.


Drug concentrations in neuropsychiatry: alternative approaches. The practical value of measuring plasma concentrations is to optimize treatment in order to attain the best balance in each particular patient between wanted clinical therapeutic effects and unwanted adverse and side-effects. This increase in treatment efficacy can be concurrent--that is, the treatment is monitored and the dosage changed as necessary--or predictive, where the results of a test dose can be used to calculate the appropriate dosage. Wanted effects include: (1) the attainment of adequate drug concentrations for the minimum period of time necessary, as in the use of antibiotics; (2) the suppression of symptoms, as in the use of the benzodiazepines in anxiety states; (3) the use of drugs to improve function, e.g. levodopa in Parkinsonism; (4) drugs are used to prevent episodes of illness; and (5) complex suppression of symptoms, as with the antidepressives and antipsychotics. The biological alternatives to plasma level monitoring depend on establishing an empirical relationship between the putative monitor and the clinical response. Such measures avoid the problem of estimation of drug concentration at the receptor. Examples include monoamine oxidase activity in platelets, the uptake of amines into platelets, neuroendocrine measures such as prolactin concentrations, the electroencephalogram, and peripheral measures such as pulse rate, pupil size and tremor.


Drug concentrations in neuropsychiatry. Methodological pitfalls: the influence of experimental design on results. The valid study of relationships between pharmacokinetic measurements and clinical effects of psychotropic drugs depends on: (i) analytical methods for the drugs; (ii) the fluid assessed and pharmacokinetic derivations; (iii) clinical assessments and the nature of psychiatric illness; and (iv) statistical work. Standard problems with analytical methods include lack of specificity, unjustified claims for sensitivity, and failure to recognize metabolites as potential analytical contaminants and compounds for separate study. Problems with pharmacokinetic derivations include inappropriate calculations and incorrect assignment of terms such as 'half-life'. Clinical difficulties mostly relate to variations between patient groups, selection procedures and rating methods, and to timing of samples. Statistical controversies concern the calculation of metabolite ratios, pooling of data from drugs and their metabolites, and abuse of statistical techniques. These methodological problems are illustrated by reference to work with phenothiazines, tricyclic antidepressants, lithium, benzodiazepines and anticonvulsants.


Interpretation of drug levels: relevance of plasma protein binding. Many centrally acting drugs bind extensively to plasma proteins, particularly albumin. It is generally the free concentration rather than the total concentration which determines the intensity of pharmacological action and the distribution and rate of elimination of a drug. Measurement of the total plasma concentration may therefore give a false idea of the amount of active drug available. Furthermore, variation in the degree of binding from one subject to another, and displacement of drug molecules by a second drug, may complicate the interpretation of serum levels when both bound and free drug are measured together. The strict use of therapeutic ranges of serum levels may therefore be harmful when a larger than normal proportion of the drug is free. In theory, monitoring the free concentration would have advantages, but on a routine basis this is not practical at present for technical reasons. Cerebrospinal fluid is an ultrafiltrate of plasma but lumbar puncture for routine monitoring purposes cannot be justified. Monitoring salivary concentrations is a practical alternative but for some drugs variation in the degree of ionization of the compound may make salivary levels unreliable.


Quality control of drug assays.

Quality control of drug assays. Most routine drug assay work is done by clinical chemists who, in general, are well aware of the importance of regular quality control checks. Few, however, have had extensive experience in analytical techniques for drugs, such as gas chromatography, and often underrate the difficulty in obtaining reliable results. Although antiepileptic drugs are among the easiest to measure, a North American study organized by Dr Charles Pippenger and a European study performed by the author demonstrated clearly the poor quality of results coming from many laboratories. From these studies have grown two external quality control schemes which together involve over 800 laboratories on a world-wide basis. Reports have indicated that the reliability of theophylline, tricyclic antidepressant and phenothiazine assays is also poor, and it might be expected that the problems will increase as attempts are made to measure drugs present in lower concentrations. Careful attention to quality control will be essential if physicians are to be provided with reliable results.


Lithium concentration and clinical responses. The clinical use of measurements of drug concentrations in blood is empirical and largely confined to compliance and toxicity monitoring. As currently used in once or thrice a day dosage, lithium treatment is pulsatile, the blood concentration varying threefold over 24 hours; routine measurements reveal nothing of this and therefore do not aid therapeutic use. In a pilot study it is shown that the plasma lithium concentration can be raised from 0 to 2 mmol/l in a few hours, inducing changes in both kidney function and neuropsychological tests after only short delay. This suggests that mania might be quickly controlled with rapid dosage and opens up a new way of analysing the mechanisms of lithium action, or of using it to reveal changes in cerebral functioning.


Blood levels of flupenthixol in patients with acute and chronic schizophrenia. Plasma levels of flupenthixol were estimated by three methods in 30 patients with acute schizophrenia and 29 patients with chronic schizophrenia. These levels were related to clinical response, anterior pituitary hormone secretion, platelet monoamine oxidase activity, the effects of the concurrent administration of anticholinergic drugs, and body weight. No clearcut relationships between plasma flupenthixol levels and any of these variables were demonstrated. The practical clinical value of the estimation of plasma flupenthixol is limited at the present time.


Examining the validity of the state board test pool examination for registered nurse licensure.


The life and health of nurses.

The life and health of nurses.


Interpersonal/professional relationship: some critical issues involving the nurse, the physician, and the patient.


Case study--"systemic violence".

Case study--"systemic violence".


Nursing practice: a right and a duty.

Nursing practice: a right and a duty.


Euthanasia: a clarification.

Euthanasia: a clarification.


Update on ethics: preliminary considerations.


Who controls nursing laws in Nevada?

Who controls nursing laws in Nevada?


Update on ethics: how to recognize and criticize an ethical claim.


Update on ethics: case studies: theories and pragmatics. "Brady's baby".


Beverly Smith addresses NNA Convention: credentialing in nursing.