Standardization of the fear survey schedule

The extended Wolpe-Lang Fear Survey Schedule (1969) was administered to 115 female and 141 male university students. Standardized data were obtained. The clinical and research implications of the data are discussed.     

Spontaneous gap phenomenon in atrioventricular conduction produced by His bundle extrasystoles.

A gap in atrioventricular conduction is a zone within the cardiac cycle during which premature impulses are blocked in the conduction system, while impulses of greater or lesser prematurity are conducted. This has previously been produced only by atrial or ventricular stimulation techniques. This report demonstrates a spontaneous gap produced by His extrasystoles.     

Assessment of imagery during covert modeling of assertive behavior

The present investigation examined the effect of covert modeling in training assertive behavior and developed a technique to assess imagery by having subjects verbalize ongoing imagery during treatment. To evaluate the effect of this procedure on therapy outcome, covert modeling groups with and without the verbalization procedure were compared. No-assertion-modeling and no-treatment control groups were included in the design to control for assertion-relevant imagery and the effects of repeated assessment without intervening treatment, respectively. Both covert modeling conditions increased assertiveness as indicated on self-report and overt behavioral measures. The gains transferred to novel situations and were maintained at a 4-month follow-up. Assessment of imagery during treatment indicated that subjects generally adhered to the conditions to which they were assigned. However, some subjects introduced scene material that deviated from that presented by the therapist.     

Hereditary defects of the conotruncal septum in Keeshond dogs: pathologic and genetic studies

Pathologic studies of a hereditary cardiovascular defect in Keeshond dogs demonstrated a spectrum of malformations, primarily involving the ventricular outflow tracts. Lesions ranged from subclinicai defects of the crista supraventricularis to end-stage tetralogy of Fallot and included isolated ventricular septal defects and pulmonic stenosis. The spectrum can be explained by assuming that the anatomic variations represent different thresholds along a continuum of maldevelopment producing hypoplasia and malpositioning of the conotruncal septum. The results of breeding experiments conducted in a colony of Keeshond dogs with conotruncal septal defects confirmed the hereditary nature of the abnormality but were not consistent with any simple genetic hypothesis. Both the incidence and the severity of the conotruncal lesions increased with the severity of the parental defect. The results are shown to fit a polygenic model with three developmental thresholds, in which multiple genes act additively to produce a continuous distribution of maldevelopment involving the conotruncal septum. Lesions of increasing severity occur with an increasing “dose” of genes predisposing to conotruncal septal defects.     

Platelet-mediated cardiac ischemia

Although platelets have been associated with angina pectoris, myocardial infarction, and sudden death, the platelet's capacity for induction and propagation of cardiac ischemia remains incompletely defined. We therefore evaluated the effects of platelet activation occurring within the coronary circulation and tested the hypothesis that inhibition of platelet function would prevent platelet-induced cardiac ischemia. Human platelets were isolated from blood obtained from normal donors by Sepharose 2B column chromatography, resuspended in Hepes buffer, and added to the perfusate of a Langendorff rabbit heart (platelet counts > 10,000/μl). Without, and with low dose (10 μM) prostaglandin E₁ (PGE₁), a reversible inhibitor of platelet function, immediate and irreversible global cardiac ischemia, as monitored by NADH fluorescent photography, ensued (N = 4) following platelet activation with thrombin (0.1 to 1 U/ml). Higher concentrations of PGE₁ (0.1 to 1 mM, N = 2) or aspirin ingestion (1000 mg taken approximately 12, 4, and 1 hr prior to experiment, N = 2) completely prevented this platelet-induced myocardial ischemia. Aspirin, unlike PGE₁, was effective despite its inability to block thrombin-induced platelet aggregation in our in vitro gel-filtered system. We conclude that activation of platelets within the coronary circulation is sufficient for induction of irreversible cardiac ischemia. The efficacy of aspirin, a cyclooxygenase inhibitor, further suggests that the products of arachidonate metabolism (e.g., thromboxanes) have a fundamental role in the genesis of platelet-mediated myocardial ischemia.     

Maternal blood pressure and fetal growth

Eleven thousand eighty-two term, singleton pregnancies were analyzed for clues to how different levels of maternal blood pressure affect fetal growth. Birth weights progressively increased with increasing pressures until the hypertensive range was reached when maternal edema and proteinuria were absent. Pressure-associated increases in fetal growth were even more rapid when mothers were edematous, and slower when 2+ or greater proteinuria was present. Birth weights leveled off or decreased when pressures reached the hypertensive range. The pressure threshold at which growth slowed increased from diastolic 75 mm Hg in the lowest maternal pregnancy weight gain category to nearly 100 mm Hg in the highest weight gain category. Decreases in birth weight associated with hypertension were most severe when mothers were thin and had low pregnancy weight gains. Diuretics reduced birth weights in low maternal weight gain pregnancies but not in high weight gain ones.     

The modified essay question: effect of author location on student performance

The Department of Family Medicine at Jefferson Medical College, Philadelphia has utilized the modified essay question (MEQ) as an evaluative instrument in its required third-year clerkship since 1976. Previous analysis had indicated that students who participated in their clerkship at the university family practice centre (FPC) consistently performed at a higher level on their MEQ examinations than students who participated in clerkship activities at affiliated FPCs. In order to test the hypothesis that university-taught students had higher final examination scores because university teachers developed and graded the examinations, MEQs were developed by affiliate teachers and used for one half of five final examinations during the 1982-83 academic year. Students at the university-trained site continued to perform better than affiliated-trained students, even on MEQs developed by their own teachers. These results, as well as the significant administrative time involved in the project, have caused the Department of Family Medicine to revert to its previous policy of university teachers being responsible for the final examination.     

National trends in admissions,repair, and mortality for thoracic aortic aneurysm and type B dissection in the National Inpatient Sample

Objective

The advent of endovascular repair for both thoracic aortic aneurysm and type B dissection has transformed the management of these disease processes. This study was undertaken to better define, compare, and contrast the national trends in hospital admissions, invasive treatments, and inpatient mortality of patients with thoracic aortic aneurysm and type B dissection in the National Inpatient Sample.