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Acute rejection is higher in VCA than in any other organ in the field of transplantation, although most episodes are controlled by high-dose steroids and optimization of maintenance immunosuppression. Because of limitations in patient number and the duration of follow-up, the long-term safety and effectiveness of VCA remain unclear. Moreover, the tests currently used to diagnose acute rejection are of limited value. Better diagnostic tools and a better understanding of the immunologic events during acute rejection are therefore needed to improve diagnosis, treatment and outcomes of this life-changing restorative surgery.

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THE STUDY OF achievement motivation would not be complete without some attempt to understand its origins. How is it that some students score high and some low? Are they simply born that way? Or are the differences in score simply temporary, reflecting momentary differences in the life situations of the individuals concerned? We can accept neither of these views if our theoretical analysis of motivation in Chapter II is correct. There we argued that all motives are learned, that they develop out of repeated affective experiences connected with certain types of situations and types of behavior. In the case of achievement motivation, the situations should involve "standards of excellence," presumably imposed on the child by the culture, or more particularly by the parents as representatives of the culture, and the behavior should involve either "competition" with those standards of excellence or attempts to meet them which, if successful, produce positive affect or, if unsuccessful, negative affect. It follows that those cultures or families which stress "competition with standards of excellence" or which insist that the child be able to perform certain tasks well by himself-such cultures or families should produce children with high achievement motivation. To state the same issue negatively-if a family does not set high standards of excellence, or if it does not permit the child to compete or strive to meet them on his own, then he could not be expected to have had the affective experiences connected with meeting or failing to meet achieve-275