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[Online bedside teaching: multimedia, interactive and case-based teaching scenarios in dermatology].

The MeduMobile project or Mobiler Campus Charité was started in the beginning of 2003 to evaluate new, multimedia supported teaching and learning scenarios. The project focuses especially on acute and rare diseases to which students usually have are very limited access. During the teaching sessions the MeduOnCall team and the academic teacher communicate with the students who are equipped with individual notebooks through a wireless net. In dermatology the MeduMobile project focused in summer 2003 and winter 2003/2004 on bedside teaching. Despite some technical difficulties in the beginning the project was well received by teachers and students. The possibility of simultaneous online searches by Internet as well as the possibility to include photographs depicting the course of the skin disease was felt to be one of the main advantages of this project. Based on these positive experiences an attempt will be made to integrate the project further into the regular teaching of the Charite.

Case-Control Studies↗

Ocean storage of nuclear wastes? Experiences from the Russian Arctic.

An international demonstration (RD&D) project for ocean storage of radioactive wastes should be proposed, to study the feasibility of the concept of ocean storage of nuclear waste. This international project should utilize the scientific, engineering and technical capabilities of selected universities, oceanographic institutions, NGOs and industries. This project would need to be an independent (non-governmental) study, utilizing the capabilities of selected universities, oceanographic institutions, environmental NGOs (Non-Governmental Organizations) and industries. Scientists and engineers first need to conduct an engineering, environmental, and economic feasibility study of the concept. The goal of the project would be to determine if ocean-based storage reduced the risks to the environment and public health to a greater degree than land-based storage. This would require comparing the risks and factors involved and making the data and information available to anyone, anywhere, anytime on the internet. The mere presence of an investigation of the ocean storage option could facilitate scientific and engineering competition between the two options, could subsequently reduce environmental and public risks and provide better protection and cost benefits in the system utilized. One of the primary concerns of the scientific community would be related to the sensitivity and precision of the monitoring of individaul containers on the ocean bottom. An advantage of the land-based option is that if there is a release, its presence could be detected at very low levels and be contained in the storage facility. On the ocean bottom, a release from a container might not be easily detected due to dispersion. Therefore the containment system would have to be a system within a system with monitoring between the two providing greater protection. Ocean storage may have greater technical and political hurdles than land-based options, but it may provide greater protection over time, because it negates the threat of terrorism, it therefore merit further study. In the future if the use of nuclear energy and nuclear wastes increases, the global society could benefit from this international project, because it could reduce environmental and public health risks and promote energy independence.

Arctic Regions↗

[Afferent and efferent connections between the hypothalamus and raphe. Study using the technic of retrograde transport of peroxidases].

Projections between rat lateral hypothalamus and dorsal and medial raphe nuclei were studied. Horse radish peroxidase (HRP) was injected into each of these structures and retrogradely labeled neurons were identified. Following HRP injections into lateral hypothalamus (LH) labeled neurons were found into medial and cortical amygdaloid nuclei (AME, ACO), into dorsal thalamic nucleus (MD), in the hippocampal gyrus (HPC) and into medial raphe nucleus (MR). Following HRP injections into medial (MR) and dorsal (DR) raphe nuclei, labeled neurons were found in medial, lateral and posterior hypothalamus. A functional circuit was supposed between midbrain raphe and hypothalamus.

Animals↗

Selecting technical skills to teach for competency.

This pilot project describes a method using data from the clinical setting to assist nurse educators in the selection of technical nursing skills to teach for competency within the basic nursing program. Based on Dr. Dorothy del Bueno's proposal that skills taught should be those which are most frequently performed and considered most important in the community where new graduates are employed, five registered nurses in 16 metropolitan hospitals were asked to rate 154 technical nursing skills for frequency and importance. Findings for medical-surgical, intensive care, obstetric and pediatric areas, as well as for all groups combined, are described as skills ranking from 1) most frequent to least frequent, 2) most important to least important, and 3) most important/most frequent to least important/least frequent. Examination of skills placement within the rankings assisted faculty within an associate degree program to decide which skills to select and which to eliminate from the program.

Clinical Competence↗

Technical aspects of haemodialysis treatment: comparative results of Scotland and Belgium.

This paper reports the findings from the European Practice Database project providing an overview of the technical aspects of haemodialysis treatment, comparing practice in Scotland and Belgium. Findings identified that in Scotland almost all centres (95%) employed renal technicians compared to 67% of centres in Belgium. There was also a higher level of technical duties performed by technicians in Scotland compared with Belgium, and marked differences in the disinfection protocols of dialysis machines between the two countries. The study highlights the need for further investigation to discover why technical practice varies somuch between the two countries.

Belgium↗

Advances in space technology: the NSBRI Technology Development Team.

As evidenced from Mir and other long-duration space missions, the space environment can cause significant alterations in the human physiology that could prove dangerous for astronauts. The NASA programme to develop countermeasures for these deleterious human health effects is being carried out by the National Space Biomedical Research Institute (NSBRI). The NSBRI has 12 research teams, ten of which are primarily physiology based, one addresses on-board medical care, and the twelfth focuses on technology development in support of the other research teams. This Technology Development (TD) Team initially supported four instrumentation developments: (1) an advanced, multiple projection, dual energy X ray absorptiometry (AMPDXA) scanning system: (2) a portable neutron spectrometer; (3) a miniature time-of-flight mass spectrometer: and (4) a cardiovascular identification system. Technical highlights of the original projects are presented along with an introduction to the five new TD Team projects being funded by the NSBRI.

Absorptiometry, Photon↗

[Research in psychiatry and legislative restrictions].

Over the last few weeks decades research in psychiatry has undergone a considerable efflorescence. Experimental projects in fields as different as neurobiology or psychopathology, neuro-anatomy or epidemiology, or even cognitive psychology are of course subject to precise conditions which may derive from ethical guidelines as well as different legal systems. These legislative contexts therefore represent a parallel set of restrictions in the path of research activities and may in some cases curb their development. Restrictions of an ethical or deontological type are direct heirs of necessity. They emerged on the eve of the second world war when it became apparent that precisely defined conditions in which research could be conducted in humans were required, and derived for the most part from the recommendations of the Nuremberg Code on the one hand, and the Helsinki declaration on the other. The last version of the Code of Medical Deontology applicable to medical practice in France, and published by decree in September 1995, devoted an article to the question of experimentation. Each country has its own specific legislation which, in France, was explicitly formulated with the publication of the Loi Huriet in December 1988. The European Union is currently attempting to produce a homologous version of the various legislative documents and recommendations should soon be forthcoming which will be applicable to all member countries of the Community. Another area of limitation is less clearly formulated and involves the technical and occasionally methodological framework within research projects take place. Technical demands are highly variable depending on the field of investigation and chiefly revolve around a dogged hunt for statistically significant results (statistical significance sometimes seems to dispense with the need to determine the real meaning of results!); in some cases they too may curb inventiveness. This last type restriction is particularly apparent in drug trials where imperatives of industrial development as viewed by the sponsor may not always coincide with the investigators' desire to mark therapeutic progress. The increasing rigidity of strategies for assessing new substances which has become obvious over the last few years may in the end risk penalizing the discovery of innovative treatments. Promoting a return to clinical practice in the setting of these research projects would indisputably provide some novel solutions. Although many of the restrictions which currently stand in the way of psychiatric research are, so to speak, natural limitations and difficult to debate, excessive formalism in some areas should be spoken out against. Much thought has been given to this subject, a trend which is likely to inject some dynamism into psychiatric research at the dawn of the third millennium just around the corner.

Data Interpretation, Statistical↗

Hair transplantation: management of donor area.

BACKGROUND: Hair transplantation entails the removing of a strip of permanent hair from the occipital scalp and reimplanting it piecemeal into the recipient area. Methodologies for effecting this are reasonably complex and have undergone many changes and improvements over the years. The simplest part of hair transplantation, at least in theory, is the removal of the donor strip and closure of the resultant defect. Unfortunately, however, the improvements that have taken place in hair transplantation in general have not spilled over into improved donor area outcomes. Unsightly donor scars and fibrosis are still not only with us, but are possibly even more pervasive than ever. One explanation given for deteriorated donor sites is the harvesting of relatively greater numbers of grafts. But is this the whole story? OBJECTIVE: To describe some technical aspects of donor area management consistent with harvesting the best possible donor strip, while leaving an inconspicuous scar and preserving the viability of the residual tissues for subsequent harvesting. METHODS: In 1994 a clinical research project designed to determine what technical surgical modalities are optimal for excising and reconstructing scalp tissues was commenced. This was done with particular reference to the donor area in hair transplantation. The study involved more than 1000 scalp operations using various techniques and instrumentation, and comparing and contrasting results. RESULTS: The best results were obtained when tissues were least traumatized. Tension generated at wound closure was found to be the main culprit in determining less than optimal residual donor sites. CONCLUSION: Notably improved postharvesting donor sites are most likely to result when measures are taken to ensure minimal trauma by taking definitive steps to combat tension in the tissues. Modest undermining combined with deep plane fixation facilitates channeling of tension vector forces from at-risk superficial tissues into nonundermined tissues and deep tissues, each of which is optimally equipped to withstand the adverse consequences of tension.

Cicatrix↗

Anaerobic treatment of condensates: trial at a kraft pulp and paper mill.

The Domtar Papers pulp and paper mill in Windsor, Quebec, Canada, investigated the potential for anaerobic treatment of contaminated kraft mill condensates. The objectives of this project were to assess the technical feasibility of replacing the steam stripper with anaerobic treatment, to provide basic information for the design of an anaerobic treatment process for condensates, and to provide information on treated condensate quality for eventual reuse. The project involved extensive chemical characterization of condensates, followed by treatability tests. The tests included laboratory bench-scale tests and on-site pilot testing using direct feed from the process. Characterization showed that the organic content of the condensates was essentially methanol, as expected, but that foul evaporator condensates had high sulfide contents. It was found that undiluted foul condensates at the Windsor mill are toxic to the anaerobic biomass because of these high concentrations of sulfides. Treatment of combined condensates is possible at an approximate volumetric loading of 10 to 12 g/L.d chemical oxygen demand (COD) with good production of biogas (0.35 L/g of COD removed) and excellent methanol removal (better than 95%). The biogas produced is of excellent fuel quality with close to 90% methane, but with a high sulfide content (close to 4%).

Bacteria, Anaerobic↗

Adaptive tele-application for remote neurology diagnosis.

This paper presents the Collaborative Tele-Neurology (TeNeCi) project which allows practitioners to use telecommunication technologies to provide medical information and services for neurological diseases. Specificities of remote neurology are described and the Cooperative Application Framework (CAliF) multimedia platform on which TeNeCi relies is presented. The technical requirements of such a project in terms of communication and consistency management, audio and video transmissions, and network support, as well as implementation of TeNeCi was evaluated. The software used in this application is composed of several services, such as a Digital Imaging and Communications in Medicine (DICOM) explorer, a DICOM viewer, and a security service. Tests performed on this first TeNeCi release showed good results, and allowed us to explore a larger collaborative experimentation between hospitals in France and Switzerland.

Emergency Medical Services↗

PREFABRICATION DESIGN CONSIDERATIONS FOR A LONG-TERM ELECTRICALLY-ACTUATED ABDOMINAL LEFT VENTRICULAR ASSIST DEVICE (E-TYPE ALVAD).

The conceptual design and development of a long-term, low-profile intracorporeal left ventricular assist device is a multifaceted project involving a series of technical, anatomic and physiologic considerations. Patients with severe left ventricular failure refractory to all other forms of therapy could benefit from such a device. Prior to fabrication of such a blood pump, consideration must be given to physiologic parameters of the projected patient population. The pump must be designed to meet physiologic demands and yet conform to the anatomic constraints posed by the patient population. We measured the body surface area (BSA) of a group of patients (n=50) and found the mean BSA for this group to be 1.804 +/- 0.161 m(2). Using 25 ml/m(2) as a stroke volume index indicative of left ventricular failure and a stroke volume index of 45 ml/m(2) as normal, distributions of stroke volumes (normal and in left ventricular failure) were plotted for a potential population and demonstrated that 63% of the projected population can be returned to normal by a pump with a stroke volume >/= 83 ml. Cadaver fitting studies established that 73% of the potential population can accommodate an ALVAD 10.8 cm in diameter. In-vitro tests demonstrated that a pump stroke volume >/= 83 ml could be achieved by the proposed pump with a 15 mmHg filling pressure at rates up to 125 B/min. A pusher-plate stroke of 0.56 inches would be necessary to provide a stroke volume >/= 83 ml. The percent of the patient population that could be served was determined by excluding those in whom the pump would not fit or in whom it would provide less than a normal resting stroke volume. Approximately 73% of the projected patient population would accommodate this pump and be returned to normal circulatory dynamics.

Journal Article↗

Probing and overcoming a mould menace.

Thorough investigation of an environmental problem within Brockville General Hospital, Ontario, Canada, was vital. This special report is by William Roth, Chris Rahm and Bruce G. Fraser--all of Jacques Whitford Environment Limited. William Roth is the first point of contact for Jacques Whitford's hospital clients and is a project manager within the Environmental Engineering group of JWEL's Ottawa office. Chris Rahm is a member of the Hazardous Materials group in JWEL's Ottawa office and was the site supervisor for the mould abatement at BGH. Bruce Fraser is the corporate technical director of indoor air quality for JWEL and regularly provides technical assistance for mould related projects carried out by JWEL.

Air Microbiology↗

Availability of funds to provide health services in the Pacific Basin--HHS. Notice of availability of funds.

The Health Resources and Services Administration (HRSA) announces that up to $331,000 is available under section 301 of the Public Health Service (PHS) ACT 42 U.S.C. 241, for funding public and non-profit private entities for projects to build capacity and improve health services and systems, particularly preventive health services, in the Commonwealth of the Northern Mariana Islands, American Samoa, Guam, the Federated States of Micronesia, the Republic of the Marshall Islands and the Republic of Palau and to provide technical assistance relative to such projects. In recognition of the extent of funding available, these funds will be available only to continue activities currently receiving funds under the section 301 Pacific Initiative grant authority. HRSA will entertain applications from current grantees for supplemental grants to modify project activities, and from eligible organizations for competing continuation grant awards to extend project activities.

Financing, Government↗

Medicare program; payments to HMOs and CMPs and appeals: technical amendments--HCFA. Final rule with comment period.

This rule clarifies and updates portions of the HCFA regulations that pertain to payment for services furnished to Medicare enrollees by health maintenance organizations (HMOs) and competitive medical plans (CMPs); appeals by Medicare enrollees concerning payment for those services; and appeals by HMOs and CMPs with regard to their Medicare contracts. This rule completes the special project aimed at the total technical revision of part 417. Part 417 contains the regulations applicable to all prepaid health care organizations, that is, HMOs, CMPs, and health care prepayment plans (HCPPs). These are technical and editorial changes that do not affect the substance of the regulations. They are intended to make it easier to find particular provisions, to eliminate needless repetition and remove obsolete content, and to better ensure uniform understanding of the rules.

Centers for Medicare and Medicaid Services, U.S.↗

[Implantation of a videoconferencing system applied to nursing research and teaching environments].

Describes the trajectory followed by a research group at the Ribeirão Preto College of Nursing-USP to implant a research/teaching/continuous education project based on videoconferencing technology. The technical characteristics of the available systems are discussed, as well as the technological solution that was adopted in this project to attend to the needs of the academic and research environment as well as in the hospital context.

Education, Nursing↗