Trends in negative defensive medicine within general practice.

Negative defensive medical practice has adverse consequences both for individual patients and for public health. This paper reports the results from a survey conducted in 1999 in which certain features indicative of negative defensive practice were compared with an identical survey conducted five years previously. Responding general practitioners stated that they are now significantly more likely to undertake diagnostic testing, refer patients, and avoid the treatment of certain conditions.     

When a laser pen becomes a stick: remapping of space by tool-use observation in hemispatial neglect

The role of active tool use in the remapping of space in hemispatial neglect patients has been extensively investigated. To date, however, there is no evidence that observing tool use can play a role in the remapping of space in hemispatial neglect patients. In this study, a patient with a severe hemispatial neglect in near but not far space and twelve healthy controls were asked to bisect near and far lines using a laser pen. The task was performed both before and immediately after sessions in which they merely observed the experimenter bisecting near and far lines with a stick. During the observation session, participants were either holding an identical stick or empty-handed. Results, in both the neglect patient and healthy controls, showed that observing the experimenter bisecting line while holding the same tool, produces a remapping of the far space into the near space. This result was particularly evident in the neglect patient where observing line-bisection task extended the spatial deficit from the near to the far space. Our results provide new empirical support to the idea that the space around us is not mapped in merely metrical terms, rather it seems to be deeply impacted by both action observation and execution.     

The VA's affiliation with academic medicine: an emergency post-war strategy becomes a permanent partnership

The creation of a cabinet-level department for veterans' programs is an occasion to review medical care of American military veterans, which dates back to colonial times. To meet the medical care crisis caused by large numbers of returning World War II veterans, the Veterans Administration (VA) entered into affiliations with U.S. medical schools, a partnership that provided physicians for veterans and allowed residents to complete graduate medical education. Increasing medical care needs of veterans of World War II and successive conflicts, and legislatively expanded entitlements, have contributed to sustained growth of the VA workload--which in turn has led to an expanded partnership with schools of medicine and allied health sciences. The affiliations continue to serve both partners well and to contribute substantively to society at large by fostering the production of medical manpower and advances in biomedical research.     

When dyspnea gets worse: Suffocation fear and the dynamics of defensive respiratory responses to increasing interoceptive threat

In patients with anxiety and/or respiratory diseases, body sensations, particularly from the respiratory system, may increase in intensity and aversiveness and thus lead into defensive action (e.g., escape) or panic. The processes, however, that might contribute to the culmination of symptoms and the switch into defensive action have not been well understood yet. The current study aimed at evaluating an experimental paradigm to characterize the dynamics of defensive mobilization to body sensations increasing in intensity and aversiveness. Persons reporting low and high suffocation fear (SF; N = 69) were exposed to increasingly unpleasant feelings of dyspnea induced by inspiratory resistive loads and a breathing occlusion requiring voluntary breath holding. Respiratory responses were assessed along with subjective reports of anxiety and panic symptoms. Presentation of respiratory loads with increasing physical resistance led to increasingly unpleasant feelings of dyspnea. Twenty‐eight participants terminated the exposure prematurely at least once. When dyspnea was severe, high compared to low SF persons exhibited an increased respiratory rate that was accompanied by reports of more intense panic symptoms. Premature terminations of exposure were preceded by a surge in anxiety, breathing frequency, and mouth pressure, and a decrease in tidal volume. We successfully established an experimental paradigm to assess changes in defensive responding with increasing intensity of an interoceptive threat. The current data foster our understanding of behavioral expression patterns observed in patients with anxiety and/or respiratory diseases and the processes involved in the culmination of bodily sensations and anxiety into panic.     

When a smile becomes a fist: the perception of facial and bodily expressions of emotion in violent offenders

Previous reports have suggested an enhancement of facial expression recognition in women as compared to men. It has also been suggested that men versus women have a greater attentional bias towards angry cues. Research has shown that facial expression recognition impairments and attentional biases towards anger are enhanced in violent criminal male offenders. Bodily expressions of anger form a more direct physical threat as compared to facial expressions. In four experiments, we tested how 29 imprisoned aggressive male offenders perceive body expressions by other males. The performance of all participants in a matching-to-sample task dropped significantly when the distracting image showed an angry posture. Violent offenders misjudged fearful body movements as expressing anger significantly more often than the control group. When violent offenders were asked to categorize facial expressions and ignore the simultaneously presented congruent or incongruent posture, they performed worse than the control group, specifically, when a smile was combined with an aggressive posture. Finally, violent offenders showed a greater congruency effect than controls when viewing postures as part of an emotionally congruent social scene and did not perform above chance when categorizing a happy posture presented in a fight scene. The results suggest that violent offenders have difficulties in processing emotional incongruence when aggressive stimuli are involved and a possible bias towards aggressive body language.     

Antibodies as defensive enzymes

Antibodies (Abs) and enzymes are structural and functional relatives. Abs with promiscuous peptidase activity are ubiquitous in healthy humans, evidently derived from germline variable domain immunoglobulin genes encoding the serine protease-like nucleophilic function. Exogenous and endogenous electrophilic antigens can bind the nucleophilic sites covalently, and recent evidence suggests that immunization with such antigens can induce proteolytic antibodies. Previously, Ab catalytic activities have been linked to pathogenic autoimmune reactions, but recent studies indicate that proteolytic Abs may also serve beneficial functions. An example is the rapid and selective cleavage of the HIV-1 coat protein gp120 by IgMs found in uninfected humans. The selectivity of this reaction appears to derive from recognition of gp120 as a superantigen. A second example is the cleavage of amyloid -peptide by IgM and IgG from aged humans, a phenomenon that may represent a specific proteolytic response to a neurotoxic endogenous peptide implicated in the pathogenesis of Alzheimers disease.     

The antiplasmin defensive reflex system

Summary A study was made of the changes in the amount and resistance of glycogen in the liver at the end of intrauterine development and during the first hours after birth; the dynamics of these changes is compared to the dynamic changes of blood glucose level. Experiments were staged on rabbits. Glycogen splitting in the liver of rabbits fetuses proved to be either absent or was only insignificant at the end of the intrauterine development. Evidently the liver does not taken an active part in the control of the glycemia level at this stage of ontogenesis. Glycogolysis is not active in controlling glycemia immediately after birth. The period, required for the appearance of activization of the enzyme systems in the liver, effecting the process of glycogen mobilization, largely determines the duration and the depth of hypoglycemia in the neonatal period.(Presented by Active Member AMN SSSR A. F. Tur) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 54, No. 9, pp. 22–26, September, 1962     

When things go badly – Managing quality problems and complaints in transfusion medicine

Continuous and dynamic progress in all segments of transfusion medicine has significantly improved the quality, safety and efficacy of transfusion therapy. In addition to the scientific and technological innovations, implementation of the quality system and haemovigilance in blood establishments significantly contributed to this progress. Despite the fact that most of the activities in transfusion chain take place without problems, some risks are still present and even the best organized and managed systems are sometimes faced with quality problems and complaints. In transfusion medicine, their causes are mostly related to the biological origin of blood products, while the complexity of the process and a large number of participants in transfusion chain facilitates the occurrence of errors. Some quality problems are caused by materials and equipment used in product realization, inadequate education or skills of the staff, suboptimal planning and organization of work. The best approach to managing quality problems is preventative approach, including comprehensive risk management, education, defining critical control points, permanent quality monitoring and audits. Quality problems and complaints should be resolved in a timely manner, following the standardized protocol with clearly defined responsibilities. All procedures and decisions should be documented and traceable. The root cause analysis of the problem should be carried out and followed by appropriate corrective actions. The ultimate goal is to increase quality, safety, productivity, efficiency and customer satisfaction, while reducing defects and costs.