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The decentralization of counseling services has become a major form of outreach on college campuses. This article describes the establishment of two such satellite services, one successful and the other comparatively unsuccessful based on the criterion of student usage. Applications of this form of outreach to other settings are also discussed. (Author)

The authors, noting the increase in the number of doctoral degrees being granted in guidance and counseling, conducted a study of recent Ph.D.'s assessing their current job status, method of securing employment, job satisfaction, and other related factors. (RP)

An implantable capsule containing circuitry to transmit the endocardial ECG and convert received radio-frequency pulses to constant current stimulus pulses is described. Inasmuch as the control unit of the pacemaker is located outside the body wall, different modes of pacing (self-synchronous,R-wave coupled, and asynchronous) are possible. Alterations in the capsule load impedance, coupled to the transmitting antenna, is the method of transmission. A signal to noise ratio of 10:1, with a 1 mv source ECG signal can be obtained through a 2 cm spacing between the implant and external coil. The endocardial ECG may be recorded and employed to reveal alterations in electrode geometry. The anode electrode is attached directly to the implanted capsule, providing a unit having a single flexible electrode. The assembly allows recording the endocardial ECG without a wire connection to the hospital utility system. Due to the constant current feature, placement of the external coils is less critical than radiofrequency coupled tissue stimulators previously described.

A patient with respiratory paralysis from injury of the cervical cord was freed from dependence upon a mechanical respirator through the use of electrical stimulation of both phrenic nerves. This was accomplished with radiofrequency transmission to two radio receiver electrode assemblies implanted subcutaneously 14 months ago. By forceful contractions of his unparalyzed neck muscles the patient is able to assist ventilation voluntarily but is unable to support adequate ventilation by voluntary effort alone for more than a few minutes. Total ventilatory support by radiofrequency electrophrenic respiration has been maintained for more than 11 months. The two sides of the diaphragm are stimulated alternately for periods of 12 hours. Normal tidal volume and blood gas concentration with the patient in the recumbent position have been demonstrated. The tracheostomy tube has been removed; the patient can speak, and he has resumed some normal activities.

1. Four applications of stimulating waveforms, cathodal and anodal unidirectional current (UDC) and two types of alternating bidirectional current (ABDC-1 and -2), were evaluated for effectiveness for long-term stimulation. 2. The decrease in tidal volume was significantly greater with cathodal UDC and ABDC-2 stimulation than with ABDC-1 stimulation in both short- and long-term experiments with anesthetized dogs. 3. The decrease in tidal volume with cathodal UDC stimulation was only temporarily restored to control levels when the stimulation was changed to a new site lower on the nerve. 4. Phrenic nerve action potentials decreased significantly following cathodal UDC stimulation. However, this decrease was temporarily reversed by anodal UDC stimulation. ABDC-1 stimulation did not affect nerve action potentials during the stimulation period. 5. Over a 24-hr period there was no change in tidal volume using ABDC-1 stimulation, whereas using UDC cathodal stimulation there was marked decrease. 6. ABDC-1 stimulation required less electricity and energy developed at threshold than cathodal UDC stimulation. 7. We conclude that fatigue accompanying long-term electrophrenic respiration may be postponed by employing an alternating bidirectional symmetrical waveform.

A newly designed epicardiac radiofrequency (RF) pacemaker implant is described. The technique allows for a possible two-month battery life and is more efficient and practical than previous RF epicardiac pacemakers. Preliminary studies on 20 animals show that stimulation with the conventional external RF unit, although difficult for prolonged periods in the canine (for anatomical reasons), is possible. Studies on electrode size and configuration were done, and the reasons for selecting a platinum peg electrode are discussed.