Population projections of the less developed regions: 1980-2000.
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An advantage of helical tomotherapy radiation therapy systems is that on-line megavoltage computed tomography (CT) images can be reconstructed to verify patient positioning. One limitation of such systems is that the field-of-view (FOV) of the photon fan-beam is limited by the aperture size of the binary multileaf collimator (MLC) used to modulate treatment beams. For patients larger than the FOV the acquired sinograms will be truncated causing artifacts in the resultant megavoltage CT images. Computer simulations are used to demonstrate that such artifacts can be eliminated or at least reduced by merging appropriately acquired truncated fan-beam sinograms to form a nontruncated parallel-beam sinogram. The necessary fan-beam sinograms are acquired with the patient translated to different offset locations within the gantry. The parallel-beam sinogram is then used to reconstruct the final CT image. The increase in patient dose due to the acquisition of more than one fan-beam sinogram can be reduced by using properly designed binary MLC fields to block redundant projection rays.
A system based on Macintosh, Hypercard and a local network was developed at the University and Hospital Department of Radiation Therapy, Florence, Italy, to manage the clinical records as a complex data structure (data, texts, drawings and image storage and retrieval). After 4 years, the system produces over 2000 new charts a year and manages more than 15,000 clinical records. Electronic records are produced, printed and updated in their traditional form to be put on file in our archive. On-line consultation of the clinical records is possible from every workstation of the structure even as it is producing, updating, or printing a chart. Physicians and clinical clerks, with different access privileges, currently use the system for all these purposes. The clinical records are typed by secretaries who receive dictation on microcassettes. No extra staff were necessary to set up and manage the system and training was simple. The new system changed neither the organization and structure of the traditional records, nor the flux of information; new tools (computers, printers and a network) were introduced to manage the information and the charts. The author describes the aims of the original project and the results.
The Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) is an ongoing prospective data collection initiative that began in January 1995. The cohort for the initiative is all patients undergoing cardiac catheterization in Alberta. Patients are followed longitudinally for the determination of short and long term clinical, economic and quality of life outcomes. The project is producing valuable information on the processes and outcomes of cardiac care in Alberta, and is now being implemented in British Columbia as well. This paper provides an overview of APPROACH with specific attention to the project's general objectives, salient features, database structure and technical specifications. Examples of applied research projects based on APPROACH data are also provided.
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A way of reducing the cost price of hospital automation is proposed. It is not necessary for it to update the whole equipment, but only a small part--the workstations used by programmers for their work, which support the stability of hospital automation; the working places of operators should be kept without modifications, but to allot them properties to inherit a potency and modernity of the purchased equipment; for this purpose they should be equipped with virtual machines copying properties of workstations being arrange in accordance with the pyramidal structure. A UNIX which represents a multi-user, multitask operational operative system providing an access on several pseudoterminals is simultaneously installed on the PENTIUM 100/133 workstation. A graphic terminal of the AMR "UnTerminal" firm (USA) is proposed for use as working places. Their advantage is that they have a special adapter connected directly to the bus of PC extension. Each user is allotted a video adapter, a keyboard controller, sequential and parallel interfaces for connection of the printer and manipulator. Each working place supports multitasking and it can be equipped with a printer, a "mouse" or modem. The image is transmitted on work places with a very high velocity-77 mehabits/sec that supports not only a text mode, but also VGA or SVGA graphics. Certainly, graphic terminals are more expensive than text terminals, but their capacities are similar to those of the main computer, here, the workstation. They may be located from the main computer at a distance of up to 75 meters or more and do not require adjustment during their installation.
The aim of this work is to determine the technical and economic feasibility of implementing different reclamation and reuse projects that improve the quality of the Apatlaco river basin located in the central part of Mexico. A special methodology based on a decision support system was developed. This methodology allows to decide if it is convenient or not to finance a reclamation or reuse project for the most common water uses in the basin. This methodology is based on the net present value criteria (NPV) of the effective cash flow during the useful life of the project. The results obtained reveal a technical and economical feasibility for industrial reuse in Jiutepec and for agricultural reuse in Zacatepec and Emiliano Zapata. On the other hand, sanitation projects are not feasible in all cases analyzed. Therefore, Mexican Regulation (Ley Federal de Derechos en Materia de Agua) as currently implemented, does not promote and support this kind of projects.
Measurement of direct and correlated responses to single-trait selection for milk yield was the major objective of regional project NC-2. The NC-2 Technical Committee included representatives from Alaska, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Nebraska, South Dakota, Wisconsin, and the USDA. All representatives, except Illinois, Kansas and Nebraska, maintained a selection line formed by using AI sires selected for high estimated transmitting abilities for milk and a second line that served as some type of a control. Stations varied in criteria for selection of bulls for control lines. Farms were managed similarly, including feeding and management of selection and control lines as one herd, random mating within line, and restricted culling policies. Selection for milk yield effectively increased milk production. All selection lines increased milk and net income per lactation more than control lines. Realized gains matched or exceeded gains expected from estimates of breeding values. Yields of milk components increased, but component percentages decreased appreciably for selection lines. Reproduction of nulliparous animals was not affected, but days open for lactating selection cows increased in some of the individual projects. Selected cows tended to have larger health costs, specifically for mammary treatment. Udder and conformation traits did not deteriorate for selection lines, although control lines with selection of sires on genetic evaluations for type received higher type scores. There should be few reservations about undesirable responses correlated with selection for milk yield.
Technical assistance agencies have a sustainable impact on the health systems of the countries they are operating in. As well as policy-makers at the national level, technical assistance agencies see themselves confronted that their interventions should be based on evidence, usually meaning the results of research. This study has the aim to analyse role of research in the implementation of technical assistance. We sent a questionnaire to all health project managers of the 'German Agency for Technical Co-operation' and performed a qualitative case study in one of the health projects. Forty-seven of 80 (58.8%) of the questionnaires were completed and sent back. The managers considered publications of International Organisations (IOs), scientific articles and local research as most important for their work. The case study showed application problems in the daily work. Research use not only depends on the relevance of the data but also on analytical skills, linguistic barriers and technical access to research by the potential users. The role of knowledge and information management has to be clearly defined in an organisation of technical assistance. The specific needs at the different levels have to be analysed so that skills and resources can be allocated adequately.
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OBJECTIVE: To determine the accuracy of drug-susceptibility testing (DST) for isoniazid, rifampicin, ethambutol and streptomycin in a provisional network of 22 regional laboratories in Italy. METHODS: Methods, definitions and reference Mycobacterium tuberculosis strains were derived from the WHO/IUATLD Global Project on Anti-tuberculosis Drug Resistance Surveillance. The laboratories were selected based on technical skills required by the project, the number of DST performed annually and geographic localisation. The results (sensitive/resistant strain) were compared with the gold standard (global project results). Sensitivity (ability to detect true resistance), specificity (ability to detect true susceptibility), positive predictive values for resistance and susceptibility, efficiency and reproducibility were calculated in two rounds. RESULTS: Eighteen of 22 laboratories completed the first round of proficiency testing for the four drugs. Sensitivity was 76.6%, specificity 97.2%, predictive value of a resistant test 89.8% and of a susceptible test 86.8%, efficiency 87.8% and reproducibility 92.8%. A second round was performed by all those laboratories that did not achieve > or = 90% agreement with the results of the Global Project. Overall, after the second round, all the parameters except specificity improved, exceeding 90%. CONCLUSIONS: A network of 15 regional laboratories that fulfil the quality criteria for determining the susceptibility of M. tuberculosis to the four primary antituberculosis drugs was established in Italy.
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