Power and visibility: the invention of teenage pregnancy.

The term 'teenage pregnancy' replaced the morally loaded terms 'illegitimate child' and 'unwed mother' around 1970. Instead of understanding the change in terminology as 'becoming more accurate', 'compelling more humane treatment' or simply as 'good', we should try to understand the meaning of the shift from treating pregnant adolescents as moral problems to treating them as scientific problems. Power organized around a moral discourse punished by exclusion, by placing its object on the other side of a moral boundary. Power organized around a scientific discourse on sexual desire makes its objects of knowledge visible and subject to unending inquiry. This paper explores the political implications of the emergence of this new form of power which disciplines its subjects not to obey the Law, but to become true to their own nature, a nature known by scientific experts.

Impediments to Alcohol Education.

Two major forces mitigate against alcoholism education within the medical school curriculum. One relates to the structure and organization of academic medicine with its emphasis on disease states and pathophysiology; sophisticated and technologically complex diagnostic and treatment modalities; and an acute illness, cure-oriented focus rather than a chronic illness, adaptational approach to illness. The second constellation of factors relates to the alcoholism field's failure to identify with other issues in medical education that similarly challenge the Flexnerian curriculum; the lack of a conceptual basis for defining the physician-alcoholism specialist in relation to other medical disciplines; the clinical treatment field's competing craft and professional orientations; and the absence of a scientific vocabulary suited to the existing biopsychosocial paradigms. It is suggested that these impediments could be overcome if the alcoholism field defined the model for managing chronic illness that is implicit in alcoholism treatment.

Relationships among total lipid, lipid classes, and polychlorinated biphenyl concentrations in two indigenous populations of ribbed mussels (Geukensia demissa) over an annual cycle.

Two indigenous ribbed mussel (Geukensia demissa) populations were sampled approximately every four weeks during 1997 to investigate the relationships among concentrations of total lipid, lipid classes, and polychlorinated biphenyls (PCBs). One population was located in a highly contaminated area near a Superfund site (New Bedford Harbor, MA, USA), while the other population was located at a relatively clean site (West Island, Fairhaven, MA, USA). Mussel tissue total PCB concentrations (quantified as the sum of 18 congeners) from the contaminated site were two orders of magnitude greater than those at the clean site. Total lipid and triacylglycerol (TG) also were higher at the contaminated site. No significant relationship (p > 0.05) was observed between total PCBs and total lipid at either location; however, the correlations at both sites increased when total PCBs were compared with total TG or, to a lesser extent, total nonpolar lipid. Principal component analysis and linear discriminatory analysis indicated that the two mussel populations could be distinguished by the proportions of their lipid classes, particularly the concentration of nonpolar lipids, which consisted mainly of TG. These results suggest that the standard method of normalizing organism PCB concentrations to total lipid may not be appropriate as a routine practice, especially when the organism has a relatively low total lipid content (<6% dry wt in this study).

The manipulative patient: an interactional approach.

The words manipulative or manipulation are used in the contemporary psychiatric literature to describe certain persons and their habitual modes of behavior. The terms represent an attempt to describe some essential quality of the patient's style of relating to others. In the following discussion, we will attempt to shift this perspective to a more interpersonal one, seeing the attribution of this label as part of a sequence of communication, mutual perception, and struggle between caretaker and patient. The accusation that a patient is manipulative signals the disruption of the helping process.

The anomaly, the chronic patient and the play of medical power.

In the middle of the twentieth century, the anomaly, the person whose body suffered the effects of an accident and who elicited a compassionate response designed to protect the anomaly from the effects of the accident, disappeared. The 'disabled', the 'handicapped', and the 'chronic patient' replaced the anomaly in medical discourse. This change is reflected in specific, technical aspects of medicine - medicine's understanding and treatment of two anomalous bodies - and in general medical ideology and the organization of medical care. The change extended the medical gaze to the most intimate aspects of life and to the fine seams of society where the anomaly used to wander. We must understand this change as part of the paradoxical play of medical power. Medical power became more totalizing, integrative and rapidly responsive just as it became more unobtrusive, humane and liberating.

Isolated myopathic involvement of the diaphragmatic musculature in a neonate.

A myopathy restricted to the diaphragm was found in an infant who died at 3 months of age of respiratory failure due to immobility of the diaphragm. Grossly, the diaphragm was thin and translucent. On microscopical examination few muscle bundles were seen. Most muscle fibers were small, and numerous necrotic fibers with large sarcolemmal nuclei, focal cytoplasmic basophilia, and hyaline or homogeneous eosinophilic degeneration in the center of the fibers were seen.

Volitional disability and physician attitudes toward noncompliance.

We develop the concept of a volitional disability as an aid in understanding those patients who behave in ways that are harmful to themselves in spite of their desire to do otherwise. Using this concept enables us to describe their behavior as intentional but 'involuntary'. We demonstrate the clinical reality of such behavior by giving clinical examples of the behavior of those with phobic, compulsive, and addictive disorders. We then attempt to show how some kinds of self-harming behavior of noncompliant patients are similar to phobic and compulsive behavior. We propose use of the concept of volitional disability to make it easier for physicians to work with these noncompliant patients and thus to improve their ability to provide better care for them.

KIE: Noncompliant patients may elicit negative feelings in their physicians which interfere with good patient care. The authors identify a subclass of these patients whom they characterize as having a volitional disability. Such patients behave in ways that are harmful to themselves in spite of their desire to do otherwise; their behavior can thus be described as intentional but 'unvoluntary'. After developing the theoretical concept of volitional disability, the authors apply it to clinical examples of phobic, compulsive, and addictive disorders, as well as to some forms of noncompliant patient behavior.

Centronuclear myopathy: extraocular- and limb-muscle findings in an adult.

Myotube-like structures were seen in extraocular and limb muscles in an adult with centronuclear myopathy. The limb-muscle fibers were very small and were of a uniform histochemical type. Extrajunctional acetylcholine receptors were not seen with immunoperoxidase stains, and ultrastructurally normal neuromuscular junctions were seen in the extraocular-muscle samples. Further studies on developing muscle are needed to identify possible mechanisms of arrest of muscle maturation.