A refinement of the concept "reticence".

This report has 1. Made a distinction between speech disorders involving defects and those that are primarily reticence, but in any case identified speech disorders as negotiated states as opposed to fixed disease states. 2. Argued that there is a clear analytical separation between speech disorders and speech behaviors which are indicative of neurotic disorders. 3. Attempted to remove anxiety as a component of the communication process by according it its rightful place, which is central in human personality. Furthermore, we have attempted to dispel the notion that anxiety is evil and the perennial (and sole) cause of speech disorders. 4. Identified a specialist known as the rhetoritherapist (a specially trained speech teacher) as the particular king of professional qualified to deal with speech disorders (in conjuction with speech pathologists and/or psychotherapists where necessary). We have accorded to the rhetoritherapist the province of instruction and training in all aspects of invention, delivery, and reception of rhetorical speech without reference to its moral intent. 5. Identified "reticence" as the most useful of the various imprecise terms used to refer to people with speech problems, because it is devoid of connotations that go beyond the speech process. Further refinement of specific categories of speech disorders is necessary to order to expand the repertoire of available treatment strategies. Such refinement will probably include reference to the various subprocesses of human speech identified earlier in this paper as they are related to the rhetorical situation. The rhetoritherapist thus emerges as the trouble-shooter, but not the "psychotherapist," of speech pedagogy.

An end to anxiety treating speech problems with rhetoritherapy.

The controversy over the connection between anxiety and nonproductive speech behavior can be resolved by taking note that alteration in behavior usually alters anxiety level. While many theorists recommend that treatment of anxiety will be beneficial, there is little contention that modification of anxiety alone alters skillful behavior. Rhetoritherapy is a mode of changing communication behavior through application of heuristics of problem solving and behavior change. Research studies tend to indicate a high level of success and selected case histories illustrate the process.

Interposed abdominal compression-CPR in human subjects.

Standard cardiopulmonary resuscitation (CPR) has been thought to produce approximately 30% of the usual resting cardiac output. Further increase of blood flow to vital organs may increase chances of resuscitation and decrease likelihood of permanent, residual central nervous system or cardiac damage. Various methods have been promoted, most requiring equipment not available to bystanders and time to initiate once advanced cardiac life support (ACLS) providers have necessary equipment at hand. Interposed abdominal compression-CPR (IAC-CPR), application of manual abdominal pressure during the release phase of chest compression in otherwise standard CPR, has been demonstrated in dogs to increase diastolic blood pressure by 100% and cardiac output by 75%. We measured systolic and mean arterial pressure (MAP) in a group of six cardiac arrest patients after resuscitation was deemed unsuccessful by the physician directing CPR. We alternated periods of CPR versus IAC-CPR measuring femoral and radial or brachial pressures in six subjects, and found a 50% increase in MAP (from 26 to 39 mm Hg). Central venous pressures (CVP) were measured in one subject and, using MAP minus mean CVP to determine mean perfusion pressure, we found a 37% increase (from 19 mm Hg to 26 mm Hg). We propose that IAC-CPR may be a significant improvement in basic CPR if these studies are reproducible in resuscitable patients.