Use of an electric ear syringe in the emergency department

Verrucous carcinoma is a rare, highly keratinizing variant of squamous cell carcinoma of the skin or mucosae characterized by a local aggressiveness but a low potential for metastasis. The plantar form is also known as epithelioma cuniculatum. Fingers and toes are rarely affected, and tumors of the nail bed are exceptional. Clinically, the lesion presents like a wart and is then often misdiagnosed. Treatment of choice is wide surgical excision. A case of verrucous carcinoma of the nail apparatus is presented, and diagnosis is discussed.     

When not to comment.

Suggests that errors, such as the one S. D. McLaughlin (1980) made in his critique of M. H. Birnbaum's (1979) article on sex bias in salaries of psychologists, could be avoided if authors would read material cited as containing theory before rushing into print with claims that procedures are atheoretical. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When not to recommend separation counseling.

Presents a strategically motivated rationale for suspending treatment, in some cases, when couples separate in the midst of conjoint marital therapy. It is suggested that when, at separation, there is a power imbalance between the spouses and when the good faith of the more powerful spouse is in question, a recommendation to suspend treatment will prevent aggravation of the imbalance and will encourage individuation in the weaker spouse. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When is a negative study not negative?

Results of Phase III randomized clinical trials can be categorized into three groups: positive, null, and negative. The jargon used in discussing results of comparative studies requires clarification because misclassification can result in incorrect interpretation. A positive result indicates that the experimental therapy(ies) is(are) superior to standard therapy. A null result indicates that no statistically significant difference between therapies was found; hence, standard therapy should not be replaced. A negative result indicates that the experimental therapy had a deleterious effect compared to standard therapy. This article presents a discussion of these categories and examples of each.     

When is a school not a school?

What and how we teach, how we learn, and how we practice nursing are fundamentally changing. Perspectives on Assessment invites dialogue on assessment's central role in the paradigm shifts currently occurring in nursing education and nursing practice. Programs of assessment in educational and practice institutions offer the opportunity for continuous feedback on the quality and effectiveness of our efforts to prepare nurses who are competent to practice in a healthcare environment that is continuously changing and increasingly community based. The assessment process itself offers the opportunity for us to engage in an ongoing conversation about our progress with these two paradigm changes.     

When stereopsis does not improve with increasing contrast

It is well known that stereoacuity for conventional (1st-order) stimuli improves with increasing contrast with an approximate slope of -0.5 on log-log axes (Halpern DL, Blake RR. Perception 1988;17:483-495; Legge GE, Gu Y. Vis Res 1989;29:989-1004). In the experiments reported here a variety of stimuli were used (Gabor patches, amplitude modulated stimuli and 1D noise patches) and tasks (stereoacuity and Dmax) to determine if 2nd-order stereopsis shows a similar square root dependence. The results consistently demonstrate that the effect of contrast on stereopsis is quite different for the 2nd-order stimuli. Increases in stimulus contrast have little effect on performance; the resulting slopes are very shallow. The pattern of results is similar when the interocular contrast ratio is varied, demonstrating that 2nd-order processing is more resilient to stimulus differences in the two eyes than 1st-order.     

When wait lists are not feasible, nothing is a thing that does not need to be done.

[Correction Notice: An erratum for this article was reported in Vol 78(3) of Journal of Consulting and Clinical Psychology (see record 2010-10440-011). There is an error in the computation of Equation 4 (p. 1165): z does not equal 2.44 as reported but, instead, equals 1.73. We had not divided by the denominator ( 2). This makes p(one-tailed) .042, not .007 as reported. The interpretation of this computation does not change, although the level of probability does. Rather than being confident that the two studies are from different populations with a p level of .007, we are still likely to see these studies as having obtained significantly different results but at the probability level of p .05.] Clinical psychology practices initially grew through the use of case studies, uncontrolled trials, and eventually through randomized controlled trials (RCTs). The use of a wait-list control group is standard practice in such trials of treatment regimens for psychopathological conditions. However, as knowledge advances regarding the successful treatment of such conditions, best practice guidelines are being developed. These guidelines have predominantly been based on the results of RCTs and use aggregating mechanisms, such as meta-analysis, to derive their conclusions. The authors argue here for statistical methods that allow for comparisons to existing data from wait-list controls for which the continued use of wait-list conditions has become problematic. Using posttraumatic stress disorder (PTSD) as an example, this article proposes various methods for obviating the need for a wait-list control under such circumstances. After conducting separate meta-analyses for both treatment and control conditions, the authors found that wait-list conditions do provide some benefit to participants with PTSD, but current best practice treatment conditions elicit far superior effect sizes. The various methods for evaluating a study without a wait-list control are proposed and demonstrated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Oxygen electrode syringe as an instrument for determining oxygen-hemoglobin dissociation curves

A new instrument is described which simplifies the measurement of the oxygen-hemoglobin dissociation curve, using small volumes of blood. An oxygen electrode, as the plunger of a syringe accommodating increasing volumes of blood at predetermined levels of saturation with oxygen, measures the amount of dissolved oxygen in the plasma, which is proportional to the gas tension.     

When cognitive exertion does not yield cognitive gain: Toward an informational explanation of learned helplessness.

This study tested a new information-processing explanation of learned helplessness that proposes that an uncontrollable situation produces helplessness symptoms because it is a source of inconsistent, self-contradictory task information during problem-solving attempts. The flow of such information makes hypothesis-testing activity futile. Prolonged and inefficient activity of this kind leads in turn to the emergence of a state of cognitive exhaustion, with accompanying performance deficits. In 3 experiments, Ss underwent informational helplessness training (IHT): They were sequentially exposed to inconsistent task information during discrimination problems. As predicted, IHT was associated with subjective symptoms of irreducible uncertainty and resulted in (a) performance deterioration on subsequent avoidance learning, (b) heightened negative mood, and (c) subjective symptoms of cognitive exhaustion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stability Analysis When Using an Engineered Berm to Increase Landfill Space

The scope of this paper is to develop a new three-part wedge method to analyze translational failure when using an engineered berm to increase landfill space. The possible failure face may pass over the back slope of the berm or pass under the bottom of the berm. This depends on the geometric dimensions of the berm which in turn influences the amount of airspace gained. Each possible failure condition must be checked to make sure both the waste mass and berm remain stable. If the waste boundary is kept to be unchanged, FSover will increase and FSunder will decrease with increase of the back slope of the berm. The critical failure condition may be changed from passing over to passing under the berm by changing the back slope of the berm. If the location of the front toe of the berm is fixed, both FSover and FSunder increase with increased height of the berm, however, the critical failure condition will change from passing under the berm to passing over the berm.     

The action profile of lispro is not blunted by mixing in the syringe with NPH insulin

OBJECTIVE: To assess the effect of mixing the insulin analog lispro (Humalog) with NPH (Humulin I) before injection on lispro's fast, short action profile. RESEARCH DESIGN AND METHODS: A total of 12 healthy volunteers received subcutaneous abdominal injections of 0.1 U/kg regular insulin and 0.2 U/kg NPH insulin as follows: lispro and NPH injected separately (treatment group A), lispro and NPH mixed in the syringe up to 2 min before single injection (treatment group B), and human regular insulin and NPH mixed and injected as in group B (treatment group C), on separate occasions, in random order. Plasma glucose was maintained for 12 h by intravenous 20% glucose. Pharmacokinetic and pharmacodynamic parameters were compared by analysis of variance for repeated measures. RESULTS: Peak plasma insulin levels (2.6 +/- 0.8 vs. 2.2 +/- 0.6 vs. 1.9 +/- 0.6 ng/ml, P = 0.075), total glucose infused (121.5 +/- 32.8 vs. 135.0 +/- 49.0 vs. 117.3 +/- 39.9 mg.kg-1.min-1, P = 0.53), and maximum glucose infusion rate (GIRmax) (8.3 +/- 0.9 vs. 8.0 +/- 1.7 vs. 7.1 +/- 2.4 mg.kg-1.min-1, P = 0.65) were not significantly different between treatments. The times until peak insulin concentrations were similar in treatment groups A and B, but significantly shorter than in treatment group C (0.9 +/- 0.3 and 1.2 +/- 0.2 vs. 2.0 +/- 0.4 h, respectively, P = 0.042). The times until GIRmax were also not different (113.9 +/- 41 and 122.0 +/- 45 vs. 209.0 +/- 51.3 min, respectively, P = 0.002). The glucose infusion rate (GIR) then fell to 50% GIRmax more quickly in treatment groups A and B than in treatment group C (239.9 +/- 40.5 vs. 292.4 +/- 133.3 vs. 399.5 +/- 78.3, respectively, P = 0.005). CONCLUSIONS: The action profile of lispro is not attenuated by mixing lispro with NPH in the syringe immediately before injection. The advantages are available to those individuals who need to combine types of insulin before injection to achieve optimal diabetes control.     

Learning (not) to talk about race: When older children underperform in social categorization.

The present research identifies an anomaly in sociocognitive development, whereby younger children (8 and 9 years) outperform their older counterparts (10 and 11 years) in a basic categorization task in which the acknowledgment of racial difference facilitates performance. Though older children exhibit superior performance on a race-neutral version of the task, their tendency to avoid acknowledging race hinders objective success when race is a relevant category. That these findings emerge in late childhood, in a pattern counter to the normal developmental trajectory of increased cognitive expertise in categorization, suggests that this anomaly indicates the onset of a critical transition in human social development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)