Determination of ultra-trace levels of uranium and thorium in electrolytic copper using radiochemical neutron activation analysis.

Uranium and thorium as natural radioactive elements are present everywhere in the environment. Their trace levels are also present in various materials, such as copper, used as a shielding material in gamma-ray spectrometry, usually located very close to the detector. Ultra-low levels of uranium and thorium in electrolytic copper were determined in this study using radiochemical neutron activation analysis (RNAA) via their induced nuclides U-239/Np-239 and Pa-233, respectively. After irradiation of copper together with uranium and thorium standards, various techniques were used for their separation from the matrix. To isolate of short-lived U-239, solvent extraction in a combination of tributyl phosphate (TBP) in toluene was used. To separate Np-239 and Pa-233, extraction chromatography using TEVA and TK-400 resins was applied. Special attention was paid to the estimation of radiochemical recovery, which was determined in each sample aliquot using U-235, Np-238 and Pa-231 tracers. For quantification of induced nuclides and tracers used in the experiment, gamma-ray spectrometry was used. Obtained results showed that electrolytic copper samples contained impurities of uranium and thorium in ultra-trace levels: up to 45 pg/g (550 nBq/g) for uranium and up to 80 pg/g (330 nBq/g) for thorium. The electrolytic copper also contained impurities of Ag, As, Au, Sb, Se and Zn as observed using the k0-INAA technique.

Contemporary ethical dilemmas in psychotherapy: cosmetic psychopharmacology and managed care.

Two contemporary ethical dilemmas facing psychotherapists have been noted and described: cosmetic psychopharmacology and the practice of psychotherapy in a managed care environment. Regarding cosmetic psychopharmacology: It was noted that whether a psychotherapist endorses the use of psychotropic agents for cosmetic purposes, such as self-transformation, seems to be a function of the severity of the client/patient symptoms as well as the psychotherapist's view of human nature and the human condition. However, recent research indicates that certain traits or reflections of the human condition, such as irritability, may actually be neurotransmitter deficiencies that are responsive not only to psychotropic agents but also to non-drug interventions. These findings add an additional dimension to discussions of the ethics of cosmetic psychopharmacology. Regarding psychotherapy in a managed care environment: Several ethical dilemmas, including confidentiality, were discussed. These dilemmas were outlined rather than analyzed in detail. Some of them will become major "thorns" of concern for the practice of psychotherapy. Others will be less consequential. Of critical concern is that limitations by managed care on the technique and optimal length of treatment of psychotherapy can conceivably lessen its efficacy for some patients and could possibly eliminate this powerful treatment procedure for others.

Mid-life Crisis: Growth or Stagnation.

Mid-life has developmental stages and particular tasks that must be successfully completed for growth to continue and psychological stagnation to be avoided. Characteristic of different phases of mid-life are three stages of ego mastery: alloplastic mastery is associated with early adulthood, autoplastic mastery is associated with maturity, and omniplastic mastery is found in old age. A special perspective on one's life and a need to examine one's life are found in mid-life. Difficulties can occur in dealing with this phase and the family physician can be of significant help to his patients who are working through the mid-life crisis.

Depression in Canadian general practice attenders.

In this study, depression among patients visiting general practitioners was examined by administering a short self-report measure of depression to 1,250 patients visiting 37 general practitioners in three Canadian centres (Winnipeg, Brandon and Virden). According to scores on the CES-D scale, 66.8% of the patients were judged to be normal, 11.8% were experiencing mild depression, 13.3% moderate depression and 8.1% were experiencing fairly severe depression. Depression scores were highest among female patients, patients who lived in Winnipeg, patients who were unemployed and patients who were divorced or separated.

The certification examination: opinions of royal college examiners.

There has been increasing concern among candidates and psychiatrists regarding the Canadian written and oral certification examinations. Views of candidates and psychiatrists have been obtained. The results presented in this survey were obtained through a questionnaire that was completed by 64 past and present Royal College examiners. General support for the establishment of guidelines for the selection of examiners, for increased emphasis on the use of in-training evaluations and for the need of clear operational criteria for examiners and candidates was voiced. Finally, the evaluation model that most responding examiners favoured included re-introducing one part essay into the written examination. Overall, although finding it exhausting, most examiners enjoy examining and are satisfied with the present system. Recommendations concerning improvements to the present system are presented.

The Canadian certification examination in psychiatry. III. Towards better certification techniques.

Although there has been much criticism of specialty certification examinations there is general agreement that they are an important safeguard of competence in medical specialties where the consumer cannot judge this. The Canadian Royal College has made strenuous attempts to improve certification techniques but these have not been heretofore widely reported. This paper reports on the rationale for the replacement of the essay examination by multiple choice questionnaires, the problems associated with MCQ, and the efforts made to improve the fairness, validity and reliability of the clinical (oral) examination. These efforts have been in the areas of selection of examiners, training for examiners, standardization of marking and the conduct of the examination. A description is given of the conduct of the examination and what the examiners look for in the candidate's performance. The development and increasing importance of the In-Training Evaluation are discussed. The publication of A Resident's Guide to Psychiatric Education with multinational participation advances the possibility of future reciprocity in psychiatric examinations conducted in several English speaking countries.

On direct patient participation in the cost of their psychiatric care. Part II: Access to services, impact on practice and training implications.

A review of the relation between insurance and psychiatric services addresses the economic concerns involved. Under third-party reimbursement, a range of predictability and stability of treatment costs is observed; overall cost benefit and effectiveness for a variety of therapeutic procedures is demonstrated and socio-cultural factors play a role in the users demand behavior. The cost of medical care is a small percentage of the system's total cost and judicious use of psychiatric consultation reduces medical and surgical expenditures. Inherent difficulties for the profession exist in a universal health care scheme. The acceptability of psychological impairment and the confidentiality dilemma are among the issues reviewed. Further attention must be paid to the therapist's fee, behaviour and income needs. A traditional defensiveness regarding these matters should be overcome through a peer review process in order to further delineate responsible financial norms of psychiatric practice. The "laissez-faire" attitude observed in most of our training programs towards financial matters must be addressed in order to participate effectively in the ongoing sociopolitical dialogue on the funding of health care.

Payment for psychiatric services under Canada's insurance system.

The authors review the impact of Canada's universal health insurance system on the delivery of psychiatric services. They believe that, on balance, Canadian psychiatrists and their patients have benefited from the system. However, certain categories of patients still do not have access to private care, and public facilities in some provinces have long waiting lists for services because of manpower shortages. A substantial number of psychiatrists have opted out of the system because of dissatisfaction with the intrusion of third-party payment on practice. The Canadian system presently discourages copayment by patients, and thus has reinforced the public's belief in free medical care as a right. The authors discuss the benefits to some patients of direct payment for services and emphasize the need for direct payment to remain an option under national health insurance.

On direct patient participation in the cost of their psychiatric care. Part I. A review of the empirical and experimental evidence.

In the midst of a sociopolitical debate regarding access to health services, an evaluation is required of the therapeutic impact of the direct participation by some patients in the cost of their psychiatric treatment. Empirical clinical concepts regarding the need for a direct payment of treatment by the patient have evolved. Initial rigorous practice systems have lead to more flexible methods allowing for the recognition of third-party financing. Psychoanalytic theory has addressed the issue most extensively, but other conceptual frameworks have reached similar conclusions as well. The experimental evidence to either support or refute the position that the direct payment of a fee has a beneficial effect on therapeutic outcome remains limited. The focus has been on studying the impact of fee manipulation, but a tested correlation of other motivators such as patient's insight, therapist's attitudes and behaviour and social pressures is mostly lacking. Two patient populations appear to be delineated. Fee participation is of particular value to the financially secure and to the educated while patients in need of less intensive involvement, with reality testing disturbance and limited insight benefit particularly from third party insurance. Different patient populations should have the right to choose different payment options.

Managed care and academic psychiatry.

Managed care, with its emphasis on cost effectiveness, case review, and treatment guidelines, has become a major influence on the delivery of mental health care and on the field of psychiatry. Given the importance of academic psychiatry in producing future psychiatrists and shaping their attitudes toward managed care, two separate surveys of chairs of 125 medical school departments of psychiatry were conducted. The surveys, completed in 1989-90 and 1991-92, indicate a trend toward accepting the usefulness and importance of managed care.