Reliability of the Part II board certification examination in psychiatry: examination stability

OBJECTIVE: The aim of this study was to examine the reliability (examination stability) of the American Board of Psychiatry and Neurology (ABPN) Part II (oral) examination in psychiatry. METHOD: The authors analyzed the consistency (agreement between grades given by two independent examiners) for a 1-year examination cycle using a weighted kappa statistic and compared different parts of the examination (live patient and videotape), different examination sites, different days, and different times of the day. RESULTS: There was no significant difference in agreement between examiners by different parts of the examination, examination site, day of the week, or time of day. CONCLUSIONS: The stability of the Part II ABPN examination in psychiatry is not influenced significantly by the format or site of administration. Candidate performance is the predominant factor in the determination of passing or failing grades.     

Hypercapnic respiratory acidosis precipitated by hypercaloric carbohydrate infusion in resolving septic acute respiratory distress syndrome: a case report

Complications may occur when nutritional support is administered either parenterally or enterally. Inappropriate nutritional formulas with high carbohydrate loads can precipitate respiratory failure in patients with compromised lung function, induce respiratory distress which manifests as dyspnea and tachypnea in an originally normal lung condition, produce hypercapnic acidosis in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) as well as patients recovering from acute respiratory distress syndrome (ARDS) without chronic lung disease, or result in difficult weaning. Hypercaloric mixed substrates administered either parenterally or enterally can also have profound impacts on gas exchange and energy expenditure. This report describes a patient who experienced exacerbation of respiratory distress and hypercapnic acidosis during recovery from septic ARDS as the result of a nutritionally-related increase in CO2 production. As carbohydrate calories were decreased, CO2 production diminished and the hypercapnia was resolved. The importance of indirect calorimetry cannot be overemphasized during tailoring of nutritional support for the critically ill patients.     

Characterization and frequency distribution of species of lactic acid bacteria involved in the processing of mawè, a fermented maize dough from Benin

Lactic acid bacteria involved in the natural fermentation of both home-produced and commercial mawè were investigated during a 72 h fermentation period. Lactobacillus spp. constitute the majority (94%) of the strains of the lactic acid bacteria isolated, among which 89% represent the Betabacterium group. They include L. fermentum (biotype cellobiosus) (41%), L. fermentum or L. reuteri (19%), L. brevis (26%), L. confusus (less than 2%), L. curvatus (less than 1%) and L. buchneri (less than 1%). Other isolated lactic acid bacteria were L. salivarius, Lactococcus lactis, Pediococcus pentosaceus, Pediococcus acidilactici and Leuconostoc mesenteroides. Several species were detected at the early stage of fermentation, but the final stage was dominated by L. fermentum (biotype cellobiosus) and L. fermentum or L. reuteri totalling 90% of the isolated strains. The trend was the same for both home-produced and commercial mawè. No strains of L. plantarum, generally reported as dominating lactic acid bacteria at the final stage of fermentation of most plant foods, were isolated.     

Partial development of the corpus callosum

PURPOSE: To determine whether the MR findings of callosal dysgenesis suggest that the partially formed corpus callosum in humans is the result of arrested growth or delayed continued development. METHODS: The MR scans of 25 patients with callosal dysgenesis were reviewed to determine whether the observed corpus callosum corresponded to the form and position of a portion of a normal corpus callosum, as suggested by a theory of arrested growth. RESULTS: In 10 of the 25 cases, the partially formed corpus callosum corresponded to a portion of a normal corpus callosum. In the remaining 15 cases, the partially formed corpus callosum was located posterior to the expected location of a normal genu and inferior to the expected location of a normal body. CONCLUSIONS: Corpus callosum dysgenesis in humans may be caused by arrested growth in some cases; in other cases it is most likely caused by delayed continued development that attempts to compensate for earlier abnormalities in the evolution of midline structures.     

Fractures of the calcaneus. Part I: Anatomy, injury mechanism, and classification

From 1987 to 1994, seasonal affective disorder (SAD) has been diagnosed using the Rosenthal or DSM-III-R criteria. No major differences between them have been found, except that the DSM-III-R criteria were more stringent and difficult to implement. Little attention has been paid to differences in the criterion of the quality of improvement in summer. This study compared two groups of winter depressives characterized by complete or incomplete summer remission. Incomplete summer remission is associated with increased heterogeneity of the demographic and clinical profile of the disorder and a shift of this profile to that of classical depression. The data support clinical use of the DSM-IV criterion 'full remission' in the diagnosis of SAD.     

Ethical issues in health education

Moral dilemmas abound during health education practice and ethical decisions have to be made. This article examines the contribution of the four guiding ethical principles (respect for autonomy, beneficence, non-maleficence and justice) to nurse decision making. Multidisciplinary ethical guidelines to assist health educators to serve the best interests of patients and clients are suggested.