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That the desire for sure answers to problems in child welfare has led to acceptance of programs on the basis of faith rather than realism is illustrated by examination of some current programs. The need for rational choices in policy, program, and practice that respond to the basic human requirements of vulnerable families is highlighted.
The recently described equivalence between the alignment of two proteins and a conformation of a lattice chain on a two-dimensional square lattice is extended to multiple alignments. The search for the optimal multiple alignment between several proteins, which is equivalent to finding the energy minimum in the conformational space of a multi-dimensional lattice chain, is studied by the Monte Carlo approach. This method, while not deterministic, and for two-dimensional problems slower than dynamic programming, can accept arbitrary scoring functions, including non-local ones, and its speed decreases slowly with increasing number of dimensions. For the local scoring functions, the MC algorithm can also reproduce known exact solutions for the direct multiple alignments. As illustrated by examples, both for structure- and sequence-based alignments, direct multi-dimensional alignments are able to capture weak similarities between divergent families much better than ones built from pairwise alignments by a hierarchical approach.
The authors describe a microprocessor-based digital image display system utilizing a solid-state image memory with a high quality television-type monitor for display of computed tomography images. It is an alternative to a commercially available display system, and offers the potential for research in digital image display. It is now under clinical evaluation. Image input to the stand-alone display system is via 9-track magnetic tape common to almost all CT machines, and it may be programmed to accept digital tapes from any type of CT machine and display them in a common format.
The Radiation Oncology Center in Sacramento, California, has developed a procedure for establishing an intraoperative radiation therapy facility in a community practice. The logistics pertaining to personnel, equipment, physical measurements, and quality assurance are presented. Particular emphasis is given to the most effective means of acquiring the large quantity of data needed to ensure a program of acceptable quality.
A method is described for measuring distribution of intrarenal blood flow in anesthetized rats by a xenon-133 washout technique that avoids the trauma of opening the abdominal cavity and manipulating the kidney. Precise delivery of the tracer to the kidney and fine collimation of the radiation reduces the amount of tracer required. Washout curve analysis is achieved by a multifit computer program that accepts only count rates and time as input data.
In this paper, a method is presented to evaluate the true values of several optical parameters of the anterior eye segment. These are: the thicknesses of the cornea and lens, the depth of the anterior chamber and the anterior and posterior curvatures of the cornea and lens. First, a photo is taken of each patient's eye with a Topcon SL-45 Scheimpflug camera. There are two effects distorting the photo. As the film plane and the object plane are perpendicular to each other, the imaging scale is not constant over the photo, a phenomenon which is called the camera distortion. As the light passes through different refractive media on its way from the inner structures of the eye to the camera, the rays of light are refracted, which is called the refractive distortion of the eye. Following these distortions, the proportions on the photo do not correspond to those in the human eye. The intention of this paper is to calculate the true optical parameters of the anterior eye segment. The seeming optical parameters are taken from the photo and the path of light from a point in the film plane through the camera and the refracting surfaces into the eye is constructed by ray tracing. A set of representative points calculated according to ray tracing provides a basis to evaluate the true optical parameters. This work is done using a Basic program, that accepts the seeming parameters from the photo as input values and provides the true values as output. The adjectives seeming and true added to the optical parameters indicate a value correlating with a distorted photo and a value that was corrected by the theory. The two terms were chosen by mnemonic reasons, although another pair of adjectives such as distorted and corrected might have been of higher precision. For an average adult human eye the optical parameters from the photo were compared with the calculated ones. A phantom eye with well-known optical parameters was constructed and photos were taken from this eye to verify the calculations.
A community mental health center operates a psychiatric consultation program as an integral part of the medical emergency service of a 550-bed general hospital. A major advantage of the system is that it allows the hospital to provide immediate comprehensive services--psychiatric as well as medical--to emergency patients. The consultation program also accepts referrals of hospitalized medical patients with apparent emotional problems and referrals of patients from such sources outside the hospital as pediatricians, clergymen, and other community agencies.
Out of 330 patients with acute myocardial infarction (AMI) admitted to our institution, 256 patients entered our 3-week rehabilitation program and discharged from the hospital. Through the execution of the program, its feasibility and safety were examined, and guidelines for the progress of the program were re-evaluated. The state of outpatient community life and its determining factors were also investigated by a questionnaire. The following results were obtained: 1) Over 90% of patients with uncomplicated MI could complete the rehabilitation nearly on schedule, indicating the feasibility of the program. 2) Mortality after ambulation and serious complications related to rehabilitative activities were very few, indicating the safety of our rehabilitation program. 3) Among guidelines for the progression of the program generally accepted, the case for an elevation of blood pressure as well as an ST depression was found to be especially important in order to prevent serious complications. 4) Age, discharge exercise capacity, left ventricular function and the severity of coronary disease were important factors influencing the patients' returning to work.
While dialysis is a medical advance that enables people to live who would otherwise die, it is often experienced as an ordeal by those who must live with it. Patients and staff experience difficulties in their adaption to chronic dialysis. A program that accepts all patients, regardless of motivation and stability, carries with it the responsibility of offering care in a way the patient can tolerate and of providing a regimen within the context of his personality structure and social adaptation.
Concurrent infection with HIV-1 and Mycobacterium tuberculosis is increasingly common in East Africa. In the past, a drug regimen consisting of 2 months of intramuscular streptomycin plus 12 months of isoniazid and thiacetazone has been used in tuberculosis control programs with acceptable efficacy and low incidence of adverse reactions. Anecdotal reports of increasing cases of Stevens-Johnson syndrome prompted a 2 month prospective search for cases of severe cutaneous hypersensitivity reactions at Muhimbili Medical Centre in Dar es Salaam, Tanzania. Five such patients were admitted to a single ward during this time, 4 of whom were HIV-seropositive and all of whom were being treated with isoniazid and thiacetazone. These findings have implications for the management of tuberculosis in East Africa and perhaps other countries with high prevalence of both HIV-1 and tuberculosis.
Strictly enforced antibiotic formulary restriction in combination with formulation of agreed guidelines for antibiotic use in common infection problems such as septicemia, febrile neutropenia, urinary tract infection, biliary sepsis, liver abscess, peritonitis, nosocomial pneumonia, soft tissue infection and purulent meningitis, generated a combined savings of 307,748.5 bahts or 13.5 per cent cost reduction over a 6 month period, and improved quality of use, appropriate 54.8 vs 67.5 per cent, statistically significance (P less than 0.002). Although this saving was offset in part by increased spending of unrestricted antibiotics, such as Penicillin and Gentamicin, an overall cost saving remained. In the months during the restrictions, no significant changes occurred regarding patients response and mortality. However, after the onset of the controls, it was revealed that antibiotics were more appropriately used afterwards. This study has shown, most importantly, that savings were achieved with no negative effect on good patient care. Moreover, the antibiotic use control was operationally successful, most house-staff and attending physicians, not only antibiotic evaluating team, have accepted the program in a very positive way. Overall, this program successfully achieved its initial goal, cost saving without compromising good medical practice. We are now continuing our program and also trying to modify so that it will be useful to all departments in the hospital.
Recent trends in the diagnosis and imaging of cancers of the gastrointestinal tract include developments in screening for colorectal cancer and innovations in ultrasonography and magnetic resonance imaging of primary and metastatic hepatic tumors. Mathematical models suggest that screening for colorectal cancer will be as cost-effective as several other widely accepted screening programs, including the Papanicolaou smear for cervical cancer and screening mammography. There is considerable discussion regarding the relative roles of procedures such as fecal occult blood testing, sigmoidoscopy, colonoscopy, and radiology in screening strategies. The issue remains unsettled. In ultrasonography, the use of intraoperative ultrasound allows for the detection of more metastatic lesions in the liver than do preoperative computed tomography and ultrasound. Esophageal endoscopic ultrasonography has been used for the preoperative assessment of depth of invasion by esophageal cancer. The technique is limited in cases of stenotic cancer in which the endoscope cannot be passed through the lesion. Similarly, endorectal ultrasound can be used for staging of rectal cancer. Color Doppler ultrasound has been used for the evaluation of blood flow in relationship to hepatic neoplasms. Magnetic resonance imaging has been used not only for detecting liver tumors but also for differentiating between neoplasm and hemangioma.
The purpose of this research was to evaluate the use and effectiveness of the Universal Medical Student Performance Profile System in enhancing the resident selection process. The Universal Medical Student Performance Profile System involved the use of a standardized student evaluation form completed by surgery clerkship directors to summarize student performance. These student profile forms were then forwarded to general surgery program directors to whom each student applied. Twenty-five surgery clerkship directors volunteered to complete student profile forms on students pursuing surgical careers for the classes of 1986 and 1987. Program directors who had accepted students in their programs on whom these standardized evaluation forms had been completed were asked to complete a similar form based on the graduate's first year of residency performance. Findings showed statistically significant relationships in several assessment categories between clerkship and program directors' ratings. A survey of program directors showed they agreed with the concept of a standardized medical student evaluation form and found the student profile forms helpful in making decisions on resident selection. We concluded form this baseline study that the use of a standardized student evaluation form will have limited predictive validity, unless clerkships improve efforts to standardize clerkship objectives, expectations, and performance measures.
A review of the literature on the health consequences of teenage pregnancy and childbirth shows remarkable similarity in findings from studies conducted in the United States, Canada, Britain, France and Sweden. In particular, results of studies conducted since 1970 have tended to indicate that the increased risk of maternal complications from pregnancy and delivery among teenagers--especially those older than 15--is associated more with socioeconomic factors than with the biological effects of age. Smaller differences in maternal mortality between teenagers and older women exist in England and Wales than in the United States and France; this finding suggests that England and Wales may have minimized the age or socioeconomic factors contributing to a difference in rates. Inadequate prenatal care may be a major cause of pregnancy-related complications for mothers, since teenagers in all countries are more likely than older mothers to seek care late in the pregnancy or not all. There is a very marked association between young age of mother and low birth weight in all countries. Sweden has the lowest rate of low birth weight at all maternal ages, and the United States generally has the highest. Some of the apparent effect of young maternal age on birth weight may be because the birth is likely to be the mother's first, and first births have a higher incidence of prematurity. As in the case of maternal health, inadequate prenatal care has been singled out as an important determinant of both prematurity and low birth weight. Late fetal death rates in the United States, England and Wales, and France are slightly higher among teenagers than among women in their 20s. In Canada and Sweden, however, no substantially increased risk for young women is found. Perinatal death rates, which one might expect to be influenced more by environmental factors than are late fetal deaths, show a more marked increase among infants of teenagers than do rates of late fetal deaths. Again, Sweden does not fit the pattern. Studies that separate data for young teens and older teenage mothers also indicate that increased perinatal and late fetal mortality rates may occur only among very young teenage mothers. There is no evidence of an overall increase in congenital malformations among babies born to teenagers. When individual birth defects are examined, some studies have shown increased rates of cardiovascular and central nervous system malformations among the children of teenage mothers.(ABSTRACT TRUNCATED AT 400 WORDS)
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At present it is generally accepted that programs of physical training which require coordinate performances of the central and the vegetative nervous system may be conducive to the complex development of central nervous functions. The aim of the study was to investigate the effect of an exhausting swim training with albino rats aged 6-30 days on the development of motor pattern of swimming and on the sleep-wake behaviour. Daily training rats performed the adult motor pattern of swimming earlier than controls which were not trained. Trained animals are more active and longer awake than control rats which were treated daily only by a short stress (stay in cold water for 10 s). During the growth period before puberty exhausting training produces complex effects: the development of motor patterns is accelerated and the central vigilance level is raised. It is unknown which consequences might possibly arise as to the central nervous integration in adult mammals which were strongly trained in early infancy.
The effect of a commercial Medical College Admission Test (MCAT) review course on MCAT retake scores and acceptance into medical school for a group of minority students is reported. The review course enhanced MCAT performance in all of the subgroups. The increase in total MCAT score was more pronounced in students with an initial MCAT score below 36 or a high undergraduate total or science grade point average. Results suggest a relationship between MCAT performance and medical school admission.
A fully automated Ecg recording and interpretation system (Hewlett Packard HP 5) consisting of a central computer and two peripheral units was evaluated during a four-month period. Ecgs were transmitted via public telephone lines, as was the report from central station to peripheral recording and print-out unit. Within a few seconds after recording and print-out unit. Within a few seconds after recording and transmission a preliminary report is available in printed format. The transmitted Ecgs are stored at the central computer and are being retrieved and evaluated manually there. Three cardiologists read the tracings and furnished final reports. 468 Ecgs were thus compared in our test time of 10 days for statistical evaluation with the following results: 1. 73.1% of all statements were read correctly by the computer. 2. There is a large range of diagnostic accuracy between 0% and 100%. 3. The evaluation of Ecg changed by cardiologists reflects the individual experience of the controllers regarding the Ecg statements as well as computer-dependent possibilities like modification etc. of Ecg. 4. As an example the diagnosis "myocardial infarction" is compared with other Ecg computer programs by means of a quality index calculated from sensitivity and specificity: HP 5 with 158.5 points reaches a similar level as the Pipberger program with 162.6 and the Bonner with 159.5 points. 5. Referring to false negative results this program is acceptable in all diagnostic groups with ca. 8%, except conduction defects with 17.7%. 6. Referring to false positive results the diagnostic groups myocardial infarction/ischemia and conduction defects are not satisfactory with 36.5% and 23.4%. 7. In all the tested system seems to be very useful in routine Ecg interpretation of bigger hospitals.