Biomedical subjects
Publications and source records attributed to G L Adams.
Attitudes have been a neglected variable in the development of public sector clinicians. Clinicians of differing disciplines may commonly possess attitudes which would affect their role in the public sector. The Houston Consortium assessed some of these attitudes in their students and faculty. The results may have heuristic implications for improving mental health care.
The myocutaneous pectoralis major flap has recently caught the attention of head and neck surgeons. Over the last 12 months, our service has used this flap in 14 patients. Reconstruction in the oral cavity and larynx as well as closure of large areas of skin necrosis of the neck have been the indications. Our complications occurred in 4 of the 14 patients and included neck abscess and fistula, flap necrosis, and chest wall hematoma or abscess. The flap is an eminently useful and successful flap when designed and performed as indicated in the body of the paper.
Forty-five patients were evaluated for reconstruction of the mandible. Thirty-four patients had a particulate cancellous bone and marrow (PCM) crib graft placed. Thirty of 34 were successful at the primary operation producing a success rate of 88%. By using secondary procedures all 33 patients repaired to date have been rehabilitated. A dynamic bendable defect bridging plate with cancellous cortical graft (DBDB plate with CCG) was used in 7 patients, 4 of whom had tumor surgery and 3 of whom were operated on after trauma to the anterior mandible. All 7 cases were successfully rehabilitated in achieving a stable, functioning mandibular arch. An osteomyocutaneous flap was planned to reconstruct the anterior mandible in 4 cases; 1 in this group was not reconstructed. The PCM graft has been our first line approach to the mandibular non-union but with experience we are beginning to rely on the DBDB plate with CCG for large bony defects after both trauma and secondarily after tumor surgery. When indicated, the osteomyocutaneous flap has been eminently successful in restoring function and form in the tumor patient.
The development of comprehensive health and mental health services depends on a number of factors. One overlooked factor, especially for the public sector, seems to be the attitudes of the health care providers. In an attempt to address this and related issues, the Houston Consortium was designed as a prototype training model. As part of that endeavor, the attitudes of mental health trainees toward the poor, interdisciplinary interaction, and community mental health were assessed. While the ethnic identity of the students had some influence, the major findings concerned the discipline of the students. Social work students, in particular, seemed to possess or be able to develop attitudes relevant to a prominent role in primary health care.
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Self-initiated responses of moderately and mildly mentally retarded subjects during three types of prompt sequences were compared. Results showed a significant difference in target behavior due to a type of prompt sequence. The prompt sequence that started with a verbal prompt and physical assistance resulted in a significantly higher rate of self-initiated responses. Giving verbal prompts while providing lessening amounts of physical assistance was superior to giving physical assistance without verbal prompts. Also, verbal prompts by themselves resulted in a low probability of self-initiated responding.
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Aflatoxin-producing ability medium was tested for its ability to distinguish aflatoxin-positive from aflatoxin-negative strains of Aspergillus flavus in naturally occurring populations from corn at harvest. All of the aflatoxin-positive strains and some of the aflatoxin-negative strains produced aflatoxins when cultured on cracked corn. Although the data indicate that aflatoxin-producing ability medium is not entirely reliable in distinguishing potential aflatoxin-producing strains of A. flavus from nontoxigenic strains, it is significant that the medium did not yield false-positives.
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Effects of passive environmental conditions (quiet, radio, and television) and manipulable objects (no toys, toys, toys plus staff interaction) on stereotypic behavior were evaluated. Four institutionalized, mentally retarded residents with high rates of stereotypic behavior were observed in a multipurpose room of their cottage. Results showed statistically significant lower levels of stereotypic behavior under the quiet and music conditions as compared to the television condition. There were no significant differences between the three manipulable-object conditions.
An interinstitutional, interagency Consortium has been formed in Houston to develop an innovative service model and provide interdisciplinary primary care/mental health training. The Houston Consortium Program integrates mental health professionals and trainees into the primary care framework of a neighborhood center serving a low-income, predominatly Mexican-American population. The introduction of mental health, psychosocial, and cross-cultural perspectives to complement the long-standing physiological concerns of health professionals fosters an holistic approach to patient care. The social workers' full participation as members of primary care teams builds upon their traditional training to provide them the experience and skills required to function effectively in the expanded coordinative capacity of health/mental health manager as defined by the President's Commission on Mental Health. It is anticipated that Consortium Program can serve as a heuristic model in the development of a nationwide pattern of comprehensive care.
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