[Inventors and innovators in medicine (1)].
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Within the last decade, the Centers for Disease Control (CDC) has increasingly emphasized environmental public health activities. The Center for Environmental Health (CEH), one of nine major units of the CDC, was established as a focus for assessment and prevention of environmentally related diseases. Many new, legislatively mandated programs have been delegated to CEH. One such mandated responsibility in Public Laws 91-121 and 91-441 directs the Department of Health and Human Services or its designee to review the Department of Defense (DOD) plans to dispose of or to transport chemical warfare agents. The Chemical Munitions Demilitarization Program, CEH, reviews DOD plans and makes recommendations to ensure that hazards to public health and safety have been provided for in the plans. In addition, these CEH staffers periodically review approved activities at DOD facilities, assessing their monitoring and evaluation programs. CEH staffers also contact State and local health and environmental agencies to identify and evaluate any concerns of the agencies or the public relating to these activities.
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Expert diagnosticians draw upon rich, integrated structures of knowledge and associated action rules to achieve their prodigious performances. Studies in both medical diagnosis and electronic troubleshooting have revealed that it is particularized knowledge that plays a vital role for experts in both domains, not inexplicable powers of intuition. Advanced knowledge engineering methods have been developed and applied in a number of Air Force technical domains so that experts' mental databases and procedural libraries can be made explicit enough to serve as targets of instruction. Instructional principles have been derived from this knowledge engineering work and are guiding the development of a new generation of Air Force technical training systems. The training dictum is to teach from realistic cases so that theory of system operation and specialized solution methods are taught in tandem. The learning environments will further foster the welding of factual knowledge to action rules by providing "assisted laboratory" experiences via intelligent tutoring systems. In these environments, trainees can practice carrying out diagnoses on increasingly complex problems with the help of an articulate expert coach.
An intelligent system contains knowledge about some domain; it has sophisticated decision-making processes and the ability to explain its actions. The most important aspect of an intelligent system is its ability to effectively interact with humans to teach or assist complex information processing. Two intelligent systems are Intelligent Tutoring Systems (ITs) and Expert Systems. The ITSs provide instruction to a student similar to a human tutor. The ITSs capture individual performance and tutor deficiencies. These systems consist of an expert module, which contains the knowledge or material to be taught; the student module, which contains a representation of the knowledge the student knows and does not know about the domain; and the instructional or teaching module, which selects specific knowledge to teach, the instructional strategy, and provides assistance to the student to tutor deficiencies. Expert systems contain an expert's knowledge about some domain and perform specialized tasks or aid a novice in the performance of certain tasks. The most important part of an expert system is the knowledge base. This knowledge base contains all the specialized and technical knowledge an expert possesses. For an expert system to interact effectively with humans, it must have the ability to explain its actions. Use of intelligent systems can have a profound effect on human resources. The ITSs can provide better training by tutoring on an individual basis, and the expert systems can make better use of human resources through job aiding and performing complex tasks. With increasing training requirements and "doing more with less," intelligent systems can have a positive effect on human resources.
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The investigations conducted in 105 students of a naval school have shown that, in the presence of insufficiently balanced routine nutrition of the students, the emotional stress induced by examinations involved negative shifts in the parameters of immune responsiveness and in the nonspecific factors of immunologic defense. Correction of the rations with olive oil and "Undevit" stimulated, to a greater extent than enrichment with sunflower oil, the humoral specific (B-lymphocytes and immunoglobulins) and nonspecific (lysozyme) immunity in the students investigated during examinations. Addition of sunflower oil to the ration influenced mainly the cellular immunity (T-lymphocytes). Providing with general balanced ration, improved due to increased content of milk protein, most favourably influenced the parameters of immune responsiveness and nonspecific defense factors.
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Kit Carson died of a ruptured aneurysm in rural Colorado in 1868. Since that time, techniques for management of aortic aneurysms have been developed and disseminated to rural areas with small hospitals. A survey of six Colorado rural hospitals' experience with ruptured abdominal aortic aneurysms is presented. Fifty-seven ruptured aneurysms had been managed during periods ranging from three to ten years. The average time to the operating room was 3.5 to 4.0 hours after hospital arrival and less than 45 minutes after diagnosis. Of those cases arriving with a systolic blood pressure less than 100 mm Hg, the mortality was 56%. The overall mortality was 53%. Groups are analyzed according to preoperative delay, occurrence of shock, and other risk factors. The results are compared with several series from metropolitan hospitals. Techniques of management that are of potential benefit in low-volume vascular case settings are discussed.
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