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Acquisition of mature functional responsiveness in T cells: programming for function via signaling.

The results discussed here provide strong evidence that different T-cell effector gene programs are activated by different signals, and that in several cases their responses to the same exogenous stimuli shift during the development and antigen responses of the cells. T-cell responses are thus conditional and plastic at the individual cell level. In the formalism of the introductory section, the results support elements of Models 2 and 3, and suggest a fusion between them as differentiation is explained in terms of alteration in the relative strengths of different intracellular signaling pathways. Returning to an initial question, how are different functional capabilities assigned nonrandomly to cells with different antigen recognition specificities? This question has not been answered, but it can be reformulated. If all virgin T cells can transiently make IL-2, then we must ask what features of cell biology explain the preferential preservation of IL-2 inducibility in CD4+ cells as opposed to CD8+ cells. If the capacity to induce IL-4 expression is not acquired in the thymus, then we may ask whether the initial opening of this locus depends on a CD4-transmitted signal. Similarly, the CD8 molecule itself might participate in inducing the initial differentiation events that render CTL-p inducible for granzyme C and perforin. This would be in accord with a large literature showing that CD8 engagement is much more important in the initial induction of CTL activity than in the exercise of function by pre-primed CTL effectors. The subtext of each of these "questions", however, is that intrathymic events may not directly affect the genes used by terminal effectors for function at all. They may instead bias a cell's complement of triggering receptors, thus rendering it differentially sensitive to particular signals generated during antigen reception. This view is extreme, and will probably turn out to be an overstatement. But it does inspire a unique set of investigations into the basis of T-cell function. It lends urgency to the question of whether CD4+ and CD8+ cells differ in their G proteins, kinases, or inducible proto-oncogenes. If they do, we can then ask whether such differences themselves arise in the periphery, or whether they can be traced back to thymocytes fresh from positive selection--or before.

Animals

Human sexuality course evaluation.

A three-day human sexuality program was offered in 1974 to medical, nursing, and graduate psychology students for the second consecutive year at the University of Cincinnati. The program was designed to cover a wide range of topics; supply accurate information; encourage participants to question, explore, and assess their own sexual attitudes; and help participants develop a more tolerant attitude toward sexual beliefs, attitudes, and behaviors of others. The Sexual Knowledge and Attitude Test and an evaluation form were used to measure students' pre- and postcourse knowledge, attitudes, and opinions. The total group of 186 subjects registered a significant difference between mean scores of the pre- and postcourse tests. When examined separately, nursing and medical students showed significant changes in attitudes and knowledge scores. Results of the three-day program were compared with those of a five-day program given the previous year. A profile analysis showed the differences in nursing and medical students in pre- and postcourse scores. An evaluation form demonstrated how each group of students felt about the course. This study documented that human sexuality content should be included in nursing and medical curriculums and demonstrated that an introductory concentrated course is an effective interdisciplinary experience for nursing and medical students.

Attitude of Health Personnel

[Preparation, characterization and control of antiserums].

The development of radio immunoassay and its application to the estimation of new substances (e.g. drugs, enzymes, viral antigens, etc.) will shed further light on the various problems which we have discussed in this introductory report. For each group of substances there will no doubt be special difficulties. If these technics have become very popular, this seems to be for two main reasons: the potential selection of individual immune response, and better understanding of the role of the parameters which control the various stages of radio-immunoassay. I am sure that the reports programmed here will provide an important contribution to advances in our knowledge in this promising field.

Antibody Specificity

Neurosurgery image manager.

Computer technology has become standard in many areas of medical practice, but computer-assisted instruction has not replaced standard textbooks and didactic lectures. This paper describes the development of a computer image-based educational system designed for neurosurgical instruction. The advantages and applications of this system for both clinical and academic use and the required software and hardware requirements are delineated. This computerized tutorial can organize and manipulate large amounts of data. The Neurosurgery Image Manager system contains an introductory help section, a self-assessment test in neurosurgery, and a data base of images from the video disc "The Slice of Life," produced at the University of Utah. Questions are taken from the Self-Assessment in Neurological Surgery series. Additionally, the system contains a reference index for all material in the tutorial, a scored clinical problems section, and a several hundred word glossary. The system is programmed using the Macintosh Hypercard authoring system. Large data bases can be manipulated and linked with graphics, text, and peripherals. Images are stored using the MacVision II digitizing system. The hardware necessary to operate the system and the method of implementation of Neurosurgery Image Manager are described. The prototype Neurosurgery Image Manager has been accepted by the Joint Committee on Education of the American Association of Neurological Surgeons and Congress of Neurological Surgeons as one of the computer formats for the next self-assessment tests.

Computer Graphics

Calcium measurements with electron probe X-ray and electron energy loss analysis.

This paper presents a broad survey of the rationale for electron probe X-ray microanalysis (EPXMA) and the various methods for obtaining qualitative and quantitative information on the distribution and amount of elements, particularly calcium, in cryopreserved cells and tissues. Essential in an introductory consideration of microanalysis in biological cryosections is the physical basis for the instrumentation, fundamentals of X-ray spectrometry, and various analytical modes such as static probing and X-ray imaging. Some common artifacts are beam damage and contamination. Inherent pitfalls of energy dispersive X-ray systems include Si escape peaks, doublets, background, and detector calibration shifts. Quantitative calcium analysis of thin cryosections is carried out in real time using a multiple least squares fitting program on filtered X-ray spectra and normalizing the calcium peak to a portion of the continuum. Recent work includes the development of an X-ray imaging system where quantitative data can be retrieved off-line. The minimum detectable concentration of calcium in biological cryosections is approximately 300 mumole kg dry weight with a spatial resolution of approximately 100 A. The application of electron energy loss (EELS) techniques to the detection of calcium offers the potential for greater sensitivity and spatial resolution in measurement and imaging. Determination of mass thickness with EELS can facilitate accurate calculation of wet weight concentrations from frozen hydrated and freeze-dried specimens. Calcium has multiple effects on cell metabolism, membrane transport and permeability and, thus, on overall cell physiology or pathophysiology. Cells can be rapidly frozen for EPXMA during basal or altered functional conditions to delineate the location and amount of calcium within cells and the changes in location and concentration of cations or anions accompanying calcium redistribution. Recent experiments in our laboratory document that EPXMA in combination with other biochemical and electrophysiological techniques can be used to study, for example, sodium and calcium compartmentation in cultured cardiac cells. Such analyses can also be used to clarify the role of calcium in anoxic renal cell injury and to evaluate proposed ionic defects in cells of individuals with cystic fibrosis.

Animals

[The community health technician and alternative in the training of health manpower].

This paper describes the general conditions of the social and economic dynamics of the rural area, with emphasis on the development of the factors that affect health in Mexico, and briefly analyzes the system for the education and training of manpower for health care. The author presents arguments in support of an alternative proposal for the training of the "community health technician" as a professional produced by four years of study following graduation from secondary school, and trained to take measures that contribute to the integral development of the community by acting upon the factors involved in the occurrence of pathological states, and to be the first contact for persons with medical problems. The course of training is described in terms of its ultimate purpose, which is improvement of the health status of a rural community, and of the general objectives in the "community development" and "medical care" areas. The course is administered in 25 modules as follows: four introductory modules to acquaint the student with the requirements for dealing with the areas, 11 modules on community development, eight modules on first-contact medical care, and the last two for practical exercises and community work, in which the student is required to bring all his knowledge to bear on a given community. Lastly, the course content of each semester is described together with the distribution of the theoretical and practical work in each module, and the outlook for its success, which points to the possibility of incorporating this resource into programs for extending coverage to rural areas.

Allied Health Personnel

Designing a neural network simulator--the MENS modelling environment for network systems: I.

During recent years, the field of neural network research has increasingly attracted the interest of workers from a large number of different disciplines. Current research topics include aspects as different as detailed simulations in brain physiology, predictions of protein structure in biochemistry, database organization in computer science, or various technical applications. The common scheme behind these different approaches is the use of distributed networks of simple computational elements that communicate with each other by means of weighted links. Computer simulations of neural networks require an appropriate software environment. Due to the computational similarities of many classes of such networks, simulation software can be structured into modular components that, to a large degree, are independent of specific applications. The aim of this and the following paper is to discuss some of the design considerations concerning software for neural network simulations. The aspects presented are interesting for both the development of new simulation software and the efficient use and modification of existing programs. Therefore, the general user as well as the software designer may hopefully benefit from this material. This paper briefly introduces some of the basic principles of neural networks. After a short discussion of different approaches to software design, two simple example applications are presented in order to demonstrate a conceptual framework common to many network simulations. The transfer of these considerations to the design of simulation software is then shown by example of the MENS network simulator developed in the Max-Planck-Institute for Brain Research. The paper gives a general introduction to the layout of data structures and different software components. Using the two introductory examples some aspects of network analysis are demonstrated. The following paper then considers further details of the design of a neural network simulator with respect to performance, implementation, and testing.

Animals

[Preventive medical measures in the federal republic of germany. Present status and problems (author's transl)].

Following brief introductory remarks on the term "preventive medicine", an outline is presented of its evolvement during the last 20 years in the Health Services of the Federal Republic of Germany. Thereby, it becomes apparent that the development of single screening efforts, e.g. to detect unknown cases of diabetes and to make special model studies, especially in Baden-Württemberg, has led to comprehensive legal motherhood care, health care for young children, early detection of cancer, and detection of diabetes cases. Problems have arisen due to the generally very low utilization of preventive medical examinations and because of the question as to whether premorbid health conditions should be included in the preventive medical program additionally. Finally, indications are given for the necessity to examine possibilities of curtailing expenditures in the present preventive medical care program, or in some of its branches, without forfeiting the efficiency of the preventive measures. Thereby, it must be considered that these measures are benefiting only that part of the population which is socially insured. The claim to measures for health protection, however, should be available to the entire population as a basic human right.

Adolescent

The New Zealand Glomerulonephritis Study: introductory report.

All patients 14 years and older seen between July 1972 and June 1983 in four of the five nephrological centers in New Zealand with biopsy-proven primary glomerulonephritis (GN), were enrolled in a central register. This study included 803 patients from 84% of the total New Zealand population in this age group. Polynesians (predominantly Maoris) were found to have a higher overall incidence of GN than New Zealanders of European descent, a higher incidence of postinfectious GN, mesangio-capillary GN and focal glomerulosclerosis and a reduced incidence of IgA nephropathy. The racial difference in the incidence of GN may account in part for the known higher rate of end-stage renal failure in Polynesians. Overall the incidence of GN in men was more than twice that in women, and this was particularly so for postinfectious GN, IgA nephropathy, antiglomerular basement membrane initiated GN and membranous nephropathy. An adverse outcome (entry into a dialysis-transplant program, death from renal failure, non-renal death), was more frequent for Polynesians than Europeans. Follow-up is continuing to define the long-term survival of patients with each histological category of GN and any potential prognostic factors.

Adolescent

[Training and use of dental manpower resources in Mexico].

The introductory section describes the general situation of dental care in Mexico, analyzes the prevailing service model (including the kind of work done by the dental professional and the technology he employs), and briefly reviews the evolution of dentistry in the country. There follows an account of a series of new approaches to service and manpower training in experimental implementation since 1972 in the stomatology curriculum at the Xochimilco campus of the Metropolitan Autonomous University, at the National School of Professional Studies at Zaragoza, in the School of Dentistry of Nuevo León Autonomous University, Monterrey, and in the Dental Services at Ciudad Netzahualcóyotl. In each case, the background, characteristics, and objectives of the programs, and their evolution and prospects are described.

Dental Assistants

SCORPIO: a system of medical teaching.

Reform in medical education is gaining momentum through the efforts of organizations such as the World Federation for Medical Education. Through the advocacy of such bodies, educational priorities have been redefined to widen the range of educational settings, upgrade evaluation systems and promote the training of teachers as educators. A system of medical teaching has been developed which addresses these issues. It is known by the acronym SCORPIO. The key elements of the system are that it is Structured, Clinical, Objective Referenced, Problem-based, Integrated and Organized. SCORPIO involves delivering a syllabus through a series of lecture-demonstrations at which students, teachers and patients gather at a defined area. Following a short introductory lecture, students rotate in small groups, through a series of teaching stations. These stations are structured to provide students with a problem-based, integrated learning experience. Assessment stations may be included before, during or after the teaching circuit. The teaching system has been formally evaluated over a period of time and now has an established place in the curriculum of this medical school.

Australia

Introductory training in occupational health service. Report on the development and evaluation of nine preliminary courses, 1988-1989.

This compulsory course is open to all newly employed, including administrative personnel, at occupational health units. The goal of the course is to create a joint view of the aims and direction of occupational health service. All nine preliminary courses have given the participants distinct and homogeneous answers to questions such as: What is the aim of the occupational health services? Who is the client? How shall we work together?

Curriculum

The problem of creating habits: establishing health-protective dental behaviors.

We describe three experiments testing treatments to promote the performance of health-protective dental behaviors. Subjects included 55 women from an introductory psychology course (Experiment 1), 45 men and women (Experiment 2), and 81 older-than-average students identified as at risk for gum disease (Experiment 3). The interventions, derived from social cognitive theory, included health education, skills training, and self-monitoring. In each study, we examined the contribution of additional treatment components, including social support (Experiment 1), intensive contact (Experiment 2), and flexible goal setting (Experiment 3). Across experiments, the behavioral results were remarkably similar: Subjects exhibited excellent adherence while in the study but, at follow-up, reported behavior that differed little from baseline. We discuss parallels between attempts to promote health-protective dental behaviors and other health-promotion programs, and we describe different perspectives from which to address the problem of creating healthy habits.

Adolescent

Introduction to the theme--state intervention and the social wage: the politics of social services expansion.

State intervention in the consumption process has become increasingly critical to economic growth on the one hand and to real family income on the other. The social wage thus tends to become a conflictual political issue. As a result, the articulation of state intervention with the changing requirements of economic growth is subject to continuous political challenge. This special issue examines the problematic relationship between state intervention in social services and the organization of the capitalist economy. Some contributors study the ways in which state inter ventions are structured so as to be consonant with the requirements of economic growth and profitability, as well as the difficulties such structures pose. Feshbach's analysis of the Hill-Burton Hospital Construction Program and Mollenkopf's study of San Francisco's public transit system both reflect this concern. Other contributors study the ways in which the organization of the economy constrains the development of democratically responsive social services. Sbragia's study of the capital market and public housing in Italy and Taylor's study of free medical clinics in the U.S. both reflect this concern. Finally, contributors study macroscopic transformations in the relationship between state intervention and the organization of the capitalist economy. Esping-Andersen's study of the political logic of increasing state intervention in production and Hirschhorn's analysis of the defunctionalization of social services attendent upon the disaccumulative tendencies in capitalism both reflect this concern. This introductory paper reviews four theories which attempt to explain how state intervention is insulated from democratic controls. For each theory, the mechanisms specified to perform this function are subject to weaknesses. An attempt is made to position the contributions to this volume with respect to these theoretical traditions.

Conflict, Psychological

Self-assessment and learning through GOSCE (group objective structured clinical examination).

The objective structured clinical examination (OSCE) was modified to serve as a means of self-assessment and learning, rather than as an examination. The main modifications were to adapt it for use by small groups instead of individuals, and to provide a correct answer or other feedback at each station. The resulting group OSCE (GOSCE) was used as an introductory session in two residential refresher courses for general practitioners. The 300 participants rated it highly as a method of self-assessment and as an enjoyable social event. Four potential applications of the GOSCE are suggested: as an assessment instrument for formative and informal summative assessment, as a resource for learning about interpersonal and interprofessional relationships, and as a framework for problem-based short courses.

Education, Medical, Graduate

Two different approaches to computer-aided teaching of microbial genetics.

Two computer packages have been developed to teach bacterial genetics on an introductory genetics course for undergraduate students in biology. The first package, 'CONJUGACION', is designed to teach bacterial conjugation and its genetic outcomes. It includes four main parts. Firstly, a tutorial part presents a theoretical framework using screens of text and animated graphics. Secondly, an interactive concept application section requires students to carry out experiments for the determination of the correct sex and genotype of 10 bacterial strains. The third part uses the previously obtained data for simulating interrupted mating experiments and mapping the bacterial genome. Finally, an evaluation section allows the students to test their understanding through a series of multiple choice questions. The second package, 'LURIDEL', is intended for teaching the preadaptative character of mutation in bacterial populations on the basis of the fluctuation test of Luria and Delbrück. It simulates, graphically, the appearance of mutations in microbial cultures and gives results of simulated fluctuation experiments. Programs were written under the PCOS operating system in MBASIC extended to graphics for running on Olivetti M20 microcomputers.

Computer-Assisted Instruction

Teaching microcomputing to student nurses: an evaluation.

This paper describes an introductory computer course designed for student nurses facing a career in nursing in which computers will play a major part. Questionnaires were given before and after the course. The purpose of the questionnaires were (a) initially to gain information about the students' previous computing experience, motivation and expectations of the course, and (b) to enable an evaluation to be undertaken. The course content, structure and results of the questionnaires are presented; modifications made to the course following the evaluation are mentioned and finally some of the issues which need to be considered when developing a computer course for nurses are raised.

Computer User Training

Distance learning in a local setting: a structured learning course for the introduction of general practice to undergraduate students.

This paper describes the development and evaluation of a structured introductory course in general practice. Following some of the principles developed in distance education, the Department provides everything the student needs for the formal learning requirement as well as detailed assistance in how best to tackle the selected topics. The course was reported to be demanding, relevant and enjoyable. The major areas requiring attention were in reducing the amount of reading required, more help in learning to work in small student-run groups and more one-to-one supervision of physical examination skills. With further refinement the course should be applicable to other medical schools in developed countries.

Curriculum