Medical versus Spiritual Orientations: Differential Patient Views toward Recovery

Background: Relapse among patients in substance abuse treatment has generated interest in identifying attitudinal factors that sustain recovery. Objective: To assess the relationship of attitudes toward approaches to motivation for treatment and Twelve Step beliefs. Methods: Dually diagnosed patients (N = 100) completed a survey assessing treatment attitudes, motivation, and Twelve Step beliefs. Results: Endorsement of medical services was positively correlated with motivation but unrelated to Twelve Step beliefs. Endorsement of religious services was unrelated to motivation but was associated with Twelve Step beliefs. Conclusions: Patients may have differing perceptions regarding routes to recovery based on preferences for professional services or spiritual resources

The evolution of language: a comparative review

For many years the evolution of language has been seen as a disreputable topic, mired in fanciful "just so stories" about language origins. However, in the last decade a new synthesis of modern linguistics, cognitive neuroscience and neo-Darwinian evolutionary theory has begun to make important contributions to our understanding of the biology and evolution of language. I review some of this recent progress, focusing on the value of the comparative method, which uses data from animal species to draw inferences about language evolution. Discussing speech first, I show how data concerning a wide variety of species, from monkeys to birds, can increase our understanding of the anatomical and neural mechanisms underlying human spoken language, and how bird and whale song provide insights into the ultimate evolutionary function of language. I discuss the ‘‘descended larynx’ ’ of humans, a peculiar adaptation for speech that has received much attention in the past, which despite earlier claims is not uniquely human. Then I will turn to the neural mechanisms underlying spoken language, pointing out the difficulties animals apparently experience in perceiving hierarchical structure in sounds, and stressing the importance of vocal imitation in the evolution of a spoken language. Turning to ultimate function, I suggest that communication among kin (especially between parents and offspring) played a crucial but neglected role in driving language evolution. Finally, I briefly discuss phylogeny, discussing hypotheses that offer plausible routes to human language from a non-linguistic chimp-like ancestor. I conclude that comparative data from living animals will be key to developing a richer, more interdisciplinary understanding of our most distinctively human trait: language

Ⅵ CLASSIC PAPERS REVISITED An Early Example of Evidence-based Medicine Hypoxemia due to Nitrous Oxide

Diffusion anoxia. By Bernard Raymond Fink. ANESTHESIOLOGY 1955; 16:511-14. In 1955, Dr. Bernard Raymond Fink published his findings that described the mechanism by which hypoxemia occurred when nitrous oxide-oxygen anesthesia was discontinued and room air breathing commenced. Using an ear oximeter and brachial artery blood gases, he measured oxygen saturation in eight healthy patients who had received 75% nitrous oxide-25% oxygen for gynecologic surgery. He showed that oxygen saturation decreased from 5% to 10% and often reached a value below 90% when the patient began room air breathing after the nitrous oxide-oxygen was discontinued. The effect was seen over a 10-min period. He concluded that "anoxia arises because the outward diffusion of nitrous oxide lowers the alveolar partial pressure of oxygen." This phenomenon can become a causative factor of cardiac arrest in patients with impaired pulmonary or cardiac reserves. IN 1955, Dr. B. Raymond (Ray) Fink (1914Fink ( -2000 was faculty in the Department of Anesthesiology, Columbia University College of Physicians and Surgeons (New York, New York) when he published one of the first articles describing a mechanism by which anesthesia could cause hypoxemia. 1 At the time, cyanosis was a recognized phenomenon during recovery from general anesthesia despite apparently good ventilation. It was also recognized that this was more frequent in patients anesthetized with a nitrous oxide-oxygen mixture. There were previous reports of a decrease in arterial oxygen saturation as measured by an ear oximeter when patients began to breathe room air, especially after a nitrous oxide-oxygen anesthetic. Ray followed this simple experiment with clinical observations in eight otherwise healthy patients undergoing gynecologic surgery who were anesthetized with 75% nitrous oxide-25% oxygen supplemented with sodium thiopental. Blood oxygen saturations were measured by either a Wood ear oximeter or brachial arterial blood analysis. Removal of the facemask at the end of the nitrous oxide-oxygen anesthetic resulted in a decrease in arterial oxygen saturation from 4.5% to 10.3% with an average of 7.9%, an effect that lasted approximately 10 min. The variability of change in oxygen saturation among the patients studied was attributed to differing levels of ventilation and lung volume. Fink observed that if patients were hyperventilating, the effect would be less, and the effect would be greater in patients with low lung volumes in which to dilute the nitrous oxide. The diffuAdditional material related to this article can be found on the ANESTHESIOLOGY Web site. Go to http://www.anesthesiology. org, click on Enhancements Index, and then scroll down to find the appropriate article and link