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Conventional bedside tests of visuospatial function such as the clock drawing (CDT) and intersecting pentagons tests (IPT) are subject to considerable inconsistency in their delivery and interpretation. We compared performance on a novel test – the letter and shape drawing (LSD) test – with these conventional tests in hospitalised elderly patients.
Methods
The LSD, IPT, CDT and the Montreal Cognitive Assessment (MoCA) were performed in 40 acute elderly medical inpatients at University Hospital Limerick The correlation between these tests was examined as well as the accuracy of the visuospatial tests to identify significant cognitive impairment on the MoCA.
Results
The patients (mean age 81.0±7.71; 21 female) had a median MoCA score of 15.5 (range=1–29). There was a strong, positive correlation between the LSD and both the CDT (r=0.56) and IPT (r=0.71). The correlation between the LSD and MoCA (r=0.91) was greater than for the CDT and IPT (both 0.67). The LSD correlated highly with all MoCA domains (ranging from 0.54 to 0.86) and especially for the domains of orientation (r=0.86), attention (0.81) and visuospatial function (r=0.73). Two or more errors on the LSD identified 90% (26/29) of those patients with MoCA scores of ⩽20, which was substantially higher than for the CDT (59%) and IPT (55%).
Conclusion
The LSD is a novel test of visuospatial function that is brief, readily administered and easily interpreted. Performance correlates strongly with other tests of visuospatial ability, with favourable ability to identify patients with significant impairment of general cognition.
Affective disorders typically have a better outcome than schizophrenia, although recent evidence suggests that some patients with affective disorder have a relatively poor outcome, with cognitive impairments and persistent symptomatology.
Method
Fifty chronically hospitalised geriatric patients with mood disorders (major depression or bipolar disorder) were compared on the clinical symptoms and aspects of cognitive impairment with 308 geriatric schizophrenic patients who were hospitalised at the same institution. The two samples did not differ in current age or in premorbid education level, but the affective patients had a later age of onset and more females in the sample.
Results
There were no overall differences in cognitive functioning between the groups, although the clinical symptom profiles resembled those seen in better outcome patients.
Conclusions
Cognitive impairment is present in poor-outcome patients with affective disorders as well as schizophrenia, suggesting that cognitive impairments predict poor outcome across psychiatric disorders and not just in schizophrenia.
Severe cognitive impairment affects many patients with schizophrenia, especially geriatric in-patients. Little is known about the course of this impairment, however.
Method
Two hundred and twenty-four geriatric schizophrenic in-patients were examined for changes in cognitive functioning over a one-year follow-up period, and 45 of them were assessed over a two-year period. In addition, the subset of 45 patients participated in a one-week and one-month test-retest reliability study of the instrument used to assess cognitive impairment, the Mini-Mental State Examination (MMSE).
Results
The average MMSE scores did not change over a one- or two-year follow-up period. The test-retest reliability of the scale was extremely good at both retest intervals.
Conclusion
Among the implications of these data are that cognitive changes in geriatric schizophrenic patients are very slow and are more consistent with a neurodevelopmental process than a neurodegenerative course.
Since the English Revolution of 1688, it has been a part of the Anglo-American tradition that elected representative assemblies control the policies and acts of the executive branch of the government. This doctrine was firmly embedded in the American state and federal constitutions. With some wartime reservations, it has been universally accepted throughout our country. At the present time, however, there is an uneasy feeling that practice does not square with theory. There is even a suspicion that practice contradicts theory—that a vast body of officials has in fact escaped the possibility of control by the people's representatives.
The trends of the last half-century have certainly complicated the problem of congressional authority over administration. This has occurred in part because administration has made impressive gains in effective organization and operation, while relatively Congress has stood still. Within the administrative system there has developed a capacity for self-direction which might well challenge the dominance of Congress, if Congress continues to be the laggard partner in the governmental team.
As in previous lists, mention is here confined generally to units specifically authorized by law or established by the President by executive order or Reorganization Plans under general authority vested in him. Changes in units created by heads of departments or independent establishments are excluded unless of major importance.
Advisory Committee on Fire Fighting and Prevention. Appointed by the Director of State and Local Coöperation of the National Defense Advisory Commission on December 5, 1940, to study the problem of fire prevention in the defense program, to provide for development of methods and training, and to disseminate information.
In the summer of 1939, President Charles G. Haines set up this committee and instructed it to study broadly the contribution which political scientists are making to government, their relations with public officials, and how these relations might be made closer and more effective. The problem assigned to the committee is one of great importance to the future of political science. The challenge to political scientists to make an effective contribution to the improvement of government processes and institutions was never so real and so great as it is today. The preservation of democratic institutions, in the long run, will depend in large measure upon scientific study and research, and intelligent, imaginative, and constructive consideration of governmental problems. If political scientists are not making their full contribution to the development and improvement of government—and we believe they are not—it is time to stop and take stock, and to set about purposefully to attune political science to the needs of modern society. We are not unmindful of the very great contribution which all social sciences may make, but we believe that the responsibility of the political scientist is especially great.
Only since 1939 have political scientists, as such, had much chance to gain entrance into the permanent federal civil service. This opportunity came as the result of two well-timed phenomena: (1) the demand of a number of federal agencies for young men and women educated in certain branches of political science, and (2) the United States Civil Service Commission's announcement of the Junior Professional Assistant examination, which included an optional called “Junior Administrative Technician.” This combination of happy circumstances, however, did not solve all the problems of the young political scientist or clarify all the requirements for federal employment; so, at the 1939 meeting of the American Political Science Association a committee was appointed to study the question.
The extent and variety of governmental action in the United States in 1933 invite the observer to search out those developments which are a continuation of the old, those which are novel, and those which may be termed transitional. Hence he becomes the central figure in Mr. Chesterton's game of “Bury the Prophet.”
National Governmental Functions. The shrinkage of state and local incomes from the yield of the general property taxes and the limited yields from other forms of taxation as the depression deepened left the national government as the most available instrument through which collective action could be taken.
Previous surveys of trends in public administration in this Review recorded developments in an era of prosperity and easy expansion. The present summary of the events of 1931 and 1932 discloses an abrupt and fundamental change in the underlying conditions affecting public activities, the effects of which have deeply influenced every aspect of governmental operations.
The depression places American government in an awkward dilemma. On the one hand is the tremendous shrinkage in productivity of taxes, proceeding far more rapidly than the corresponding reduction of expenditures; the resulting outcry against waste and extravagance in public expenditures and the rapid development of organized demands for retrenchment; the appearance of tax strikes in many communities, embarrassing public treasuries still more, and threatening the actual collapse of essential government services—eventually leading in some cases to a thoughtless and ill-advised attack on government itself, often by the very elements in the community who most violently deprecate “radical” criticism of our institutions. Faced with these situations, administrative expenditures have been substantially curtailed in the last two years in many directions, although few administrative services have been abandoned.
In 1929, the University of Chicago Press published the first intensive study of the prestige rating of municipal employment, the results of an experiment enlisting the cooperation of over 5,000 residents of Chicago and yielding over 90,000 separate expressions of opinion on the relative status of municipal and private employment. The results of this inquiry were disturbing. The prestige of municipal employment in Chicago appeared to be less than that of corresponding private employment, and special inquiries into the integrity, courtesy, and competence of city employees revealed serious lack of public confidence.
Since the day when Queen Victoria gave her reluctant consent to allow her Government to introduce a form of pass examinations as a means of entrance to the public service, there has been at least one grand inquest each generation into the operation of the experiment thus timidly launched. The Playfair Commission (1874-75) looked skeptically upon the system of open competition inaugurated in 1870; the Ridley Commission (1886-90) reflected the growing confidence in merit and in the Upper Division; the MacDonnell Commission (1912-15) faced, without making commitments, the new organized service which had already made itself felt in the Post-Office, and which was destined in the brief era of “new world” psychology after the war to entrench itself firmly in the Whitley councils for the civil service.