bluuebunny/crossref_metadata_2025 huggingface dataset:
The sensitivity and spectral identity of the cones driving the
b-wave of the rat electroretinogram
Authors: AKULA JAMES D. , LYUBARSKY ARKADY L. , NAARENDORP FRANK
Published: November 2003

In the retina of rat, cones make up ∼0.85% of the photoreceptor
population: 93% of these cones contain a midwave-sensitive pigment, the
rest expresses a short-wave-sensitive pigment (Szel & Rohlich, 1992).
We used normal adult Long Evans rats to determine the spectral sensitivity
of the cone-driven electroretinogram (ERG) b-wave and its absolute
sensitivity at λmax of the cone pigments. ERGs were recorded
at the cornea of anesthetized animals under dark- and light-adapted
conditions. Rod responses were suppressed by steady rod-saturating orange
backgrounds and/or by a flashed “white” background.
Cone-driven b-waves were evoked by “white” or
narrowband full-field stimuli of varying intensity. The action spectrum
for the cone b-wave indicates the presence of an absorbance
peak at 510 nm; a second, twofold lower, peak was found at 360 nm (after
correction for transmittance by the lens). Chromatic adaptation experiments
strongly suggest that retinal responses to midwave and UV stimuli are
mediated by a single cone type. On a background producing ∼17,000
R* rod−1 s−1, which completely
suppressed the saturated a-wave, the absolute sensitivity of the
cone b-wave was 18 nV photon−1 μm2
at 510 nm and 4 nV photon−1 μm2 at 360 nm
which is 20–30 times higher than for the mouse. It is suggested that
the relatively large number of on-cone bipolar cells in the retina of rat is
responsible for the remarkable sensitivity of the cone b-wave.
Morphology and spectral absorption characteristics of retinal
photoreceptors in the southern hemisphere lamprey (Geotria
australis)
Authors: COLLIN SHAUN P. , HART NATHAN S. , SHAND JULIA , POTTER IAN C.
Published: November 2003

The morphology and spectral absorption characteristics of the retinal
photoreceptors in the southern hemisphere lamprey Geotria
australis (Agnatha) were studied using light and electron
microscopy and microspectrophotometry. The retinae of both downstream
and upstream migrants of Geotria contained two types of cone
photoreceptor and one type of rod photoreceptor. Visual pigments
contained in the outer segments of these three photoreceptor types had
absorbance spectra typical of porphyropsins and with wavelengths of
maximum absorbance (downstream/ upstream) at 610/616 nm
(long-wavelength-sensitive cone, LWS), 515/515 nm
(medium-wavelength-sensitive cone, MWS), and 506/500 nm
(medium-wavelength-sensitive rod). A “yellow” photostable
pigment was present in the myoid region of all three types of
photoreceptor in the downstream migrant. The same
short-wavelength-absorbing pigment, which prevents photostimulation of
the beta band of the visual pigment in the outer segment, was present
in the rods and LWS cones of the upstream migrant, but was replaced by
a large transparent ellipsosome in the MWS cones. Using
microspectrophotometric and anatomical data, the quantal spectral
sensitivity of each photoreceptor type was calculated. Our results
provide the first evidence of a jawless vertebrate, represented today
solely by the lampreys and hagfishes, with two morphologically and
physiologically distinct types of cone photoreceptors, in addition to a
rod-like photoreceptor containing a colored filter (a cone-like
characteristic). In contrast, all other lampreys studied thus far have
either (1) one type of cone and one type of rod, or (2) a single type
of rod-like photoreceptor.
Coexistence of GAD-65 and GAD-67 with tyrosine hydroxylase and
nitric oxide synthase in amacrine and interplexiform cells of the
primate, Cebus apella
Authors: ANDRADE DA COSTA BELMIRA LARA DA SILVEIRA , HOKOÇ JAN NORA
Published: November 2003

The expression of glutamate decarboxylase forms, GAD-65 and GAD-67,
in GABAergic cells was studied by immunocytochemistry in the retina of
the New World monkey, Cebus apella. In the innermost rows of
the inner nuclear layer (INL), somata that express GABA correspond to
about 45% of the total number of cells in the central retina and about
25% on the periphery. Three subsets of GABAergic amacrine cells were
identified along the horizontal meridian: about 5% express only GAD-65
and 40% GAD-67, and approximately 50% contain both forms of GAD. In the
INL, GAD-65 immunoreactivity was detected in broad bands around strata
1, 3, and 5. GAD-67 immunoreactivity was observed throughout all
strata. Somata that expressed GAD-67 exclusively stratified only in
narrow bands around strata 2 and 4 of the INL and colocalized with
β2 and β3 subunits of GABA-A receptor. Interplexiform and
amacrine cells that express GABA also express tyrosine hydroxylase (TH)
or nitric oxide synthase (NOS). GAD-67 colocalized with TH or NOS in
presumed amacrine cells of the inner plexiform layer (IPL) and ganglion
cell layer (GCL). GAD-65 was expressed in the TH- and
NOS-immunoreactive interplexiform and amacrine cells, respectively.
Different from what has been described in other mammals, TH and NOS
were coexpressed in some neurons, indicating a partial overlap in
retinal cell populations containing dopamine or nitric oxide in this
primate.
Activation of the cGMP/nitric oxide signal transduction system
by nicotine in the retina
Authors: BLUTE TODD A. , STRANG CHRISTIANNE , KEYSER KENT T. , ELDRED WILLIAM D.
Published: November 2003

Acetylcholine is one of the primary excitatory
neurotransmitters/neuromodulators in the retina, but little is
known about the downstream signaling pathways it can activate. The
present study immunocytochemically examines the potential sources of
acetylcholine and the location of the nicotinic cholinergic receptors
in the turtle retina. It also examines how activation of these
receptors can influence the nitric oxide (NO)/cyclic guanosine
monophosphate (cGMP) signal-transduction pathways. Photoreceptors,
amacrine cells, and potentially ganglion cells contain choline
acetyltransferase-like immunoreactivity (LI). Nicotinic acetylcholine
receptors are immunocytochemically localized on photoreceptors,
horizontal, bipolar, and ganglion cells. Nitric oxide imaging indicates
that stimulation with nicotine increases NO production primarily in
photoreceptors, horizontal, Müller, bipolar, and ganglion cells.
In turn, very select populations of amacrine cells respond to this NO
with increased levels of cGMP-LI. Selective inhibitors reveal that
nitric oxide synthase is involved in most, but not all, of these
increases in cGMP-LI. These results show that acetylcholine can
activate the NO/cGMP signal-transduction pathways in both the inner
and outer retina. This indicates that both of the major excitatory
retinal transmitters, glutamate and acetylcholine, can stimulate NO
production that increases levels of cGMP-LI in overlapping populations
of retinal cells.
Biphasic modulation of voltage-dependent currents of retinal cones
by cannabinoid CB1 receptor agonist WIN 55212-2
Authors: FAN SHIH-FANG , YAZULLA STEPHEN
Published: November 2003

Endogenous cannabinoids modulate neurotransmitter action and release
in the brain. The effects are exerted on membrane permeability to
Ca2+ and K+via protein kinase A (PKA).
Cannabinoid CB1 receptors are present at the synaptic
terminals of cones in goldfish retina. We investigated the effects of
CB1 receptor agonist WIN 55212-2 on voltage-gated currents
of goldfish cones. Whole-cell currents were recorded with
conventional-patch-clamp methods in goldfish retinal slices.
Depolarizing pulses elicited inward ICa and
Ioutward that contained several components:
IK, IA, and
ICl. WIN 55212-2 (<1 μM) enhanced
IK, ICl, and
ICa, while at >1 μM, IK,
ICl, and ICa were suppressed.
The voltage-activation ranges of these currents were not affected. All
effects of WIN 55212-2 were blocked by the CB1 receptor
antagonist SR 141716A as well as the PKA inhibitor Wiptide. The
enhancing effect of WIN 55212-2 was blocked selectively by 0.5 nM
cholera toxin and the suppressive effect was blocked by pertussis
toxin. The results obtained from long and short single cones and double
cones were basically the same.
Structure–function analysis of rods and cones in juvenile,
adult, and aged C57BL/6 and Balb/c mice
Authors: GRESH JEFFREY , GOLETZ PATRICE W. , CROUCH ROSALIE K. , ROHRER BAERBEL
Published: November 2003

To determine whether the photoreceptors change structurally and
functionally during aging, and to analyze whether pigmentation in the
retinal pigment epithelium might be a contributing factor. Young,
adult, and aged C57BL/6 and Balb/c mice (1, 4, and 17 months of
age) were housed under a 12-h light/12-h dark cycle, with an
ambient light intensity at the eye level of the mice of 85 ± 18
lux. Scotopic single-flash and photopic-flicker electroretinograms
(ERGs) after complete dark adaptation were used to assess rod and cone
function, respectively. Numbers of rod photoreceptors were counted in
plastic sections, and rhodopsin levels were measured using absorption
difference spectrophotometry. Numbers and types of cones were
determined using lectin staining in retinal flatmounts and
cone-specific antibodies in radial frozen sections. Young pigmented
C57BL/6 and nonpigmented Balb/c mice had similar numbers of
rods. In both mouse strains, there was an overall decline in rod
photoreceptor number during aging, which was more pronounced in albino
mice. Rod cell numbers correlated with a drop in the overall amount of
rhodopsin and a reduction in the maximum a-wave of the rod
ERG. The number of short-wavelength cones was unaffected by age and
pigmentation, whereas an age-related decline was observed in
mid-wavelength (MWL) cones in albino, but not in pigmented mice. In
contrast, MWL cone function was reduced during aging in both strains.
Bioethics in the United Kingdom: Genetic Screening, Disability
Rights, and the Erosion of Trust
Authors: HERISSONE-KELLY PETER
Published: November 2003

It goes almost without saying that there are no academic bioethical
debates that are unique to the United Kingdom. The debates in which
U.K. bioethicists become involved take place in international journals
and in books with a worldwide readership. The contributions of those
from these shores are frequently made in response to work by academics
from the United States, Australia, Scandinavia, and a whole host of
other countries.
Healthcare Ethics in Finland
Authors: TAKALA TUIJA , LOUHIALA PEKKA
Published: November 2003

Finland is a country in Northern Europe with a population of
approximately 5.1 million people. It lies between Sweden and Russia and
has a border with Norway too. It is part of the European Union and also
belongs to the European Monetary Union. It is a welfare state in the
sense that healthcare services, schools, universities, and social
services are for the most part paid for by tax-based funding. In terms
of basic healthcare, the state, through local municipalities, provides
comprehensive coverage to all residents, and this is utilized by both
the wealthy and the poor.
Biomedical Ethics in Japan: The Second Stage
Authors: AKABAYASHI AKIRA , SLINGSBY BRIAN T.
Published: November 2003

In Japan, modern biomedical ethics emerged in the early 1980s. One of
the main triggers was the nationwide debate on organ transplantation
and brain death. A lengthy process of academic, religious, and
political discussion concerning organ transplantation, lasting well
over a few decades, resulted in the enactment of the Organ
Transplantation Law in 1997.1 The defining of death and
other bioethical issues, including death with dignity and euthanasia,
were also stimulating topics throughout the latter end of the twentieth
century. For instance, the death-with-dignity movement, which started
around the late 1960s, developed into a hospice/palliative-care
movement by the end of the 1980s.
Changing Roles in Russian Healthcare
Authors: TICHTCHENKO PAVEL
Published: November 2003

In the early 1990s, the primary problem in Russian bioethics was to
gain the attention and recognition of the public and the medical
establishment. Very few people were even familiar with the word
“bioethics.” Within medical education, only a paternalistic
and scholastic “medical deontology” was viewed as the
professionally acceptable way to deal with the existing moral problems.
The public was ignorant of the rights of patients and consumers of
medical services. The usual way of resolving conflicts between patients
and physicians was to complain to medical authorities. Very few cases
of disputes were brought to the courts. Representatives of religious
groups did not participate in discussions involving dilemmas generated
by progress in biomedical technologies, and they did not seek to
influence legislation in this area.
South Korea: Human Embryo Research
Authors: UM YOUNG-RHAN
Published: November 2003

On May 18, 2001, the Korean Bioethics Advisory Commission (KBAC),
sponsored by the Ministry of Science and Technology, published a set of
recommendations for biotechnological research and application,
including scientific experiments with human embryos. Four days later,
the KBAC held a public hearing to finalize its recommendations. Since
then, public reaction and debate over the ethical aspects of human
embryo research have actively surfaced. Most leaders of religious
organizations, especially Catholic churches, objected to any type of
embryo research. On the other hand, some leaders of the scientific
community supported freer scientific research on human embryos.
End-of-Life Care in Turkey
Authors: OGUZ N. YASEMIN , MILES STEVEN H. , BUKEN NUKET , CIVANER MURAT
Published: November 2003

Most physicians confront the moral and technical challenges of
treating persons who are coming to the natural end of their lives. At
the level of the health system, this issue becomes a more pressing area
for reform as premature death decreases and more people live a full
life span. Well-developed countries and international organizations
such as the World Health Organization (WHO) and the Organisation of
Economic Cooperation and Development (OECD) have made recommendations
for improving healthcare problems in aging societies. Turkey belongs to
the WHO and the OECD. This article describes end-of-life healthcare in
Turkey, the design of the healthcare system to meet this need, challenges
that should be addressed, and solutions that would be appropriate to
Turkish culture and resources.
CQ Sources/Bibliography
Authors: Anton Bette
Published: November 2003

These CQ Sources were compiled by Bette Anton.
The Ethical Management of the Noncompliant Patient
Authors: BROWNE ALISTER , DICKSON BRENT , VAN DER WAL RENA
Published: November 2003

It is a rare patient who always does everything healthcare providers
advise. Sometimes no harm comes from this; sometimes good does. But
occasionally, great harm comes from not listening, as when it results
in patients returning time and again for costly and invasive treatments
of, say, infections, valve replacements, pressure ulcers, and so forth.
No class of patients arouses more anger and resentment in healthcare
providers, who often put out a call to invoke some version of the three
strikes rule and refuse care. And if the patients are also unemployed
substance abusers who live in a local park, impolite or dangerous to
staff, disruptive to other patients, and have intimidating visitors,
the call to say “No” is louder. Can care ever be refused?
If so, when? These are the questions we take up in this article. The
answers we provide were developed as part of a Paraplegics and
Quadriplegics with Pressure Ulcers Project carried out at Vancouver
Hospital and Health Sciences Centre. Following an established usage,
we refer to patients who exhibit a cluster of the above characteristics,
the dominant one of which is a reluctance to heed medical advice, as
“noncompliant patients.” This term is offensive to some, but
the politically correct lexicon does not provide any alternative which is
as short and clear or substantially different. We use the term as a
convenient way of referring to a familiar class of patients and without any
imputation of blame.
Managed Care, Doctors, and Patients: Focusing on Relationships, Not
Rights
Authors: SHAPIRO ROBYN S. , TYM KRISTEN A. , EASTWOOD DAN , DERSE ARTHUR R. , KLEIN JOHN P.
Published: November 2003

For over a decade, managed care has profoundly altered how healthcare
is delivered in the United States. There have been concerns that the
patient-physician relationship may be undermined by various aspects of
managed care, such as restrictions on physician choice, productivity
requirements that limit the time physicians may spend with patients,
and the use of compensation formulas that reward physicians for
healthcare dollars not spent. We have previously published data on the
effects of managed care on the physician-patient relationship from the
physician's perspective. In 1999, we collected data on
the impact of managed care arrangements on the physician-patient
relationship from the patient's perspective. This article
discusses our collective findings.
Oregon v. Ashcroft: The Battle over the Soul of Medicine
Authors: RICH BEN A.
Published: November 2003

When one considers the protracted and continuing struggle of the
citizens of Oregon to include physician-assisted suicide (also known as
“physician aid in dying”) among the panoply of measures
available to dying patients and the physicians who care for them, the
depth and breadth of the issue becomes inescapable. The potential
intractability of the dispute is illustrated by the very fact, noted in
the preceding parenthetical phrase, that consensus eludes us on even
the most basic of semantic points—how we are to most aptly
characterize the conduct in question? The case featured in this
issue's The Caduceus in Court must be examined as the latest
battle in a long war of attrition waged by opponents of physician-assisted
suicide against the Oregon Death with Dignity Act (“the
Oregon Act”). After briefly reviewing that history, I will then
consider the details of Oregon v. Ashcroft and the implications
of the litigation not only for the care of dying patients but also for
the regulation of medical practice in the United States and, more broadly
still, the search for resolution of serious medical disputes in a democratic
society.
Attention deficit hyperactivity disorder and neurocognitive correlates after childhood stroke
Authors: Max Jeffrey E. , Mathews Katherine , Manes Facundo F. , Robertson Brigitte A.M. , Fox Peter T. , Lancaster Jack L. , Lansing Amy E. , Schatz Amy , Collings Nicole
Published: November 2003

We investigated the frequency and neurocognitive correlates of attention deficit hyperactivity disorder and traits of this disorder (ADHD/Traits) after childhood stroke and orthopedic diagnosis in medical controls. Twenty-nine children with focal stroke lesions and individually matched children with clubfoot or scoliosis were studied with standardized psychiatric, intellectual, academic, adaptive, executive, and motivation function assessments. Lifetime ADHD/Traits were significantly more common in stroke participants with no prestroke ADHD than in orthopedic controls (16/28 vs. 7/29; Fisher's Exact p < .02). Lifetime ADHD/Traits in the orthopedic controls occurred exclusively in males with clubfoot (7/13; 54%). Participants with current ADHD/Traits functioned significantly worse (p < .005) than participants without current ADHD/Traits on all outcome measures. Within the stroke group, current ADHD/Traits was associated with significantly lower verbal IQ and arithmetic achievement (p < .04), more nonperseverative errors (p < .005), and lower motivation (p < .004). A principal components analysis of selected outcome variables significantly associated with current ADHD/Traits revealed “impaired neurocognition” and “inattention-apathy” factors. The latter factor was a more consistent predictor of current ADHD/Traits in regression analyses. These findings suggest that inattention and apathy are core features of ADHD/Traits after childhood stroke. This association may provide clues towards the understanding of mechanisms underlying the syndrome. (JINS, 2003, 9, 815–829.)
Exploring semantic memory by investigating buildup and release of proactive interference in healthy older adults and individuals with dementia of the Alzheimer type
Authors: Multhaup Kristi S. , Balota David A. , Faust Mark E.
Published: November 2003

There is debate regarding the integrity of semantic memory in dementia of the Alzheimer type (DAT). One view argues that DAT is associated with a breakdown in semantic memory; the other argues that DAT is associated with predominantly preserved semantic memory and a breakdown in retrieval. The classic release from proactive interference (RPI) paradigm was used to shed light on this debate. Individuals with early-stage DAT (n = 36) and healthy older adult controls (n = 45) participated in an RPI paradigm. Each trial was a Brown–Peterson task in which participants read three-word lists, counted (for 0, 3, 6, or 9 s), and recalled the words. Both groups showed significant proactive interference (PI), but the size of the PI was significantly smaller in the DAT group. The group difference in PI may be due to the faster forgetting rate in the DAT group. Both groups showed significant RPI and there was no group difference in size when RPI was considered in terms of PI levels. Both groups showed PI and RPI in prior list intrusions. The DAT group's significant buildup and release of PI based on semantic categories suggest predominantly preserved semantic memory activity, at least, in early-stage DAT individuals. (JINS, 2003, 9, 830–838.)
Working memory and relational reasoning in Klinefelter syndrome
Authors: Fales Christina L. , Knowlton Barbara J. , Holyoak Keith J. , Geschwind Daniel H. , Swerdloff Ronald S. , Gonzalo Irene Gaw
Published: November 2003

Klinefelter syndrome (KS) is a sex chromosome abnormality associated with male infertility and mild cognitive deficits. Individuals with KS have been reported to have impaired verbal ability, as well as deficits in executive function. To further understand the nature of their deficits, we assessed specific elements of frontal lobe function such as working memory and relational reasoning. Men with KS exhibited a deficit in a transitive inference task in which participants ordered a set of names based on a list of propositions about the relative heights of the people named. This deficit was present even for items in which the propositions were given in order, so a chaining strategy could be used. Men with KS are also impaired on the n-back task, which uses letters as stimuli. In contrast, these men performed as well as controls in nonverbal reasoning (Raven's Progressive Matrices). These results suggest that men with KS have intact nonverbal reasoning abilities, but that a difficulty in encoding verbal information into working memory may underlie their executive and linguistic impairments. (JINS, 2003, 9, 839–846.)
Examining the range of normal intraindividual variability in neuropsychological test performance
Authors: Schretlen David J. , Munro Cynthia A. , Anthony James C. , Pearlson Godfrey D.
Published: November 2003

Neuropsychologists often diagnose cerebral dysfunction based, in part, on marked variation in an individual's cognitive test performance. However, little is known about what constitutes the normal range of intraindividual variation. In this study, after excluding 54 individuals with significant health problems, we derived 32 z-transformed scores from 15 tests administered to 197 adult participants in a study of normal aging. The difference between each person's highest and lowest scores was computed to assess his or her maximum discrepancy (MD). The resulting MD values ranged from 1.6 to 6.1 meaning that the smallest MD shown by any person was 1.6 standard deviations (SDs) and the largest MD shown by any person was 6.1 SDs. Sixty-six percent of participants produced MD values that exceeded 3 SDs. Eliminating each person's highest and lowest test scores decreased their MDs, but 27% of the participants still produced MD values exceeding 3. Although MD values appeared to increase with age, adjusting test scores for age, which is standard in clinical practice, did not correct for this. These data reveal that marked intraindividual variability is very common in normal adults, and underscore the need to base diagnostic inferences on clinically recognizable patterns rather than psychometric variability alone. (JINS, 2003, 9, 864–870.)
Number processing after stroke: Anatomoclinical correlations in oral and written codes
Authors: Mayer Eugène , Reicherts Michael , Deloche Gérard , Willadino-Braga Lucia , Taussik Irène , Dordain Monique , Van Der Linden Martial , Annoni Jean-Marie
Published: November 2003

Calculation and number-processing abilities were studied in 49 patients with chronic single vascular brain lesions by means of a standardized multitask assessment battery (EC301), as well as through other tasks, testing functions thought to be implicated in calculation such as language, visuo-perceptive abilities, verbal and spatial working memory, planning, and attention. The results show that (1) lesions involving parietal areas—particularly left parietal lesions—are prone to alter calculation processing. A more detailed analysis showed that patients with lesions involving left parietal areas were impaired in both digital (i.e., comprehension and production of numbers written in Arabic code) and oral (i.e., comprehension and production of numbers heard or expressed orally) processing while lesions involving right parietal areas lead to an impairment in digital processing only. However, linguistically related alphanumerical processing (i.e., comprehension and production of numbers written orthographically) was not influenced by parietal lesions. (2) Semantic representations (knowledge of the magnitude related to a given number) as well as rote arithmetical knowledge are also impaired following damage to parietal and particularly left parietal lesions, suggesting that these areas are also implicated in magnitude comparisons and in the retrieval of arithmetical facts. (3) Performance in calculation is highly correlated with language. (4) Moreover, we found a highly significant correlation between performances in oral calculation and verbal working memory, and between written-digit calculation and visuospatial working memory. Performances in regard to visuo-perceptive abilities, planning, and attention were less consistently correlated with calculation. These results stress the close correlation, but relative independence between calculation and language, as well as a dissociated sensitivity of oral and digital processing to brain lesions. (JINS, 2003, 9, 899–912.)
Presurgical cognitive deficits in patients receiving coronary
artery bypass graft surgery
Authors: Rankin Katherine P. , Kochamba Gary S. , Boone Kyle B. , Petitti Diana B. , Buckwalter J. Galen
Published: November 2003

Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) can produce a higher incidence of neuropsychological complications than other types of highly invasive noncardiac vascular surgery. Cognitive complications most likely arise from either embolization or hypoxia. An alternative surgical procedure has been developed that allows CABG to be performed without stopping the heart (“off-pump” CABG, or OPCABG). This study examined the neuropsychological performance of patients undergoing OPCABG, hypothesizing that patients undergoing OPCABG would show fewer cognitive deficits than patients whose hearts were stopped. A 1-hr neuropsychological battery was administered preoperatively to 43 patients before prospective randomization to either CPB CABG or OPCABG, and again to 34 of those patients 2 to 3 months postoperatively by an examiner blind to surgical condition. Neuropsychological status did not change 2.5 months postsurgically in either OPCABG or CABG groups. However, both groups showed dramatic presurgical cognitive deficits in multiple domains, particularly verbal memory and psychomotor speed. This corroborates previous research suggesting that patients requiring CABG surgery may evidence significant presurgical cognitive deficits as a result of existing vascular disease. (JINS, 2003, 9, 913–924.)
The myth of testing construct validity using factor analysis or correlations with normal or mixed clinical populations: Lessons from memory assessment
Authors: Delis Dean C. , Jacobson Mark , Bondi Mark W. , Hamilton Joanne M. , Salmon David P.
Published: November 2003

For nearly a century, the primary method employed by psychologists to define and test the validity of constructs evaluated by assessment instruments has been shared-variance techniques such as intervariable correlations or factor analysis with large normative or mixed clinical samples. To illustrate the shortcomings of this approach, we conducted (1) correlational analyses of immediate- and delayed-memory measures separately in normal participants and in homogeneous samples of patients with either Alzheimer's disease or Huntington's disease; and (2) factor analysis of immediate and delayed-recall and recognition measures in a large, homogeneous sample of patients with Alzheimer's disease. The findings revealed that cognitive measures that share variance in the intact brain—thereby giving the facade of assessing a unitary construct—can dissociate and contribute to unique variance in the damaged brain, but only if the pathology occurs in brain regions known to disrupt vital cognitive processes tapped by those measures. The results illustrate that shared-variance procedures applied to normal or mixed clinical populations can mask some of the most vital cognitive constructs, such as the classic distinction between short- and long-term memory. Implications of these findings for research and clinical practice are discussed. (JINS, 2003, 9, 936–946.)
An ethical dilemma in a hospice setting
Authors: McMAHON ROBIN L.
Published: November 2003

The codes of ethics of the National Hospice and Palliative Care Organization and the National Association of Social Workers support ethical standards of client self-determination and confidentiality. Lack of societal consensus on the parameters of a terminally ill person's right to die continues to confound at times the health care field, including hospice programs. This article explores an actual case where a hospice social worker faced an ethical dilemma related to the sanctity of life versus patient autonomy. While a more seasoned social worker might have chosen a different alternative to the dilemma, this case illustrates the importance of creating an interdisciplinary rather than multidisciplinary hospice team and the need for ongoing dialogue on how to support patient choice.
The existential moment
Authors: MOUNT BALFOUR M.
Published: November 2003

From earliest times, sages have advised us to become comfortable with
transience, more than that, to be at peace with our approaching death
and to keep it in constant view. Whatever the benefits of such a
perspective, they must surely be harvested in abundance by those
working in Palliative Care! An ongoing personal cost/benefit
analysis of our daily confrontation with death is for many a legacy of
the trade. “Why” questions are our persistent
companions. They have colored my recent days as I holiday with my
family in a cottage on Lac Massawippi in Quebec.
Should symptoms be scaled for intensity, frequency, or both?
Authors: CHANG CHIH-HUNG , CELLA DAVID , CLARKE SUSAN , HEINEMANN ALLEN W. , VON ROENN JAMIE H. , HARVEY RICHARD
Published: November 2003

Objective: This study evaluated the comparability of two
5-point symptom self-report rating scales: Intensity (from “not
at all” to “very much”) and Frequency (from
“none of the time” to “all of the time”).
Questions from the Functional Assessment of Chronic Illness Therapy
(FACIT)-Fatigue 13-item scale was examined.

Methods: Data from 161 patients (60 cancer, 51 stroke, 50 HIV)
were calibrated separately to fit an item response theory-based rating scale
model (RSM). The RSM specifies intersection parameters (step thresholds)
between two adjacent response categories and the item location
parameter that reflects the probability that a problem will be
endorsed. Along with patient fatigue scores (“measures”),
the spread of the step thresholds and between-threshold ranges were
examined. The item locations were also examined for differential item
functioning.

Results: There was no mean raw score difference between intensity
and frequency rating scales (37.2 vs. 36.4, p = n.s.). The high
correlation (r = .86, p < .001) between the intensity
versus frequency scores indicated their essential equivalence. However,
frequency step thresholds covered more of the fatigue measurement continuum
and were more equidistant, and therefore reduced floor and ceiling
effects.

Significance of results: These two scaling methods
produce essentially equivalent fatigue estimates; it is difficult to
justify assessing both. The frequency response scaling may be
preferable in that it provides fuller coverage of the fatigue
continuum, including slightly better differentiation of people with
relatively little fatigue, and a small group of the most fatigued
patients. Intensity response scaling offers slightly more precision
among the patients with significant fatigue.
Mental adjustment after surgery for non-small cell lung cancer
Authors: UCHITOMI YOSUKE , AKECHI TATSUO , FUJIMORI MAIKO , OKAMURA MASAKO , OOBA AKIRA
Published: November 2003

Objective:Although surgery for early-stage non-small cell lung cancer (NSCLC) is generally considered curative, the outcome is still unsatisfactory, leaving patients faced with uncertainty and fear of recurrence for a long time after surgery. The purpose of this study was to clarify the course of patients' mental adjustment after surgery for NSCLC and to identify predictors of long-term outcome.

Methods:A total of 205 patients completed a baseline interview for patient characteristics at 1 month after curative resection of NSCLC and for social support at 3 months, and the Mental Adjustment to Cancer scale at 3 and 12 months. Univariate and multivariate analyses were used to identify predictors of their psychological outcome.

Results:The helplessness/hopelessness subscale score improved slightly after curative resection (p< .001), but the score on the fighting spirit subscale score was unchanged (p= .659). Significant predictors of helplessness/hopelessness at 12 months included helplessness/hopelessness at 3 months and advanced disease stage, and satisfaction with confidants. Significant predictors of fighting spirit at 12 months included fighting spirit at 3 months existence of confidants.

Significance of results:The results suggested that mental adjustment improved slightly after curative resection for NSCLC. They also suggested the need to maintain continuity of psychosocial care that provides social support, and that an approach that includes careful attention to patients with advanced stage disease may be a strategy for improving mental adjustment after surgery for NSCLC.
Spiritual pain and its care in patients with terminal cancer: Construction of a conceptual framework by philosophical approach
Authors: MURATA HISAYUKI
Published: November 2003

Objective:In discussing spiritual care of patients with terminal cancer, it is important to clarify the structure of spiritual pain to be evaluated.

Methods:In this article, spiritual pain is defined as “pain caused by extinction of the being and the meaning of the self,” and its structure was evaluated according to the three dimensions of the human being, that is, a being founded on temporality, a being in relationship, and a being with autonomy.

Results:As a result, spiritual pain of patients with terminal cancer could be described as meaninglessness of life, loss of identity, and worthlessness of living derived from loss of the future, loss of others, and loss of autonomy of a dying individual.

Significance of results:On the basis of these understandings, the author deduced principles of spiritual care of terminally ill cancer patients as recovery of the future beyond death, others beyond death, and autonomy toward death in each dimension of the human being.
A comparison of patients dying at home and patients dying at a hospice: Sociodemographic factors and caregivers' experiences
Authors: CARLSSON MARIA E. , ROLLISON BRITTA
Published: November 2003

Objective:The aim of this study was to investigate whether there were any differences between patients who died at home and patients who died at a hospice, that is, sociodemographic variables, the family caregivers' experiences of burden, and their opinion of reasons for hospice care.

Methods:The study comprises a consecutive sample of family caregivers to adult patients: (I) who were cared for by the advanced palliative home care team (APHCT) and died at home, (II) who were cared for by the APHCT and died at the Hospice, (III) who were cared for and died at the Hospice in Uppsala during a period of one year. A questionnaire was mailed to caregivers and the medical records of all the patients were analyzed.

Results:The place of death differed significantly and varied according to gender and cohabitation status. Men died to a greater degree at home compared with women. The family caregivers' experiences of burden were moderate. Caregivers of patients who died at home thought that this care form has a more positive influence on the patients' quality of life than was the case in the other groups. They were also more satisfied with their own achievement. The caregivers' opinion of why patients needed hospice care was nearly the same in groups II + III, acutely developing symptoms being the most common reason.

Significance of results:This study showed that women died to a lesser degree at home than men. The explanation for this is unknown and requires further investigation. It is important to establish whether female patients or male caregivers need another type of support than male patients or female caregivers, since the aim of palliative care is that every patient who wishes to die at home should have this wish fulfilled.
A psychiatrist in hospice
Authors: MORGENSTERN ALAN , BOVERMAN HAROLD , GANZINI LINDA
Published: November 2003

Dr. Alan Morgenstern joined the psychiatry faculty at Oregon
Health and Science University (OHSU) in 1965. He also served as
chairman of psychiatry at Good Samaritan Hospital and Medical Center in
Portland, Oregon. His many accomplishments include his part in a World
Health Organization Travel-Study Fellowship. He served as a senior
examiner for the American Board of Psychiatry and Neurology and he
published a critique of this process, which resulted in a humanization
of the experience for examinees. While teaching at OHSU he had a
tremendous impact on generations of students who were impressed by his
humane approach to medicine. He received the OHSU Meritorious
Achievement Award for Teaching. He also served as a captain in the
United States Air Force School of Aerospace Medicine. His close friend,
Harold Boverman, M.D., wrote, “He loved his family, his work, his
patients, his friends, and his music; his license plate read
‘etude.’”

Dr. Morgenstern contacted us regarding his hope that we would
facilitate publishing this account of his experience as a hospice
patient. This represents an edited version of his manuscript. L.G. and
H.B.
Living in the face of death: Interviews with 12 terminally ill women on home hospice care
Authors: GRUMANN MAREILE M. , SPIEGEL DAVID
Published: November 2003

Objective:To determine how home hospice patients deal with their impending death and whether there is a need for greater involvement of mental health professionals in the care of patients dying at home.

Method:In a pilot study, 12 female home hospice patients with advanced cancer and a median survival time of 42 days were assessed using structured interviews and brief questionnaires. Topics of inquiry included facing death, fear of death, pain, fatigue, depression, and anxiety. Three key themes were extracted from the information reported by the women: (1) confronting the issue of death, (2) fear of dying and death and its correlates, and (3) spirituality/religious faith and its role in mitigating fear of death.

Results:First, all subjects reported thinking about their approaching death. For half of them, this thought was bothersome and these women were frequently troubled by unresolved issues and higher anxiety, pain, and fatigue. The majority of the subjects expressed a desire to actively discuss their impending death. Second, more than half of the patients reported being afraid of death and high death anxiety was associated with fear of dying in pain, high peak or usual pain, unresolved issues, and difficulty in parting with family in death. Third, most subjects experienced their religious faith as an important source of comfort and strength.

Significance of results:A substantial subgroup of home hospice patients expressed problems dealing with their approaching death. These problems are amenable to psychological treatment, such as fear of death, unresolved issues, parting with family, and pain. The findings, thus, highlight the need for close collaboration of mental health professionals with home hospice institutions.
A systematic review of spiritual and religious variables in
Palliative Medicine, American Journal of Hospice and
Palliative Care, Hospice Journal, Journal of
Palliative Care, and Journal of Pain and Symptom
Management
Authors: PUCHALSKI CHRISTINA M. , KILPATRICK SHELLEY DEAN , McCULLOUGH MICHAEL E. , LARSON DAVID B.
Published: November 2003

Objective: There has been increasing recognition and
acceptance of the importance of addressing existential and spiritual
suffering as an important and necessary component of palliative
medicine and end-of-life care in the United States. This paper seeks to
empirically and systematically examine the extent to which there is an
adequate scientific research base on spirituality and its role in
palliative care, in the palliative care and hospice literature.

Methods: We sought to locate all empirical studies published
in five palliative medicine/hospice journals from 1994 to 1998. The
journals included: American Journal of Hospice and Palliative
Care, Journal of Palliative Care, Hospice
Journal, Palliative Medicine, and The Journal of Pain
and Symptom Management. Journal contents were searched to identify
studies that included spiritual or religious measures or results. Case
studies, editorials, and theoretical or descriptive articles were not
included in the search.

Results: During the years 1994–1998, 1,117 original
empirical articles were published in the five journals reviewed. Only
6.3% (70 articles) included spiritual or religious variables. This
percentage, while low, was better that the 1% previously reported in an
examination of studies published in Journal of the American Medical
Association, The Lancet, and New England Journal of
Medicine.

Significance of results: While researchers in the field of
palliative care have studied spiritual/religious variables more
than other areas of medicine, the total percentage for studies is still
a low 6.3%. To move the field of palliative medicine forward so
appropriate guidelines for spiritual care can be developed, it is
critical that good research be conducted upon which to base spiritual
care in an evidence-based model. Recommendations are made for future
studies on spiritual care in palliative medicine.
Poems
Authors: Weeks Valentine Luisa
Published: November 2003

“Cultured Mourning” and “Solstice of My Life”
“Because you know there's an end to it”: Caring
for a relative or friend with advanced breast cancer
Authors: SINDING CHRISTINA
Published: November 2003

Objective: The aim of this paper is to delineate the
particular nature of the end-of-life care experience from the
perspective of family members and friends. Ideas drawn from feminist
analyses of caring and the sociology of death and dying are used to
illuminate study respondents' accounts.

Methods: Qualitative study with people who cared for a
family member or friend who died of breast cancer. Two interviews were
conducted with each of 12 study participants, and one carer responded
by letter to a series of questions drawn from the interview guide.
Accounts were analyzed with reference to grounded theory methods.

Results: The analysis presented here suggests that
anticipating the death of an ill relative or friend generates
imperatives to care, imperatives that are both “felt” and
linked to wider social structures and processes. The value assigned to
closeness with the ill person can be seen to reflect cultural
injunctions toward a “good death,” and to shape informal
carers' perceptions of their labor. Also discussed in this paper
are the complex negotiations undertaken by relatives and friends, for
the life and death of someone with advanced cancer.

Significance of results: This paper offers insight into the
social processes of caregiving, revealing how care may be shaped in
particular ways by an awareness of approaching death.
The strongman
Authors: BREITBART WILLIAM
Published: November 2003

Growing up on New York City's Lower East Side of the
1950s there were no other Breitbarts to be found, so it was not
surprising that I would be drawn to the heroic legend of my famous
ancestor and namesake, Siegmund (Zishe) Breitbart. My parents were
survivors of the Holocaust, born in Turka, a small shtetl in Galicia,
Poland, not far from the Lodz birthplace of the “greatest Jewish
strongman—the modern Samson.” Being related to the famous
Jewish “Iron King” was, for me, a proud link to a legacy of
strength, courage, and defiance in an environment scarred by the
profound losses and overwhelming grief of my generation of
“children of survivors.” In 1994, I attended the
International AIDS Congress in Berlin, and was the first Breitbart, to
my knowledge, to visit Zishe's grave site in a small Jewish
cemetery in the former East Berlin. Zishe Breitbart was a looming
figure of strength in my subconscious.
Palliative and Supportive Care: Introducing a new
international journal; The “Care” Journal of Palliative
Medicine
Authors: Breitbart William
Published: November 2003

We are extremely proud and gratified to present the inaugural issue
of our new international palliative care journal, Palliative &
Supportive Care (P&SC). P&SC is the
first international journal of palliative medicine that focuses on the
psychiatric, psychosocial, spiritual, existential, ethical,
philosophical, and humanities aspects of palliative care. The
journal's aim is to serve as an educational resource for
practitioners from a wide array of disciplines engaged in the delivery
of care to those with life-threatening illnesses along the entire
continuum of care, from diagnosis to the end of life. The journal also
seeks to both stimulate and provide a forum for research in the
psychiatric, psychosocial, and spiritual components of palliative
care.
Quality of life pilot intervention for breast cancer patients: Use
of social cognitive theory
Authors: GRAVES, KRISTI D. , CARTER, CINDY L. , ANDERSON, EILEEN S. , WINETT RICHARD A.
Published: November 2003

Objective: The purpose of this article is to evaluate an
8-week pilot intervention based on Social Cognitive Theory to improve
quality of life for women with breast cancer.

Methods: A total of 32 breast cancer patients were
randomized to either the intervention or standard care. Outcome
variables included quality of life, mood, self-efficacy, outcome
expectations, and self-regulation.

Results: Effect sizes were calculated to examine the impact
of the intervention, with moderate to large effect sizes found for
several subscales of the outcome expectations variable: learning about
cancer and treatment (d = 0.85), having a positive attitude
(d = 0.54), talking about cancer (d = 1.02), engaging
in relaxation (d = 0.62), and setting goals (d =
1.58).

Significance of results: A nonparametric sign test was
conducted, indicating that women in the intervention condition either
improved more or showed less decline than the women in standard care,
p = .034, two-tailed. Implications and suggestions for the
content and delivery of future psychosocial interventions with cancer
patients are reviewed.