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PubMed2004

A quantitative analysis of 3-D coronary modeling from two or more projection images.

A method is introduced to examine the geometrical accuracy of the three-dimensional (3-D) representation of coronary arteries from multiple (two and more) calibrated two-dimensional (2-D) angiographic projections. When involving more then two projections, (multiprojection modeling) a novel procedure is presented that consists of fully automated centerline and width determination in all available projections based on the information provided by the semi-automated centerline detection in two initial calibrated projections. The accuracy of the 3-D coronary modeling approach is determined by a quantitative examination of the 3-D centerline point position and the 3-D cross sectional area of the reconstructed objects. The measurements are based on the analysis of calibrated phantom and calibrated coronary 2-D projection data. From this analysis a confidence region (alpha degrees approximately equal to [35 degrees - 145 degrees]) for the angular distance of two initial projection images is determined for which the modeling procedure is sufficiently accurate for the applied system. Within this angular border range the centerline position error is less then 0.8 mm, in terms of the Euclidean distance to a predefined ground truth. When involving more projections using our new procedure, experiments show that when the initial pair of projection images has an angular distance in the range alpha degrees approximately equal to [35 degrees - 145 degrees], the centerlines in all other projections (gamma = 0 degrees - 180 degrees) were indicated very precisely without any additional centering procedure. When involving additional projection images in the modeling procedure a more realistic shape of the structure can be provided. In case of the concave segment, however, the involvement of multiple projections does not necessarily provide a more realistic shape of the reconstructed structure.

Algorithms↗
PubMed1992

Calbindin-D28K (CaBP28k)-like Immunoreactivity in Ascending Projections.

This study concerns the involvement of calbindin-D28K (CaBP28k)-containing neurons in the efferent projections of both the trigeminal nucleus caudalis and the dorsal vagal complex (nucleus of the solitary tract and area postrema) in rats. Recent evidence has shown that these projections are particularly important for the processing of visceroception and/or nociception at central levels. The trigeminal nucleus caudalis has dense projections to both the nucleus of the solitary tract and the parabrachial area; the dorsal vagal complex is intimately connected to the parabrachial area. CaBP28k is a calcium-binding protein the function of which could be a determining factor in controlling the excitability of cells by acting on intrinsic calcium metabolism. CaBP28k content of projections was ascertained using a double labelling approach that combined the retrograde transport of a protein - gold complex to identify projection cells and immunocytochemistry to identify CaBP28k-positive cells. The trigeminal nucleus caudalis is rich in both CaBP28k-immunoreactive cells and cells projecting to the parabrachial area or the nucleus of the solitary tract. Cells containing both the protein and the retrograde tracer, however, were mostly restricted to the superficial layers (laminae I and outer II) and to their rostral extensions, the dorsal paramarginal and paratrigeminal nuclei. These trigeminal subdivisions are targets for nociceptive, visceroceptive and thermal inputs of peripheral origins. The dorsal vagal complex is rich in CaBP28k. Dense populations of immunoreactive cells are observed in the ventrolateral part of the area postrema and all of the three main subdivisions of the nucleus of the solitary tract (rostral gustatory, ventrolateral respiratory and medial cardiovascular subregions). The subnucleus commissuralis, subnucleus centralis and dorsal subnuclei are particularly densely stained. The subnucleus centralis, which is involved in regulating food and water intake, does not project to the parabrachial area. The area postrema, subnucleus commissuralis and dorsal subnuclei, which are implicated in cardiovascular and/or ingestive behaviours, have dense projections to the parabrachial area, many of which contain CaBP28k. The present results demonstrate that CaBP28k-containing cells form a major part of the solitary and trigeminal projection systems, including subregions that are involved in visceroception and/or nociception processing. The location of solitary nucleus projection cells overlaps those of some neuropeptidergic projecting populations, suggesting colocalization. Consequently, certain neuropeptidergic actions may be CaBP28k-dependent.

Journal Article↗
PubMed1999

Setting up improvement projects in small scale primary care practices: feasibility of a model for continuous quality improvement.

OBJECTIVES: To evaluate the feasibility of a model for continuous quality improvement in small scale general practice and the improvement projects that practices ran after the introduction of continuous quality improvement. DESIGN: A descriptive study. SETTING: Twenty general practices in the Netherlands tested the model in an intervention period of 18 months. INTERVENTION: A model for continuous quality improvement adapted for general practice was introduced into the practices using a structured strategy. Practices were supported by trained facilitators. MAIN OUTCOME MEASURES: Acceptance at introduction and continued application of the model; the topics of improvement projects that were set up in the practices; whether the improvement projects had been completed; whether they had met the criteria (the use of the "quality cycle" and the Oxford audit score); and whether the self set objectives had been met. RESULTS: The model was introduced and accepted in all participating practices. Practices started 51 improvement projects. At the end of the study period 33 improvement projects had been completed. Practices chose a wide variety of objectives for these projects; most of them concerned medical or organisational topics. Practices started projects mainly because the topic was felt to be a problem or was causing a bottleneck in the organisation. The quality cycle was used in all projects, but practices did not always collect data and evaluate the outcomes. Fourteen projects could be discerned as "full audit". No differences existed in the quality of improvement projects among the various types of practice or between the topics addressed. At the end of the study period half of the practices continued applying the model. CONCLUSION: This study showed that the model was feasible for small scale general practice. However, application of the model tended to disintegrate after the facilitator had left the practice. Practices succeeded reasonably well in running improvement projects. Introduction of continuous quality improvement should particularly focus on this. It is suggested that intensive support is necessary to implement and maintain continuous quality improvement in small scale practices.

Evaluation Studies as Topic↗
PubMed1983

Corticotectal and corticothalamic efferent projections of SIV somatosensory cortex in cat.

Substantial corticotectal (and corticothalamic) projections from the cortex of the anterior ectosylvian sulcus (AES) were demonstrated in the cat using the axonal transport methods of autoradiography and horseradish peroxidase. The corticotectal projection arises nearly exclusively from medium-large pyramidal cells in lamina V. One of the densest projecting areas of the AES is the rostral aspect of its superior bank, where a fourth somatotopic representation (SIV) has recently been demonstrated. It terminates in the intermediate and deep laminae of the superior colliculus, where somatic cells are located. The pathway is bilateral but much heavier ipsilaterally than contralaterally. In contrast to the substantial corticotectal projection from SIV and adjacent tissue, there was no unequivocal evidence for a corticotectal projection from traditional somatosensory cortex SI-SIII. This finding, that somatosensory projections to the cat superior colliculus arise from an area outside of SI-SIII, was unexpected on the basis of what is known about visual corticotectal projections. However, it is consistent with the patterns of other cortical projections that terminate in the intermediate and deep laminae of this structure and with the absence of demonstrable corticotectal influences from SI to SIII in this animal. These data are in contrast to demonstrations by other investigators that there is a corticotectal projection from SI cortex in rodents. Apparently there is a fundamental species difference in the organization of descending somatosensory pathways. A corticothalamic projection of the AES was also observed. This descending projection appeared to form a shell of labeled cells and fibers around the ventrobasal complex, but unequivocal terminal labeling within the ventrobasal complex could not be demonstrated. Dense terminal labeling was apparent in the posterior group of thalamic nuclei (PO) where thalamocortical afferents to the AES originate.

Animals↗
PubMed2003

Detection and characterization of intracranial aneurysms with MR angiography: comparison of volume-rendering and maximum-intensity-projection algorithms.

OBJECTIVE: The purpose of this study was to compare volume rendering and maximum intensity projection as postprocessing techniques of MR angiography in the detection and characterization of intracranial aneurysms. MATERIALS AND METHODS: Three-dimensional time-of-flight MR angiography studies performed in 82 patients were retrospectively evaluated by two independent reviewers who were unaware of digital subtraction angiography findings, the standard of reference. Panoramic maximum-intensity-projection and volume-rendered angiograms were produced from each data set to investigate the presence of underlying aneurysms. Each detected aneurysm was then interactively evaluated with subvolume maximum-intensity-projection and targeted volume-rendering algorithms to evaluate aneurysm morphology and size. Aneurysm detection and characterization were evaluated by means of the receiver operating characteristic analysis, and aneurysm size was evaluated using the limits-of-agreement method. Image quality, aneurysm neck depiction, and vascular delineation were also compared between maximum-intensity-projection and volume-rendered images. The time required for the generation and interpretation of maximum-intensity-projection and volume-rendered images was assessed. RESULTS: Volume rendering tended to improve the diagnostic confidence (A(z) [area under the receiver operating characteristic curve] = 0.95 vs A(z) = 0.90 for maximum intensity projection) and yielded a considerable improvement in sensitivity (89% vs 71% for maximum intensity projection), particularly in the detection of small cerebral aneurysms. Regarding aneurysm morphology, volume rendering performed significantly better than maximum intensity projection in lobulation detection (p < 0.001) and slightly better in neck categorization (p > 0.238). Limits-of-agreement analysis showed a trend toward improved assessment of the aneurysm size by volume rendering (-0.31 +/- 1.62 mm vs -1.27 +/- 2.84 mm by maximum intensity projection). Overall image quality and vascular delineation of involved vessels on volume-rendered images were rated better than that obtained by maximum intensity projections (p < or = 0.007 and p < or = 0.001, respectively). Evaluation of time-of-flight MR angiography data sets was significantly facilitated with volume rendering (p < 0.001). CONCLUSION: The volume-rendering technique facilitates the evaluation of cerebral time-of-flight MR angiography data sets and allows better detection and more reliable characterization of intracranial aneurysms than does maximum intensity projection.

Adolescent↗
PubMed2005

Experiences from three community health promotion projects in Greenland.

OBJECTIVES AND METHODS: Three community health promotion projects have been implemented in Greenland in the municipalities of Upernavik, Ittoqqortoormiit and Qasigiannguit. Based on project reports and other written material, this paper describes experiences from the three projects and discusses the implications of the differences in project design and organization for potential outcomes. RESULTS: None of the three projects were formally evaluated. They all experienced problems and have only been partially successful in reaching their goals. The Upernavik and the Ittoqqortoormiit projects were organised with strong leadership and a central organisation, whereas the Qasigiannguit project was designed as a community project with population participation in all phases of the project. The two former projects have probably had a greater direct change impact on the community, whereas the latter has strengthened aspects of community capacity building. CONCLUSION: We need to learn more about how to employ the resources of communities, how to achieve better partnerships and how to support people in their efforts in order to secure population participation at all project stages. It is important to build coalitions with broad representation in the community and to secure population participation in order to disseminate the efforts and reach the needs of the whole community.

Community Health Services↗
PubMed1999

Efferent projections of the ectostriatum in the pigeon (Columba livia).

The ectostriatum is a major visual component of the avian telencephalon. The core region of the ectostriatum (Ec) receives visual input from the optic tectum through thalamic nuclei. In the present study, the efferent projections of the ectostriatum were investigated by using the anterograde tracers Phaseolus vulgaris leucoagglutinin and biotinylated dextran amine. Projection patterns resulting from these tracers were confirmed by the retrograde tracer cholera toxin subunit B. When anterograde tracers were injected in Ec, primary projections were seen traveling dorsolaterally to the belt region of the ectostriatum (Ep) and the neostriatal area immediately surrounding Ep (Ep2). Neurons in Ep sent projections primarily to the overlying Ep2. The efferents of Ep2 traveled dorsolaterally to terminate in three telencephalic regions, from anterior to posterior: (1) neostriatum frontale, pars lateralis (NFL), (2) area temporo-parieto-occipitalis (TPO), and (3) neostriatum intermedium, pars lateralis (NIL). A part of the archistriatum intermedium and the lateral part of the neostriatum caudale also received somewhat minor projections. In addition, some neurons in Ec were also the source of direct, but minor, projections to the NFL, TPO, NIL, and archistriatum intermedium. The topographical relationship among the primary (Ec), secondary (Ep and Ep2), and tertiary (NFL, TPO, NIL) areas indicate that the neural populations for visual processing are organized along the rostral-caudal axis. Thus, the anterior Ec sent efferents to the anterior Ep, which in turn sent projections to anterior Ep2. Neurons in the anterior Ep2 sent projections to NFL and the anterior TPO. Similarly, the intermediate and posterior Ec sent projections to corresponding parts of Ep, whose efferents projected to intermediate and posterior Ep2, respectively. The intermediate Ep2 gave rise to major projections to TPO, whereas posterior Ep2 neurons sent efferents primarily to NIL. The organization of this neural circuit is compared with those of other sensory circuits in the avian telencephalon, as well as the laminar arrangement of the mammalian isocortex.

Animals↗
PubMedDate not supplied

Project planning in the diagnostic imaging department.

Certain common steps in the planning process are necessary to ensure the success of any construction project in a diagnostic imaging department. Determining the need for the project, analyzing requirements for equipment, space and personnel, and budgeting for the project are necessary steps. They are followed by scheduling and designing the various aspects of the project. Engineering the construction phase and implementation with follow-up are the last steps. Determining whether a proposed project is necessary is the essential first step. Doing a cost-benefit analysis and determining if the return on the investment will be positive are important for a project's success. Good planning and communication with key staff members of the healthcare institution and the members of the design and construction team will help ensure successful implementation of any project. The role of the facility engineer is often critical in the early planning stages of a project to determine what utilities may be needed, any need for plumbing or electric work, power sources, building code requirements, the need for medical gasses and suction and so forth. Analysis of a potential project's equipment, space and personnel needs is also critical. Gathering the necessary information from various sources within the healthcare institution is essential. The steps for scheduling and designing an entire project should include finalizing the design and developing a schedule for its implementation. Keeping accurate minutes and documenting action items from all project meetings can serve to protect the budget. By following the steps outlined, budgeting time efficiently and delegating some tasks to others, the radiology administrator can continue to perform tasks involved in the day-to-day management of a radiology department.

Budgets↗
PubMed1999

Review of University of British Columbia Family Practice Resident Research Projects 1990-1997.

BACKGROUND: Resident research projects can be an important component of building a strong and diversified research presence in family medicine. One of the requirements for graduation from the University of British Columbia (UBC) Family Practice Residency Program is that family practice residents complete a scholarly piece of work. METHODS: UBC family practice resident projects from 1990-1997 were reviewed and classified by methodology. A survey was sent to 251 former residents to determine 1) if their project was published, 2) if not, was there any interest in publication, and 3) what were the main reasons for not pursuing publication. Fifteen projects were selected as suitable for publication and were, with permission of the resident, submitted to medical journals. RESULTS: Sixty-nine percent of the resident projects involved data collection and hypothesis testing, and 40% were cross-sectional, of which patient surveys were the most common method. A total of 190 former residents (71%) have responded to our survey. Seven percent of respondents stated that their project had been published, and 55% would have liked to have tried to publish their project. Of the 15 resident projects we submitted for publication, seven were accepted. CONCLUSIONS: Family practice residents are capable of producing a wide variety of research projects. Only a minority of projects are being published despite the fact that the majority of residents are interested in pursuing publication. Greater assistance by faculty can increase publication of research projects.

Academic Medical Centers↗
PubMed2000

Use of timelines in senior design--an efficient project management tool for faculty.

An important part of any multi-tasked project or undertaking is a work plan. Large contractors with multi-year design projects use a work plan to schedule resources and identify critical design decisions; a smaller company may map out the course and order of work as well as schedule resources. Either way, the work plan is an indispensable tool that assists the project manager in the planning and timely execution of the project. Introduced is the concept of the timeline (or work plan) and its utilization in an Undergraduate Senior Design Course by both Faculty and Student as a Project Management Tool and device from which to chart student progress towards completion of course requirements. Discussed are examples of student project planning and comments with regards to the effectiveness of project planning for the student as well as a discussion of how this device has assisted faculty in charting student progress towards project completion, meeting course requirements, and grading. Project and Time Management issues described in this paper are through the Senior Design Program at the University of Connecticut (UCONN) with National Science Foundation Senior Design Projects to Aid Persons with Disabilities and industry-sponsored projects [1].

Management Information Systems↗
PubMed1988

Class-specific cell death shapes the distribution and pattern of central projection of cat retinal ganglion cells.

The development of the nasotemporal division in cat retina was studied. We find that in the normally pigmented neonatal cat significant numbers of ganglion cells of all types in temporal retina project to the contralateral dorsal lateral geniculate nucleus (LGNd); far fewer cells in temporal retina project contralaterally to the LGNd in the normal adult. Thus, most of these cells must be eliminated during development. Experimental interruption of one optic tract in the neonate results in the retrograde degeneration of the ipsilaterally projecting ganglion cells in the temporal retina ipsilateral to the lesion. Consequent to the loss of the ipsilaterally projecting cells in this hemiretina, many of the ganglion cells projecting to the intact contralateral LGNd, which are normally eliminated, survive. Also, unlike in the normal cat, in which very few of the small ganglion cells in temporal retina project contralaterally to the thalamus, in optic tract sectioned (OTX) cats, significant numbers of the smallest ganglion cells in the temporal retina ipsilateral to the lesion project contralaterally to the intact thalamus. In order to make a quantitative comparison of the distributions of ipsilaterally and contralaterally projecting cells in the temporal retinae of normal cats, OTX cats, and neonatal kittens, it was necessary to determine the position of the vertical meridian in all animals. We defined the vertical meridian as the median edge (Stone, 1966). The median edge was determined from the distribution of the most nasally located, ipsilaterally projecting cells in temporal retina. The results indicate that the angle of the vertical meridian (median edge) with respect to the area centralis and optic disc is specified before birth and does not differ in normal cats, OTX cats, or neonatal kittens. Since the location of the vertical meridian does not change with age in postnatal life and is not affected by optic tract section, corresponding regions of retina in the different groups could be compared. A quantitative analysis of ganglion cell density in the temporal retina contralateral to the section, ipsilateral to the intact hemisphere, indicated that there was a reduction in the population of ipsilaterally projecting ganglion cells that was complementary to the abnormally large number of contralaterally projecting cells surviving in the temporal retina ipsilateral to the lesion.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1981

Evidence for collateral projections by neurons in Ammon's horn, the dentate gyrus, and the subiculum: a multiple retrograde labeling study in the rat.

Although it has been recognized for some years that each cytoarchitectonic field of Ammon's horn and the subiculum gives rise to a specific pattern of cortical and subcortical projections, it has not been clear whether these various projections arise from different populations of neurons within each field or whether they arise as collaterals from an essentially homogeneous population of cells. We have examined this problem, and the related issue of the origin of the commissural and ipsilateral associational projections of the dentate gyrus, by injecting retrogradely transported fluorescent dyes into two or more of the relevant projection fields in adult rats and subsequently examining the brains for doubly or triply labeled neurons. It is clear from these experiments that at least two of the known efferent projections of field CA1 (to the septum and to the entorhinal cortex) arise from the same pyramidal neurons and also that the commissural, ipsilateral associational, septal, and subicular projections of the other major field of Ammon's horn--field CA3--similarly are due to collaterals. Double-labeling experiments also indicate that at least 80% of the cells in the deep hilar region of the dentate gyrus give rise to both an ipsilateral (associational) and a crossed (or commissural) projection to the dentate granule cells. In contrast, the projection neurons in the dorsal part of the subiculum form a quite heterogeneous population; cells that project to both the septum and the entorhinal area are intermingled with others that project to one or the other area but not to both. The cortical and cortico-subcortical connections of the hippocampal formation thus appear to be quite different from those of the neo-cortex, and the existence of such an extensive system of collateral projections clearly has important consequences for studies of the development of the hippocampus and of its response to selective deafferentation.

Afferent Pathways↗
PubMed1995

Re-examination of the plasticity of the corticothalamic projection after unilateral neonatal lesion of the sensorimotor cortex in the rat: a phaseolus vulgaris-leucoagglutinin tracing study.

After unilateral lesion of the sensorimotor cortex in neonatal rats (postnatal days 2-4), the reorganization of the corticothalamic projection originating from the opposite intact sensorimotor cortex was studied. Three months after the lesion, the anterograde tracer phaseolus vulgaris-leucoagglutinin (PHA-L) was injected in the caudal forelimb area (CFA) of the intact opposite sensorimotor cortex to label the corticothalamic axons, in order to establish their trajectory as well as the distribution of their terminal fields in the thalamus. As previously reported, in addition to the standard ipsilateral corticothalamic projection, lesioned rats were characterized also by the presence of a contralateral corticothalamic projection, reaching the decorticate hemithalamus. There is some controversy in literature whether such bilateral corticothalamic projection is present in normal intact rats. On the basis of counts of axons crossing the midline to innervate the hemithalamus contralateral to the cortical injection, the present study provides evidence that the corticothalamic projection is indeed bilateral in normal rats, although the contralateral projection is sparse. Lesioned rats subjected to a similar small size PHA-L injection in the CFA of the intact opposite cortex showed a significantly increased contralateral corticothalamic projection. The number of labeled axons crossing the midline in the thalamus was, on average, five times higher in lesioned rats than in normal rats. It can be concluded that the contralateral corticothalamic projection from the CFA, observed after neonatal lesion of the opposite sensorimotor cortex, is not a novel projection resulting from the lesion, but rather an enhancement and extension of an existing, minor, projection present in normal rats. The enhancement of the crossing corticothalamic projection in lesioned rats is due to an increase of the number of crossing axons in the thalamus rather than to an increase of the degree of branching of the few axons present in control animals.

Animals↗
PubMed1998

Auditory cortical projections to the cat inferior colliculus.

The projection from 11 auditory cortical areas onto the subdivisions of the inferior colliculus was studied in adult cats by using two different anterograde tracers to label cortico-collicular (CC) axon terminals. The main results were that: 1) a significant CC projection arose from every field; 2) the principal inferior collicular targets were the dorsal cortex, lateral nucleus, caudal cortex, and intercollicular tegmentum, with only a sparse projection to the central nucleus; 3) the input was usually bilateral, with the ipsilateral side by far the most heavily labeled, and the contralateral projection was a symmetrical subset of the ipsilateral input; 4) the CC system is both divergent and convergent, with single cortical areas projecting to six or more collicular subdivisions, and each auditory midbrain subdivision receiving a convergent projection from two to ten cortical areas; 5) cortical areas devoid of tonotopic organization have topographic projections to collicular target nuclei; 6) the heaviest CC projection terminated in the caudal half of the inferior colliculus; and finally, 7) the relative strength of the cortico-collicular labeling was far less than that of the corresponding corticothalamic projection in the same experiments. The CC system is strategically placed to influence both descending and ascending pathways arising in the inferior colliculus. Nuclei that participate in the premotor system, like the inferior collicular subdivisions that project to the pons, receive substantial corticofugal input. Both the dorsal (pericentral) and the lateral (external) nuclei of the inferior colliculus project to parts of the medial geniculate body whose closest auditory affiliations are with non-tonotopic cortical regions involved in higher order auditory perception. The cortico-collicular system may link brainstem and colliculo-thalamic circuits to coordinate premotor and perceptual aspects of hearing.

Animals↗
PubMed1999

Chernobyl post-accident management: the ETHOS project.

ETHOS is a pilot research project supported by the radiation protection research program of the European Commission (DG XII). The project provides an alternative approach to the rehabilitation of living conditions in the contaminated territories of the CIS in the post-accident context of Chernobyl. Initiated at the beginning of 1996, this 3-y project is currently being implemented in the Republic of Belarus. The ETHOS project involves an interdisciplinary team of European researchers from the following institutions: the Centre d'etude sur l'Evaluation de la Protection dans le domaine Nucleaire CEPN (radiological protection, economics), the Institute National d'Agronomie de Paris-Grignon INAPG (agronomy, nature & life management), the Compiegne University of Technology (technological and industrial safety, social trust), and the Mutadis Research Group (sociology, social risk management), which is in charge of the scientific co-ordination of the project. The Belarussian partners in the ETHOS project include the Ministry of Emergencies of Belarus as well as the various local authorities involved with the implementation site. The ETHOS project relies on a strong involvement of the local population in the rehabilitation process. Its main goal is to create conditions for the inhabitants of the contaminated territories to reconstruct their overall quality of life. This reconstruction deals with all the day-to-day aspects that have been affected or threatened by the contamination. The project aims at creating a dynamic process whereby acceptable living conditions can be rebuilt. Radiological security is developed in the ETHOS project as part of a general improvement in the quality of life. The approach does not dissociate the social and the technical dimensions of post-accident management. This is so as to avoid radiological risk assessment and management being reduced purely to a problem for scientific experts, from which local people are excluded, and to take into consideration the problems of acceptability of decisions and the distrust of the population towards experts. These cannot be solved merely by a better communication strategy. This paper presents the main features of the methodological approach of the ETHOS project. It also explains how it is being implemented in the village of Olmany in the district of Stolyn (Brest region) in Belarus since March 1996, as well as its initial achievements.

Animals↗
PubMed1991

Clarification of projective identification.

This paper clarifies the various current usages of the term "projective identification." The author presents a broad reference model of projective identification based on the work of Ogden. This model divides projective identification into three steps. Step 1 is the projection of a part of oneself onto an external object. Step 1a is the blurring of self and object representations. Step 2 is an interpersonal interaction in which the projector actively pressures the recipient to think, feel, and act in accordance with the projection. Step 3 is the reinternalization of the projection after it has been psychologically processed by the recipient. The different definitions of projective identification are shown to relate to exactly how the term "projection" is conceptualized (in step 1), to whether step 1a is deemed necessary, and to how many of the three steps are required for the definition of projective identification. The author reviews the work of Ogden, Kernberg, Meissner, Sandler, Malin and Grotstein, Porder, and Zinner et al. Six detailed case examples are provided from within and outside psychotherapy to illustrate all three steps of projective identification.

Countertransference↗
PubMedDate not supplied

A community project to encourage compliance with mental health treatment aftercare.

Rehospitalization of mentally ill persons has been associated mainly with two major factors, noncompliance with the prescribed course of medication and noncompliance with planned aftercare. The authors developed and pilot tested a community health project designed to assist chronically ill mental health patients who, when discharged from hospital care, are considered at high risk for rehospitalization. The project was designed to support clients' efforts to comply with their prescribed course of aftercare therapy, support, and medication. The project was developed at the University of Maryland at Baltimore, School of Nursing, in cooperation with the U.S. Department of Veterans Affairs. The project consisted of interventions during the critical time after hospital discharge but before the client becomes fully established in outpatient treatment. The interventions were based on the principle of catching the high-risk client before a crisis situation occurred. The four interventions were (a) discharge planning for the individual client that stressed education about the client's psychiatric illness; (b) education about medications prescribed for the client; (c) an education program for family members and others to assist them in helping the individual client; and (d) communicating with the client to reinforce the support network concept, using a 48-hour followup telephone call, an information contact by post-card, and a non crisis telephone line. The project was implemented on a pilot basis during the fall of 1992 by the nursing students and staff members at a major urban Department of Veterans Affairs Medical Center (VAMC). The pilot project involved 31 staff and community health professionals and 68 client interactions during 1992. Data were collected from clients and staff members during and after the project was implemented. The project was evaluated using a multimethod evaluation tool, and revisions were incorporated based on the results.Clients who participated in the program indicated that establishing caring relationships within a support network was the most significant factor in achieving compliance with aftercare. The results of the project, noted by staff members and observers, have led to implementation and expansion of interventions by subsequent groups of nursing students. Plans for the future of the project include determining rates of recidivism and obtaining more information on other health outcomes of clients.

Aftercare↗
PubMed1996

Efferents from the lateral frontal cortex to spinomedullary target areas, trigeminal nuclei, and spinally projecting brainstem regions in the hedgehog tenrec.

This study was done in the Madagascan lesser hedgehog tenrec, an insectivore with a very poorly differentiated neocortex. The cortical region, known to give rise to spinal projections, was injected with tracer, and the cortical efferents to brainstem and spinal cord were analyzed. Bulbar reticular fields, in addition, were identified according to their cells of origin and the laterality of their spinal projections after injection of tracer. Only few cortical fibers could be traced from the bulbar pyramid into the ipsilateral spinal cord, particularly to the lateral funiculus. The projections to the dorsal column nuclei and the classical spinally projecting brainstem regions were also weak. Faint projections were demonstrated to the nucleus of the posterior commissure and the nucleus of Darkschewitsch. In comparison to other mammals, there was no evidence that the contralateral cortico-bulbo-spinal pathway was strengthened, substituting for the almost non-existent contralateral corticospinal projection. Unlike the sensorimotor apparatus controlling limb and body movements, the brainstem regions controlling the head and neck received prominent cortical projections. Direct corticotrigeminal projections and indirect pathways were well represented. The projections to the trigeminal nuclei and the lateral reticular fields were clearly bilateral; those to the superior colliculus were predominantly ipsilateral. The corticobulbar fibers left the pyramid along its entire extent; the principal trigeminal nucleus and the dorsolateral pontine tegmentum were supplied by additional fibers of the corticotegmental tract. The lateral frontal cortex also projected densely to the dorsolateral hypothalamus, the periaqueductal gray, and the adjacent mesencephalic tegmentum, components of the emotional motor system.

Animals↗