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Motorcycling freedom: a paraplegics dream.

People with disabilities have the same rights as other members of society in directing and implementing the decisions which affect their lives, although it is not always afforded them due to physical limitations. A chance encounter by the author, a University of Western Australia mechanical engineering student, with a paraplegic man who expressed his dream of being able to ride a motorcycle again led to the design and build of a specially modified motorcycle that could be ridden safely and comfortably by a person without the use of their legs. The prototype involved several modifications which allow it to be ridden by a paraplegic person. They included, a thumb controlled pneumatic gear shifter, an integrated front and rear brake actuated with a single hand lever, ergonomic supports to hold the riders legs in place and an automatic stabilising system to balance the motorcycle at low speeds. The benefits that result from the inclusion of people with disabilities into regular leisure activities include normalisation as well as a sense of independence and freedom for the individual. It also allowed one man the chance to reach for his dreams.

Equipment Design↗

Freedom of movement in the European Community.

The regulations which operate with regard to the freedom of movement of dentists working within the European Community (EC) are described. The actual effects of these directives on dental manpower and planning are discussed, together with other aspects of EC policy and effects which they may have on the dental profession both currently and in the near future. Governmental controls over the dental profession are also discussed in relation to oral and general health with consideration being given to the 'consumer led' developments of health policies.

Dentists↗

Freedom from fat: a contemporary multi-component weight loss program for the general population of obese adults.

This report summarizes results for the first 2,037 participants in the Freedom from Fat (FFF) weight loss program. FFF combined nutrition education, a low-fat dietary pattern, exercise, behavioral self-management, and social support in a program designed to serve the general population of overweight and obese adults. Participants ranged in age from 18 to 84 and from ideal weight to massively obese. After enrolling, program participants attended professionally led weekly meetings as long as they wished. Participants were encouraged to keep daily food diaries, to reduce the proportion of calories from fat to 30% or less, to exercise at moderate intensity for 30 minutes a day 5 days a week, to keep graphic records of weight change and exercise, and to display their graphs at each weekly group meeting. Attrition rates were comparatively low for a large-scale program, with half of the participants still active in the fifth month and 22% still active after 1 year. Mean weight loss for obese participants (BMI 30 or greater) at 6 months was 7.3 kg (16.2 lb) for men and 5.3 kg (11.6 lb) for women. The best predictors of weight loss at 6 months were number of days per week in which food diaries were kept, baseline body mass index, number of minutes of exercise per week, and age.

Adult↗

Mandatory HMO enrollment in Medicaid: the issue of freedom of choice.

In areas where HMOs have enrolled a small proportion of the general population, physician participation is less in mandatory HMO programs for Medicaid beneficiaries than in fee-for-service Medicaid. But where HMOs have enrolled over one-quarter of the general population, participation rates are indistinguishable under the two systems. In those areas, mandatory enrollment restricts freedom of choice of provider. A plausible reason for this is that individual practice associations, which contract with large numbers of physicians with both fee-for-service and HMO patients, are becoming the lead form of HMO.

Civil Rights↗

Direct reimbursement to nurse practitioners: the importance of the Federal Employees Health Care Freedom of Choice Act (H.R. 382).

This article discusses H.R. 382: The Federal Employees Health Care Freedom of Choice Act, first introduced to Congress in 1987. This act would directly reimburse nurses, nurse practitioners, nurse midwives, family and marriage therapists, and chiropractors under the Federal Employees Health Benefits Program. Few third-party payers currently directly reimburse nurse practitioners. Passage of H.R. 382 is important because it would increase health care availability, make provisions for cost-effective care and increase provider choice. Direct reimbursement to nurse practitioners would not increase health insurance premiums, according to the Office of Personnel Management and the Congressional Budget Office. Suggested strategies for nurse practitioners to lobby for the bill are discussed.

Government Agencies↗

Actuarial survival, freedom from reoperation, and other events after repair of atrioventricular septal defects.

Repair of an atrioventricular septal defect was performed in 134 patients from 1973 to 1985. Interventricular communication was present in 54 (40%) and none was present in 80 (60%). There were 12 hospital deaths (9%; 70% confidence limits 6%-12%). Earlier date of operation (p = 0.03) and younger age at repair (p = 0.005) were incremental risk factors for hospital death after repair of partial atrioventricular septal defect. Smaller size (p = 0.003) and longer cross-clamp time (p = 0.002) were risk factors for hospital death in those patients with complete atrioventricular septal defect. Higher preoperative pulmonary vascular resistance was a risk factor for death in both groups (p = 0.007). The 10 year actuarial survival rate was 82% overall. Increasing preoperative severity of left atrioventricular valve incompetence was not a risk factor for early (p = 0.001) or late (p = 0.002) death. The 10 year actuarial freedom from reoperation after repair of partial atrioventricular defects was 85%, and it was 68% for complete atrioventricular defects (p = 0.06). We conclude that the intermediate term results after repair of atrioventricular septal defects are good. Incompetence of the left atrioventricular valve has apparently been neutralized as a risk factor for hospital death in this series. However, the durability of the repair has been disappointing. A policy of earlier repair has been adopted and should improve hospital mortality and permit better preservation of the atrioventricular valve structures with resultant improved late term functional status.

Actuarial Analysis↗

The analyst's conceptual freedom in the method of free association.

Anna Freud's observation of the loss entailed in the progress from the topographical to the structural theory is taken as the starting point of a discussion of the relationship between psychoanalytic theory and the psychoanalytic method. The discussion considers the dangers of misapplying theories in he clinical situation and the disadvantages of defining the method and aims of psychoanalytic treatment and investigation in theoretical terms. A focus on free association, with systematic initial formulation based on an operational rather than a theoretical framework, preserves the analyst's conceptual freedom while it permits further articulation with the wide range of psychoanalytic theoretical propositions. The problem of theoretical bias on the analyst's part can be lessened or even solved by moving with restraint from the associations to the formulations rather than in the opposite direction and by systematic attention to the sequences and patterns of the associations.

England↗

Pharmacy and freedom.

The development of pharmacy in Western civilization has been influenced by ideas of individual liberty; the impact of these ideas is traced. For a short time during the French Revolution, individuals without qualifications could practice pharmacy, but abuses prompted return of regulation; from 1803, pharmacy was closely regulated by the state. Liberal thinking in 19th-century Britain left control of pharmacy mainly within the profession; regulation was definitive rather than restrictive. With the influence of Jacksonian Democracy and freedom of trade in the United States, there were no effective pharmacy regulations until the late 19th century and few educational requirements for licensure until the 1920s. In Germany, the old system of concessions and privileges was upset after World War II when any qualified pharmacist was allowed to open a shop wherever desired in the American-occupied zone; the courts upheld this policy as the basis for establishment of pharmacies in West Germany. Liberty in dispensing drugs has been limited out of concern for the well-being of individuals and of society as a whole. In Great Britain and the U.S., restrictions on dispensing antedated laws establishing qualifications for pharmacists. The history of pharmacy demonstrates that there are moral and social barriers to realization of the ideals of liberty. History also suggests that if pharmacists assume responsibilities that use their specialized training, they can defend against inroads by nonpharmacists.

Civil Rights↗

Beyond the freedom to choose. Medicaid, managed care, and family planning.

In this article we examine the federal freedom-of-choice statute, which was enacted in the mid-1980s to protect Medicaid beneficiaries' access to timely and confidential family planning services. We also examine how these provisions have been implemented in 15 jurisdictions and provide a case study of 5 family planning programs. We found that this attempt to "carve out" family planning services from managed care has led to numerous problems. First, there is virtually no federal guidance concerning to which services and supplies the exemption applies. Second, there are no guidelines as to how carve-outs are to function. Therefore, if managed care systems are inaccessible or nonresponsive to reasonable community care seeking patterns, then a carve-out carve-out may be the only answer. Carve-outs should be used as a last resort, however, because they are so difficult to design.

Choice Behavior↗

A high-resolution line sensor-based photostereometric system for measuring jaw movements in 6 degrees of freedom.

Photostereometry has widely been applied to the measurement of mandibular movements in 6 degrees of freedom. In order to improve the accuracy of this measurement, we developed a system utilizing small LEDs mounted on the jaws in redundant numbers and a 5000 pixel linear charge-coupled device (CCD) as a photo-sensor. A total of eight LEDs are mounted on the jaws, in two sets of four, by means of connecting facebows, each weighing approximately 55 g. The position of the LEDs are detected in three-dimensions by two sets of three CCD cameras, located bilaterally. The position and orientation of the mandible are estimated from the positions of all LEDs measured in the sense of least-squares, thereby effectively reducing the measurement errors. The static overall accuracy at all tooth and condylar points was considered to lie within 0.19 and 0.34 mm, respectively, from various accuracy verification tests.

Biomedical Engineering↗

Konstantin Konik--a great Estonian surgeon, statesman and freedom fighter.

The author of this review had the honour of delivering the First Konik's Lecture in the Joint Meeting of the Estonian Surgical Association and the Finnish Surgical Society on 12th May 1994 at the Sakala Centre, Tallinn, Estonia. In the introduction of this lecture the personal history of Konstantin Konik, a great Estonian surgeon, statesman and freedom fighter, was highlighted.

Estonia↗

Freedom of choice: an issue concerning alternate therapies chosen by patients with cancer.

Patients with cancer who choose alternate therapies often use limited sources of information from lay literature to influence their therapy decisions. The biomedical assessment of these alternate therapies usually is not made available to patients in the lay literature; therefore, patients' true freedom of choice must be questioned. This paper discusses alternate therapies in light of two recent ethnographic studies that examined the alternate-care beliefs and practices chosen by hospital patients in Canadian prairie cities. The alternate cancer therapies that patients have chosen are presented along with the biomedical perspective of these therapies. The patients' own descriptions of their searches for cures are included, and implications for nursing are provided.

Choice Behavior↗

Automatic head positioning system using PSD-equipped camera-based photostereometry and a 5-degree-of-freedom robotized chair: calibration and accuracy verification.

In measurements of jaw movements employing an X-ray television, the orientation of the patient's head must be normalized relative to the measuring device. To avoid interferring with natural jaw movements caused by using a positioning jig, we have developed an automatic head positioning system consisting of a head position sensor and a robotized chair. The position and orientation of the head is monitored by detecting the three-dimensional positions of four non-coplanar LED markers mounted on the head, by means of a set of two photoelectronic cameras. If they are incorrect, the head is moved into the required position, using a 5-degree-of-freedom robotized chair. To accomplish this accurately, the positional relations of system components must be determined precisely. This paper proposes a least-square technique of calibrating the relationship between the position sensor and the chair. Consequently, accurate positioning is achieved. Accuracy verification studies revealed that overall positioning errors lay within 2.42 mm and 1.28 degrees with respect to the position and orientation, respectively, if the markers are secured to the head support of the chair.

Biomechanical Phenomena↗

Simulation of protein conformational freedom as a function of pH: constant-pH molecular dynamics using implicit titration.

Solution pH is a determinant parameter on protein function and stability, and its inclusion in molecular dynamics simulations is attractive for studies at the molecular level. Current molecular dynamics simulations can consider pH only in a very limited way, through a somewhat arbitrary choice of a set of fixed charges on the titrable sites. Conversely, continuum electrostatic methods that explicitly treat pH effects assume a single protein conformation whose choice is not clearly defined. In this paper we describe a general method that combines both titration and conformational freedom. The method is based on a potential of mean force for implicit titration and combines both usual molecular dynamics and pH-dependent calculations based on continuum methods. A simple implementation of the method, using a mean field approximation, is presented and applied to the bovine pancreatic trypsin inhibitor. We believe that this constant-pH molecular dynamics method, by correctly sampling both charges and conformation, can become a valuable help in the understanding of the dependence of protein function and stability on pH.

Aprotinin↗

T-cell-depleted allogeneic bone marrow transplantation as postremission therapy for acute myelogenous leukemia: freedom from relapse in the absence of graft-versus-host disease.

Thirty-one consecutive patients with acute myelogenous leukemia (AML) in first complete remission and 8 with AML in second complete remission received T cell-depleted allogeneic bone marrow transplants from HLA-identical sibling donors. Patients received myeloablative cytoreduction consisting of hyperfractionated total body irradiation, thiotepa, and cyclophosphamide. Those patients at risk for immune-mediated graft rejection received additional immune suppression with antithymocyte globulin and methylprednisolone in the early peritransplant period. Patients with AML who underwent allogeneic T-cell-depleted bone marrow transplantations (BMT) in first or second remission have achieved respective disease-free survival (DFS) probabilities of 77% (median follow-up at approximately 56 months) and 50% (median follow-up at approximately 48 months). Ten of 31 patients transplanted in first remission were > or = 40 years old and have attained a DFS at 4 years of 70%. For patients with AML transplanted in first or second remission, the respective cause-specific probabilities of relapse were 3.2% or 12.5%, and those of nonleukemic mortality were 19.4% or 37.5%. There were no cases of immune-mediated graft rejection and no cases of grade II to IV acute graft-versus-host disease (GVHD). All survivors enjoy Karnofsky performance scores (KPS) of 100%, except 2 patients with KPS of 80% to 90%. T-cell-depleted allogeneic BMT can provide durable DFS together with an excellent performance status in the majority of patients with de novo AML. In addition, GVHD is not an obligatory correlate of the graft-versus-leukemia benefit or freedom from relapse afforded by allogeneic BMT administered as postremission therapy for AML. This study provides a basis for prospective comparison with other postremission therapies considered standard in the management of patients with this disease.

Adolescent↗

[Therapeutic freedom of the physician].

The therapeutic freedom of choice is one of the main elements of the medical profession. It is fought for by two competing powers: the patient's will on the one hand, and the reasons of welfare state on the other. A threatened fundamental maxim is at stake, which the characteristic of the medical profession depends on essentially. Its content is to be illustrated and showed clearly in the context of greater interrelations and reciprocity.

Drug Prescriptions↗

[Limiting prescribing freedom in the hospital].

The restrictions on the independence of prescriptions in hospitals result from the health insurance law and from the legal regulations for the hospital finances. Within the hospital, the restrictions on the freedom of prescription are laid down by law. Although on the one hand, the head doctor responsible for the medical treatment within his ward is independent of any restrictions regarding diagnosis and therapy, he is, however, committed to a treatment as economical as possible, which creates a field of conflicts that are quite frequently very difficult to solve.

Cost Control↗

"Absolute" sterility and "absolute" freedom from particle contamination.

Until the recent past, sterility of an injectable product was only discussed in absolute terms. Any description of sterility other than as an absolute could simply not be envisioned. While dealing in absolute yes/no statements is philosophically satisfying, these yes/no statements can't accommodate all real world scientific problems. Among these problems is the sterility problems faced in the mass production of injectable compounds. Many descriptions of procedures employed to achieve sterility in parenteral production batches were reported in the literature. The theoretical framework that could unite the widespread observations and practices into practical methodology was missing until recently. Production line control of the sterility of injectable products was essentially based on gut evaluations. The present achievement of rational, production line control of product sterility is based on the recognition that product sterility could not be simply regarded as a sharply edged yes/no affair. The present rational control is based on the fact that the sterility of a product is determined by the degree of contamination in the product prior to sterilization and to the parameters of the sterilization process. The end result of the sterilization process is now described as a probabalistic reduction of the initial contamination. The essential laboratory measurements on which this conclusion was based is due to Pflug (1-3). He assembled a theoretical framework, based on experimental data, that characterizes the sterility achieved in an injectable product with a single number. The end result of the sterilization process is now described as a probabalistic reduction of the initial contamination. As in many disciplines, the ability to achieve an objective evaluation of this important attribute provided the basis for scientific analysis, improved control and thus improved production and reduced cost. An equivalent framework is essential for the communication and standardization of the results of a visual inspection for contaminating particles. The control of particle contamination in injectable products is a two-fold problem for the pharmaceutical industry. The two parts of the problem are 1) achieving contamination free product and 2) achieving this contamination free quality at an economic cost acceptable to the user. Today, there is no commonly accepted framework for the definition or analysis of the results of a manual inspection for "visible" particles. Any progress toward global harmonization of the results of a visual particle inspection must commence with the development of a common scientific language with which inspection security and economic effectiveness of an inspection can be discussed and rationally evaluated. The tools with which to define and control the results of this inspection have been developed in biophysics, illumination engineering, optics, pharmaceutical manufacturing and statistics. With them, statistically replicable measures have been developed. The statistically replicable measures are then used to evaluate the results of semi- and fully automated particle inspection systems in terms of human inspection performance. The numerical evaluation of both the freedom from contamination achieved with an inspection for particle contamination and the economic effectiveness of the inspection are compared to Pflug's sterility index. In the case of particle contamination, the final product quality depends on product quality prior to inspection and to the parameters of the inspection process.

Drug Contamination↗