Effect of dietary amino acids on transfer ribonucleic acid charging levels in rat liver. In order to examine the mechanism of the effect of dietary amino acids on hepatic polysome aggregation and protein synthesis, tRNA charging levels (tRNA acylated with amino acids) were measured in the livers of rats meal-fed (trained to eat for 2 hours/day) a 15% casein diet at the high and low point of polysome aggregation, and of meal-fed and control-fed (ad libitum feeding from 1800 to 0800 hours) rats fed an isoleucine deficient diet. The charging levels of tRNAs for two of the amino acids tested, namely isoleucine and phenylalanine, did not drop with the diurnal changes that occur in polysome aggregation, whereas, the feeding of an isoleucine deficient diet resulted in a 25% decrease in the ile-tRNA charging levels. Although it is not clear how amino acid supply regulates polysome aggregation and protein synthesis, it would not appear to be mediated via a decrease in tRNA charging levels.


Trends in nonionizing electomagnetic radiation bioeffects research and related occupational health aspects. The international literature (circa 1970-1977) on biological and clinical phenomena associated with exposure to microwave or radiofrequency (RF) electromagnetic (EM) fields was selectively reviewed. It was concluded that the mechanisms by which EM fields exert their biological effects are becoming better understood as investigative technology and methodology improve. Concurrent with this trend, there is some recent eivdence in the West which supports traditional Soviet and some European claims that EM fields can affect nervous system function and morphology in small mammals, birds and invertebrates at power levels below those defined as thermogenic in the West. These experimental findings coupled with the pressure of public opition may eventually have a significant effect on the establishment of revised occupational exposure limits and on unique positions regarding maximum permissible exposure (MPE). At present, the exposure level established in the Soviet Union is 0.01 m W/cm2 for a work day, while the United States adheres to a level of 10 m W/cm2 averaged over 0.1 h. At the same time, however, findings from clinical studies conducted in the West do not corroborate findings from extensive clinical surveys of occupational workers collected in Russia and in some East European countries. The latter continue to report a plethora of psychophysiological dysfunctions and impairments of a reversible nature as a result of chronic exposure to EM fields of relatively low power density (e.g., less than 10 m W/cm2, and occasionally below the 1 m W/cm2 level). Neither is there any recent compelling evidence to support certain speculations that modulated EM fields can be used to remotely control human behavior. Interaction between the concerned research and development communities in the East and West has increased substantially in the 1970s. Such interaction promises to provide a medium in which differences in doctrine, experimental methodology and protocol, and the interpretation of biological and clinical phenomena may be resolved.


Potentially hazardous microwave radiation source--a review. An increasing proliferation of microwave sources and their continuously broadening scope of applications result in the necessity of an assessment of the potential radiation hazard in various situations. Recently, there has appeared quite a large number of references dealing with specific sources. This paper provides a review of various microwave radiation sources to assist in a general understanding of the basic characteristics of the sources which are pertinent to microwave radiation hazards.


Bladder assessment in the postpartum patient. Bladder assessment is a crucial function of the postpartum nurse. Information about the rationale for and the method of performing bladder assessment is meager in nursing literature as well as in other sources. The anatomical-physiological facts about the effects of pregnancy and delivery on the urinary tract are presented. Bladder distention and the methods of ascertaining it are described, along with ways to encourage voiding. The article also covers the issues of timing and volume of voidings of the postpartum patient.


The unwed pregnant adolescent: implications for the professional nurse. To promote better care fo the unwed pregnant adolescent, an overview of adolescent development, feelings, and behaviors is given, followed by a generalized description of the patient herself. Then, to help enhance the care given to this patient, who needs strong support and encouragement during this crucial time, the role of the nurse if outlined.


Contraceptive counseling for the younger adolescent woman: a suggested solution to the problem. The younger adolescent woman seeking contraceptive counseling presents clinicians with special problems specific to her age group. These include long-term physiological considerations plus psychological and social dynamics. An individualized clinic program, with emphasis on backup contraceptive methods, is suggested as a comprehensive solution.


Who helps? coping with the unexpected outcomes of pregnancy. Death in our obstetric and neonatal units causes grief, not only to the families of the patient, but to the nursing and medical staff. It is a primary duty of hospital administrators and nursing leaders to assist the staff to resolve their grief processes in order that they can more effectively support the bereaved. This article explores some effective means of providing such support to staff members through self-awareness and group sessions.


The first coital experience of one hundred women. A retrospective survey of the first coital experience of 100 women, with emphasis on the incidence of bleeding and pain, is reported. Eleven of the women interviewed had vaginismus on pelvic examination. The article includes a discussion of the etiology and treatment of vaginismus, as well as possible applications of survey findings in teaching and counseling patients.


Pain in labor: a conceptual model for intervention. A conceptual model, based on the Grantly Dick-Read fear-tension-pain cycle concept, for intervening in pain in labor is presented. The model can serve as a guide to help break the cycle and to establish a new cycle which operates on positive, rather than negative, forces, i.e., education, purposeful activity, and supportive care, each directed toward breaking a specific segment of the cycle. The conceptual model can be used in educational settings and as a tool for determining priority of focus for nursing intervention with the labor patient.


Group process and childbirth education: a position paper. Each childbirth education class has a group life of its own, and the responsibility for the group functioning is shared among all members. Experimental learning derived through group functioning has the potential for being as significant as the learning of specific skills. Formulating a contract between the teacher/leader and the members of the class can help in clarifying realistic objectives and goals. The teacher/leader can assist couples to learn new behavior and to confront their own feelings about becoming patents.


The mammography controversy: a case for breast self-examination. More and more nurses are held legally accountable for their practice. The mammography controversy and the directives in the NIH guidelines must be taken into account by nurses because of their implications for preventive health care and early detection of breast cancer. Mortality rates from breast cancer are high enough that the importance of regular, competent BSE by women cannot be overestimated. Nursing is in an ideal position within the health care delivery system to promote BSE. In the meantime, the answer to the question of whether to use mammography as a routine screening device for asymptomatic women under age 50 can only come from research that is designed to demonstrate the relative risks and benefits of the procedure for this age group.


Resistance of staphylococci to penicillin-G and cloxacillin. Staphylococcus aureus and epidermidis species from patient cultures and hospital environmental samples were studied for resistance to Penicillin-G and Cloxacillin, a penicillinase resistant penicillin. Only 4--7% of the 232 Staphylococcus aureus strains were sensitive to Penicillin-G; 40--41% were sensitive to Cloxacillin. Patient strains (57) of Staphylococcus epidermidis were sensitive to Penicillin-G in 29% and to Cloxacillin in 53% of the cases. The incidence of sensitivity of the hospital strains (50) of Staphylococcus epidermidis to Penicillin-G was 78% and to Cloxacillin was 93%. In view of their high resistance to Cloxacillin, the strains were evaluated for sensitivity to Gentamicin, an alternate choice for antibiotic therapy. Approximately 90% of the Staphylococcus aureus strains were sensitive to Gentamicin while 99% of the Staphylococcus epidermidis strains were sensitive. This study indicates that differences may exist in regard to antibiotic resistance patterns in various localities and this should be evaluated.


Cutaneous groin lesions.

Cutaneous groin lesions. The groin, the lowest portion of the abdominal wall near the junction with the thigh, is the site of a disproportionately large amount of dermatologic disease. Because of its close proximity to the genitalia it is the site of numerous sexually transmitted disorders. Maceration of the skin, which can occur quite readily in this area as the result of heat, perspiration, friction, and irritation, is a second factor enabling many cutaneous diseases to begin and to fluorish. This paper discusses the major cutaneous groin disorders with particular emphasis on practical diagnostic and therapeutic features.


Cutaneous lesions of sarcoidosis.

Cutaneous lesions of sarcoidosis. Sarcoidosis is a disease of varied clinical and dermatologic manifestations. The extent and severity of the skin lesions may be of value in the diagnosis and prognosis of the systemic disease.


Basal cell carcinoma: a practical approach to diagnosis and therapy. Basal cell carcinoma is the most common cancer of the skin, and the majority of those afflicted are elderly Caucasians with sun-damaged skin. Knowledge of the indications for and contraindications to the various treatment modalities is required in order to choose the proper treatment for each patient. Only long-term follow-up can detect recurrent or new lesions.


Squamous cell carcinoma of the skin.

Squamous cell carcinoma of the skin. Squamous cell carcinoma of the skin is not an uncommon problem. It is often accompanied or preceded by actinic keratoses, arsenical keratoses, or other skin cancers. The most common cause is exposure to sunlight. This paper will deal with squamous cell cancer of the skin and actinic keratoses.


Keratoacanthoma: clinical and therapeutic considerations. Keratoacanthoma is a rapidly growing tumor of the skin which causes concern to both the affected individual and the examining physician. In spite of its clinical and histological similarity to squamous cell carcinoma, the lesion has, as a rule, a benign course with spontaneous involution in a period of weeks to several months. Recognition of the lesion and familiarity with its biological behavior are indispensable for adequate management. The different types of tumor, complications, and therapy are discussed.


Primary cutaneous malignant melanoma: recognition, properties, and management. The fact that malignant melanoma occurs on a readily observable organ, the skin, and behaves in a predictable biological pattern in many cases suggests that its rate of cure should be high. Yet, despite advances in recognition and management, a significant percentage of patients still succumb to their disease. More sensitive methods of early detection and more effective therapies are required to improve survival.


Comparative in vivo activities of cefsulodin, sulbenicillin, and gentamicin against Pseudomonas aeruginosa. The in vivo activities of cefsulodin, sulbenicillin, and gentamicin were compared in mice infected intraperitoneally with Pseudomonas aeruginosa. In mice infected with sulbenicillin- and gentamicin-susceptible strains, cefsulodin was about 12 to 60 times more active than sulbenicillin and had an activity similar to gentamicin. In mice, the activity of cefsulodin was independent whether the strains were resistant to gentamicin or not, but it was considerably affected by resistance of the strains to sulbenicillin.


Liver enzyme induction by 1,1,1-trichloro-2,2-bis-(p-chlorophenyl)ethane (DDT) is accompanied by an increase in the specific activity of elongation factor 1. Homogenates of liver were obtained from control rats and from rats that had received DDT [1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane]. The postmicrosomal supernatant fractions were used for the purification of elongation factor 1 by hydroxyapatite chromatography and phosphocellulose chromarography. The amount of binding factor present was essentially the same for both groups of animals, but the specific activity, as measured by the binding assay, was about twice as high in the DDT-treated preparations. After sucrose-gradient sedimentation, the difference in specific activity was found to reside in the low-molecular-weight (50000) form of elongation factor 1. The implications of an increased reactivity of elongation factor 1 during the induction of membrane enzymes are discussed.


The rationale for a ban on detergent phosphate in the Great Lakes Basin. Immediate reduction of phosphorus loadings to the Great Lakes is essential to slow accelerated eutrophication. The Great Lakes National Program Office of the US Environmental Protection Agency now advocates adoption of bans on detergent phosphates as the most practical and feasible means of immediately reducing the phosphorus loadings to the Great Lakes. This change in policy from previous reliance on removal by sewage treatment has been adopted for the following reasons: (1) Bans on phosphates will reduce capital and operating costs of treatment and, were adopted, have met with consumer acceptance. (2) In practice, treatment plants have not met design expectations for phosphate removal. (3) Neither nitrilotriacetic acid nor other substitutes for phosphates have proved to be a public health problem. (4) Reduction of phosphorus loadings to treatment plants avoids increasing levels of chlorides and total dissolved solids in effluents. (5) Water quality has improved in small lakes with phosphorus reduction. In summary, detergent phosphate bans alone will not reduce phosphorus loadings to the Great Lakes sufficiently for the long term but the Environmental Protection Agency has concluded that such action is necessary in addition to continued efforts to control non-point sources.


Can the availability of phosphorus be critical for mankind? The biological cycle of phosphorus differs from that of other bulk elements in so far that the complete cycle has a long half-life. The cycle is described and man's inputs are analysed. The immediate problems are the inputs to the environment of phosphate through fertilizers and detergents, but the long-term problem is the availability of workable sources of phosphate.


Balance sheet for phosphorus in the UK.

Balance sheet for phosphorus in the UK. A balance sheet for the inputs, uses and outputs of phosphorus in the UK economy has been drawn up. The major import is fertilizer, amounting to about 200 kt P per year. After fertilizers, the other imports (in kt P) are in animal feeds (63), detergents (38) and human food (14). The major outputs are sewage (50), animal excreta (26) and refuse (21); soil losses are about 20 kt. The flowpaths for phosphorus through humans, animals and plants are described. The discrepancy of about 210 kt P/yr is explained by the fact that the amount of phosphorus in the soil increases each year by almost as much as the amount of fertilizer phosphorus added. In view of UK dependence on this imported resource it is suggested that priority is given to work which might eventually have some practical application in preventing or reversing the immobilization of phosphorus in the soil.


The use of phosphate in detergents and possible replacements for phosphate. About 5% of the total phosphate mined worldwide is used in detergents. The chemical form in which phosphate is used in detergents is predominantly pentasodium triphosphate (PSTP). The most significant feature for the use of PSTP in detergents is its ability to form soluble and strong complexes with calcium and magnesium ions. This provides a strong synergism with regard to detergency when PSTP is used in combination with synthetic surfactants. Other important features of PSTP are its ability to disperse dirt in the washing solution, its weak alkalinity, its crystalline form when dry (which enables production of crisp powders) and, last but not least, its toxicological acceptability. The development of PSTP for use in detergents has a history of over 25 years. In certain areas of highly developed countries where effluents from major centres of population can reach stagnant surface waters a rapid increase of eutrophication of these surface waters is observed. Phosphates are being recognized as one of the essential nutrients contributing to the eutrophication and detergents are one of the many sources of phosphate discharged to the environment. This is now causing demands for reduction in or even banning of the use of phosphates in detergents. Major reserach projects and some practical approaches to meeting these demands are described. The potential environmental impact of removing phosphate from detergents remains, however, doubtful, as it has been demonstrated in Sweden that phosphate removal by sewage treatment is the most effective measure to control phosphate discharges. This makes the case of phosphates in detergents an example of how science and technology can become entangled with politics.


[ECG changes in psychiatric patients under long-term therapy with psychopharmaca (author's transl)]. Within the scope of an epidemiologic study on risk factors and coronary heart diseases, 1726 mentally ill, aged 40-69, under permanent hospitalization were examined electrocardiographically. There were few pronounced indications of a relationship between pathological ECG findings and psychopharmaca. ECG changes were rarest among patients treated exclusively with non-tricyclic drugs, and most often among those patients who received tricyclics and non-tricyclics simultaneously. Statistically ascertained, however, was only the connection with lesser pathological changes in the rest and load ECG's (T-flattening). In this connection, these disturbances appeared more often among women. A reciprocal effect between sex and the influence of psychopharmaca appeared on the ECG. Contrary to males, females under treatment with tricyclica or with several psychopharmaca simultaneously showed more ECG changes than those treated without medication.


The rights of nurses.

The rights of nurses. The rights of nurses are those of all individuals in society. This paper examines some of the fundamental issues underlying the 'rights of nurses' in the context of the declaration of a belief in the inalienable rights of all members of society.


Attitudes and beliefs versus study results: exemplified by attrition in a school of nursing in Israel during 1968-1974. Head nurses and faculty members have their own beliefs on and attitudes towards the process of selecting candidates to schools of nursing. Many times these are based on impressions and/or everyday experiences that might have a crucial influence on perception of the issue. These impressions are not always verified when a study is conducted. This article reports on some of the issues and findings regarding attrition in one school for registered nurses in Israel during the years 1968-1974. It also describes what head nurses and faculty members thought to be valid criteria in the selection process, though findings revealed that things are not always as they are believed to be. For example, psychological tester recommendations were thought to be crucial in selecting candidates and preventing attrition, but no significant correlation was found between the recommendations and attrition. Head nurses thought that the main reason for attrition was dissatisfaction, although this was not found to be a stated reason. This belief of the head nurses should evidently be investigated. Findings support the author's belief that local studies are important and that faculty members and head nurses should communicate on the issue of student nurse selection and education.


Effect of hospitalization on weight of psychiatric patients. The hypothesis that patients hospitalized for long periods and receiving psychotrophic drugs increase in weight is tested, and it was discovered that women patients were somewhat heavier than their 'standard' weights. This, however, was not due to hospitalization or drug effects. Contrary to expectation, the ratio of observed/'standard' weight frequently observed in affective disorder patients, we discovered puzzling higher mean ratios in men with this illness. This paper shows that small research projects can be carried out by nurses who are actively involved in patient care. It also demonstrates that small scale investigations, replicating locally some other research, testing its validity in a different setting are eminently worthwhile.


Staphylococcus aureus endocarditis. Combined therapy with vancomycin and rifampin. Two children with persistent bacteremia and endocarditis due to Staphylococcus aureus failed to respond to vancomycin therapy, even though serum levels greatly exceeded the inhibitory concentrations. The Staphylococcus from one patient was resistant to methicillin; the other patient had a penicillin hypersensitivity. There was a wide disparity between the minimum inhibitory and the minimum bactericidal concentrations of vancomycin. Striking clinical and laboratory evidence of improvement was demonstrated with the addition of rifampin therapy.


Women with cured breast cancer a study of mastectomy patients in North Carolina. A study of 49 postmastectomy patients in North Carolina, four years following the surgery, revealed that the women did not feel they had been prepared for their postoperative experiences; were not, in general, familiar with Reach to Recovery as a supportive organization, nor perceived it as such; only occasionally examined their remaining breast; and had a number of persisting physical complications. The extent of physical disability was found to be related to the quality of life inasmuch as women with a high number of physical symptoms were much more likely to have a higher number of symptoms of depression than women with fewer complications. Social supports mediated the effects of surgical complications on mental outlook, but only up to a point. Sexual adaptation was found to be associated with the quality of the marital-sexual relationship and its importance to the woman.


Personality profile of pediatric nurse practitioners associated with role change. In a study of personality needs conducive to desired role change for nurse practitioners, 125 nursing students in a four-month pediatric nurse practitioner training program at Northeastern University, Boston, Massachusetts, were given the Edwards Personal Preference Schedule before and after the course. Students in the program were found to have needs associated with the assertiveness and flexibility required by the new role. Before and after training they were low in need for order, endurance, abasement, and deference and high in need for autonomy and aggression. During training, the need for order, endurance, and abasement decreased further. Inconsistent with this interpretation was the finding that students were actually lower in dominance and higher in succorance after training. The decrease in dominance may be related to the program's special emphasis on counseling; the high succorance at the end of the program may have resulted from the transitional state associated with leaving the program.


Baccalaureate nursing students' identification with the women's movement. To determine if nursing and nonnursing students changed their attitudes about themselves and the "typical nurse" in relation to feminist movement goals, results of 291 questionnaires were studied. A significant difference was found in the view of self and typical nurse for female nursing students, the nurses showing more feminist leanings as they progressed in school. Male nurses, nonnurses, and females in typical and atypical female majors rated themselves lower than female nurses on the feminist scale.


Relationship between loss of auditory and visual acuity and social disengagement in an aged population. When 122 residents, aged 58 to 95 years, of two public-high-rise dwellings were interviewed on the Social Lifespace Measure, Perceived Lifespace Measure, Role Count Measure, and Total Disengagement Index and given vision and auditory tests, no relationships were found among the variables. There were no relationships between the variables and age and sex. Implications for nursing are discussed.


Masculinity and femininity in nursing.

Masculinity and femininity in nursing. The concept of the "ideal nurse" was rated by 186 undergraduate and graduate nursing students on the 24-item Personal Attributes Questionnaire. PAQ contains independent subscales that measure masculinity and femininity as well as a bipolar subscale in which masculinity and femininity represent opposite endpoints on a single continuum. The ideal nurse was rated as being highly masculine, highly feminine, and midway between masculine and feminine endpoints on the bipolar subscale. Compared to undergraduate females, graduate and male nursing students rated the ideal nurse as being more masculine. Implications of these findings in the field of nursing are discussed.


A methodologic framework to study nurse-patient communication. Communicative interaction patterns among nurses and patients in a complex hospital setting were examined, using the methodologic framework, synchronology. Extensive videotaped time-series data of patient-health care personnel interactions, involving four patients admitted for elective surgery, were collected approximately 16 hours a day from admission to discharge and computerized in both mnemonic word form and numeric files. These interactional data were instrumental in the methodologic development. Communicative interaction is conceptualized as a dynamic, ongoing behavior process which can be studied by identifying the observed effects of presenting behaviors on the participants. The process is complex, contex-related, and multivariate in nature. Synchronology provides a structure for in-context description and analysis of the complex verbal and nonverbal interaction patterns, preservation of multivariate data, and identification of key concepts in human interaction which are of use in education, practice, and research.


Generalized expectancy, situational perception, and morale among institutionalized aged. This article was based on a larger study which sought to identify selected personality and situational variables that contribute to high morale of the institutionalized elderly. The relationship of generalized expectancy of control and perceived situational control to morale of the institutionalized aged was examined within a framework developed for the study. Locus of control, self-report, trust, self-rated health, and the Revised Philadelphia Geriatric Morale scales as well as a situational control of daily activities (SCDA) interview schedule were administered individually to 30 residents, aged 65 to 96, in four skilled nursing facilities. Congruence between internal orientation and self-determined SCDA resulted in higher morale than incongruence; however, congruence between external orientation and other-determined situations resulted in lower morale than incongruence.


Registration and voting participation of four faculty groups. This study compared registration and voting behavior of nursing faculty, male medical school faculty, female education school faculty, female music school faculty, and the general population of the voting area in the 1972 general election and all 1974 elections. The faculty groups voted in higher proportions than the general population. Nursing faculty registered at a higher rate than the other three faculty groups; nursing faculty voted more than music and education faculty and less or at the same rate as medical school faculty. The male medical faculty registered less frequently than the female faculty, but generally voted in larger percentages. The medical faculty were found to be more consistent voters. The fact that nursing faculty were largely of lower rank and younger age than the other three faculty groups was suggested as a factor in their lower voting consistency.


The Swan-Ganz catheter: a review.

The Swan-Ganz catheter: a review. Right heart catheterization, first reported in 1905, is now used for bedside assessment and management of the critically ill patient. A Swan-Ganz catheter and pulmonary artery pressure monitoring are the tools employed. In spite of the complications cited, the occurrence of hazard to the patient is infrequent. The catheter is particularly valuable in the hemodynamic evaluation of cardiac function. Right and left heart pump performance can be assessed by pressure measurements. The ability of the left heart to provide an adequate cardiac output can be numerically calculated, and its adequacy at a cellular level can be evaluated by determining arterial-venous oxygen saturation difference. One of the more important and newest uses of the Swan-Ganz catheter is the preventive function it plays in anesthesia administration. Implications of the Swan-Ganz catheter for nursing practice are: (1) explanation and support to patient and family; (2) technical understanding and knowledge of set-up; (3) care and maintenance of the catheter after insertion; (4) the understanding of physiologic principles underlying the use of the catheter; and, most important, (5) ability to correlate clinical observations and physiologic changes occurring in the patient with pressure measurements.


Temporary cardiac pacing: causes, recognition, and management of failure to pace. Proper management of temporary cardiac pacing is based on the knowledge of the system's vulnerable points and the practice of preventive maintenance measures. This article has described emergency measures for and systematic analysis of pacing failure keyed by the presence or absence of pacing spikes, as well as the correction of such failures. The authors have addressed only one aspect of pacing failure, however. The reader is also encouraged to become familiar with sensing failure and the complications of insertion of pacing catheters.


Monitoring cardiovascular status with noninvasive techniques. Useful information regarding a patient's cardiovascular status can be gained through noninvasive monitoring techniques. Health assessment skills developed over a period of time by the nursing practitioner will aid in identifying problems, planning care, and understanding the total patient profile more comprehensively.


Twenty-four hours ambulatory monitoring: a new electrocardiographic tool. In summary, this author has been able to assist in alerting the physician to the critical findings of his patients' cardiac analyses so that immediate medical intervention could be initiated. The implications for such a tool are far-reaching. Heart disease is still America's number one killer, but with devices such as this one, advances are being made to undermine its life-threatening effects.


Nursing interventions with obese cardiac patients. There is much conflicting data and many opinions regarding the relationship between obesity and cardiovascular disease. The best information shows that there is a relationship between multiple factors and cardiac problems. Nurses need to assist patient populations to assess their learning needs and should present material regarding multiple risk according to those needs. Classification of patient status as primary, secondary, or tertiary can assist in this process. Nurses need to help fill the void in proven data in this area by conducting longitudinal research into multiple risk factors and a variety of interventions.


A coronary teaching program in a community hospital. In conclusion, the teaching program we developed appears to meet the needs originally established by the audit. Nurses are provided with a method of assessment, evaluation, and documentation. The program also provides a means of teaching continuity while following a structured time schedule that allows for recognition and satisfaction of individual patient needs. The patient teaching record provides the final tool as a reference and ongoing source of evaluation.


Intra-aortic balloon pumping: concepts and patient care. Definite indications for intra-aortic balloon support include cardiogenic shock (with or without complicating mechanical defects) following acute myocardial infarction, unstable angina pectoris refractory to medical therapy, and left ventricular failure following cardiopulmonary bypass. Balloon effectiveness is based upon diastolic augmentation and reduction of left ventricular pressures and work load, as well as an increase in coronary artery perfusion pressure. The highly skilled nursing management required by the patient with balloon assist is based upon the nursing process principles of assessment, planning, implementation, and evaluation, combined with a thorough knowledge of cardiovascular and other integral systems and balloon function and physiology.


Chest trauma.

Chest trauma. For any patient with obvious or suspected chest trauma, one must first assure an adequate airway and adequate ventilation. One should never hesitate to administer oxygen to a victim with a chest injury. The nurse should be concerned with adequate circulation--this may mean the administration of intravenous fluids, specifically volume expanders, via large-bore cannulae. Any obvious open chest wound should be sealed, and any fractures should be splinted. These patients should be rapidly transported to the nearest Emergency Department capable of handling this type of injury. The majority of patients who arrive in the Emergency Department following blunt or penetrating trauma should be considered to be in critical condition until proven otherwise. On presentation, it is essential to recognize those signs, symptoms, and laboratory values that identify the patient's condition as life-threatening. Simple recognition of these signs and symptoms and early appropriate intervention may alter an otherwise fatal outcome.


Aphasia: providing better nursing care.

Aphasia: providing better nursing care. The ability to communicate affects the total person and penetrates nearly every aspects of living. To best assist those persons experiencing language loss, the nurse needs to gain basic knowledge about the types of aphasia and about techniques to guide these persons in regaining communication skills that promote self-care. For the aphasic, relearning each small step in communication is a triumph. It is hoped that we can aid these individuals in experiencing many triumphs.


Pituitary stalk-section and some of its effects on endocrine function in the fetal lamb. A detailed description is given of a method to section the pituitary stalk of the fetal lamb after 105 days gestational age. The approach to the stalk is made through a window in the frontal bone. In order to prevent regeneration of the hypothalamo-pituitary connections a silicone plate is introduced through the probe used to fracture the stalk. The surgical outcome and viability of 11 pituitary stalk sectioned fetuses is described over periods of up to 23 days. The presence of pituitary infarction following stalk section was related to damage of the anterior hypophysial vesssels if the probe was deviated from the mid-line at any time in its course. The effect of this procedure on fetal plasma T4 and PRL concentrations and the initiation of premature labour by the continuous infusion of cortisol into the fetus is described.


Mechanism of hypothalamic control of cardiac component of sinus nerve reflex. The modulatory influence of hypothalamic structures on sinus nerve induced bradycardia was investigated in anaesthetized cats. Stimulation of the hypothalamic defence area inhibits the bradycardia produced by sinus nerve stimulation both in intact animals and also in animals with the spinal cord sectioned at C1 or C6. This inhibition was accompanied in the normal animal by an increased sympathetic discharge and by a sustained inspiration or tachypnoea. The same respiratory effects were noted in a spontaneously breathing C6 spinal animal, while an artificially ventilated C1 spinal animal still displayed a powerful central inspiratory drive in its recurrent laryngeal electroneurogram. The presence of central inspiratory activity was found to be an absolute impediment to the development of bradycardia. If this activity was eliminated by simultaneous stimulation of the superior laryngeal nerve, it was possible to obtain bradycardia during combined sinus nerve and hypothalamic defence area stimulation, though this bradycardia was modified by the presence of sympathetic discharge. The level of sympathetic neural discharge affects the magnitude of the bradycardia produced by sinus nerve stimulation. The bradycardia was less with normal or augmented level of sympathetic activity and was greater if this activity was reduced or absent. A lesion just caudal to the mammillary bodies disclosed a tonic hypothalamic influence both on respiration and on sympathetic discharge; stimulation of the sinus nerve produced a much more powerful bradycardia after the lesion. The existence of a respiratory "gate" through which afferent stimuli pass on their way to the nucleus ambiguus, and which can be operated by the hypothalamic defence and depressor areas, is postulated and discussed.


Effects of bile salts on the motor activity of the guinea-pig gall-bladder in vitro. Intra-luminal pressures were measured in in vitro preparations of the guinea-pig gall bladder. Intrinsic tone and spontaneous activity were recorded together with the response of the gall-bladder to Pancreozymin. The effect of the presence of a variety of conjugated and unconjugated bile salts in the luminal fluid [pH 7.4] was studied. Sodium deoxycholate and sodium chenodeoxycholate had in inhibitory effect on motor activity at concentrations as low as 6.0 times 10(-6) mol. 1(-1) Sodium taurocholate at a concentration of 3 times 10(-3) mol. 1(-1) promoted regular spontaneous activity. The results are discussed in relation to their possible physiological, pathological and pharmacological implications.


Cardiac output during submaximal exercise in New Guineans: the relation with body size and habitat. Cardiac performance in moderate bicycle exercise has been measured in five groups of New Guineans (N = 161). Men and women in both coastal and highland (2000 m) locations were studied, as well as a group of highland men after migration to the coast. The results have all been standardized to an oxygen consumption of 1 1.min(-1). Cardiac output values are similar to those previously quoted for Europeans; a significant positive correlation with body size is found, and resident highlanders appear to have slightly larger cardiac outputs (+4%) and larger stroke volumes (+10%) after adjustment for body size, but this is not because they have larger hearts. The highland migrants at sea-level share none of the 'altitude' characteristics of the highland residents and, after size-adjustment, correspond with the lowlanders. The cardiac frequencies of the lowland women are higher than the other groups (+15 beats.min(-1)) after adjustment for differences in body size. Their values are close to those found previously for moderately active Europeans, while all the other New Guinean subjects have lower cardiac frequencies probably because of their greater habitual activity.


In vitro and in vivo evaluation of benzamidomethyl-benzylpenicillinate (FI7303). A new 'repository' form. A new type of hydrolyzable ester of penicillin G, benzamidomethyl benzylpenicillinate (FI 7303), was studied for the antibacterial activity and kinetics of absorption in comparison with DBED-penicillin G. FI 7303 resulted to be a good repository form of penicillin G, slowly eliminated in mouse, dog and man. It exerted a remarkable therapeutic activity in mice infected with Staphylococcus aureus even when administered 26 h before infection. The protective effect in mice was more prolonged than that of DBED-penicillin G, in agreement with the longer persistence of significant blood levels.


Metabolism of glycosides by Pseudomonas maltophilia. A study of the abilities of 23 strains of Pseudomonas maltophilia to hydrolyze synthetically-prepared and naturally-occurring glycosides is presented. Direct detection of liberated aglycones was used to determine hydrolysis of the five most-commonly-used glycosides (amygdalin, arbutin, esculin, ONPG (o-nitrophenyl-beta-d-galactoside), and salicin). The capabilities of the strain for acid production from 17 glycoside substrates were also determined using a medium designed to minimize the production of acid-neutralizing end-products from peptones.


Ventricular tachycardia-flutter associated with disopyramide therapy: a report of three cases. Three patients developed episodes of ventricular tachycardia and/or flutter-fibrillation while receiving disopyramide (Norpace). Syncope was the presenting complaint in all of them. The arrhythmias did not recur after disopyramide was discontinued. The Q-T interval was markedly prolonged in all three patients. One patient developed syncope associated with both quinidine and Norpace therapy. It is postulated that disopyramide, like quinidine, may provoke ventricular flutter-fibrillation in sensitive patients by similar mechanisms.


Unilateral vascular plethora--a sign in advanced unilateral basal bronchiectasis. Unilateral basal bronchiectasis results in a regional high vascular pressure and the flow of blood is thereby diverted to the uninvolved portion of the lung through bronchopulmonary anastomoses. Unilateral plethora of the upper lobe vessels in significant basal bronchiectasis of the same lung constitutes an important additional sign in the recognition of bronchiectasis on the plain chest radiograph. Attention is drawn to the fact that this will not occur if the adjacent lung is compromised by a related or unrelated disease process.


Wolff-Parkinson-White syndrome mimicking myocardial infarction: unmasking by means of rapid atrial pacing. A patient is presented who had Q waves in Leads II, III, and aVF suggestive of inferior myocardial infarction. Despite a normal P-R interval, Wolff-Parkinson-White syndrome was suspected because of an abnormal delta wave-type QRS configuration. By means of rapid atrial pacing the accessory pathway was blocked, and the QRS complex was temporarily normalized. The abnormal Q waves disappeared, removing the suspicion of infarction. Rapid atrial pacing is a simple procedure that is recommended for clarifying the electrocardiographic diagnosis when WPW syndrome is suspected.


Cardiac rehabilitation in the coronary care unit. Part II. The rehabilitation of the complicated-MI patient in the CCU should consist of early use of the bedside chair and progressive activity with the level and rate of advancement determined by frequent assessment of the clinical state. Patient education is an important part of the rehabilitation program, especially in the patient with complicated MI.


Laetrile--an overview.

Laetrile--an overview. The original theory in the 1920s on the mode of action of Laetrile is described along with the research that followed in light of this theory. For over 40 years, studies were conducted, using test animals, in an attempt to substantiate the theory. All of these studies have shown Laetrile does not preferentially kill cancer cells. In spite of these studies, the misconception persists that Laetrile prevents and cures cancer. The legal and socioeconomic implications of Laetrile are examined and the role of health education in combating this problem is explored.


The relevance of health education to health activation and self-care. Contemporary medical care is a valuable but incomplete approach to health. The individual is coming to be recognized by many providers and consumers of health care alike as the primary health care resource, and individual behaviors and lifestyles are now recognized as the principle determinants of health. A new trend toward health activation is emerging which emphasizes self-care and self-help. This movement is transforming the traditionally passive patient into an active, informed and effective participant in health care and health promotion. The recent interest in programs designed to enhance self-care skills is extremely relevant to health education in the schools and the community. The prime justification of health education has traditionally been one of promoting individual responsibility for generating and maintaining health. Integration of health education concepts may have an overall effect of enhancing health in the United States.


Parental attendance at a school dental program: its impact upon the dental behavior of the children. The Okanagan dental health team invited parents of kindergarten children to attend an educational and brush-in session of the school dental program. This included actively participating in the brush-in. In four school districts, data were compiled comparing children whose parents attending with children whose parents did not. Behavioral variables compared included dental visits, routine oral hygiene, and the use of fluoride paste and rinse at the sessions. Dental exams both a priori and a posteriori allowed an assessment of the dentition and gingival tissue of both groups. Results showed a significantly greater improvement in both the dental behavior and dental health of the children whose parents attended the session. These results give valid evidence to the advantage of involving parents in a school based dental program.


An evaluation model for school health services. The following article represents a summary of a study conducted during the 1976-77 school year in Virginia. The investigation was an attempt to describe some characteristics of school health services around the Commonwealth. The study also provided an opportunity to implement an evaluation model designed specifically for the Virginia situation, but its flexibility allows for modification in order to meet the evaluation needs of other school populations.


Persuasion and coercion for health: ethical issues in government efforts to change life-styles. What should be government's role in promoting the kinds of personal behavior that lead to long life and good health! Mild measures of education and exhortation may be ineffective; imposition of stronger coercive actions may be unacceptable. Philosophical and social principles involved are complex, and threats to freedom can be averted through an understanding of moral justification for any intrusion.


Single and combination antibiotic therapy of Staphylococcus aureus experimental endocarditis: emergence of gentamicin-resistant mutants. The efficacy of nafcillin and gentamicin used alone and in combination at doses giving serum concentrations comparable to those achieved in patients was studied in rabbits with experimental Staphylococcus aureus endocarditis. The organism used was a penicillinase-producing, methicillin-susceptible, clinical isolate. The addition of gentamicin to nafcillin significantly increased the rate of killing of organisms in valvular vegetations, compared to the effect of nafcillin alone. Gentamicin alone delayed mortality but was not effective in reducing the bacterial populations of the vegetations. Bacteremia persisted in the animals treated with gentamicin alone, in contrast to the groups treated with nafcillin or the combination. Selection of a subpopulation of aminoglycoside-resistant small-colony variants occurred in animals treated with gentamicin alone. This variant was subsequently employed in the rabbit model and produced endocarditis, metastatic infection, and bacteremia comparable to those caused by the parent strain. Animals with infection produced by the variant died later than animals infected by the parent strain. Nafcillin was equally effective in reducing the population of both parent and variant strains in vitro and in therapy of the infected animals. Population studies showed the variant to be a mutant emerging at a rate of 1.9 x 10(-7). It was shown to differ from the parent strain in coagulase and hemolysin production, colonial morphology, and aminoglycoside susceptibility, but was similar by light and electron microscopy and in phage type, pigmentation of colonies, deoxyribonuclease production, mannitol fermentation, and growth rate.


Upper extremity total joint replacement. Current techniques of total joint replacement surgically correct badly destroyed joints by the insertion of plastic and metal components, which are secured to the skeleton by methylmethacrylate cement. This approach began in England in 1962 and in the United States in 1967. Recent development in the field of upper extremity joint replacement allow implementation of refined total shoulder, elbow, and wrist prostheses. Although less experience has been gained with these prostheses than with total hip and knee replacements, preliminary results are encouraging.


The role of guanine nucleotides in the interaction between aminoacyl-tRNA and elongation factor 1 of Artemia salina. The low-molecular-weight form of elongation factor 1 (EF-1L) of the cysts of the brine shrimp Artemia salina and [3H]phenylalanyl-tRNA are able to form a stable complex which can be isolated on a Sephacryl S200 column. The formation of this complex is inhibited by increasing concentrations of magnesium acetate and KCl. Furthermore, the formation of this complex is independent of the presence of guanine nucleotides. Complex formation between EF-1L and phenylalanyl-tRNA appears to be specific, since acylation of the tRNA is a necessity for this interaction. Although EF-1L alone binds GDP somewhat more strongly than GTP, the complex between EF-1L and phenylalanyl-tRNA binds GTP exclusively. Our results support the idea that complex formation between EF-1L and aminoacyl-tRNA precedes the enzymatic binding of aminoacyl-tRNA to the 80-S ribosome. Subsequently to this binding, release of EF-1L from the ribosome occurs.


[Anti-smoking therapy (author's transl)]. This is a comprehensive survey of the different anti-smoking therapies indicating the difficulty of comparing one method to another. It points out the minimum standard to be set for anti-smoking therapies. Reference is also made to advantages and disadvantages of the different kinds of treatment. The account of anti-smoking therapies includes hypnosis, aversion therapies, anti-smoking clinics, medical treatment, polyeclectrical and other methods of therapy. Detailed description is especially to be found of the behavior therapy. Eleven different techniques of the multimodal behavior treatment are presented. Finally consideration is given to the need of anti-smoking therapies, prevention from smoking as well as prophylaxis against relapse.


[The influence of German speaking psychiatrists and neurologists in Northamerica and England (author's transl)]. The influence of German speaking psychiatrists has been quite remarkable in many countries. The German-Swiss Adolf Meyer placed the emphasis of his "psychobiological" school on psychodynamics a fact which opened the way for psychoanalysis. Those who had been invited to the Cnited States prior to 1933 like Franz Alexander and Sandor Rado, were followed by a great number of immigrants mostly from Vienna and Berlin. Representatives of nonanalytical psychiatry were the genetic psychiatrist Franz Kallmann and pioneers of somatic treatments like Sakel and Meduna. Prominent among neurologists coming from Germany to the United States were Kurt Goldstein, Hauptmann, Hans Strauss and Wartenberg. In England Mayer-Gross and Erich Guttmann exerted great influence. It seems that especially in Psychiatry the effort of so many representatives of our specialty in other countries has helped to promote international exchanges which formerly were missing.


Ventricular fibrillation in Wolff-Parkinson-White syndrome, type A. A young individual who developed ventricular fibrillation following atrial fibrillation in the WPW syndrome is presented. The precise cardiac rhythm diagnosis is extremely important for proper management. When the QRS morphology is bizarre and the ventricular rate is very fast (200 to 300 b.p.m.) in atrial fibrillation, the WPW syndrome should be considered as the underlying disorder. Digitalis should be avoided in this circumstance because anomalous conduction may be accelerated by the drug, leading to deterioration of the clinical picture and even death. When an antiarrhythmic drug is to be used, intravenous lidocaine is the drug of choice. For the prophylactic measure, oral quinidine or procainamide is equally effective for atrial fibrillation with anomalous conduction in the WPW syndrome.


Sexual activity in exercising patients after myocardial infarction and revascularization. In order to evaluate the effects of exercise training on coital habits after myocardial infarction and revascularization, questionnaires were mailed to 130 patients enrolled in a gymnasium exercise program. Of 87 (67%) responding, 68 had experienced myocardial infarction and 19 had undergone myocardial revascularization. The postinfarction group significantly decreased their frequency of coitus after infarction by 28%; the revascularization group, however, decreased activity by only 10%. The myocardial infarction group waited 9.4 weeks after infarction to resume sexual intercourse, while the revascularization group waited a mean of only 5.7 weeks. These data suggest that physically trained post-myocardial infarction patients decrease frequency of coitus significantly more than physically trained patients with myocardial revascularization. The overall decrease, however, is notably less than that reported in nontrained post-myocardial infarction patients and suggests a "bedroom benefit" of medically supervised exercise in selected patients after infarction or revascularization.


Exercise stress testing in the patient with coronary artery disease. Part I. Treadmill cardiac stress tests have a number of well known, identifiable criteria for positivity. One that is less known and thus often not appreciated, is the appearance of an inverted U wave in the left chest leads at the peak of exercise. This, even as an isolated finding, indicates a positive test. Of clinical significance is that this electrocardiographic response to a stress test is associated with an isolated lesion of the left anterior descending coronary artery.


A review of microwave oven safety.

A review of microwave oven safety. The microwave leakage from current microwave ovens, which are manufactured to meet government emission standards, is reviewed. Typical leakage values imply exposure values well below the most conservative exposure standards in the world. A review of recent developments discloses increasingly stringent government regulation along with advances in techniques for suppression of microwave leakage. The nature of the leakage field is described and studies relating emission to exposure are reviewed. Field survey data are reviewed and it is found that the overwhelming majority of certified ovens in the field show leakage well below permissible limits with an increasing degree of certainty as time goes on. The conclusion is that microwave ovens are not only just as safe as they were in 1973 but they are being accepted as safe under essentially equivalent emission regulations in various countries including those in Eastern Europe.


Effects of dietary choline and N,N-dimethylaminoethanol on lung phospholipid and surfactant of newborn rats. Pups delivered by rats fed during pregnancy a choline-deficient (CD) diet containing 1% N,N-dimethylaminoethanol (DME) die within 36 hr of birth. The concentrations of sphingomyelins, phosphatidyl cholines, and disaturated phosphatidyl cholines in the lungs of these pups are lower than those in the lungs of pups delivered by dams fed a choline-supplemented diet (CS). The amount of surfactant isolated from the lung of the pups was also reduced. These changes were accompanied by alterations in the activity of enzymes (choline kinase, EC 2.7.1.32; choline phosphotransferase, EC 2.7.8.2) involved in the synthesis of lung lecithins. These results strongly suggest that pups delivered by dams fed a CD diet containg 1% DME die of respiratory distress syndrome due to altered metabolism of lung surfactant.


Nursing care of oncology patients receiving chemotherapy. As part of a research effort directed at identifying specific nursing activities related to the subsequent health status of the patient, this study explored relationships between selected nursing activities and patient outcomes for the oncology patient who was receiving chemotherapy. The study was correlational in design and descriptive in nature. Included in the study were 57 subjects from oncology and/or medical units in public and private nonprofit general hospitals. Human subjects' clearance was obtained for the study in each participating hospital. Data were collected primarily by means of patient and nurse responses to self-administered questionnaires. In the initial phase of data analysis, zero-order correlations were obtained for each pair of nursing activity and patient outcome variables. In addition, to identify relative contributions of different nursing activities to the health status of patients, regression analyses were performed in selected situations. The content and the quality of the explanation of the treatment and care regime were observed to be correlated positively with the patient's self-esteem. The quality of the explanation was observed to be positively related to the patient's knowledge base. Involving the patient in his care plan and giving him control over the activities of the day were positively correlated with importance of having things explained to him.


Evaluating the performance of nurses: a multidimensional approach. This article describes the development--including content, structure, validity, and reliability--of the Six-dimension Scale of Nursing Performance (Six-D Scale), which consists of a series of 52 nurse behaviors grouped into six performance subscales: leadership (5 items), critical care (7 items), teaching/collaboration (11 items), planning/evaluation (7 items), interpersonal relations/communications (12 items), and professional development (10 items). The scale may be used to obtain self-appraisals of performance, employer appraisals of performance, or perceived adequacy of nursing school preparation for performance. The case is made for the construct and pragmatic validity of the Six-D Scale, and all six subscales are shown to be highly reliable. The instrument was found to be suitable for performance evaluation as well as a useful research tool.


Status consistency and nurses' expectations and perceptions of role performance. To determine if behavior of individuals at various levels within a profession may be predicted, relationship between expectations and perceptions of role performance among nurses and status consistency and status inconsistency was investigated. Two variables were selected as the best predictors in regression analysis of the scores for expectations and perceptions: type of basic nursing program from which a subject graduated and type of status consistency of the subject. Of the three variables--education, position, and income--education was the most important for determining status consistency. This study supported the conclusion that a significant relationship exists between expectations and perceptions of role behavior and status consistency.


Development of a research tool: Patient Indicators of Nursing Care. A tool, Patient Indicators of Nursing Care, was designed to measure quality of nursing care, defined in this study as prevention of nursing care complications. Nursing-accountable complications are seen as the presence of negative patient care outcomes as evidenced by observable physiologic indicators. A negative outcome results when either an observed indicator which was present at admission remains evident up to seven days postadmission or an absent indicator becomes evident during this time period. PINC is a 24-item list. Th list is first administered up to 48 hours postadmission; the second administration takes place between five and seven days postadmission. Scoring of PINC is based on the idea that four important presence-absence conditions exist and that each represents a value of quality of nursing care. Split-half reliability was computed for PINC, based on a sample of 124 patients from four hospital settings. The Spearman-Brown reliability coefficient was .871. An item analysis was accomplished by computing the correlation of each item with the total score. The computed correlation of .797 was a measure of interrater agreement. Face validity was established early in the test development by having the investigators judge the items in terms of observability, availability, and credibility. Predictive validity was not explicity examined although a major difference in PINC scores was found between critical care patients and other groups.


Relationship between length of time and contamination in open intravenous solutions. This study investigated rate of contamination in simulated in-use intravenous solutions to obtain data from which to recommend a standard time period for the administration of intravenous solutions. Although the Center for Disease Control and many medical institutions have recommended that all bottles of in-use intravenous solutions be changed every 24 hours, there are no published data to support the 24-hour standard. In this study, samples were drawn from 80 bottles of Ringer's Lactate solution at predetermined time intervals over 48 hours and cultured on blood agar plates to determine rate of contamination. A low incidence of intravenous solution contamination was found at all time periods. Of 430 total samples, only 12 (2.8%) were contaminated. Results of this study did not indicate a significant relationship between time and contamination of simulated in-use intravenous solutions. Therefore, contamination that does occur within 48 hours in intravenous solutions must be introduced from some exogenous source. Further research is required to elucidate exogenous sources of contamination. In the meantime, it can be concluded, the 24-hour standard is adequate to protect against contamination that would occur solely from preparation of the intravenous solution for administration.


Correlation of chest roentgenology and lung physiology. Most disease states giving rise to pulmonary symptoms represent a composite of physiologic changes involving ventilation and perfusion. The major initial physiologic abnormality is identified for a number of problems commonly encountered.


Preoperative evaluation of patients with bronchogenic carcinoma. The preoperative evaluation of patients with suspected or proven bronchogenic carcinoma is directed at establishing the diagnosis, the extent of disease, and the ability of the patient to withstand the removal of lung tissue. The diagnosis may not be established until thoracotomy, but sputum cytologies or specimens taken at the time of fiberoptic bronchoscopy may diagnose a malignant process preoperatively.


Pulmonary embolism: dilemmas in diagnosis and therapy. Pulmonary embolism is unique among cardiorespiratory diseases because of its high frequency of both overdiagnosis and underdiagnosis. The lack of specific and consistent clinical, laboratory, roentgen, and electrocardiographic features lead to this paradox. While the lung scan may be diagnostic in selected cases, the pulmonary angiogram is the most accurate method of demonstrating emoboli short of operative or pathological examination.


Nuclear medicine procedures in diagnosis of pulmonary diseases. Nuclear medicine studies make it possible to identify areas within the lung where ventilation/perfusion changes have occurred, and allow precise quantification of the regional distribution of ventilation and perfusion.


Aspiration pneumonia and anaerobic lung infections. Anaerobic organisms and their role in pleuropulmonary infections have been recognized with increased frequency with advances in diagnostic techniques. Valuable clinical, microbiologic and radiologic clues exist and are extremely useful in the diagnosis and treatment of such infections.


Pulmonary infections in the compromised host. Immunocompromised hosts are predisposed to pulmonary infection with a wide variety of pathogens. A cooperative team effort is recommended to complete, in stepwise fashion, the procedures necessary to establish the specific cause of pulmonary infiltrates in the compromised host. The diagnostic approach needs to be individualized, and will depend in part on the urgency of the clinical situation and the skills available at the institution providing treatment.


Acute respiratory failure: an approach to diagnosis and management. Acute respiratory failure can be diagnosed using clinical judgment and simple bedside measurement of physiologic function. Respiratory support is based on the pathophysiology of the disorder. Initial therapy is directed at correcting life-threatening hypercapnia, hypoxia, and acidosis. The final outcome is positively influenced by skillful intensive care and a team approach.


Chest trauma.

Chest trauma. Direct or secondary injury to the organs in the chest not only present the physician with a structural problem but will set up a situation where his knowledge of cardiopulmonary physiology is tested. Although major operative repair is usually not needed, procrastination and failure to meticulously treat even what appears to be a minor injury may result in rapid death or prolonged morbidity.


Methicillin-resistant Staphylococcus epidermidis. Staphylococcus epidermidis is frequently associated with infection of prosthetic heart valves, prosthetic orthopedic devices, and neurosurgical shunts. Penicillinase-resistant semisynthetic penicillins, such as methicillin, have been the therapeutic and prophylactic agents of choice for S epidermidis infection. However, more S epidermidis isolates are now resistant to methicillin and other penicillins. In our laboratory 41% of S epidermidis isolates were resistant to methici-lin. All of the methicillin-susceptible isolates and 82% of the methicillin-resistant isoates were susceptible to cephalothin. Cephalothin should replace methicillin as the prophylactic and therapeutic agent of choice in institutions with a high percentage of methicillin-resistant S epidermidis.


New developments in antibiotics. Future clinical studies for the National Institute of Allergy and Infectious Diseases. The classes of anti-infective agents and the numbers in each class that are currently available and in use in the United States are listed, and current activity with respect to discovery and development of new drugs in the most widely used categories is briefly reviewed. Fifteen major areas for future research in the therapy and control of infectious diseases are recommended, and the relative roles for industry, academic and clinical investigators, and government (National Institute of Allergy and Infectious Diseases) in these areas are discussed. There are many problems requiring extensive research and financial support.


A method for neurological evaluation within the first year of life: experience with full-term newborn infants with birth injury. In a prospective study undertaken at Port-Royal Maternity Hospital, Paris, 1785 deliveries were studied during a 15-month period. Signs of cerebral dysfunction were observed in 57 newborn infants--mild signs in 38 infants, moderate in 17, severe in 2. There was a high incidence of abnormal labour in 28 of these 57 infants (50%) (dysfunctional labour patterns without obvious cephalopelvic disproportion, including false labour, prolonged active-phase dilatation, (prolonged descent, marked caput succedaneum). During the first year of life, 30 of the 57 infants were followed. In 14 of the 30 infants transitory abnormalities were observed. In five infants abnormalities persisted at the end of the first year. Eleven infants were normal throughout the first year. In another study the incidence of cerebral symptoms at birth was compared in full-term infants born in 1974 and those born in 1976. Thirteen infants with moderate and severe symptoms were observed out of 1578 deliveries during 1974 and five out of 1934 deliveries during 1976, the incidence of Caesarean section necessitated by acute fetal distress being the same in both groups. This decreasing percentage of complications appears to be linked with improving care, including more widespread use of fetal monitoring.


Aetiology of severe handicapping conditions in early childhood. The hypothesis that the incidence of major childhood handicap could be significantly reduced by an increase in the availability of intensive care facilities for newborn babies has been considered in an examination of possible aetiological factors in 128 young children with mental and/or neurological handicaps referred to the Armitstead Child Development Centre, Dundee, 1973-77. Thirty-three children suffered from primary mental retardation; adverse perinatal factors were possibly implicated in one case. Low birth weight was considered to be the primary aetiological factor in 23 of 73 children with cerebral palsy +/- mental retardation and in 13 with other adverse perinatal factors. Moderate or severe neonatal complications were reported for 37% but in 27% complications were likely to have resulted from existing brain damage or abnormality. Available evidence suggested that early embryonic origin of handicap was most likely in three-quarters of cases of primary mental retardation, and in one-third of cases of cerebral palsy. Severity of handicap in children with cerebral palsy was significantly increased in those whose handicaps had a prenatal origin. Of this selected group of handicapped children (cerebral palsy being over-represented), adverse perinatal factors may have caused or exacerbated existing brain damage in, at most, one-third.


ABCs of perinatal medicine.

ABCs of perinatal medicine. The purpose of this paper is to illustrate the continuum of perinatal risks responsible for developmental handicaps in infancy. The first step is the Assessment of risks during pregnancy so that intervention can occur naturally in the process of preventive health care. A valid risk-assessment system has been developed which can facilitate identification of the high-risk pregnancy. New methods of perinatal care during the Birth process are now available which allow active intervention aimed at reducing the likelihood of a high-risk patient delivering an infant destined to become handicapped. During the neonatal period Critical care has been shown to reduce morbidity and mortality. However, the perinatal profile of the handicap is not yet complete enough to fully explain developmental delay. A new health care strategy based on prospective risk assessment and early intervention must now be seriously considered which will allow technological medicine to continue to improve well-being.


Neonatal intensive care and the prevention of major handicap. During the past 20 years there has been a great increase in the understanding of deranged physiological mechanisms in certain groups of newborn infants that were, in the past, at high risk for death or major handicap. Much information of direct clinical relevance has come from the study of experimental animals, particularly about the changes that occur in the lungs and circulation at birth. Work in progress on an animal model of intraventricular haemorrhage suggests that this, like many other causes of brain damage, is a potentially preventable condition. Technological advances, such as continuous blood-gas analysis, make the prevention of handicapping conditions simpler, but the application of modern methods can be expensive. Current evidence shows that neonatal intensive care saves lives, and that the incidence of major handicap in the survivors is reduced. Society will have to decide how much money should be put into this area of medicine, and it will also have to help neonatal paediatricians with the difficult ethical dilemmas that they are now having to face.


[Preventive drug therapy against anaerobic bacteria]. Anaerobic organisms can found normally in be normally major i.e. the upper airways, the gastrointestinal tract (beyond the caecum) and the female genital tract. Whereas the first group of microorganisms is usually sensitive to penicillin, the others are sensitive to clindamycin, metronidazole and chloramphenicol. An appropriate prophylactic regimen will have to comply with these microbiological data. Prophylactic antibiotics should be started during operation and should be given for a short period of time; their efficacy has been proved and confirmed, particularly in bowel surgery. Nevertheless, side-effects should be carefully watched for.


Weaning from the breast for a happy ending to a satisfying experience. Weaning from breastfeeding is often more traumatic for both the mother and her child than most people think. A mild form of postpartum blues often occurs and is intensified when the mother lacks the needed emotional support. Advice by specialists varies from "weaning naturally" to "gradual omission of each separate breastfeeding", but all emphasize the need for gradual weaning. Little information is available on "how to wean". The nurse's role is to learn of the parent's feelings toward breastfeeding, provide for support, and avoid any actions that might undermine the mother's confidence in her decision to wean or not to wean.


Maternal anxiety in pregnancy and fetal homeostasis. Although it is recognized that pregnant women may be extremely anxious and that anxiety is accompanied by sympathetic nervous system hyperactivity, little clinical consideration has been given to the potential harm to the fetus. A review of the literature, including research on both animal and human pregnancies, reveals what is known about this subject. A section on implications for maternity care follows, including a summary of the possible effects of anxiety during pregnancy, identification of women most at risk from anxiety, and intervention measures.


Using a teaching guide for better postpartum and infant care. The development and use of a guide for postpartum and infant care teaching is discussed, including the rationale, methods,and advantages of using this tool at two hospitals of different sizes. Also discussed are the preparation of personnel, ongoing development, and extended uses of the guide.


A statewide program to teach nurses the use of fetal monitors. The regionalization concept in perinatal medicine has opened many new areas of information and practice for obstetrical nurses. One of these areas is in electronic fetal monitoring. Since the technique is relatively new to most nurses, the need for in-hospital training is tremendous. This article describes the first steps taken in establishing such an educational program, the expansion of that program to statewide coverage, and the incorporation and expansion of such a program to meet the needs of the area in the regionalization of perinatal health care.


Preparation for breastfeeding: a one-year followup of 34 nursing mothers. A retrospective survey of 34 breastfeeding mothers was undertaken. From the data the following hypotheses have been suggested for further study: 1) Class preparation for breastfeeding favors a longer duration of nursing. 2) Nipple rolling and breast massage with manual expression of colostrum during pregnancy are not associated with a longer duration of nursing, nor do they prevent sore nipples or breast engorgement postpartum. 3) Mothers with multiple complications are at high risk for lactation failure. 4) Limiting nursing time for the first few days postpartum does not prevent sore nipples.


Satisfaction with prepared childbirth and locus of control. The study tests the hypothesis that there is a positive association between a sense of personal control (internal locus of control) and satisfaction with the experience of prepared childbirth. Women delivering at a university hospital were studied by the administration of the Rotter I-E Scale and a postpartum questionnaire. The results demonstrated that internal locus of control was related to satisfaction in the prepared group of women. Class attendance alone did not distinguish the subjects with respect to satisfaction.


Evaluation of a prepared childbirth program. A study was undertaken to ascertain what effects on the outcome of labor and delivery could be attributed to a prepared childbirth program. Three tables are included setting forth statistical relationships. The basic conclusion was that more than five hours of structured prenatal education has a positive impact on maternal-child health.


Characteristics of posthospitalization recovery following hysterectomy. A study to determine the characteristics of posthospitalization recovery after hysterectomy was designed and implemented. Explicit consideration was given to women's feelings of sexuality and the fears and myths which precede and follow the surgery. Retrospective and current self-report data on four major areas were obtained: a) physical changes, b) emotional changes, c) changes in sexuality, and d) fears or beliefs. The results identify some common posthysterectomy physical and emotional experiences. The data challenge the belief that hysterectomy is usually a blow to a woman's concept of self and indicate that most women do not harbor unrealistic fears of physical, emotional, and sexual sequelae. The study findings have implications for nursing care of hysterectomy patients.


An instrument to assess the quality of maternal behavior. Early assessment, detection, and therapeutic intervention in maladaptive maternal behavior can be facilitated by a simple nursing appraisal instrument employed initially on the third postpartum day. The Funke-Irby Interactional Assessment not only discriminates between early adaptive and maladaptive maternal behaviors, but it also illustrates a mother's progress or lack of progress toward adaptive mothering, making the instrument useful to the community health nurse during the early postdelivery weeks. This instrument has been effectively used as a screening device for nurses making decisions about the need for further referral for family therapy.


The role of the nurse during amniocentesis. Amniocentesis is a relatively simple, safe, and accurate diagnostic tool which is being performed with increased frequency in local hospitals. The maternity nurse has a responsibility to know the clinical applications, the role of the nurse during the procedure, and the potential risks associated with amniocentesis.


Gentle birth: its safety and its effect on neonatal behavior. Leboyer describes a method of handling babies at birth designed to decrease initial stimulation and lessen trauma for the infant. Twenty clinic patients were delivered using a modification of this method. They were compared to 17 control patients delivered in the customary manner. Significant differences were noted between the two groups in five of 18 neonate behaviors observed in the delivery room. Among control subjects there was significantly more time spent with hand muscles tense during the first ten minutes after birth; more trembling, shuddering, and blinking during the first 15 minutes after deliver; and more trembling and shuddering overall. Experimental subjects spent significantly more time with hand muscles relaxed during the first ten minutes after birth and more time with open eyes overall. Results of this study indicate the Leboyer method is safe for mother and infant and promotes infant relaxation in the delivery room.


Theories regarding endocrine contributions to the onset of labor. A review of the literature on endocrine factors influencing labor is presented. Treated separately are oxytocin, the prostaglandins, the fetus, and estrogen/progesterone. Implications for nursing practice and theory are discussed where appropriate, and the reader is encouraged to think of parturition as a complex interplay of factors.


Code pink: a system for neonatal resuscitation. It has been documented that the care given to the high-risk neonate in the first moments after birth correlates with the incidence of mortality and morbidity in the first 24 hours of life. In an effort to reach optimal outcome for each individual infant, Columbia Hospital for Women developed an emergency system for neonatal resuscitation and provided a team of highly skilled professionals to deliver this emergency care. "Code Pink" provided an effective method of reducing mortality and morbidity and improving outcome.


School mental health programs: a challenge to the health professional. Mental health programs which facilitate prevention and remediation within the school system are indicated by large numbers of children at risk for problems. Counseling, consultation and communication activities to promote mental health can readily be provided by school health personnel. Barriers to the development and implementation of a mental health program include problems in staffing and communication as well as a continued illness orientation of the health professional.


School counseling and positive mental health: when does 1 + 1 = 3? School counseling and guidance services are specifically intended to develop and maintain positive mental health among students. Although some school counselors have been highly effective, the majority have been only moderately effective because of the difficulties they have encountered in this mission. Personal, academic, and vocational counseling and information processing from either remedial or preventative perspectives are currently the most common functions within school counseling services. The factors limiting the effectiveness of these and other school counseling functions include discrepancies between school counseling training and practice, school counselor professional isolationism, lack of understanding of school counseling roles and functions, and the poor professional attitudes of some school counselors. As the school counseling profession develops, these inhibiting factors should be overcome as a result of changes in school counselor roles and activities and associated changes in school counseling and guidance services.


Identity crisis in school psychology.

Identity crisis in school psychology. The problem of identity crisis in school psychology has been with us for many years. It has been suggested in these pages that the problem does not constitute a weakness within the profession but rather promotes a healthy interchange in ideas. Instead of seeking to provide a narrow definition of the school psychologist's identity, it seems to be wiser to recognize the roles of school psychologists to be as broad as the needs of children in the schools. There will continue to be debate about school psychologists' identity and about what they can do or ought to do in the schools. Those whom school psychologists serve will be the ultimate beneficiaries of this vibrant and constructive debate within the profession.


[Urinary uropepsin activity in patients with different forms of stroke]. The investigations were carried out in 30 control cases, in 20 patients with acute transient cerebral circulatory failure, 20 patients with intracerebral haemorrhage, and 22 patients with thrombotic encephalomalacia. The determinations of uropepsin activity were done on the 1st, 3rd, 7th and 14th days of the disease. Uropepsin activity in 24-hour urine was determined by the method of West, Ellis and Scott. In the group of patients with acute transient cerebral circulatory failure abnormalities in urinary uropepsin activity were not significant. The mean activity of uropepsin in 24-hour urine in patients with intracerebral haemorrhage and brain infarction on the 1st day of the disease was significantly higher than in controls. The rise in the activity of this enzyme in patients with encephalomalacia was lower in relation to patients with intracerebral haemorrhages. During improvement of the condition of patients with brain stroke the uropepsin activity in 24-hour urine decreased.


Patterns of codon recognition by isoacceptor aminoacyl-tRNAs from wheat germ. Isoacceptors of Ala-, Arg-, Glu-, Gln-, Ile-, Leu-, Lys-, Ser-, Thr- and Val-tRNAs from wheat germ have been resolved by reverse phast chromatography. Codon recognition properties have been determined on isolated fractions of each of these aa-tRNAs and codon assignments have been made to a number of isoacceptors. Evolutionary changes which have occurred in patterns of codon recognition by isoacceptor aa-tRNAs in wheat germ and other organisms are discussed.


Mortality in meningococcal infections.

Mortality in meningococcal infections. Among 124 patients with meningococcal infections between 1966-1976, 108 had meningitis with a fatality rate of 7.4%, and 16 septicaemia with 18.8% fatality. High risk patients (more than 3 prognostically unfavourable characteristics) increased from 3.5% 1966-1970 to 15.6% 1971-1976, and the total mortality from 3.6 to 10.4%. The most unfavourable prognostic factor was low blood pressure at admission. High risk patients were more common among those who had meningococci with complete or partial sulfonamide resistance (25.7%) than among those having sensitive meningococci (11.9%). When the meningococci were at least partially sulfonamide-resistant, initial therapy with the combination of benzylpenicillin, sulfaisodimidine and chloramphenicol seemed to be more successful than benzylpenicillin alone in patients above 10 years. Ampicillin was used only in children, and these all survived.


Nucleoside composition of lysine transfer RNAs from Lupinus luteus seeds. Analysis of the nucleoside composition of five lysine tRNAs from lupin seeds has shown their general similarity to other eukaryotic lysine tRNAs, except that lupin lysine tRNAs do not contain either t6A, Tm, or thioderivatives of uridine. It is assumed that each of the lupin tRNALys is coded for by a separate gene. The acceptor activity of the analysed tRNAs ranged from about 1200 (tRNA3Lys, tRNA4Lys, tRNA5Lys) to 1470 (tRNA2Lys) pmoles of lysine per one A260 unit of tRNA.


Single unit and lesion experiments on the sensory inputs to the hippocampal cognitive map. The hippocampal cognitive map theory states that the hippocampus calculates the animal's location in an environment and also the locations of objects such as rewards and threats. In this paper we report single cell experiments which explored how sensory inputs are used by the hippocampus to calculate spatial information and behavioural experiments which tested the sensory capabilities of fornix-lesioned rats. Both sets of experiments were done in cue-controlled enclosures which contained only a few distant cues by which the rat could locate itself and the goal. Other cues were eliminated by rotating the constellation of cues and the goal from trial to trial. The results of the single cell experiment show that the place fields of hippocampal cells recorded in this environment are related to the controlled cues and, further, that some of these place cells maintain their fields after the removal of any two of four controlled cues. The lesion studies show that rats with damaged fornices can learn to approach distant cues behind and below the level of the goal but not ones behind and above the goal. A second study showed that the addition of redundant distant cues to the enclosure impairs the learning ability of the lesioned, but not the normal, animals.


Hippocampal electrical activity during waking behaviour and sleep: analyses using centrally acting drugs. Rhythmical slow activity (RSA) occurs in the hippocampus under many conditions including waking behaviour, active sleep and surgical anaesthesia. Under all these conditions RSA, apparently, is produced by the coupled operation of CA1 and dentate gyrus generators. Two ascending brainstem systems appear capable of initiating activity in these coupled generators. One system, ascending via the diagonal band and medial septal nucleus, may contain cholinergic synapses since it is blocked by atropine and stimulated by eserine. The RSA produced by this system usually has a frequency of 4--7 Hz and can occur during total immobility during the waking state, active sleep or anaesthesia. A second ascending system produces RSA of higher frequency (usually 7--12 Hz) and is active during waking if, and only if, movements such as walking occur. During active sleep this system is active only during phasic muscular twitches. Anaesthetics (ether, urethane) and morphine abolish activity in this second system but it is resistant to atropinic and nicotinic drugs. Amphetamine stimulates, and major tranquillizers depress the atropine-resistant system but these drugs do not abolish its normal relation to behaviour. Neocortical activity appears to be controlled by two ascending systems which parallel closely those ascending to the hippocampus.


An experimental 'dissection' of the septal syndrome. I present evidence from several different lines of investigation (including partial lesions, intraseptal and intrahippocampal drug injections, and surgical transections of the major fibre systems that enter, leave, or traverse the area) which indicates that individual components of the septal syndrome in the rat and cat reflect an interruption of different neural elements. The 'disinhibitory' effects of septal lesions on behaviour that is suppressed as a consequence of non-reward are due to an interruption of septo-hippocampal (or hippocampo-septal) connections that do not have a cholinergic synapse in the septum but do have one in the hippocampus. The inhibitory effects of punishment are not mediated by the same pathways but involve amygdalo-septal (no directionality intended) projections that have a cholinergic synapse in the septal area. This component of the septum may communicate with the hippocampus via entorhinal and periamygdaloid projections. This pathway does not appear to have a cholinergic synapse in the hippocampus. The effects of septal lesions on active avoidance are related to an interruption of at least two pathways. The facilitated shuttle box conditioned avoidance response acquisition is related mainly to an interruption of ventral connections of the septum with the lower brainstem. The impaired acquisition of most other avoidance problems seems to be due to an interruption of components of the stria medullaris. Both pathways have a cholinergic synapse in the septal area. The hyperdipsia, finickiness, and sudden weight loss are related to an interruption of pathways that interconnect the septum with the lower brainstem.


The anatomical organization of septo-hippocampal projections. Since the time of Elliot Smith (1910) it has been recognized that the septal complex occupies a pivotal position within the mammalian telencephalon, being strategically placed between the hippocampal formation on the one hand and the basal forebrain and diencephalon on the other. However, it is only in the last few years that the detailed interrelationships between the different nuclear groups within the septum and the various subfields of the hippocampus have been studied. We have recently re-examined the connections of both the septum and the hippocampal formation using the techniques based on the anterograde transport of isotopically labelled proteins and the retrograde transport of the enzyme marker, horseradish peroxidase. Our findings may be summarized as follows. Field CA1 of Ammon's horn and the adjoining subiculum project through the fimbria and pre-commissural fornix upon the lateral septal nucleus of the same side in a topographically ordered manner. Field CA3, on the other hand, projects bilaterally upon the lateral septum. The lateral septal nucleus in turn, projects partly upon the medial septal nucleus and nucleus of the diagonal band, and partly to the lateral hypothalamus and the mamillary complex. The medial septal-diagonal band complex projects back, through the fimbria and dorsal fornix, to fields CA3 and CA4 of the hippocampus, to the dentate gyrus, to the subicular complex, and to the entorhinal area. The subicular complex projects through the post-commissural fornix to the anterior thalamic group, the mamillary complex, and the ventromedial and arcuate nuclei of the hypothalamus. Ammon's horn and the subiculum also project to the posterior septal nuclei (triangular and septofimbrial), which in turn send their output to the habenular and interpeduncular nuclei. The significance of these projections is analysed in a review of the major known afferent and efferent connections of the septum and hippocampus, and the cell groups to which they project directly.


The function of septo-hippocampal connections in spatially organized behaviour. The role of septo-hippocampal connections in spatial behaviour is examined in lesion and stimulation experiments in rats. Destruction of septo-hippocampal connections produces a severe and enduring deficit in the ability to perform a spatial memory task. Furthermore, crossed unilateral lesions of the entorhinal area and fimbria-fornix produce the same deficit as bilateral lesions in either the entorhinal area or the fimbria-fornix, as predicted from a disconnection analysis of hippocampal lesions. Evidence also suggests that septo-hippocampal damage produces a greater deficit in spatial behaviours when a flexible response is required than when a consistent response is required, although this difference is a relative one rather than an absolute one. Finally, disruptive stimulation of the hippocampus while rats are performing a spatial memory task produces retrograde amnesia but not proactive interference. Taken together, these data indicate an important role of the septo-hippocampal system in spatial behaviour, and in the maintenance of spatial memories.


Multivariate analysis of the septal syndrome. Since recent reviews of the behavioural effects of septal lesions agree that more than one explanatory concept is required, a multivariate analysis of the septal syndrome has been made. A total of 127 rats have been tested 73 with septal lesions and 54 controls. The rats were tested in a standard test battery consisting of a residential maze, spontaneous alternation, spatial learning, approach/avoidance conflict and one-way active avoidance. Factor analyses reveal a complex change in the factor structure after septal lesions. None of the previous explanations of septal functions receives unequivocal support. The findings do not exclude the possibility that septal lesions interfere with a few general behaviour mechanisms or perhaps only one. However, if so, this factor does not explain as much of the variance as expected. Situational or test-dependent factors play a greater role in the variance. This is interpreted as an indication of insufficiency in the theoretical structure, or in conventional test designs.


A comparison of hippocampal pathology in man and other animals. Bilateral damage to the medial temporal lobe, including the hippocampus, in man is associated with a severe amnesic syndrome. It is still not clear whether the hippocampus (or its output pathways and related target projection sites) is the critical structure in producing this syndrome, especially as more severe learning deficits in animals are found with lesions in the anterior inferotemporal cortex than with hippocampal lesions per se. But the problem of trying to relate memory deficits in man and animals depends on the characterization of the amnesic syndrome itself. It was originally thought to be a failure of input into long-term memory store or a failure of consolidation. Medial temporal and hippocampal lesions in animals do not produce results that fit such a characterization. On re-examination of the human syndrome, however, for which some of the evidence is reviewed, it appears that the amnesic patients can learn and remember over long intervals if certain testing paradigms are used. The results are more readily matched to some of the results of hippocampal lesion studies in animals. Two main classes of current theories of the amnesic syndrome are discussed. A somewhat different approach is suggested here, based on the dissociation between human amnesic subjects' commentaries and their objective performance, which suggests a dissociation between levels of processing rather than a failure on any particular level.


Intramolecular interactions, enzyme activity and models. The specificity of protein binding and the specificity-catalysis relationship in enzymes are analysed. Many enzymes use extended binding sites to achieve specificity and to create special environments which activate chemical groups on both the substrate and the enzyme itself. Aside from this effect, which is not adequately available in model compounds, the use of models is exemplified for several possibly separable effects in enzyme-substrate reactions. These include proximity (entropy loss on binding), locking into a productive binding mode, desolvation, electrostatic effects, changes of pKa by local environments, geometric strain, acid-base catalysis, and formation of other intermediates.