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The purpose of this article was to investigate the relation between anthropometric and physiological variables to linear bat swing velocity (BV) of 2 groups of high-school baseball players before and after completing a 12-week periodized resistance exercise program. Participants were randomly assigned to 1 of 2 training groups using a stratified sampling technique. Group 1 (n = 24) and group 2 (n = 25) both performed a stepwise periodized resistance exercise program and took 100 swings a day, 3 d·wk-1, for 12 weeks with their normal game bat. Group 2 performed additional rotational and full-body medicine ball exercises 3 d·wk-1 for 12 weeks. Fourteen variables were measured or calculated before and after 12 weeks of training. Anthropometric and physiological variables tested were height, body mass, percent body fat, lean body mass (LBM), dominant torso rotational strength (DTRS) and nondominant torso rotational strength (NDTRS), sequential hip-torso-arm rotational strength measured by a medicine ball hitter's throw (MBHT), estimated 1 repetition maximum parallel squat (PS) and bench press (BP), vertical jump (VJ), estimated peak power, angular hip velocity (AHV), and angular shoulder velocity (ASV). The baseball-specific skill of linear BV was also measured. Statistical analysis indicated a significant moderately high positive relationship (p <= 0.05) between prelinear BV and pre-NDTRS for group 1, pre-LBM, DTRS, NDTRS, peak power, and ASV for group 2; moderate positive relationship between prelinear BV and preheight, LBM, DTRS, peak power, BP, PS, and ASV for group 1, preheight, body mass, MBHT, BP, and PS for group 2. Significantly high positive relationships were indicated between postlinear BV and post-NDTRS for group 1, post-DTRS and NDTRS for group 2; moderately high positive relationships between postlinear BV and post-LBM, DTRS, peak power, BP, and PS for group 1, postheight, LBM, VJ, peak power for group 2; moderate positive relationships between postlinear BV and postheight, body mass, MBHT, and VJ for group 1, postbody mass, MBHT, BP, PS, and ASV for group 2. Significantly low positive relationships were indicated between prelinear BV and prebody mass, MBHT, and VJ for group 1, pre-VJ and AHV for group 2; postlinear BV and post-AHV for group 2. These data show that significant relationships do exist between height, body mass, LBM, rotational power, rotational strength, lower body power, upper and lower body strength, AHV, and ASV to linear BV of high-school baseball players. Strength coaches may want to consider using this information when designing a resistance training program for high-school baseball players. Those recruiting or scouting baseball players may want to use this information to further develop ways of identifying talented players. However, one should be cautious when interpreting this information when designing strength training programs for high-school baseball players to increase linear BV. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The authors sought to determine whether integrated mental health services or enhanced referral to specialty mental health clinics results in greater engagement in mental health/substance abuse services by older primary care patients. METHOD: This multisite randomized trial included 10 sites consisting of primary care and specialty mental health/substance abuse clinics. Primary care patients 65 years old or older (N=24,930) were screened. The final study group consisted of 2,022 patients (mean age=73.5 years; 26% female; 48% ethnic minority) with depression (N=1,390), anxiety (N=70), at-risk alcohol use (N=414), or dual diagnosis (N=148) who were randomly assigned to integrated care (mental health and substance abuse providers co-located in primary care; N=999) or enhanced referral to specialty mental health/substance abuse clinics (i.e., facilitated scheduling, transportation, payment; N=1,023). RESULTS: Seventy-one percent of patients engaged in treatment in the integrated model compared with 49% in the enhanced referral model. Integrated care was associated with more mental health and substance abuse visits per patient (mean=3.04) relative to enhanced referral (mean=1.91). Overall, greater engagement was predicted by integrated care and higher mental distress. For depression, greater engagement was predicted by integrated care and more severe depression. For at-risk alcohol users, greater engagement was predicted by integrated care and more severe problem drinking. For all conditions, greater engagement was associated with closer proximity of mental health/substance abuse services to primary care. CONCLUSIONS: Older primary care patients are more likely to accept collaborative mental health treatment within primary care than in mental health/substance abuse clinics. These results suggest that integrated service arrangements improve access to mental health and substance abuse services for older adults who underuse these services. [ABSTRACT FROM AUTHOR]

This paper explores the experiences of three young people with emotional and behavioral challenges and their families as they entered, participated in, and completed a community-based system of care. Using a case narrative approach, the characteristics and experiences of the children and families who successfully completed the Dawn Project system of care are described. For each of the three narratives, the young person's parent or caregiver, teacher, and service coordinator were interviewed and a review of available records was conducted. Several themes appear to be related to successful completion of the system of care, including active and ongoing involvement of the family and collaboration of team members, a collective commitment to follow through on developed plans, an emphasis on child and family strengths, and concerted efforts to keep the young people at home and their services in the community. [ABSTRACT FROM AUTHOR]

Background: For DSM - 5, the American Psychiatric Association Board of Trustees established a robust vetting and review process that included two review committees that did not exist in the development of prior DSMs, the Scientific Review Committee (SRC) and the Clinical and Public Health Committee (CPHC). The CPHC was created as a body that could independently review the clinical and public health merits of various proposals that would fall outside of the strictly defined scientific process., Methods: This article describes the principles and issues which led to the creation of the CPHC, the composition and vetting of the committee, and the processes developed by the committee - including the use of external reviewers., Results: Outcomes of some of the more involved CPHC deliberations, specifically, decisions concerning elements of diagnoses for major depressive disorder, autism spectrum disorder, catatonia, and substance use disorders, are described. The Committee's extensive reviews and its recommendations regarding Personality Disorders are also discussed., Conclusions: On the basis of our experiences, the CPHC membership unanimously believes that external review processes to evaluate and respond to Work Group proposals is essential for future DSM efforts. The Committee also recommends that separate SRC and CPHC committees be appointed to assess proposals for scientific merit and for clinical and public health utility and impact.

Competing Interests: Declaration of competing interest Wolfgang Gaebel, Alkomiet Hasan, and Peter Falkai were the responsible members for project management and supervision of the DGPPN Steering Group for the development of the S3 Guideline for Schizophrenia. Johannes Stricker, John S. McIntyre, and Ariane Kerst have no interests to declare.

Background: Selective non-operative management (NOM) of hemodynamically stable pediatric patients with blunt hepatic trauma is the standard of care. Traumatic bile leaks (TBL) are a potential complication following liver injury. The use of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of TBL is described in adults, but limited in the pediatric literature. We report our experience with a multidisciplinary and minimally invasive approach to the management of TBL., Methods: This was an IRB-approved 13-year retrospective review (January 1999-December 2012) of an institutional pediatric trauma registry; 294 patients (≤ 17 years old) sustained blunt hepatic injury. Those with TBL were identified. Patient demographics, mechanism of injury, management strategy and outcomes were reviewed., Results: Eleven patients were identified with TBL. Hepatobiliary iminodiacetic scan (HIDA) was diagnostic. Combinations of peri-hepatic drain placement, ERCP with biliary stenting and/or sphincterotomy were performed with successful resolution of TBL in all cases. No child required surgical repair or reconstruction of the leak. Cholangitis developed in one child. There were no long-term complications., Conclusions: A multidisciplinary and minimally invasive approach employing peri-hepatic external drainage catheters and ERCP with sphincterotomy and stenting of the ampulla is a safe and effective management strategy for TBL in children., (© 2014.)

Purpose: To evaluate uveal and capsular biocompatibility of a 1-piece intraocular lens (IOL) manufactured from a new hydrophobic acrylic material that incorporates a barrier step at the optic-haptic junctions., Setting: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA., Design: Experimental study., Methods: The study IOL (Eternity-Uni W-60) was implanted in the right eyes of 5 New Zealand rabbits and the control IOL (Acrysof SN60WF) in the left eyes. Slitlamp examination was performed 1 through 4 weeks postoperatively. After death, the globes were enucleated and fixed in formalin. Capsular bag opacification scoring (Miyake-Apple view) was then performed followed by complete histopathology., Results: At the 4-week examination, the mean posterior capsule opacification (PCO) score was 1.5 ± 1.0 (SD) in the study group and 2.2 ± 1.09 in the control group (P=.02). Anterior capsule opacification (ACO) was not present in the study eyes and was mild in the control eyes. On gross examination, the mean central PCO score was 0.9 ± 0.65 in the study group and 1.7 ± 1.20 in the control group (P=.07); the mean peripheral PCO score was 1.3 ± 0.67 and 2.4 ± 1.14 (P=.01) and the mean Soemmerring ring score was 3.8 ± 0.44 and 4.2 ± 1.09, respectively (P=.47). Histopathology confirmed that both IOLs were equally tolerated by the rabbit eyes., Conclusions: In this rabbit study, the new hydrophobic acrylic material was biocompatible. The barrier step incorporated to the optic-haptic junctions has the potential to enhance PCO prevention., (Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate a single-piece hydrophilic acrylic intraocular lens (IOL) designed for sulcus fixation in a piggyback configuration in postmortem pseudophakic human eyes., Setting: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA., Design: Experimental study., Methods: Pseudophakic human cadaver eyes were imaged by high-frequency ultrasound (Artemis) to assess the overall position of the primary IOL and the sulcus diameter. The piggyback IOL (Sulcoflex) was then injected into the ciliary sulcus of these eyes. After fixation in formalin, they were reevaluated by high-frequency ultrasound for assessment of IOL fixation, fit, centration, tilt, and clearance from the primary IOL and intraocular structures and analyzed after sectioning., Results: Data could be obtained from 11 eyes, all in which the primary IOL was located in the capsular bag. Different foldable IOLs and different degrees of Soemmerring ring formation were represented. The piggyback IOL could be injected and positioned in the ciliary sulcus and had overall appropriate centration and minimum or no tilt. Clearance between the 2 IOLs ranged from 232 to 779 μm, mostly depending on the thickness of the primary IOL. Direct assessment of the sulcus-fixated haptics showed no disturbances to the ciliary processes., Conclusions: The new IOL has large optic and overall diameters, smooth and undulating haptics, and a convex-concave optic profile. Results show that these characteristics minimize the possibility of interaction with the primary IOL and uveal tissues, decreasing the likelihood of optical aberrations and pigmentary dispersion., (Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate capsular bag opacification with a new disk-shaped single-piece hydrophilic acrylic intraocular lens (IOL) suspended between 2 haptic rings connected by a pillar of the haptic material and with a commercially available single-piece hydrophobic acrylic IOL in rabbits., Setting: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA., Design: Experimental study., Methods: The study IOL was implanted in the right eyes of 5 New Zealand rabbits and the control IOL in the left eyes. Slitlamp examination was performed at weeks 1 through 5. After the rabbits were humanely killed, the globes were enucleated and examined by ultrasound. Capsular bag opacification scoring from the posterior aspect (Miyake-Apple view) was then performed, followed by histopathology., Results: Trace honeycomb posterior capsule opacification (PCO) was noted in some study eyes. All control eyes developed moderate to marked PCO, which was more pronounced at the level of the optic-haptic junction. The mean PCO score was 0.4 ± 0.22 (SD) in the study group and 3.4 ± 0.54 in the control group (P=.000179, paired t test). Minimal proliferative cortical material was confined to the space between the anterior and posterior rings of the study IOL haptics. Anterior capsule opacification was absent in study eyes and mild in control eyes. There was no contact between the anterior capsule and the anterior surface of study IOLs., Conclusion: The peripheral rings of the study IOL, by expanding the capsular bag and preventing IOL surface contact with the anterior capsule, appear to prevent opacification of the capsular bag., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Object: Normative morphological data pertaining to the development of the occipital condyle have not been reported. The first goal of this study was to establish normative data characterizing the shape of the occipital condyle in healthy children. The second objective of the study was to compare these data with measurements collected in patients with congenital occipitoatlantal instability (COI) or Down syndrome (DS). The effectiveness of CT and plain radiography data was also compared., Methods: The authors retrospectively reviewed data obtained in 39 patients (14 with DS/COI and 25 age-matched controls). Patients underwent plain lateral radiography and CT scanning of the cervical spine. Normalized measurements of the occipital condyle were obtained for both groups using plain radiography and CT imaging techniques., Results: The curvature of the occipital condyle in healthy children increased by 60% from infancy to adolescence. Comparison of condylar morphology on plain lateral radiographs and CT scans in patients with DS/COI and in age-matched controls demonstrated a significant difference in mean normalized depth/length ratios. Comparison of curvature data obtained using plain lateral cervical radiography with measurements obtained using cervical CT scanning demonstrated a correlation coefficient of 0.63. However, intra- and interobserver reliability for plain radiographic analysis of the occipital condyle was poor (r(2) = 0.40 and 0.44, respectively)., Conclusions: Patient with DS/COI who have occipitoatlantal instability fail to develop the curved architecture in the occipital condyle that occurs in age-matched controls over time. Sagittal 2D CT reconstructions accurately determine the precise structure of the occipital condyle, although the indications for CT scanning are limited. Because of the poor intra- and interrater reliability on static plain radiographs, dynamic flexion/extension cervical spine radiographs remain the study of choice by which to directly evaluate occipitocervical motion.

This investigation examined the effect of torso rotational strength on angular hip (AHV), angular shoulder (ASV), linear bat-end (BEV), and hand velocities (HV) and 3 repetition maximum (RM) torso rotational and sequential hip-torso-arm rotational strength (medicine ball hitter's throw) in high school baseball players (age 15.4 +/- 1.2 y). Participants were randomly assigned to 1 of 2 training groups. Group 1 (n = 24) and group 2 (n = 25) both performed a stepwise periodized resistance exercise program and took 100 swings a day, 3 days a week, for 12 weeks with their normal game bat. Group 2 performed additional rotational and full-body medicine ball exercises 3 days a week for 12 weeks. A 3RM parallel squat and bench press were measured at 0 and after 4, 8, and 12 weeks. Participants were pre- and posttested for 3RM dominant and nondominant torso rotational strength and medicine ball hitter's throw. Angular hip velocities, ASV, BEV, and HV were recorded pre- and posttraining by a motion capture system that identified and digitally processed reflective markers attached to each participant's bat and body. Groups 1 and 2 increased (p < or = 0.05) BEV (3.6 and 6.4%), HV (2.6 and 3.6%), 3RM dominant (10.5 and 17.1%) and nondominant (10.2 and 18.3%) torso rotational strength, and medicine ball hitter's throw (3.0 and 10.6%) after 12 weeks. Group 2 increased AHV (6.8%) and ASV (8.8%). Group 2 showed greater improvements in BEV, AHV, ASV, 3RM dominant and nondominant torso rotational strength, and medicine ball hitter's throw than group 1. Groups 1 and 2 increased predicted 1RM parallel squat (29.7 and 26.7%) and bench press (17.2 and 16.7%) strength after 12 weeks. These data indicate that performing additional rotational medicine ball exercises 2 days a week for 12 weeks statistically improves baseball performance variables.

This study examined the effects of 12 weeks of wrist and forearm training on linear bat-end velocity (BV), center of percussion velocity (CV), hand velocity (HV), and time to ball contact of high school baseball players. Forty-three baseball players were randomly assigned by a stratified sampling technique to 1 of 2 training groups. Group 1 (n = 23) and group 2 (n = 20) performed the same full-body resistance exercises while training 3 days a week for 12 weeks according to a stepwise periodized model. Group 2 also performed wrist and forearm exercises 3 days a week for 12 weeks. Wrist and forearm strength were measured pre- and posttraining. Linear BV, CV, HV, and time to ball contact were recorded pre- and posttraining by a motion-capture system. A 3 repetition maximum (RM) parallel squat and bench press were measured at baseline and after 4, 8, and 12 weeks of training. Both groups showed statistically significant increases (p < or = 0.01) in linear BV, CV, and HV (m.s(-1) +/- SD) after 12 weeks of training; however, there were no differences between the 2 groups. Both groups statistically increased wrist and forearm strength (p < or = 0.05). Group 2 had statistically greater increases (p < or = 0.05) in 10 of 12 wrist and forearm strength measures than did group 1. Both groups made statistically significant increases in predicted 1RM parallel squat and bench press after 4, 8, and 12 weeks of training; however, there were no differences between groups. These data indicate that a 12-week stepwise periodized training program can significantly increase wrist and forearm strength, linear BV, CV, and HV among high school baseball players. However, increased wrist and forearm strength did not contribute to further increases in linear BV, CV, or HV.

Background: Schizophrenia guidelines differ considerably in methodology and content., Aims: To systematically compare national schizophrenia guidelines from different countries., Method: An international survey was conducted on guideline development and a methodological comparison was made using a validated guideline appraisal instrument (the Appraisal Guideline Research and Evaluation Europe)., Results: The methodological quality of many schizophrenia guidelines was at best moderate. Few guidelines had included key stakeholders in their development process. Although pharmacotherapy recommendations were similar, there were strong variations in the type of psychosocial interventions recommended., Conclusions: The methodological quality of guidelines has a strong influence on their applicability. However, the lack of financial means to develop and implement guidelines is a serious problem. Independent international organisations could contribute to defining a core set of unbiased schizophrenia treatment recommendations. In countries with a shortage of resources, this could be a basis for adaptation to different cultural and economic backgrounds in collaboration with stakeholders.

The staff of the American Psychiatric Association (APA), the American Psychiatric Institute for Research and Education (APIRE), and a national panel of experts in bipolar disorder and practice guideline development have collaborated to generate a set of quality of care indicators for the pharmacologic and psychosocial treatment of bipolar disorder. The indicators were derived from APA's evidence-based Practice Guideline for the Treatment of Patients with Bipolar Disorder, 2002 (1) and the Expert Consensus Guideline Series: Medication Treatment of Bipolar Disorder, 2000 (2) These quality indicators can be used for quality monitoring, benchmarking, and quality improvement efforts across health plans, systems of care, and health care providers to improve quality and outcomes of care for patients with bipolar disorder.

Many communities have implemented systems of care in an effort to better coordinate and integrate mental health and other social services for children and youths, while simultaneously managing existing funding sources more effectively. Systems of care represent a fundamentally different way of delivering mental health services and accordingly require new approaches for both developing and sustaining collaboration. This article examines obstacles to collaboration and addresses key factors required to build and sustain collaboration.

Background: Gender differences in clinical assessment and treatment have been reported in several areas of medicine. We examine whether differences exist in the routine outpatient psychiatric management of men and women with major depression., Methods: Psychiatrists practicing in the community completed case forms on a systematic sample of their adult outpatients with major depression. Comparisons are presented between male (n=261) and female (n=472) patients focusing on their background characteristics, clinical presentation, assessment, and treatment. Significant gender disparities in assessment and treatment are also examined with respect to the gender of the treating psychiatrist., Results: Although male and female patients had generally similar clinical profiles, a significantly greater proportion of males than females had psychomotor retardation and substance use disorders. No significant gender differences were observed in the assessment of depressive symptoms, psychiatric comorbidities, and treatment with antidepressant medications or psychotherapy. However, a significantly smaller percentage of depressed women than men received assessments of sexual function and medication-related sexual side effects. Female patients were also less likely to have discussed their treatment preferences with their psychiatrists., Limitations: Only a minority (33.2%) of psychiatrists invited to participate contributed patients to this study. The results are based on structured assessments completed by practicing psychiatrists rather than patient self-assessments or independent research assessments., Conclusions: Although we find overall little evidence of gender bias in the clinical management of major depression, both male and female psychiatrists need to further explore sexual function and treatment preferences in female patients.

Over the past two decades there have been great advances in the understanding of depression and in the development of pharmacological agents and psychosocial treatments that have demonstrated efficacy in the treatment of this common and disabling illness. Unfortunately, this knowledge and evidence is not consistently translated into actual treatment, and depression remains undiagnosed in a large percentage of patients, and when it is accurately diagnosed, it often is suboptimally treated.The frequent failure to properly diagnose depression may be due to the continuing stigma of mental illness, the persistence of the biomedical, rather than the biopsychosocial, paradigm of illness and treatment, educational issues and the time constraints in the typical medical practice. The suboptimal treatment may be due to all of these issues plus the difficulty in changing physician behaviours even when there exists much evidence that would seem to dictate such a change. The development of a criteria-based nomenclature and the subsequent development and dissemination of evidence-based practice guidelines addresses some of these issues. Copyright 2001 John Wiley & Sons, Ltd.

Despite extensive studies on the epidemiology of mental disorders and advances in the treatment of these conditions, there is a paucity of detailed information concerning the characteristics of psychiatric patients and how treatments are administered in routine psychiatric practice. This 1997 observational study collected detailed information from 417 psychiatrists on the demographic, diagnostic, clinical, and treatment characteristics of a systematic sample of 1228 patients. Six hundred thirty-seven patients (51.9%) were women and the mean patient age was 41.9 years. The most common diagnostic category (53.7%) was mood disorders, followed by schizophrenia/psychotic disorders (14.6%), anxiety disorders (9.3%), and disorders of childhood (7.7%). Six hundred seventy-one patients (54.6%) had at least one comorbid Axis I condition and almost half (49.8%) had a history of psychiatric hospitalization. Patients received a mean of 2.0 psychotherapeutic medications, most commonly antidepressants (62.3%). Findings demonstrate that psychiatrists in routine practice treat a patient population with severe, complex conditions.

Objective: The authors' goal was to characterize psychiatric practice by reporting findings from the 1996 National Survey of Psychiatric Practice., Methods: A random sample of 1,481 APA members was selected to participate in the study; 1,375 APA members were determined to be eligible for study participation. The authors report data from 970 respondents (70.5% response rate) and compare them with data from previous surveys of psychiatrists., Results: Twenty-five percent of the participating psychiatrists were women, compared with 19% in a 1988-1989 survey. Since 1988-1989, the proportion of psychiatrists 39 years old or younger has decreased and the proportion of those 55 years old or older has increased. In 1996, psychiatrists saw, on average, 35.4 unduplicated patients and worked an average of 46.4 hours in a typical week. Patients with mood disorders as their primary diagnoses accounted for the greatest proportion of psychiatrists' caseloads, followed by patients with anxiety disorders, then those with schizophrenia and other psychotic disorders. Public sources of payment and uncompensated care were the main sources of payment for psychiatrists services for 41.7% of patients. The primary payment mechanism for psychiatrists' patient care services was fee-for-service, accounting for 52.5% of psychiatrists' income from direct patient care. Twenty-nine percent of psychiatric patients received care through some form of managed care system, and 41.6% received treatment through a nonmanaged public or private health plan., Conclusions: As psychiatry moves into the next century, findings from the National Survey of Psychiatric Practice will form a baseline for monitoring changes and trends in the delivery and financing of mental health services.

The American Psychiatric Association's practice guidelines provide authoritative guidance for assessing and treating major clinical problems that psychiatrists face. This article reviews the social context in which practice guidelines have emerged, opportunities they afford educators, and limitations in their educational and practice applications. Practice guidelines should be used in residents' and medical students' seminars and in continuing medical education activities. The incentive to study guidelines may increase as their likely use as information sources for questions on in-service and specialty board certification examinations as well as in clinical quality-assurance activities becomes more widely recognized.

Objective: The authors describe the APA Practice Research Network (PRN), a national research initiative that ultimately will engage 1,000 practicing psychiatrists in collaborative clinical and services research. The PRN is designed to generate practice-relevant information and to inform future service delivery, policy, and financing decisions pertinent to psychiatry., Method: The authors review the relative strengths and limitations of practice-based research compared with other widely used research methods. They also describe the structure of the PRN and its procedures for recruiting network members and for identifying and developing specific network studies. The three primary sources of data for the PRN are 1) the biannual National Survey of Psychiatric Practice, which provides not only a mechanism for randomly recruiting the two-thirds of network participants who are not volunteers but also a baseline for assessing the generalizability of PRN findings; 2) separate biannual studies of psychiatric patients and treatments to characterize the network patient/treatment denominator, which is used to monitor trends in psychiatric practice and plan network studies; and 3) specific studies., Results: Pilot data from the PRN have yielded detailed information on the diagnostic and clinical characteristics of 725 patients and on the treatments provided by network psychiatrists., Conclusions: The APA PRN offers a powerful complement to traditional clinical and health services research approaches. The PRN will help psychiatry improve its ability to meet patients needs in a context of rapidly evolving scientific and clinical progress and legislative and economic forces affecting health care delivery.

A survey was conducted in Rochester, NY, of the attitudes and practices of psychiatrists (both in private practice and fulltime academic settings), psychiatric residents, internists, and fourth-year medical students concerning physical examinations of psychiatric patients. Thirteen percent of the psychiatrists frequently perform an initial physical examination on their inpatients and 8% frequently do an initial physical examination on their outpatients. These percentages are much larger for the resident groups. A very high percentage of all respondents report that they feel a physical examination of psychiatric patients is important especially when the patient is receiving medication. The largest number of psychiatrists report that they omit the physical examination because the patient has been referred to them after a physical examination by another physician or they refer the patient for such an examination. A notable percentage of psychiatrists in this sample report that they do not feel competent performing a physical examination.

Four experimental tasks were employed to explore the initial stages of visual information processing in a group of dyslexic boys and in a group of normal control subjects ranging in age from 8 to 14 years. Two tasks involved visual backward masking; the other two were temporal integration tasks. The backward-masking tasks yielded evidence of slower rates of visual information processing in dyslexic children; the temporal-integration tasks yielded evidence of longer duration of visible persistence in dyslexic children. This effect was most evident in situations in which sequential stimuli impinged on the same retinal location. Some age trends in the development of these effects are noted. It is suggested that the dyslexic visual system may take an unusually long period of time to recover from the aftereffects of neural activity evoked by an inducing stimulus.