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The real truth is that the boundary between psychiatry and public opinion is too transparent cheap diflucan 150mg free shipping. History 1801 discount 200 mg diflucan with visa, Pinel: people with sanguine fury and blind tendency to violent acts but who knew they were doing wrong - non-confusional mania or manie sans délire 1812 discount diflucan 200mg on-line, Benjamin Rush: morally deranged individuals; aggressive buy diflucan paypal, irresponsible, callous, and shameless from early youth; possibly born with these tendencies 1810 Personality disorder categories are rarely discrete, most patients fitting the descriptions of a number of them. A rounded picture of a patient’s personality can be got from interviews from the patient, informants who know the patient well, and from tests of personality such as the Personality Disorder Examination. Henderson: 3 types of psychopath - aggressive, inadequate (passive ) and creative - creative 1815 psychopath is individualistic, carves a way through life, suffers no obstruction, and may become driven leaders Donald Winnicott (1896-1971), a British psychoanalyst, wrote that antisocial proclivities were due to a child being able to attribute deprivation to external forces (self-attribution leads to depression) and thereafter annoying others in order to get them to fill a void Cleckley (1964) divided psychopathy into primary (cold, aggressive and never upset), secondary (suffers more, high tension levels, low self esteem, hidden guilt or regret), and a possible third (secondary to psychoneurosis) types Cloninger (2005, p. The present author prefers to distinguish between primary (recognisable to friends and family) and subcultural (normal antisociality within a locality) types. It is important that the normal (and transient) risk-taking and group effects found in adolescence are not labelled as being pathological. For instance, the obsessional personality and the criminal psychopath are not natural bedfellows. Many psychopaths learn from experience to avoid punishment in borstals and prisons yet find it difficult to stop getting into trouble despite knowledge of the probable consequences. Children with psychopathic traits may have a reduced ability to avoid frustration and this may relate to abnormal ventromedial prefrontal cortical function. This could account for low arousal, poor fear conditioning, lack of conscience, and decision-making deficits. The amygdala is important in aversive conditioning, instrumental learning, 1825 and in responding to emotionally laden facial expressions. Disruptive youths with callous-unemotional traits fail to activate the amygdala when processing fearful expressions. Maternal nutritional deprivation during early pregnancy in wartime Holland has been associated with antisocial personality disorder in young adult offspring. Adoptive parents may show negative parenting when the parents of their children had antisocial proclivities, possibly reacting to some inherited trait in the children. Novelty seeking may be associated with the type 4 dopamine receptor (but this was not so in a meta-analysis: Kluger ea, 2002) and the type 1 cannabinoid receptor. According to Fu ea, (2002) who studied male twin pairs who served in Vietnam, shared risks between antisocial personality disorder, major depression and marijuana dependence may be explicable as stemming from the antisocial personality disorder. It does appear that parenting style can moderate the doing something despite negative consequences, and this tendency is found in animals who have a dysfunctional septo-hippocampal system. The neuronal isoforms of nitric oxide synthase may be involved in modifying various behaviours, including aggression, and deficits in neuronal signalling via nitric oxide in moderating prefrontal circuitry may be important in the origin of impulsiveness. The screening version contains interpersonal/affective (superficial, grandiose, manipulative, lacking remorse, no empathy, doesn’t accept responsibility) and social deviance (impulsive, poor control of behaviour, lacking goals, irresponsible, antisocial as adolescent and adult) factors. Psychopathy is a narrower concept than antisocial personality disorder, insofar as the former may not have broken overt rules or have been caught doing so. The former had impairments on dorsolateral prefrontal cortical executive function tasks of planning ability and set shifting. Antisocial personality disorder is nearly always preceded by conduct disorder (see box) in childhood. A 40 year follow-up of conduct-disordered adolescents (Colman ea, 2009) found that they were likely to leave school without any qualifications and to experience many social and health problems that had adverse effects on them, their families, and society. Children who have early feeding, washing, or dressing problems, who cry loudly, who protest at novelty, and who have tantrums may later be over-represented among the ranks of psychopathy. The earlier the onset of conduct disorder in childhood and the more pervasive it is the more likely is antisocial personality disorder to be present in adulthood. Also, environmental deprivation is more closely linked to antisocial behaviour than is social class. Some findings 1831 suggest a dysregulation of the hypothalamico-pituitary-adrenal axis in conduct disorder and antisocial personality disorder. Conduct disorder Not an entity in itself Various forms of unacceptable behaviour Different levels of severity Prevalence: 1% - 10% M > F, but females may be catching up1832 Reading disorder in one-third Family (e. Childhood adversity associated with maladaptive family functioning is a strong predictor of chronic functional impairment. The outlook tends towards improved social behaviour with time (Paris, 2002) but there remains the possibility of domestic violence thereafter. Problems, ranging from illness to early demise, may result from accidents, drug and alcohol abuse, fighting etc. Many, if not the majority, of psychiatrists, hold that there is no legitimate treatment for personality disorder in general and psychopathic personality disorder in general. There is persistent defiance toward authority (teachers and other adults) characterised by hostility, resentment, and argumentativeness. The syndrome is more common in young boys than young girls but it affects the sexes equally by adolescence. Symptoms are more often displayed in front of people familiar to the child and may not be revealed to the clinician. Early onset, aggression, poverty, and parental drug abuse favour the development of conduct disorder. Female adolescent conduct disorder may progress to antisocial personality disorder and somatoform disorder, depression and other ‘internalizing’ conditions. Social problems, especially deviant peers, are significant factors in the genesis of adolescent-onset cases, i. The author is aware of inner urban dwellers who had no moral qualms about stealing from ‘outsiders’ but who were outraged if one of their peers stole from a neighbour! This may be a product of ‘outsiders’ being seen as ‘haves’ and the subculture/neighbourhood as ‘have not’s. There is affective instability, minimal planning and frequent angry outbursts, with violent and explosive behaviour. Borderlines recall less parental care than do non-borderlines, especially from the mothers. They are lonely, lacking in emotional tone, anhedonic, and have a low stress tolerance. Regression and transient psychosis often occur during psychotherapy – thoughtless attempts to ‘probe the emotional depths’ of these patients may exacerbate the situation. This fact and complications may account for suggested relationships with schizophrenia and affective disorders. Torgersen ea, 2001) Perhaps females are more likely to look for or be referred for treatment. Pope ea (1985) diagnosed ‘factitious psychosis’ in two of their cases, both of whom also had factitious neurological symptoms. The term factitious is problematic in such cases because it has been variably defined as ‘subconscious’ or ‘simply seeking (inappropriate) medical care’. Psychosis in borderline personality disorder may be associated with drugs or mood disorder. Lynch (2008) discussed Linehan’s ‘biosocial’ theory in relation to borderlines: emotional vulnerability (high sensitivity and reactivity and slow return to baseline), environmental invalidation (being told that one is wrong – this is associated with autonomic hyperactivity as shown by the galvanic skin response) and problems with regulating emotions interact. The person is hyperresponsive to environmental cues/triggers that lead to emotional dysregulation (Fertuck ea [2009] found that borderlines have an enhanced sensitivity to the mental states of others. Therapists need a ‘consultation team’ to call on for support because patients may dysregulate the therapist. Borderlines are better than controls at assessing facial expressions for all emotions. Treatment aims to prevent the self-cutting response and replace it with problem-solving. Finally, when separation threatens, psychic decompensation follows with increasing levels of harm to the self. Stevenson ea, 2005) Drugs are also used although the risk of abuse is increased; some authors eschew treatment of ‘secondary’ problems like mood problems or ‘voices’, suggesting that they improve once control over impulsiveness and anger is achieved. In the present author’s experience, a patient may appear to be doing very well between psychotherapy sessions and suddenly kill themselves because of an event outside the therapist’s control, e. There are moments during treatment when sense of self is disrupted by traumatic memories. Therapist empathy with the patient and reflections help the patient to think about and gain understanding of what is happening within the self and between therapist/others and the self (mentalisation or reflective function).

The extrication team will often require heavier cutting and lifting equipment to deal with the heavier vehicle and its structure discount diflucan express. This may necessitate the dispatch of specialist rescue units which can impact on extrication time discount diflucan 50mg without a prescription. Removal of the patient from the vehicle A-plan casualty removal When following an A-plan buy discount diflucan, the roof of the vehicle is often removed to give better access to the patient purchase line diflucan. If not possible earlier, an assessment of leg entrapment is usually made once the roof is off. If trapped by the dashboard of the vehicle, then space may be made with a ‘dash-lift’ or a ‘dash-roll’. Once the legs are free, a long-board is slid down between the patient’s back and the back of the seat. The board is then held upright with the patient braced against it while the seat back is lowered back as far as possible. Additionally, if the mechanism is still intact, the whole seat may slide back horizontally creating more space. Tricks of the trade Typical roles during the movement of the casualty along the Positioning the long board can be made easier by first sliding two rescue board include: ‘tear-drops’ down behind the patient’s back. The long board is then guided between these, which act as introducers, making the process • manual in-line cervical stabilization (this person in control) easier and often more comfortable for the patient (Figures 21. With very little space and so many roles, think about temporarily disconnecting lines and cables. Once the patient is lying full-length against the board, it is lifted to the horizontal position and then slid out the back of the vehicle. During the release of the casualty on a long-board, there is often a lull when the board becomes horizontal while the patient is strapped to it for ‘control’ or ‘safety’. Strapping and blocking the patient on the board while half out of the vehicle is often precarious, takes time and can be poorly controlled. When the patient arrives at the reception area, they will need to have a full primary survey which necessitates strap removal anyway. B-plan casualty removal The B-plan removal of the casualty is often done through the side door of a vehicle and follows similar principles of command and control. By its nature it tends to be much brisker and with less space so control is rarely as optimal as the A-plan approach. In the usual scenario, a rescue board is slid onto the patient’s car seat and braced to provide a horizontal platform. The patient is then rotated and laid down on the board before being moved up along its length. Tricks of the trade The scenario of a patient suspended upside down in a seatbelt can be particularly challenging. In practice the best solution is probably any that minimizes the time the patient is suspended while providing cervical spine protection as best as possible. Sometimes a firefighter can crawl below the patient’s lap area, on their hands and knees, to support the patient as they are released from their Figure 21. Once free, they are usually extricated as a B-plan option on a long board through the side of the vehicle. The long board used for extrication of casualties is not designed Post-extrication care as a transport device, but may be acceptable for very short journeys. Once free, the patient should be taken to a pre-designated casualty Patients can often be packaged more comfortably and securely on reception area. This is typically 5–10 metres away from the crashed a ‘scoop-stretcher’, which can also help minimize rolling required vehicle and can be prepared in advance with ambulance trolley, when transferred at hospital. At the casualty reception area a rapid reassessment of the patient is made and immediately necessary interventions carried out. This involves securing them onto the trolley with formal spinal immobilization and monitoring, The management of entrapped patients is challenging and com- and protection from the cold. The multi-agency rescue team can develop skills by training in transit then this is preferable in order to minimize further regularly together in order to develop skills leading to safe, efficient on-scene delay. Trauma: Extrication of the Trapped Patient 117 Further reading Tips from the field Calland V. Extrication of entrapped • Communicate with other emergency personnel and agree a target victims from motor vehicle accidents: the crew concept. Eur J • Minimize unnecessary medical intervention in the vehicle Emerg Med 1996;3:244–246. International Cardiac Arrest Guidelines Initial actions Introduction If the victim is unresponsive and not breathing or only having occa- Since the original publication of successful closed-chest cardiac sional gasps, immediately call for help and activate the Emergency compressions by Kouwenhoven, Knickerbocker and Jude in 1960, Medical Services or appropriate Resuscitation Team. If unknown, use interposed breath being delivered every 6–8 seconds (8–10 breaths the maximum available energy setting, or use 360 joules if the per minute). Once an advanced airway is the administration of vasopressors and antiarrhythmics can be in place, continuous chest compressions can be performed, with an considered. Hypothermia Toxins 5 Back-up facilities – Seldom in the prehospital environment is Hypo-/hyperkalaemia Thrombosis (cardiac) there a wide variety of extra equipment (or range of appropriate Hydrogen ion imbalance Thrombosis (pulmonary) sizes) easily available, no extra personnel to back one up in a desperate situation, and no security personnel to protect one in a volatile situation. If possible, for example, place routinely recommended, as absorption via this route is unreliable the defibrillator at the left side of the patient. Space around the adrenaline, amiodarone may be administered intravenously patient is often very limited. For torsades de pointes or suspected hypomagnesaemia, give 1–2 g of poor address information, can be challenging. A meticulous search for reversible causes The success of prehospital resuscitation is pivotal upon early and correction thereof is paramount. However, when The exhilaration and urgency of prehospital emergency care is the cause of the arrest can only be treated in-hospital, or when nowhere more tangible than when confronted by a cardiac arrest extenuating or particularly reversible conditions warrant prolonged victim. Prehospital cardiac arrest in the trauma 2 Equipment – The only equipment you have is the equipment victim you carry. This means that one’s kit must be well prepared, checked and cleaned prior to Introduction the call-out. Ideally the emergency bag should be packed exactly victim is generally associated with low survival rates. Cardiac Arrest 121 4 Breathing techniques The administration of supplemental oxygen to the traumatic cardiac arrest victim is mandatory as these patients are inevitably hypoxic from cardiac and/or respiratory causes. In addition to positive pressure ventilation and chest compres- sions, the following should be considered: ◦ Closure of open chest wounds and control of active bleeding. Should administration, relief of pericardial tamponade, or even open car- emergency thoracotomy be performed, fluid administration diac massage via emergency thoracotomy. It is therefore necessary, may be undertaken via the right atrium directly if necessary. Evidence of need to be administered in order to maintain the patient in a longstanding death such as rigor mortis, dependent livido or state of adequate anaesthesia prior to transport to the receiving putrefaction are obvious indicators of futility. Injuries incompatible Care must be taken when calculating effective doses of medi- with survival such as hemicorporectomy, severe head trauma cations and fluid administration in the post-traumatic cardiac and emaceration do not warrant resuscitation. Ventricular fibrillation Once the pulse returns, it may be prudent to adopt a ‘permissive or pulseless electrical activity would indicate potential viability hypotension’ approach, maintaining the systolic blood pressure as opposed to an asystolic rhythm. Opening, maintaining and protecting the airway in a traumatic 7 Evacuation to hospital cardiac arrest victim may present challenges due to distortion The post-traumatic cardiac arrest victim who has a return of of normal anatomy caused by the mechanism of injury. This spontaneous circulation, or who has a specific in-hospital medi- may lead to the necessity of providing spinal protection and the cally or surgically correctible cause of cardiac arrest, will require early use of supraglottic, glottic or infraglottic devices to provide transportation to the nearest and most appropriate emergency adequate oxygenation. Associated severe head injury ◦ Inadequate rescuer training, equipment, assistance or system resources Haemorrhage control en route, particularly following return Inadequate emergency department or specialist surgical support within a of spontaneous circulation. Large rescue-type scissors Large sharp-pointed scissors Artery forceps or equivalent Prehospital emergency thoracotomy Foley catheter 3/0 non-absorbable suture on a curved needle or staples Introduction Numerous large abdominal type swabs. Prehospital emergency thoracotomy, although still a controversial subject, has a definitive role in the resuscitation of the critically injured patient when performed by an appropriately trained and Table 22. Curved Mayo scissors This systemized approach ensures that guidance is available in the Toothed forceps Large vascular clamp (e. Satinsky) decision-making process, safety is maintained during the operative Aortic clamp (e.

Elvevåg ea (2003) found that schizophrenics are relatively inaccurate at estimating brief time periods (< 1 s) purchase 50mg diflucan fast delivery. Thought disorder might be due to dysfunction of the cortico-subcortical loops that project into the prefrontal cortex buy diflucan discount. Executive processes include a broad range of operations involved in initiating and maintaining controlled information processing and co-ordinated mental activity buy cheap diflucan line. Included are goal or context representation and 1133 maintenance best purchase diflucan, attention allocation and stimulus-response mapping, and performance monitoring. Besides disturbances in these areas, functional imaging studies in schizophrenia have reported disturbances in tempero-limbic regions, including the hippocampus, superior temporal gyrus, striatum and cerebellum. In a meta-analysis, Bora ea (2009) found no categorical differences in terms of cognitive functioning between schizophrenia, schizoaffective disorder and affective psychosis, except that a subgroup of schizophrenia sufferers with particularly severe negative symptoms may be more cognitively impaired than those in the other groups. Gross cognitive impairment in schizophrenia was found by Buhrich ea (1988) to be related to the disease and not premorbid intellectual impairment or past physical treatment. Hyde ea (1994) found that intellectual function did not decline markedly during the course of schizophrenia, suggesting to the authors that schizophrenia was more likely to be a static encephalopathy than a dementing disorder. Walder ea (2006) found that language was more impaired in males than in females with schizophrenia, but that phonology was, relative to controls, more affected in the female patients. Verbal memory (see Leeson ea, 2009) is defective from the beginning of a schizophrenic illness, and the extent of this deficiency may be greater the earlier the age at onset of the illness. In fact, schizophrenics may even confabulate with answers that 1132 Classically out by about five years in their determination of how long they are in hospital. Patients have difficulty in giving their ages correctly (age disorientation – usually the patient says they are much younger than their chronological age) or telling the time. Schizophrenic patients have difficulty solving a problem when the solution is not obvious or when they must use the knowledge they already posses in a novel way. They find it difficult to keep information ‘in the forefront of their minds’ (on-line). When testing different races for cognitive function it is essential to control for confounding variables such as education and motivation. Elderly schizophrenics have been reported to demonstrate greater cognitive deterioration than can be accounted for by necropsy evidence of a dementing process. According to González-Blanch ea (2008) cognitive impairment is common in first- episode psychosis regardless of good prognostic features such as short illness duration, being female or having a later illness onset, and negative family history of psychosis. Researchers (Brewer ea, 2005; Barnett ea, 2005; Tiihonen ea, 2005) have reported visuospatial processing impairment and some memory deficits prior to full development of psychosis. Reichenberg ea (2010) examined a cohort of males and females born 1972-3 in Dunedin, New Zealand, when they were aged 3-32 years: children who went on to develop schizophrenia in adults entered primary school with major problems of verbal reasoning and they lagged behind other children in working memory, attention, and processing speed as they aged. Such impairment identified more cases at risk for schizophrenia-spectrum psychosis than for affective-spectrum psychosis. The left hemisphere is superior in its use of syntactic or semantic information, the right hemisphere being better for contextual information. It has been suggested that thought disorder relates to poor organisation of semantic memory. Schizophrenic patients are better able to recall concrete facts about social situations but seem impaired when attempting abstract deductions, e. There may be no problem in recalling that an event happened, but there may be difficulty remembering when it occurred, a so-called context memory deficit. Not surprisingly, patients with schizophrenia may tend not to recall past achievements but rather recall hospitalisation and the stigmatisation of illness. Elderly chronic schizophrenics may perform particularly poorly on tests of naming and constructional praxis. Both poverty of speech and incoherence of speech could be due to difficulties retrieving words from an internal lexicon, the former reflecting premature cessation of searching for words and the latter being related to incorrect word selection. The unaffected close relatives of schizophrenic patients have an excess of impaired information processing and deficits in working memory. Neuropsychological testing supports a relationship between temporal lobe dysfunction and reality distortion. However, a meta-analysis (Sprong ea, 2007) found that all symptom subgroups (especially disorganised) and patients in remission had deficits in theory of mind. Lysaker ea, 2009) suggesting that individuals with schizophrenia have difficulty recognising the emotions of other people. Bach ea (2009) suggest that people with schizophrenia have a general difficulty in identifying high-clarity emotional cues. Barrett ea (2009) found that first-episode bipolar disorder and schizophrenia subjects, relative to healthy controls, were most impaired in terms of memory, executive function and language but bipolar patients performed much better on tests of response inhibition, verbal fluency and callosal function; and the differences could be explained by the greater likelihood of schizophrenia cases to be globally impaired and to have negative symptoms. Negative symptoms (subtractions from behaviour and emotion) may be a primary feature of schizophrenia (e. The idea that they are confined to ‘burned out’ cases has been abandoned; anyway, evidence for ‘burn out’ is weak at least. Nevertheless, there is some support for the idea that negative symptoms are less prominent in late-onset schizophrenia and more prominent in early-onset cases that have grown old. Schizophrenic patients tend to be less concerned by their negative symptoms than are depressives. The relatives of patients with mainly negative symptoms may be at less risk for schizophrenia than is the case in other circumstances. Johnstone and Frith (1996) divided schizophrenia into three dimensions (‘poverty’, ‘hallucinations and delusions’, ‘disorganisation’) based on principal component analysis. Mayerhoff ea (1994) reported their findings in first episode cases in remission from positive schizophrenic symptoms. Those patients in the last group had better premorbid functioning and a better global outcome than did patients with deficit symptoms. A patient’s negative symptoms may 329 1141 be exacerbated by D2 blockade, possibly by downregulation of prefrontal D1 receptors. There is still some debate as to whether atypicals like clozapine are effective against primary as distinct from negative 1142 symptoms. A number of authors, including Frith and Done (1988), attributed positive symptoms (e. In pseudoneurotic schizophrenia, described by Hoch and Polatin in 1949, a diagnosis that is basically redundant, the presentation consists of neurotic symptoms, the patient being mistaken initially as having a ‘neurosis’. Some authors would hold that Hoch and Polatin were actually describing borderline personality disorder. Hard signs, on the other hand, are localisable to specific brain regions and typically involve motor or perceptual systems. The borderland between soft and hard signs is difficult to follow in the literature, e. In comparison with normals and psychiatric controls, left- and mixed- handedness are significantly more common in schizophrenia. Dragovic ea (2005) found that leftward reversal (shift to left in behavioural lateralisation) rather than reduced lateralisation was associated with clinical severity and neurocognitive deficits in schizophrenic patients. The head circumference of long-stay schizophrenic patients and at birth in those later to develop the illness has been found to be pathologically small by some but not all researchers. There have been reports of facial anomalies in schizophrenia in the form of an overall narrowing and elongation of the mid- and lower face. Relatives and controls differed even more markedly on signs involving motor system abnormalities of localising significance. Lawrie ea (2001) consider soft signs and minor physical anomalies to be non-genetic, non-specific markers of developmental deviance. Whitty ea (2003) concluded that motor and cortical signs were state-dependent whereas ‘harder’ signs were more static. Bachmann ea (2005) found that the level of soft signs varies with illness course in first-episode 1141 Hirvonen ea (2006) looked at twins dicordant for schizophrenia and found that high D1 receptor density in medial prefrontal cortex, superior temporal gyrus, and angular gyrus was associated with increasing genetic risk for schizophrenia and that D1 receptor binding showed widespread reduction in medicated schizophrenic patients. Also, predictors of soft sign scores at follow-up were soft sign levels at remission and compliance with treatment. It should be noted that minor physical anomalies are very common in the normal population. However, the comparison was between psychoses and ‘normals’ (general population), so other diagnoses were not tested. These findings supported the 1147 notion of cognitive dysmetria with disruption of the cortico-cerebellar-thalamo-cortical circuit in schizophrenia. There is some evidence that Parkinsonism, not attributable to medication, may be part of the schizophrenia spectrum, e.

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Students may who could distill complex medical subject arrange independent study with a faculty member matter into clear, effective teaching images. Netter was not only a skilled draftsman, any quarter of the second year as an overload. Sample top- Family and friends established this scholar- ics: illustration ethics, electronic publishing, web- ship to recognize a student in Art as Applied based learning, e-commerce, intellectual property, artist rights, art pricing, and virtual reality. Depart- to Medicine who displays a similar balance ment faculty and guest lecturers. Winners of this award have Scholarships excelled in their academic courses; displayed The W. Saunders Company Fellowship exceptional art expression; and most impor- in Art as Applied to Medicine This fellow- tantly utilized both resources to create well ship was established in 1964 in honor of Law- designed and effective didactic illustrations. Financial aid and scholarships are award- ed to students within the program based on Postdoctoral Training fnancial need and academic performance. Crosby, Director of ence, as well as receive training that brings Art as Applied to Medicine from 1943 to 1983, them to the forefront of research in their par- is awarded for scholarly contributions to the ticular area of interest. A series of core cours- advancement of art as applied to the medical es in neuroscience, along with advanced sciences. The recipient is selected by a com- electives, seminar series, laboratory rota- mittee at intervals of from one to three years. Feldman, sisters of Samson Feld- Students enter the program from different man, established a visiting lectureship to honor backgrounds and the laboratories in which his life as an artist and lifelong patron of the they elect to work cover different disciplines; arts. 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Most students begin lar genetics of bacteria and eukaryotic cells, their thesis research at the beginning of their leading to the Ph. School of Medicine’s interdepartmental pro- gram in Biochemistry, Cellular and Molecular Courses Biology, which is described in detail on page A year long core course provides an integrat- 35. Candidates must meet the course require- ed overview of molecular and cellular neu- ments of the interdepartmental program, roscience, neuroanatomy and systems and including elective courses in their special cognitive neuroscience. This course is aimed area of interest, and must carry out original at providing Neuroscience graduate students research under a departmental preceptor. The courses can be found in the department state- student must then conduct original research ment on page 211. Graduate trainees participate actively Program utilizes laboratory facilities located in these series throughout their training, in the Department of Neuroscience plus sev- including inviting and hosting three speak- eral other basic and clinical departments ers each year. A weekly lecture is given by closely associated with the Neuroscience an outstanding researcher in some feld of Department. Modern an overall balance of subject matter is cov- state of the art facilities for research in molec- ered yearly. Students are given an opportu- ular biology, neurophysiology, pharmacol- nity to meet with each speaker for questions ogy, biochemistry, cell biology, and morphol- and discussion. The Mind/Brain Institute, presented on current literature by graduate located on the Homewood Campus of the students, and postdoctoral fellows. 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December 8 is the deadline for receipt of the application form Requirements for the PhD Degree and all application materials. Program study, the student must successfully com- About one quarter of the current predoctoral plete the required course requirements. All and Immunology, School of Public Health entering and frst-year students are encouraged Intracellular parasitism; apicomplexa- to apply for individual fellowships such as those mammalian cell interactions. Associate Professor of Oncology The Faculty Breast cancer/immunology and cancer Faculty of the program have diverse interests vaccines; clinical trials united by a focus upon human disease. Underrepresented Professor of Pathology minority students are strongly encouraged to Neuropathology; stroke. Personal interviews at Johns Hop- Assistant Professor of Surgery kins are normally required. Wilhelmena Braswell, progression; genome-wide analyses; Program Coordinator, Graduate Program in bioinformatics. Tel: (443) 287-3163, Professor of Pediatrics Fax: (410) 614-3548, E-mail: pathobio@jhmi. Degree Cancer genetics; female reproductive cancer Students must successfully complete for- notch signaling; early detection of cancer. Beginning in the frst year host students and award doctoral degrees to and continuing throughout the program, stu- M. All students must Cellular and Molecular Biology, Cellular and complete a course in the responsible conduct Molecular Medicine, Immunology, Neurosci- of research, and two translation research ence, and Pathobiology) rotations. Student research is supervised by the The Faculty mentor with oversight by a thesis committee A list of the members of the staff and their comprised of University faculty with relevant felds of specialization may be found in the expertise. Students are expected to complete their to have completed college-level courses in studies in fve years. Before graduation it is chemistry (inorganic, organic, and physical), expected that students will publish at least calculus, and physics; a strong background in one article where the student is frst author. The Department of Pharmacology and Molec- Students in the Pharmacology program are ular Sciences hosts the Pharmacology Gradu- able to select a course of studies uniquely ate Program, which offers a program of study suited to their own career goals. Biophysical Principles, Molecular Biology The mission of departmental research is to and Genomics, Cell Structure and Dynamics, understand the molecular processes underly- Organic Mechanisms in Biology, Pathways ing physiology and pathology, and to apply this and Regulation, and Bioinformatics), Mecha- knowledge to discovering new drug targets nisms in Bioorganic Chemistry, and Graduate and developing novel therapeutics. Students must also take three the program, students may choose to focus advanced elective courses selected from their efforts in any of a large number of spe- those offered by this or other departments. If you are planning ahead, consider undertaken while in residence as a graduate searching out an experience of this kind.

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