Thoughts of agoraphobic people during scary tasks

The authors examined the occurrence of theoretically derived patterns of thinking in 74 agoraphobic participants as they drove alone or tolerated an enclosed place. During the increasingly scary tasks in a behavioral test hierarchy, participants responded to a periodic beep by stating aloud what they were thinking at that moment, yielding more than 1,800 tape-recorded statements. Content analyses revealed that participants were mainly preoccupied with their current anxiety (expressed in 29% of the statements) and with their self-efficacy (15%). Despite participants' mounting feelings of anxiety, fewer than 1% of their statements expressed a thought of danger or an anticipation of future anxiety or panic. The rarity of danger thoughts poses an explanatory challenge for all cognitive theories of phobia and especially for the perceived danger theory of A. T. Beck (1976) and A. T. Beck, G. Emery, and R. L. Greenberg (1985).

Thoughts of agoraphobic people during scary tasks

The authors examined the occurrence of theoretically derived patterns of thinking in 74 agoraphobic participants as they drove alone or tolerated an enclosed place. During the increasingly scary tasks in a behavioral test hierarchy, participants responded to a periodic beep by stating aloud what they were thinking at that moment, yielding more than 1,800 tape-recorded statements. Content analyses revealed that participants were mainly preoccupied with their current anxiety (expressed in 29% of the statements) and with their self-efficacy (15%). Despite participants' mounting feelings of anxiety, fewer than 1% of their statements expressed a thought of danger or an anticipation of future anxiety or panic. The rarity of danger thoughts poses an explanatory challenge for all cognitive theories of phobia and especially for the perceived danger theory of A. T. Beck (1976) and A. T. Beck, G. Emery, and R. L. Greenberg (1985).

The effects of human macrophage inflammatory protein-1 alpha and its genetically modified variant, BB10010, on phagocyte function

BB-10010 is a genetically modified form of human macrophage inflammatory protein-1 alpha (MIP-1 alpha) with a single amino acid substitution of Asp26 by alanine, which inhibits aggregation of the native molecule. BB-10010 has stem cell protective properties, and has entered clinical trials for this purpose. The aim of this study was to determine the effects of BB-10010 on human phagocyte function and compare them with the native molecule. MIP-1 alpha and BB-10010 had identical dose-response curves in assays of calcium mobilization; however, neutrophils were less sensitive than monocytes to either MIP-1 alpha form, suggesting differences in receptor expression. Neither MIP-1 alpha type directly stimulated phagocyte superoxide production, nor did it have any priming effect on agonist-induced superoxide production. Both MIP-1 alpha and BB-10010 enhanced monocyte migration; however, cells were more sensitive to the native molecule, with optimal effects seen at 1 ng/ml compared with 100 ng/ml BB-10010. Concomitant alteration of CD11b, CD18, and CD49d (VLA-alpha 4) cell adhesion molecule expression was not seen with either MIP-1 alpha type. With the exception of the difference in monocyte sensitivity in chemotaxis assays, BB-10010 reproduces the effects of the native molecule on phagocytes. BB-10010 does not have proinflammatory effects on neutrophil activation, and this bodes well for its clinical use.

The activity of rifabutin against Mycobacterium leprae in armadillos

The activity of rifabutin (LM 427) against Mycobacterium leprae was evaluated in armadillos inoculated earlier with human-derived M. leprae. Rifabutin was administered daily at a dose of 6 mg/kg body weight/day. The effect of rifabutin on M. leprae harvested from armadillos was determined by measuring the intracellular levels of ATP (an indicator of metabolic activity) of M. leprae and also their ability to multiply in the mouse footpads and in vitro in DH medium. Within 2 weeks of initiating the treatment, ATP levels declined to 21% of the original (pre-treatment level) and these M. leprae failed to multiply in the footpads of mice as well as in the in vitro culture system. This suggests that rifabutin was able to kill all M. leprae within 2 weeks. After 8 weeks the treatment was terminated and results showed that M. leprae from the treated armadillos remained non-viable in the mouse footpad system as well as in the in vitro system, indicating bactericidal action of rifabutin. The results suggest that rifabutin can be a substitute for rifampin in the leprosy multi-drug therapy regimen.

Lower third molar treatment planning ability of general dental practitioners and oral maxillofacial surgeons using receiver operating characteristics methodology

A comparison of lower third molar treatment planning ability of six oral and maxillofacial surgeons (three consultants, two senior registrars and one senior house officer) and 27 general dental practitioners was carried out using Receiver Operating Characteristics (ROC) methodology. Each clinician was presented with the same series of 50 case histories and asked to indicate, using a rating scale, how certain they were that each lower third molar required removal. These data, together with NIH gold standard treatment decisions for each third molar, were then used to construct ROC curves for each clinician and, using combined data, to produce ROC curves for the groups of hospital specialists and general dental practitioners. These curves were then compared statistically. There were significant differences between the best and worst practitioners, both in the hospital service and within general dental practice. When combined data were examined, however, there was no statistical difference in the treatment planning ability of hospital specialists and general dental practitioners. These findings indicate that lower third molar treatment planning ability is more dependent upon individual factors than specialist training. Further, the data presented here suggest that general dental practitioners are as capable of treatment planning for lower third molars as the specialists to whom they refer.

A functional model of nerve repair. Reanastomosis vs entubulation repair

OBJECTIVE

To compare reanastomosis and entubulation repair after transection of the peroneal nerve in rats with the use of 2 functional models: gait analysis and a tension transduction device.

DESIGN

Prospective, randomized, blinded control study. Each animal served as its own control. The injured site was alternated between the left and the right. Gait analysis was evaluated in a blind fashion at postoperative weeks 1, 3, 7, and 13, and the tension transduction device at week 13, for injured and uninjured legs.

SUBJECTS

Animals underwent unilateral peroneal nerve transection injury, half with entubulation and half with end-to-end reanastomosis repair.

INTERVENTION

Nerve transection was performed 6 mm proximal to the anterior tibialis muscle insertion followed by reanastomosis (epineurial suture placement to align the sectioned nerve ends) or entubulation (placement of nerve ends into a 4-mm-long sterile Silastic tube secured with 2 epineurial sutures).

RESULTS

Gait analysis demonstrated a poorer ankle angle in all injured legs compared with uninjured legs at each postoperative period. Ankle angles for reanastomosis were statistically better than those for entubulation at weeks 3, 7, and 13. The tension transduction device demonstrated poorer force in injured than uninjured animals at 13 weeks. Reanastomosis repair groups demonstrated no difference in force development compared with entubulation repair groups.

CONCLUSIONS

Reanastomosis of the transected rat peroneal nerve demonstrated improved functional return by gait analysis when compared with entubulation-repaired nerves at postoperative weeks 3, 7, and 13. Force development of injured nerve groups measured by the tension transduction device was decreased compared with control, but no difference was detected between the 2 repair methods. Further studies are needed to evaluate the possible functional benefit of reanastomosis.

Hyperbaric Oxygen Treatment after rat Peroneal Nerve Transection and Entubulation

Rat peroneal nerves were transected and entubulated with a Silastic channel. The experimental group was treated with hyperbaric oxygen to evaluate changes in acute edema, functional recovery, and histology. Hyperbaric oxygen was administered with 100% O2 at 2.5 atmospheres absolute for 90 minutes twice a day for 1 week and then four times a day for 1 week. Acute edema changes based on nerve water weight and transfascicular area measurements were greater in injured than in uninjured nerves but demonstrated no differences between hyperbaric oxygen–treated and –untreated groups 2, 8, and 16 days after surgery. Functional evaluation with gait analysis demonstrated significant changes between injured and uninjured groups 1,3,7, and 13 weeks after injury but no differences between hyperbaric oxygen-treated and –untreated groups. Thirteen weeks after the initial injury, elicited muscle force measurements demonstrated no significant improvement from hyperbaric oxygen treatment of injured nerves. Histologic evaluation of nerve area, myelinated axon number, myelinated axon area, myelin thickness, and blood vessel number and area revealed no significant differences between hyperbaric oxygen–treated and –untreated groups. Hyperbaric oxygen was not associated with improvement of nerve regeneration with any of the outcome variables in this model.

Cognitive and performance-based treatments for panic attacks in people with varying degrees of agoraphobic disability

Compared the effectiveness of cognitive therapy and performance-based exposure as treatments for panic attacks. Subjects were 48 panicky individuals selected without regard to agoraphobic disability, and who varied widely in that respect. Subjects were assigned randomly to either cognitive treatment, performance-based exposure treatment, a combined cognitive/performance treatment, or a no-treatment control condition. All three treatments led to marked and enduring improvements in panic, and did not differ from one another in effectiveness, whereas the control condition produced little benefit. However, on several measures of phobia and panic-related cognitions, performance exposure was significantly more effective than cognitive therapy. Degree of agoraphobic disability had a significant bearing on panic treatment effectiveness. Whereas 94% of the low agoraphobia Ss were free of panic after treatment, only 52% of the high agoraphobia Ss became panic-free. The findings suggest that when panic treatment research excludes people with serious phobias, as it has routinely done in recent years, an overly positive estimate of panic treatment effectiveness can result.

The regulation of neutrophil phospholipase A2 by granulocyte-macrophage colony-stimulating factor and its role in priming superoxide production

Experiments were performed to investigate the relative role of phospholipase A2 (PLA2) in the activation and cytokine-mediated priming of neutrophil superoxide production. PLA2 activity was measured with a radiometric assay which discriminates between PLA2 and the downstream enzyme, 5-lipoxygenase. In cells that had not been primed by prior incubation with granulocyte-macrophage colony stimulating factor (GM-CSF), PLA2 and NADPH oxidase were differentially stimulated by the chemotactic peptide N-formyl-met-leu-phe (FMLP), calcium ionophore, or phorbol ester. In addition, inhibition of PLA2 by mepacrine (0-100 micromol/l) did not concomitantly inhibit FMLP-stimulated superoxide production. These findings suggest that the activity of PLA2 and NADPH oxidase may be uncoupled in the unprimed cell. In cells preincubated with GM-CSF, time- and dose-dependent priming of FMLP-stimulated PLA2 responses were observed and inhibition of PLA2 by mepacrine was accompanied by the inhibition of FMLP-stimulated superoxide production down to the level of unprimed cells. The effect of mepacrine was not due to inhibition of FMLP receptor expression. These data suggest that a mepacrine-sensitive PLA2 may have a role in the GM-CSF mediated priming of superoxide production. Using ionophore-stimulated PLA2 activity as a model, we showed that Bordatella pertussis toxin did not inhibit GM-CSF mediated priming, demonstrating that a pertussis-sensitive GTP-binding protein does not mediate signal transduction from the GM-CSF receptor to PLA2. The tyrosin kinase inhibitor, genestein, selectively inhibited GM-CSF primed but not unprimed PLA2 activity, demonstrating that GM-CSF-mediated priming requires tyrosine kinase activity.

Hyperbaric oxygen treatment after rat peroneal nerve transection and entubulation

Rat peroneal nerves were transected and entubulated with a Silastic channel. The experimental group was treated with hyperbaric oxygen to evaluate changes in acute edema, functional recovery, and histology. Hyperbaric oxygen was administered with 100% O2 at 2.5 atmospheres absolute for 90 minutes twice a day for 1 week and then four times a day for 1 week. Acute edema changes based on nerve water weight and transfascicular area measurements were greater in injured than in uninjured nerves but demonstrated no differences between hyperbaric oxygen-treated and -untreated groups 2, 8 and 16 days after surgery. Functional evaluation with gait analysis demonstrated significant changes between injured and uninjured group 1, 3, 7, and 13 weeks after injury but no differences between hyperbaric oxygen-treated and -untreated groups. Thirteen weeks after the initial injury, elicited muscle force measurements demonstrated no significant improvement from hyperbaric oxygen treatment of injured nerves. Histologic evaluation of nerve area, myelinated axon number, myelinated axon area, myelin thickness, and blood vessel number and area revealed no significant differences between hyperbaric oxygen-treated and -untreated groups. Hyperbaric oxygen was not associated with improvement of nerve regeneration with any of the outcome variables in this model.

A quantitative cytological study of lesional and non-lesional mucosa in oral lichen planus

Smears of buccal mucosa, dorsal surface of the tongue and floor of mouth were taken from 10 patients with histologically confirmed oral lichen planus and 12 healthy age- and sex-matched controls. In buccal smears, no significant differences in cytoplasmic and nuclear areas were observed between lesional, adjacent non-lesional and control tissues. However, the cytoplasmic area in smears from lichen planus lesions on the dorsum of the tongue and adjacent clinically normal mucosa was reduced compared with healthy controls. The cytoplasmic: nuclear ratio in smears from clinically normal floor of mouth in oral lichen planus was similarly reduced. Papanicolaou-stained smears from buccal lichen planus showed increased keratinization compared with normal buccal mucosa. These findings demonstrate that quantitative cytology can detect both cytoplasmic and nuclear changes in oral lichen planus.

Peroneal motor nerve crush injury and hyperbaric oxygen effect

The potential therapeutic effect of hyperbaric oxygen (HBO) after rat peroneal nerve crush was evaluated. Animals were given 100% oxygen at 2.5 atmosphere absolute for 90 minutes twice daily for 1 week and then once daily for 1 week. Edema increased in crushed nerves compared with control nerves, but no effect was associated with the administration of HBO. Gait analysis demonstrated injury at 1, 7, and 14 days after nerve crush, but no difference was found at 22 and 28 days after injury (analysis of variance: P < .001, 10 animals per group). Eight weeks after injury, nerve stimulation and muscle force measurements were 114 g for the injured group and 146 g for the control group (P < .001). There were no HBO-associated changes in gait parameter or nerve/muscle force measurements. This study demonstrated that rat peroneal nerve crush injury causes acute intraneural edema and temporary decrement of gait parameters. Elicited nerve stimulation demonstrated persistent loss of force 4 weeks after normalization of gait, but no HBO effect.

Neuromuscular evaluation using rat gait analysis

We have developed a rat gait analysis model to evaluate if ankle angle and other associated gait parameters could consistently define normal peroneal nerve and anterior tibialis muscle function. The second part of the study was designed to determine if such a model would be useful to measure recovery of function after a peroneal nerve crush injury (NCI). A clear plexiglas tunnel was designed for high-speed frame videotaping and subsequent computergraphic gait measurement and analysis. Normal gait patterns for ankle angle, back height, step and stride lengths and the stance and swing times were determined in 8 rats. Data analysis demonstrated no significant left/right differences for any of the variables (ANOVA) with the exception of step length. Subsequently, 12 rats with a peroneal NCI were evaluated. All gait parameters evaluated from the injured side were significantly different from the uninjured side after injury except stride length. Ankle angle was the most sensitive outcome variable. Weekly gait analysis provided objective measurements as the ankle angle gradually returned to normal within 3 weeks. The rat gait model is a sensitive and reproducible method for non-invasive evaluation of neuromuscular function during nerve recovery after a peroneal crush injury.

Tension transduction device for functional evaluation of the rat peroneal nerve

Current techniques for evaluating animal model nerve regeneration lack accurate, sensitive and reproducible methods to determine neuromuscular function. We have developed a tension transduction apparatus which measures the magnitude of ankle dorsiflexion produced by normal rats during bipolar stimulation of the surgically exposed peroneal nerve. Three groups of animals were used to evaluate the consistency and overall reliability of this apparatus. Within the first group of 4 animals, we determined variability in a single testing period of 8 successive stimulations. The mean normalized standard deviation of dorsiflexion tension produced was 2.9% of the mean. In the second group, comparison of right and left dorsiflexion tension in 8 animals showed a difference of less than 2% (right: 134.2 g; left: 131.6 g), demonstrating that one lower limb can be used as a control for the contralateral limb. In the third group, 12 animals were tested on two separate occasions, 2 months apart, tension production increased 10% (from 122 to 134 g) and corresponded with an average weight increase, per animal, of 100 g (30%) during the 2-month rest period. Despite the increase in weight and strength, the initial procedure had a negative effect upon the maximum tension produced compared to a previously unoperated leg (prior operation: 134 g; no prior operation: 144 g). The reproducibility of data obtainable with this new device allows for its incorporation in future studies, as well as the correlation of such functional data with other current methods of studying nerve regeneration.

Two-staged breast reconstruction in patients with symptomatic macromastia requiring mastectomy

Patients with symptomatic macromastia undergoing mastectomy for the treatment of malignant breast disease are candidates for a two-staged operation resulting in breast reconstruction and contralateral breast reduction. Five patients with symptomatic macromastia underwent a skin-sparing mastectomy for breast disease using a modified Wise incision. The first stage of the breast reconstruction was performed with a de-epithelialized transverse rectus abdominis musculocutaneous (TRAM) flap. Second-stage breast reconstruction was conducted 4 to 6 months later when revision of the TRAM reconstructed breast and concurrent contralateral breast reduction were performed with the intent of tailoring the reduced breast to approximate the revised TRAM breast mound. Excess areola from the reduced breast was harvested and used as a full-thickness graft to reconstruct the TRAM areola complex. Patients followed for 5 to 30 months postoperatively confirm resolution of macromastia symptoms, correction of the mastectomy defect, and symmetrical breast mound creation in a timely two-staged procedure. The two-staged breast reconstruction described represents an expedient plan for patients with symptomatic macromastia requiring mastectomy for breast disease. Skin-sparing mastectomy, modified Wise pattern incisions, utilization of usually discarded areola tissue, and creation of symmetrical breast mounds during the second stage of the reconstruction highlight the salient features of this patient management paradigm.

The pediatric patient in the post anesthesia care unit

This article provides an overview of pediatric post anesthesia care. It highlights important aspects of care that are frequently encountered in practice or have the potential for being problematic. These include airway management, fluid maintenance, the treatment of seizures, thermoregulation, the management of malignant hyperthermia, the identification and treatment of emergence delirium, and the availability of appropriate emergency equipment and medications.

Partial mastectomy and breast reduction as a valuable treatment option for patients with macromastia and carcinoma of the breast

The essential goals of every reconstructive procedure of the breast are to create a breast mound and establish symmetry. Breast conservation operation is now a widely accepted treatment for carcinoma of the breast. Four patients who presented with macromastia or mammary hypertrophy and a simultaneous carcinoma of the breast were treated by combined partial mastectomy and bilateral breast reduction. Incisions on the breast were made using standard Wise pattern (keyhole) markings. In each instance, the tumor was removed with a generous margin of normal surrounding mammary tissue. Two procedures used the inferior pedicle technique and two were done by resection and transplantation of the nipple. The average mammary tissue resection was 825 grams. All incisions healed primarily and necessary adjuvant chemoradiation was not delayed. Each patient is alive and well without evidence of disease with a follow-up period ranging from seven to 43 months. Postoperatively, the appearance of the breast is esthetically improved and all symptoms related to macromastia have resolved. Advantages of combining these two techniques include improved symmetry, easier postoperative self-examination of the breast and decreased radiation effect noted with larger breasts. Postoperative mammograms have been useful for patient follow-up evaluation. Combined segmental mastectomy and breast reduction represents a valuable treatment option for the patient who presents with macromastia and carcinoma of the breast. The carcinoma ablative procedure is not compromised and the improved symmetry of the breast has resulted in an excellent cosmetic outcome in these patients.

Prior exposure to a running wheel and scheduled food attenuates polydipsia acquisition

Groups of rats were given different histories before exposure to daily, 2-h fixed-interval (FI) 1-min food-schedule sessions with water available. In a previous study, a group with a history of chronic exposure to FI 1-min sessions without water subsequently had a reduced rate of acquisition and final level of schedule-induced polydipsia compared to a control group lacking this history. In the present study, groups with histories of chronic exposure to FI 1-min sessions and a concurrent running wheel were even more attenuated in their subsequent acquisition of polydipsia. Substitution of 5% ethanol for session water in the final phase produced a convergence in group intakes, except for a group which continued to have access to the running wheel. The ethanol intake of this group was relatively suppressed.

Cervical cancer metastatic to the breast: a rare presentation of tumor dissemination

Metastatic disease presenting in the mammary gland from gynecologic malignancies is a rare occurrence. A case of metastatic adenosquamous carcinoma of the cervix presenting as an inflammatory breast lesion is reported. Metastases within the breast have distinct clinical, radiographic, and histologic features and should be suspected in a patient with a breast mass and a known extramammary primary. As with other distant metastases of cervical cancer, mammary gland involvement portends a poor prognosis.

The effect of cataract severity and morphology on the reliability of the Lens Opacities Classification System II (LOCS II)

Data collected from 3646 eyes in the Italian-American Natural History Study of Age-Related Cataract were used to investigate whether the reliability of the Lens Opacities Classification System II (LOCS II) by the severity of the opacity that is being graded or is influenced by the presence and severity of coexisting opacities. Reliability was assessed by comparing the slit-lamp gradings of two clinical examiners (346 eyes) and the gradings performed at the slit lamp with gradings of photographs (3646 eyes). The severity of cortical and nuclear opacities did not affect the reproducibility of slit-lamp gradings, but clinical grading of posterior subcapsular opacities became more reliable as the severity of the posterior subcapsular opacities increased. More advanced coexisting opacities decreased the agreement in the slit-lamp diagnosis of nuclear, but not cortical or posterior subcapsular, opacities. Comparisons of clinical and photographic gradings showed very good to excellent agreement for nuclear and cortical opacities, regardless of the severity of the specific opacity or the severity of the coexisting opacities. Agreement in diagnosing posterior subcapsular opacities was decreased in eyes with milder posterior subcapsular opacities and in eyes with more severe coexisting nuclear and/or cortical opacities. The effect of the severity of the opacity being graded and the severity of coexisting opacities on the reliability of the LOCS II must be considered in studies that use the system to classify and grade cataracts.

Effectiveness and tolerance of long-term malaria prophylaxis with mefloquine. Need for a better dosing regimen

To measure the effectiveness and tolerance of long-term malaria prophylaxis with mefloquine, the incidence of Plasmodium falciparum malaria and of adverse reactions was compared in Peace Corps volunteers in West Africa who took mefloquine every 2 weeks and in volunteers who took chloroquine phosphate weekly. Mefloquine was only 63% more effective than chloroquine; the monthly incidence of P falciparum infections was one case per 100 volunteers who took mefloquine and 2.7 cases per 100 volunteers who took chloroquine. Using daily proguanil (chloroguanide) hydrochloride in addition to chloroquine did not provide additional protection. All mefloquine prophylaxis failures occurred during the second week of the every-2-weeks dosing regimen in volunteers who had used mefloquine for more than 2 months. Blood concentrations of mefloquine were lower during the second week of the alternate-week regimen than during the first week, suggesting that blood levels are too low during the second week to suppress parasitemia. No serious adverse reactions were observed. The results indicate that a dosing regimen of 250 mg of mefloquine weekly should be considered for travelers to areas with chloroquine-resistant P falciparum malaria.

Effect of temperature on myosin phosphorylation in mouse skeletal muscle

The effect of muscle contraction on phosphorylatable myosin light chain (P-light chain) phosphate content and isometric twitch tension was examined at 25, 30, and 35 degrees C in intact mouse extensor digitorum longus muscle. Peak tetanic tension was unaffected by temperature, whereas peak unpotentiated isometric twitch tension was inversely proportional to muscle incubation temperature. The extent of phosphate incorporation into P-light chain elicited by a 20-s train of twitches (5/s) was inversely proportional to muscle incubation temperature, whereas the fractional increase in twitch tension (twitch potentiation) elicited by repetitive stimulation was directly proportional to muscle incubation temperature. After the twitch train, the rate of decline of potentiated twitch tension and of P-light chain dephosphorylation was directly proportional to muscle incubation temperature. The net result was that a significant and unique relationship between P-light chain phosphate content and contraction-induced tension potentiation existed at each temperature examined. The slope of the P-light chain phosphate vs. isometric twitch potentiation relationship varied directly as a function of muscle incubation temperature. The observations that the slope of this relationship increases and that unpotentiated twitch tension decreases when muscle incubation temperature is increased support the hypothesis that contraction-induced tension potentiation in intact mammalian skeletal muscle is the result of a sensitization of the contractile element to activation by Ca2+ that is brought about by P-light chain phosphorylation.

Trends in prescribing of antihypertensive drugs in Australia, 1977-1987

Prescribing of hypotensive agents, beta-blockers and diuretics was analysed using data from the Pharmaceutical Benefits Scheme, adjusted to reflect prescribing for hypertension, over 1977-1987. Prescribing of these three drug groups combined increased by approximately 50% over the period. Notable trends were decreased prescribing of bendrofluazide, chlorothiazide and methyldopa and increased prescribing of hydrochlorothiazide with amiloride, atenolol, metoprolol and prazosin, and, most recently, captopril and enalapril. The increase in prescribing of drugs for hypertension, combined with the choice of more expensive drugs, has resulted in a substantial increase in the drug costs associated with treating hypertension.

Generalization of therapeutic changes in agoraphobia: the role of perceived self-efficacy

Investigated the extent and mechanisms of therapeutic generalization across distinct areas of agoraphobic dysfunction. Twenty-seven severe agoraphobics were each given performance-based treatment for some phobic areas while leaving their other phobias untreated. Behavioral tests revealed that (a) the treated phobias improved significantly more than the untreated (transfer) phobias, (b) the transfer phobias improved significantly more than control phobias, and (c) the transfer benefits were highly variable within and between subjects. Analyses of possible cognitive mechanisms revealed that perceived self-efficacy accurately predicted treatment and transfer effects even when alternative factors such as previous behavior, anticipated anxiety, anticipated panic, perceived danger, and subjective anxiety were held constant. In contrast, these alternative factors lost most or all predictive value when self-efficacy was held constant. Agoraphobia thus appears to be neither a unitary entity nor a mere collection of independent phobias, but a complexly patterned problem governed largely by self-perceptions of coping efficacy.

The Bay Area Functional Performance Evaluation: development and standardization

The Bay Area Functional Performance Evaluation (BaFPE) was developed in 1977-1978 to meet the need for a reliable and valid instrument for assessing the general functional performance of patients treated in psychiatric occupational therapy. It consists of two subtests, the Task-Oriented Assessment and the Social Interaction Scale. These subtests evaluate two aspects of general functional performance--task-oriented and social behavior--that are important in assessing clients with emotional, cognitive, or behavioral deficits. This article traces the instrument's standardization over a 10-year period of development and includes a discussion of its theoretical premises, its content, and the revisions to date. Research on the reliability and validity of the BaFPE is summarized.