Smooth pursuit eye movements in schizophrenics: quantitative measurements with the search-coil technique

Eye movements of five schizophrenic and five normal subjects were measured with the magnetic-field search-coil technique. Subjects followed targets moving smoothly at various speeds, either unpredictably in a step-ramp fashion or predictably in a triangular wave. The tracking stimulus was either a small dot or a large, richly-textured image that occupied a large portion of the visual field. Tracking by schizophrenics was abnormal; it was punctuated by catch-up saccades that corrected for smooth following movements of inadequate velocity. We did not, however, find saccadic intrusions, such as square wave jerks. Under all tracking conditions steady-state gains (eye velocity/target velocity) and, in the case of step-ramps, average acceleration in the first 120 ms were lower in patients than in normal subjects. The differences were most pronounced for tracking of the small target, moving at the highest speed tested (30 degree/s), in the nonpredictable, step-ramp waveform. With this stimulus mean steady-state gain was 0.36 (SD +/- 0.12) for the schizophrenic patients and 0.73 (SD +/- 0.11) for the normal subjects. When the target was changed to the large-field stimulus or moved in a predictable (triangular-wave) fashion, tracking improved in both patients and normal subjects, and even more so when these features were combined.     

Katamnestische Untersuchungen zur Genese des Mesothelioms

Zusammenfassung In 150 von 251 autoptisch gesicherten Hamburger Mesotheliomfällen konnte rückschauend die Arbeits- und Umweltvorgeschichte erhoben werden. In 85 Fällen war eine berufliche Asbestexposition nachweisbar: 18 Patienten waren in der Asbest-Textil- und -Isoliermittelindustrie stark gefährdet. 67 waren bei anderen Tätigkeiten, vor allem im Schiffbau und bei der Kriegsmarine, asbestexponiert. 20 Patienten waren durch die Nachbarschaft eines Asbestbetriebes gefährdet. In einem Vergleichskollektiv waren nur 35 Personen beruflich exponiert (Unterschied P 0,001). Das Sterbealter liegt im Mittel um 65 Jahre, die Latenzzeit im Mittel um 40 Jahre.Diese Befunde stehen im Einklang mit internationalen Ergebnissen. Daher erscheint es gerechtfertigt, zukünftig ein klinisch ausreichend gesichertes Mesotheliom als Berufskrankheit unter bestimmten Voraussetzungen anzuerkennen. Im Regelfall sollte eine berufliche Exposition von mindestens 2 Jahren und eine Latenzzeit von mindestens 20 Jahren vorangegangen sein; bei massiver Exposition können beide Zeiten kürzer sein. Die bisherige Möglichkeit der Anerkennung als Quasi-Berufskrankheit nach § 551 (2) RVO sollte durch Aufnahme des Mesothelioms in eine zu erwartende neue europäische Berufskrankheitenverordnung abgelöst werden.Die autoptische Sicherung der Diagnose mit Lungenveraschung bleibt anzustreben.Mit Unterstützung des Bundesministeriums für Arbeit und Sozialordnung der Bundesrepublik Deutschland, Bonn.     

Clinical teaching reexamined.

In an effort to determine the most effective clinical teaching behaviors of clinical teachers or preceptors in individual or small group settings, investigators at the University of North Carolina and the University of Alabama developed an instrument to survey all clinical medical students at the two institutions. This process resulted in a compilation of the specific behaviors found to be most helpful to the responding students in facilitating their clinical learning. All items were then factor analyzed, resulting in six more general teaching dimensions or factors being identified. There were active student participation, preceptor attitude toward teaching, emphasis on applied problem-solving, a student-centered instructional strategy, humanistic orientation, and emphasis on content and research. The more specific behaviors which loaded on each factor were also examined.     

Challenging symptoms in children with rare life-limiting conditions: findings from a prospective diary and interview study with families

Aim: The aim was to describe the nature, frequency, severity and management challenges of symptoms in children with two rare life‐limiting conditions [Mucopolysaccharide (MPS) and Batten disease]. Methods: This was an embedded mixed‐method study set in the UK between 2009 and 2011. Twenty‐six children from 23 families took part. Seventeen children had an MPS condition [MPS III (Sanfilippo) n = 15; MPS I (Hurler) n = 1; MPS IVA (Morquio); n = 1]. Nine children had Batten disease. Prospective data relating to symptoms were collected over 8 weeks using a symptom diary, and qualitative retrospective interviews with families were conducted. Main outcome measures included frequency, severity rating and identification of most challenging symptoms to manage. Results: The most common and severe symptoms in MPS III were agitation, repetitive behaviours, hyperactivity and disturbed sleep, and in Batten disease were agitation, joint stiffness, secretions, and disturbed sleep. The data highlighted the high prevalence of behavioural symptoms. Distress caused to families by symptoms was not related simply to their occurrence, but to difficulty in management, likelihood of control and extent to which they signalled disease progression and decline. Conclusion: In challenging contrast to the dominant biomedical framing of these rare conditions it was behavioural symptoms, rather than the physical ones, that families documented as most frequent, severe and challenging to manage. The diary developed for this study has potential use in aiding parents and clinicians to document and communicate concerns about symptoms.