Rapid improvement in beliefs, mood, and performance following an experimental success experience in an analogue test of recovery-oriented cognitive therapy.

BACKGROUND: Negative symptoms significantly contribute to disability and lack of community participation for low functioning individuals with schizophrenia. Cognitive therapy has been shown to improve negative symptoms and functional outcome in this population. Elucidation of the mechanisms of the therapy would lead to a better understanding of negative symptoms and the development of more effective interventions to promote recovery. The objective of this study was to determine (1) whether guided success at a card-sorting task will produce improvement in defeatist beliefs, positive beliefs about the self, mood, and card-sorting performance, and (2) whether these changes in beliefs and mood predict improvements in unguided card-sorting. METHODS: Individuals with schizophrenia having prominent negative symptoms and impaired neurocognitive performance (N = 35) were randomized to guided success (n = 19) or a control (n = 16) condition. RESULTS: Controlling for baseline performance, the experimental group performed significantly better, endorsed defeatist beliefs to a lesser degree, reported greater positive self-concept, and reported better mood than the control condition immediately after the experimental session. A composite index of change in defeatist beliefs, self-concept, and mood was significantly correlated with improvements in card-sorting. CONCLUSIONS: This analogue study supports the rationale of cognitive therapy and provides a general therapeutic model in which experiential interventions that produce success have a significant immediate effect on a behavioral task, mediated by changes in beliefs and mood. The rapid improvement is a promising indicator of the responsiveness of this population, often regarded as recalcitrant, to cognitively-targeted behavioral interventions.

From neurocognition to community participation in serious mental illness: the intermediary role of dysfunctional attitudes and motivation.

BACKGROUND: Evidence for a relationship between neurocognition and functional outcome in important areas of community living is robust in serious mental illness research. Dysfunctional attitudes (defeatist performance beliefs and asocial beliefs) have been identified as intervening variables in this causal chain. This study seeks to expand upon previous research by longitudinally testing the link between neurocognition and community participation (i.e. time in community-based activity) through dysfunctional attitudes and motivation. METHOD: Adult outpatients with serious mental illness (N = 175) participated, completing follow-up assessments approximately 6 months after initial assessment. Path analysis tested relationships between baseline neurocognition, emotion perception, functional skills, dysfunctional attitudes, motivation, and outcome (i.e. community participation) at baseline and follow-up. RESULTS: Path models demonstrated two pathways to community participation. The first linked neurocognition and community participation through functional skills, defeatist performance beliefs, and motivation. A second pathway linked asocial beliefs and community participation, via a direct path passing through motivation. Model fit was excellent for models predicting overall community participation at baseline and, importantly, at follow-up. CONCLUSIONS: The existence of multiple pathways to community participation in a longitudinal model supports the utility of multi-modal interventions for serious mental illness (i.e. treatment packages that build upon individuals' strengths while addressing the array of obstacles to recovery) that feature dysfunctional attitudes and motivation as treatment targets.

Pigmentary dispersion syndrome with a secondary piggyback 3-piece hydrophobic acrylic lens. Case report with clinicopathological correlation.

We describe a case of pigmentary dispersion syndrome resulting from secondary piggyback implantation of a 3-piece hydrophobic acrylic squared-edged intraocular lens (IOL) in the ciliary sulcus. The intraocular pressure remained elevated despite pharmacological treatment, with a heavily pigmented trabecular meshwork. The piggyback IOL was subsequently explanted and replaced by a silicone IOL with smooth round edges. Examination of the explanted IOL under light and scanning electron microscopy showed clusters of pigment epithelial cells located around the periphery of the anterior optic surface.

Late postoperative opacification of MemoryLens hydrophilic acrylic intraocular lenses: case series and review.

PURPOSE: To report clinical and spectrographic analyses of 2 explanted hydrophilic acrylic intraocular lenses (IOLs). SETTING: John A. Moran Eye Center, Salt Lake City, Utah, USA, and Johannes Gutenberg-University, Department of Ophthalmology, Mainz, Germany. METHODS: We report 6 cases of opacification of MemoryLens IOLs (Ciba Vision) that occurred approximately 2 years after implantation. The anterior and posterior surfaces of the IOLs had a white, frosted appearance, and the IOLs' interior looked brown, similar to the appearance of a brunescent cataract. Two of the IOLs were explanted because of a significant decrease in visual acuity. The IOLs were sent for further clinicopathologic analysis including scanning electron microscopy and energy dispersive x-ray spectroscopy (EDX). RESULTS: Microscopic analysis revealed multiple, fine, granular deposits of various sizes on the surface of the lens optics. The EDX analysis showed the presence of calcium within the deposits. CONCLUSIONS: Our cases show that hydrophilic acrylic IOLs can opacify even years after implantation. Analysis of the explanted IOLs revealed calcification.

Alternative regulatory perspectives of obstetrics and gynaecology.

In addressing whether the field of obstetrics and gynaecology demands internal self-regulation or external state intervention, the authors look at the distinct yet at once interrelated notions of ethics, deontology and law. The distinctness of these concepts relates not only to their optional and/or obligatory natures, but also to the group and/or groups they influence and/or regulate. The interrelated nature of these concepts suggests that they are complimentary paradigms in as much as they collectively form a framework of individual, professional and societal norms. Given the emergence of both legal pluralism and self-regulation over the last two decades, it is believed that neither self-regulation nor state intervention is in itself appropriate. Rather, it is contended that only a pluralistic system--incorporating ethics, deontology (self-regulatory models) and law (state regulatory model) can effectively and comprehensively regulate the medical community so that it may efficaciously and appropriately respond to the continually emerging issues raised by contemporary medicine.

Characteristics and coping patterns of families with infants on home apnea monitoring.

The purposes of this study were to: (a) describe the characteristics of families with children who require apnea monitors in the home setting; (b) describe the family functioning characteristics and coping patterns of families with children on apnea monitors; and (c) describe the relationship between family functioning and coping patterns in these families. This descriptive study focused on families of 22 children ranging in age from 8 to 64 months who required home apnea monitoring. Interview results indicate that these families are high in adaptability and average in cohesion. Results also describe families who perceive themselves as coping adequately. Analysis of the data reveals significant correlations among family functioning scores and coping pattern subscale scores. Findings from this study support the importance of understanding the role of family functioning and coping patterns of families with children on home apnea monitoring. Information from this study can assist nurses in planning comprehensive family-centered care.

Women at the top.

Management has long been male dominated, but recently women have been entering the field in increasing numbers. This influx has required the management establishment to think and behave in new ways.

Effect of adenosine 3',5'-monophosphate on serine metabolism in chick tissues.

The effect of cyclic 3',5'-AMP and supplemental dietary glycine upon de novo synthesis of serine metabolic enzymes in chick livers were examined. Chicks fed crystalline amino acid diets containing 2% glycine had approximately twofold the activity in liver for 3-phosphoglycerate dehydrogenase and phosphoserine phosphatase compared to liver tissue from chicks fed diets lacking in dietary glycine. Chicks subjected to daily intraperitoneal injections of cyclic 3',5'-AMP and fed diets containing no dietary glycine contained biosynthetic enzyme activity similar to glycine-fed chicks suggesting a correlation between glycine and cyclic AMP for serine enzyme induction. The elevated enzyme activity in liver of chicks fed dietary glycine or injected with cyclic AMP was inhibited when chicks were also injected with actinomycin D indicating de novo synthesis of 3-phosphoglycerate dehydrogenase and phosphoserine phosphatase. Dietary glycine or cyclic AMP, however, did not change serine dehydratase and glycerate dehydrogenase activities in chick liver.

Effect of breast-feeding on seroresponse of infants to oral poliovirus vaccination.

Three hundred Indian infants between 6 and 51 weeks of age were divided into six groups and given three doses of trivalent oral polio vaccine (OPV) of known adequate potency. One group was on unrestricted breast-feeding with mandatory breast-feed during the interval between 30 minutes before and 15 minutes after each dose of OPV. In four groups of infants breast-feeding was withheld for three, four, five, and six hours both before and after each dose of OPV. The sixth group was bottle-fed. Samples of blood were collected from all infants before vaccination and from 227 infants further samples were collected four weeks after the first and/or third doses of OPV. Antibody responses to poliovirus types 1, 2, and 3 were determined following one dose and three doses of OPV, and the rates of response were found to be approximately equal in all groups of breast-fed infants irrespective of their feeding schedules, as well as in bottle-fed infants. Thus breast-feeding is shown to have no inhibitory effect on antibody response of infants beyond the newborn period to OPV.