Impact of Kendall,Hollon, Beck,Hammen, and Ingram (1987) on treatment of the continuity issue in “depression” research

The article, Issues and Recommendations Regarding Use of the Beck Depression Inventory (Kendall, Hollon, Beck, Hammen, & Ingram, 1987), has had a major impact on depression research. A majority of studies using only the BDI in nonclinical samples now refer to the construct measured as dysphoria rather than depression. This word change, however, is not always accompanied by other changes in research design and interpretation that would seem warranted by the concerns that initially prompted the dysphoria recommendation, such as the nonspecificity of high BDI scores to major depression. Researchers typically continue to derive hypotheses from depression theory, use only the BDI to measure dysphoria rather than purer markers of negative affectivity, cite as a limitation of their findings the danger of assuming continuity between subclinical and clinical depression, and sometimes lapse into depression terminology. Alternative suggestions are made for considering how the particular goals of a study might lead to various ways of handling the continuity issue.We are grateful to Tony Ahrens, Diane Arnkoff, and anonymous reviewers for feedback on earlier drafts.     

The effects of PEEP on arterial oxygenation

The effect of positive end expiratory pressure (PEEP) on arterial oxygenation depends on many factors. Two of the most important are the quality and the quantity of the physiological shunt. The quality depends on the mixed venous oxygen tension, and the quantity on the shunt fraction. Each of these factors may rise or fall with PEEP, depending on the pulmonary and circulatory state of the patient. Their ultimate balance influences the change in arterial oxygen tension.     

Similarities between cognitive and humanistic approaches to psychotherapy

It is suggested that humanistic and cognitive therapies share some similar goals. Both see the employment of rigid absolutistic shoulds as generative of dysfunctional behavior. Both value self-acceptance, in the form of discouraging the client from forming negative overgeneralized trait-like self-judgements. Both value viewing one's failures and mistakes as part of a process of exploration and coping. Hypothesis-testing and holding constructs tentatively is also valued. At the level of practice some of Beck's cognitive strategies appear to help the client learn to stick to his/her moment to moment experiencing, and to be more phenomenological. Similarly Rogers' client-centered interventions appear to lay bare the client's negative self-statement process, and to counter and correct overgeneralized negative cognitions.     

Action control as a vulnerability factor in dysphoria

Kuhl (1984) recently has advanced a theoretical account of metacognitive processes which allow one to exert a measure of voluntary control over one's emotions and cognitions and which assist in the translation of intentions into actions. Central to the theory is the idea that individual differences have an important impact on the ability to exert such controls. It also has been hypothesized (Kuhl, 1984) that persons who are lower in control resources (state-oriented persons) are more vulnerable to depression. The present research tested this hypothesis and provides support for it. The results show that state-oriented persons are more likely to be dysphoric and that stressful life events have a more adverse impact on state-oriented persons. The results also show that future levels of dysphoria can be predicted by current level of state orientation.     

The concept of “baby lung”

Background The baby lung concept originated as an offspring of computed tomography examinations which showed in most patients with acute lung injury/acute respiratory distress syndrome that the normally aerated tissue has the dimensions of the lung of a 5- to 6-year-old child (300–500 g aerated tissue).Discussion The respiratory system compliance is linearly related to the baby lung dimensions, suggesting that the acute respiratory distress syndrome lung is not stiff but instead small, with nearly normal intrinsic elasticity. Initially we taught that the baby lung is a distinct anatomical structure, in the nondependent lung regions. However, the density redistribution in prone position shows that the baby lung is a functional and not an anatomical concept. This provides a rational for gentle lung treatment and a background to explain concepts such as baro- and volutrauma.Conclusions From a physiological perspective the baby lung helps to understand ventilator-induced lung injury. In this context, what appears dangerous is not the V_T/kg ratio but instead the V_T/baby lung ratio. The practical message is straightforward: the smaller the baby lung, the greater is the potential for unsafe mechanical ventilation.     

Two Bankrobbers With “Antisocial” and “Schizoid/Avoidant” Personality Disorders, Comorbid With Partial Seizures: Temporal Lobe Epilepsy and Limbic Psychotic Trigger Reaction, Respectively

Diagnostic overshadowing is illustrated by two cases of unplanned, motiveless bank robbery, initially merely attributed to antisocoial or schizoid/avoidant (loner) personality disorder, respectively. Both disorders, however, were comorbid with their potentially unobservable counterparts, with brief partial seizures, supported by both men's abnormal scalp-EEG's, their symptomatology with psychosis, and their histories of closed head injury in childhood. Such injuries are known to render particularly the temporo-limbic brain system susceptible to later partial seizure: Mr. A. had temporal lobe epilepsy (TLE) with stereotypic auditory command hallucinations and clouding of consciousness. (His past antisocial aggressive behavior might also have reflected TLE-related inter-ictal events.) Mr. B. had the symptomatology proposed as limbic psychotic trigger reaction (LPTR). Mr. B., a social loner, typically ruminated on past intermittent moderate stresses, a specific precondition of seizure kindling, ultimately elicited by a specific stimulus, resembling his past hurts. As is typical for LPTR, Mr. B. had no clouding of consciousness and no amnesia for his atavistically regressive acts, committed with flat affect, nausea, and fleeting delusions of grandeur (being gifted, like Rembrandt).     

Learning about new anesthetics using a model driven,full human simulator

Objective.New pharmacological agents are introduced into medical practice at an ever-increasing pace. Teaching how to use new medications in the clinical setting presents educational challenges and puts patients at risk. Methods.Patients and clinical settings in which remifentanil might provide clinical advantages over existing anesthetics were identified. A simulator curriculum was developed to demonstrate the use of remifentanil in the sample cases. The simulation was designed to highlight the clinical advantages and potential side effects of remifentanil. A screen displaying the concentrations of remifentanil in plasma and in the hypothetical effector site was developed. A simulator was modified (addition of an infusion pump and a pharmacokinetic screen display) and transported to several cities in the U.S.A. An instructor guided small groups of anesthesiologists and anesthetists through a structured program that enabled participants to observe drug effects in simulated patients. Results.There were 836 participants in the remifentanil program, which was offered in 58 cities in the U.S.A. Surveys were completed by 574 anesthesiologists. There was a significant difference in comfort level for using remifentanil after the session compared to before (Chi-square, p< 0.001.) The statement: Clinical simulation experience is a means to learn about new agents like remifentanilwas rated as excellent by 81% and as good by 19% of participants. No participant found the experience to be not useful. Conclusions.Patient simulation is a novel method of introducing new drugs to the medical community and is perceived by anesthesia providers as a valuable addition to available teaching methods.     

A Computational Positron Emission Tomography Simulation Model for Imaging β-Amyloid in Mice

Purpose We aimed to develop a computational simulation model for -amyloid (A) positron emission tomography (PET) imaging.Procedures Model parameters were set to reproduce levels of A within the PDAPP mouse. Pharmacokinetic curves of virtual tracers were computed and a PET detector simulator was configured for a commercially available preclinical PET-imaging system.Results We modeled the effects of A therapy and tracer affinity on the ability to differentiate A levels by PET. Varying affinity had a significant effect on the ability to quantitate A. Further, PET tracers for A monomers were more sensitive to the therapeutic reduction in A levels than total brain amyloid. Following therapy, the decrease in total brain A corresponded to the slow rate of change in total amyloid load as expected.Conclusions We have developed a first proof-of-concept A-PET simulation model that will be a useful tool in the interpretation of preclinical A imaging data and tracer development.     

Positionspapier zur Qualifikation und Zertifizierung von Untersuchern in der Echokardiographie

Ohne ZusammenfassungKonsensus der Kommission Zertifizierung Echokardiographie     

Reversible “locked-in” syndromes

Two young patients are described who made good recoveries from a locked-in syndrome presumed to be due to ventral pontine ischemia. The first patient recovered completely from quadriplegia and mutism. In the second patient the only permanent sequellae were slight dysarthria and mild spasticity. Since patients may recover nearly completely from a locked-in syndrome, aggressive supportive therapy seems justified during the initial weeks or months.     

The effects of norepinephrine on hemodynamics and renal function in severe septic shock states

Objective To investigate the effect of norepinephrine (NE) on hemodynamics, oxygen metabolism and renal function in patients with severe septic shock.Design Prospective study.Setting Post-operative ICU in a municipal general hospital.Patients The study included 56 patients with extreme low resistance states due to abdominal sepsis, who remained hypotensive (MAP<60 mmHg) despite optimal fluid therapy and dopamine>20g/kg/min and cumulative doses of dopamine and dobutamine>30g/kg/min, respectively.Interventions After registration of baseline values dopamine was reduced to 2.5g/kg/min, and norepinephrine was administered starting at a dose of 0.05 g/kg/min until a mean arterial pressure of more than 60 mmHg could be maintained.Measurements and results During norepinephrine infusion (dosage ranging between 0.1–2g/kg/min, mean dose rate: 0.4g/kg/min) mean arterial pressure and systemic vascular resistance index increased significantly (p<0.001). After 8h a significant increase in stroke volume (p<0.05) and decrease in heart rate (P<0.05) could be observed. There was no significant change in cardiac index (CI), oxygen delivery (O₂AVI) and oxygen consumption (VO₂I). Creatinine clearance increased significantly (p<0.005) from a control value of 75±37 ml/min to 102±43 ml/min after 48 h NE-trearment.Conclusion Our results suggest that norepinephrine can be used safely in the treatment of severe septic shock states. Mean arterial pressure and glomerular filtration rate improved markedly without deleterious effects on CI, O₂AVI and VO₂I.     

Effect of rational and irrational beliefs on intensity and “inappropriateness” of feelings: A test of rational—emotive theory

This study tested the central rational-emotive hypothesis that greater inappropriate emotional distress is caused by irrational rather than rational beliefs about undesirable situations. Ellis and Harper (1975) have suggested that inappropriate emotions (such as anger) differ qualitatively from appropriate emotions (such as annoyance). Previous research, however, indicates that irrational beliefs are associated with greater appropriate as well as inappropriate negative emotions. In this study, a 3 ×2 pretest—posttest factorial design was used, in which 10 undergraduates of either sex were randomly assigned to one of three treatments, which involved imagining being in a situation. The control condition comprised an emotionally neutral scene, while the two experimental treatments contained rational and irrational statements about being left alone by one's partner at a party. The experimental manipulation was successful, and both inappropriate and appropriate negative emotions were found to be greater in the irrational condition as compared to the neutral or rational condition. Thus irrational beliefs were shown to have an effect on emotions, but the emotions associated with irrational beliefs differed from those associated with rational beliefs in quantity rather than in quality.     

Causal Thinking About Somatic Symptoms—How Is It Related to the Experience of Symptoms and Negative Affect?

The relation between causal thinking about somatic symptoms (psychological, somatic, and external symptom attribution) and the experience of somatic complaints and negative affect was studied in a community sample of 208 individuals. Although cluster analysis identified groups of individuals with psychological, somatic, and external attribution styles, the analysis also revealed groups of individuals with combinations of high or low scores on two or three attribution dimensions. Consistent with previous research, psychological attribution of symptoms was associated with a higher degree of somatic complaints and negative affect; this effect, however, was primarily due to a group of psychologizers/externalizers, and not to the pure psychologizers. Also in replication of earlier studies, all three attribution subscales were intercorrelated. The findings are discussed in terms of rumination processes. It is argued that the findings concerning psychological symptom attribution have received too little attention in the literature so far, probably because they go against dominant theoretical paradigms in psychosomatic medicine.     

Stories from doctors of patients with pain. A qualitative research on the physicians’ perspective

Goal of work .The aim of this study was to explore the physicians internal representation of the doctor–patient relationship in the dramatic field of the patient with pain.Methods Using an open narrative format, 151 physicians were asked to Tell us about an episode during your professional experience in which you found yourself in difficulty whilst confronting a patient who was in pain. The narrations were examined in accordance with a clinical-interpretive method.Main results Three perspectives of observation were identified, namely: the biological perspective, the professional perspective, and the personal perspective. The biological perspective is about the biological model and the depersonalization of pain. In the professional perspective, the narrative concerns the patient as a person and the reattribution of the pain to the suffering person. The personal perspective is about the emotional-relational explosion within the meeting between the doctor as human being and the patient as human being. Most of the narrations did not strictly connect to one or another of the perspectives, but each story seemed a journey without peace back and forth among the perspectives.Conclusions The professional perspective seemed to be the only place in which physicians could stop, a space not extreme in which they seemed to express the need for education about the management of the professional relationship with the other person.     

Depression and negative processing of evaluative feedback

Beck's cognitive behavioral model of depression served to predict that depressed college students would negatively bias their processing of evaluative feedback relative to nondepressed college students. Depressed and nondepressed students performed a dot estimation task and received good, average, poor, or ambiguous feedback following each of 40 trials. Half of each subject group also received feedback under conditions of high or low task importance to assess the generality of depressive biasing tendencies. Analyses revealed significant negative processing biases among depressives relative to nondepressives in immediate perception and latencies of response to feedback stimuli during the latter 20 feedback presentations but not in response to earlier feedback trials. In addition, biases in the immediate perception of feedback stimuli were most pronounced under ambiguous feedback conditions. No differences were observed between depressives and nondepressives in the long-term recall of evaluative feedback, and measures of bias were not significantly affected by the perceived importance of the experimental task. Explanations are offered for the specificity of the findings obtained.The research in this article was conducted while the first author was supported by a National Science Foundation Graduate Fellowship. The authors would like to thank David Berman, Mindy Perlman, and Carol Reinsel for their help in data collection, and Ken Knoblauch and Denise Varner for their technical assistance.     

Cognitive therapy and research: A question of questions

Although cognitive-behavioral approaches have now earned substantial recognition within clinical psychology, they face a host of challenges which merit careful attention. In the interest of their own refinement and growth, a philosophy of critical and cautious self-scrutiny has much more to offer than one of unbridled enthusiasm and defensiveness. Three of the major challenges facing contemporary workers in this area are (a)a clearer demonstration of enduring effectiveness with clinically revelant problems, (b)refinements in our conceptualization and analysis of therapeutic process, and (c)a clearer specification of the operations and procedures employed in various therapies. But perhaps the greatest problem facing cognitive therapy researchers is the tendency of confirmatory bias—i.e., selective reporting, emphasis, and publication of studies which support cognitive hypotheses. Unless we communicate and seriously examine negative results and replicational failures, we will encourage a distorted view of our knowledge and, more importantly, sacrifice the invaluable information which these failures might offer toward the refinement of our models and procedures. For their comments on an earlier draft of this article, I am indebted to Eric Nelson, Kitty Mahoney, Todd Rogers, and Don Meichenbaum.     

Cognitive Mechanisms in the Avoidance of Painful and Dangerous Thoughts: Elaborating the Assimilation Model

The emotional processing of problematicexperiences is a central feature of psychotherapy.Stiles et al. (1990) propose an Assimilation model as ageneric account of such processes. This paper focuses on two aspects of this model: the concepts ofwarding off and unwantedthoughts showing how a cognitive scienceperspective can enrich our understanding of them. Wefocus on the ways in which cognitive processes (particularly different sorts ofmemory) mediate between experience and psychopathology.Two classes of problematic experiences that can beavoided or barred from full awareness to varying degrees are distinguished. We refer to this distinctionas the pain paradigm, in which experiencesare inaccessible to memory retrieval using verbalmnemonics,versus the panic paradigm, inwhich experiences fail to be retrieved or reported because theperson anticipates catastrophic consequences. We discusshow understanding the cognitive origins of thesephenomena promises to allow researchers and therapists to generate new approaches to overcome blocksin therapy.     

Pharmacokinetics of panipenem/betamipron in patients with end-stage renal disease

Panipenem/betamipron (Carbenin), a parenteral carbapenem antibiotic, is used for the treatment of severe and intractable bacterial infections caused by gram-positive and gram-negative bacteria. Because 30% of panipenem and most of the betamipron are excreted in the urine in an unchanged form, renal function is the important determinant of the dosage regimen of panipenem/betamipron. In this study, the pharmacokinetics of panipenem/betamipron were investigated in patients with end-stage renal disease (ESRD) undergoing hemodialysis treatment to establish an appropriate dose regimen. We further attempted to predict the in vivo clearance in patients undergoing hemodialysis based on the in vitro dializability. The pharmacokinetics of panipenem/betamipron were investigated in eight patients after a 1-h intravenous infusion of panipenem/betamipron (500mg/500mg). The in vitro extraction ratios of panipenem/betamipron through a high-flux dialyzer were obtained, and compared with those obtained in vivo. The clearances of panipenem in patients were 9.53 ± 1.26l/h with hemodialysis, and 2.92 ± 0.238l/h without hemodialysis. In contrast, those of betamipron were 4.18 ± 0.643l/h and 0.615 ± 0.511l/h, respectively. The clearance of panipenem with hemodialysis were predicted well from in vitro extraction ratios, while that of betamipron was overestimated about 1.4-fold, probably due to high plasma protein binding and the binding difference between patients and healthy subjects. After comparing the pharmacokinetic behavior of panipenem in patients with ESRD and that of a surrogate marker of efficacy, we recommend that these patients be treated with 500mg/500mg of panipenem/betamipron once daily, which gives a similar clinical result in a patient with normal renal function.     

The activity of grepafloxacin in two murine models of <Emphasis Type="Italic">Mycobacterium avium</Emphasis> infection

The activity against Mycobacterium avium complex (MAC) of varying doses of grepafloxacin (GRE; 25mg/kg, 50mg/kg, 100mg/kg, and 200mg/kg) were compared to clarithromycin (CLA; 100mg/kg and 200mg/kg), ethambutol (EMB; 100mg/kg), and rifabutin (RBT; 10mg/kg) using an intranasal (IN) infection model compared to an intravenous (IV) infection model. Beige mice (C57BL6/J-Lyst bg J/+) were infected intranasally with about 10⁶ organisms and for the IV model about 10⁷ organisms. Treatment for both models was started 1 week postinfection and given by gavage 5 days/week for 4 weeks. At the initiation of therapy, an early control group was killed to determine the initial organism load. Three days following the completion of therapy, drug-treated groups of mice and the late control group were killed and the response to therapy measured. The most effective agents were CLA and RBT. GRE and EMB had modest activities in both the IN and the IV models. A matched comparison between IN and IV challenges for each of the agents used revealed greater suppression of MAC in the IN model compared to the IV model.     

Ultrasonic-enhanced gentamicin transport through colony biofilms of <Emphasis Type="Italic">Pseudomonas aeruginosa</Emphasis> and <Emphasis Type="Italic">Escherichia coli</Emphasis>

The hypothesis that ultrasound increases antibiotic transport through biofilms of Escherichia coli and Pseudomonas aeruginosa was investigated using colony biofilms. Biofilms grown on membrane filters were transferred to nutrient agar containing 50µg/ml gentamicin. A smaller filter was placed on top of the biofilm and a blank concentration disk was situated atop the filter. Diffusion of antibiotic through the biofilms was allowed for 15, 30, or 45min at 37°C. Some of these biofilms were exposed to 70-kHz ultrasound and others were not. Each concentration disk was then placed on a nutrient agar plate spread with a lawn of E. coli. The resulting zone of inhibition was used to calculate the amount of gentamicin that was transported through the biofilm into the disk. The E. coli and P. aeruginosa biofilms grown for 13 and 24h were exposed to two different ultrasonic power densities. Ultrasonication significantly increased the transport of gentamicin through the biofilm. Insonation of biofilms of E. coli for 45min more than doubled the amount of gentamicin compared to their noninsonated counterparts. For P. aeruginosa biofilms, no detectable gentamicin penetrated the biofilm within 45min without ultrasound; however, when insonated (1.5W/cm²) for 45min, the disks collected more than 0.45µg antibiotic. Ultrasonication significantly increased transport of gentamicin across biofilms that normally blocked or slowed gentamicin transport when not exposed to ultrasound. This enhanced transport may be partially responsible for the increased killing of biofilm bacteria exposed to combinations of antibiotic and ultrasound.