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This article presented an overview of the available alternatives to homologous blood transfusion. Each of these alternatives will be examined in depth in subsequent articles of this issue. The recurrent themes of conservatism and recycling of one's own blood will be emphasized throughout the text by the various authors. Emerging technologies and techniques, and their potential influence on transfusion therapy will be evaluated.
The thoracic outlet syndrome (TOS) is a highly controversial concept. The incidence of TOS is high in the United States, essentially unknown in Australia and seldom diagnosed in Great Britain. In spite of the skepticism in the recent medical literature many patients are still surgically treated with resection of the first rib for a symptom complex diagnosed as TOS. Resection of the first rib is the most extensively used surgical approach in the treatment of TOS. This operation gives a good result in 24% to 100% of the patients. The reasons for this huge variation are considered to be related to difficulties in patient selection, variable examination procedures, operative techniques and a lack of proper follow-up. The goal of this review is to bring forth the diverging results after first rib resection for TOS and to pinpoint the importance of further studies concerning the possible functional disturbance of the thoracic outlet in these patients. Conservatism is encouraged.
Conservation of energy suggests that during cycling the constrained lower extremity is capable of delivering energy to the bicycle without expending energy to move the limbs. The purpose of this study was to characterize the management of mechanical energy during cycling and, specifically, to evaluate the potential for system energetic conservatism. Mechanical energy contributions derived from lower extremity energy sources were computed for 12 experienced male cyclists riding at five combinations of cadence and power output. The knee joint dominated (> 50%) in contributing to system energy and a moderate amount of energy was derived from hip joint reaction forces (> 6%). Energy generations and dissipations at the sources were sensitive to power output and, within the range of conditions studied, insensitive to cadence. Two energy models estimated mechanical energy expenditure under hypothetical single-joint and multijoint muscle operating conditions. When multijoint muscles were incorporated into the energy management analysis, a significant reduction in mechanical work relative to the single-joint muscle operation occurred. Energy savings associated with multijoint muscle energy transfers were enhanced at higher bicycle power levels, suggesting that conservation of mechanical energy is plausible given appropriate actions of two-joint muscles.
The 708- and 769-bp fragments from alfalfa and cotton containing the 3'-end of the 18S gene, the internal transcribed spacer. 1 (ITS1) the 5.8S gene, ITS2, and the 5'-end of the 28S gene were obtained using primers to the 18S and 28S ends of rDNA from tomato by a polymerase chain reaction. These sequences were cloned into pTZ19R. The 5.8S rDNA, ITS1 and ITS2 nucleotide sequences of alfalfa and cotton were determined. Comparative analysis of nucleotide sequences of alfalfa and cotton showed large hypervariability of spacer regions and conservatism of 5.8S rDNA sequence.
We argue that the abortion controversy has one major source--religion--and two less important ones--attitudes towards sexual permissiveness and women's employment. Traditional Christianity promotes opposition to abortion using three distinct modes of moral reasoning: through deductive moral reasoning, by the Christian world view's implication that abortion violates the sanctity of life and is a rebellion against God's design; through authoritative moral reasoning by appeal to Catholic dogma; and through consequentialist moral reasoning, as a means of control over sexuality and as a means of confining women's activities to the home. Even aside from Christian belief, adherence to traditional morality promotes opposition to abortion on these consequentialist grounds. We posit a model in which religious belief, anti-feminism, sexual permissiveness, and attitudes towards abortion are distinct concepts (a four-factor model) rather than all simply aspects of a single conservatism factor. We develop reliable, multiple item attitude scales; show that our four-factor model fits the data much better than the one-factor alternative; and test our hypotheses on new data from a large, representative national sample of Australia (N = 4540). Using maximum likelihood structural equation methods, we find that deductive reasoning from Christian belief is the most important source of opposition to abortion, with strong effects both direct and indirect. Exposure to the authority of the Catholic hierarchy is a real but weaker source of opposition. Consequentialist reasoning from traditional moral views on sex--partly buttressed by religion, partly independent of it--is also influential. But views on women's employment matter only a little, contrary to received wisdom.
Localization of genes GALA, G6PD, HPRT and PGK on X-chromosome of Microtus subarvalis has been proved. Using the radiation hybrid mapping technique of Goss and Harris, the order of these genes for two species M. subarvalis and M. Kirgisorum was established. Statistical methods (program package RHMAP) result in the only gene order PKG--HPRT--G6PD--GALA for M. subarvalis. The same order was found to be the most probable for M. kirgisorum. Relative distances between these genes in two species appeared to be practically equal. A conservatism of a linear order of the X-linked genes in various mammalian taxons is discussed.
This paper presents the results of a survey on premarital sex conducted in 1988. The study focused on what respondents considered proper sexual behavior, what they reported they did, and what they thought others were doing at five stages of dating. Respondents were asked about cohabitation, the effect of AIDS on their premarital attitudes and behavior, and their views regarding the morality of premarital sex. When compared to the results of a similar study conducted in 1983, the data provided some evidence of change in premarital sexual attitudes and behavior. Female respondents in the 1988 sample showed lower levels of sexual intercourse at all five dating stages than did their counterparts in the 1983 study. However, males in the 1988 sample reported higher levels of sexual intercourse for the first four stages of dating than did males in the 1983 survey. In general, both males and females in the 1988 sample reported changing their attitudes and behavior regarding premarital sex in the direction of greater conservatism since hearing about AIDS. Attitudinal change was more widespread than actual behavioral change.
1. Today, cosmetic extended wear lenses have numerous aliases; continuous wear, provisional extended wear, and flexible wear, all referring to the same products, but on a relative scale of wearing time. Cosmetic extended wear lenses are elective and differ from the medical necessity of extended wear that few patients require. Refractive surgery has made significant advances in the cosmetic extended wear lens market. 2. Despite growing conservatism, positive marketing kept growing the EW philosophy for almost a decade until the FDA laid down some new rules, including a 1-week maximum for overnight wear. Coincidentally, this mandate came with the advent of the disposable lens in 1989. Since then, 1-week EW with disposable contacts has proved to be a safer modality for cosmetic EW; however, the concern of corneal complications continues to decline the market. 3. Patients risk a microbial ulcerative keratitis secondary to cosmetic EW. If daily wear contact lens options or occasional part-time EW is not amenable to the patient, refer the patient to an experienced refractive surgeon. Today, patients have more healthful vision choices than ever before.
One hundred and twelve patients with penetrating abdominal injuries seen at the Kingston Public Hospital, Jamaica, over a twelve month period from January 1 to December 31, 1992 were reviewed. Seventy-five (67%) patients had stab wounds and thirty-seven (33%) sustained gunshot wounds. There were 10 deaths (27%) from gunshot wounds, and seven deaths (9%) due to stab wounds. Using a protocol of selective conservatism for stab wounds, 41 (60%) were observed, 27 (40%) explored and 5 (12%) patients had negative laparotomy. The male to female ratio was 10:1 with 88% in the age group 16-35 years. A decision to perform laparotomy was based entirely on clinical diagnosis of peritonitis. In gunshot wounds a policy of mandatory laparotomy was used and is recommended.
Between January 1989 and December 1992 a total of 102 patients (88 pc male and 12 pc female) were treated for stab wounds at Mpilo Central Hospital, Bulawayo, Zimbabwe. The case records of these patients have been studied retrospectively. The mean age of the patients was 30 years (Standard Deviation 9). Most of the patients, 82 pc (82/102) were residents of the city of Bulawayo with only 18 pc (18/102) coming from rural areas. The mean delay in presentation was 12 hours (SD 11). A knife was the stabbing instrument in most cases (82 pc). Fights, 38 pc (26/68), domestic disputes, 26 pc (18/68) and robbery 21 pc (14/68) were the commonest motives for stabbing. In most cases stabbing occurred in a beer hall, 47 pc (26/55) and at home, 31 pc (17/55). The majority of stab wounds occurred in the chest, 51 pc followed by the abdomen, 31 pc. Of the patients with stab wounds of the chest 22 pc (14/65) required intercostal chest drains. Of the 39 patients with stab wounds of the abdomen 20 patients were subjected to laparotomy. No abnormality was found at operation in 50 pc (10/20) of cases. No major complications or mortality were recorded in this series. Based on the findings in this study, there is need for us to adopt a more conservative approach to the management of stab wounds, especially those involving the abdomen. This policy of "selective conservatism" should be based on a thorough physical examination and appropriate special investigations. Active surgical intervention should be reserved for specific indications.
Domains differing in the degree of evolutionary conservatism were revealed within the 17S ribosomal DNA (rDNA) sequence from Tetrahymena pyriformis by means of computer analysis. The method proposed allows evolution of rDNA structure to be studied in eukaryotes. Superconservative regions revealed within the DNA sequence tested can be used to construct universal primers for studying rDNA structure in various taxa by means of polymerase chain reaction (PCR).
State-of-the-art prospective quality-control systems entail the use of medically relevant, analyte-specific quality control limits. With analyte-specific limits broader than those generally used in the clinical laboratory, there will be fewer false rejections, fewer unnecessary reanalyses, and shorter delays in run reporting. If the analyte-specific limits are narrower than those used in the laboratory, more errors will be detected, but the user is at risk of identifying errors over which s/he and the manufacturer have little control. The use of various patient data quality-control algorithms is described. Conservatism is stressed in adopting manufacturers' guidelines for surrogate, nondestructive quality-control testing. A simple, optimized approach is suggested for the systematic retrospective review of proficiency data. Finally, an approach is presented for converting from older, previously accepted quality control procedures to more efficient analyte-specific quality control.
An overview of the spectrum and natural history of fibrous dysplasia is an essential prerequisite of management. Current medical interest has focused upon the intriguing pathogenesis of the bone lesions, the endocrinopathies, the cutaneous pigmentation, and malignant transformation. The mundane aspects of diagnosis and the complications of a soft bone disorder reside with the clinical orthopedist. Diagnosis is straightforward with the aid of biopsy. Conservatism in the surgical treatment of monostotic lesions and experience in the care of fractures and deformity in polyostotic fibrous dysplasia constitute the lessons learned in a series of over 50 patients with fibrous dysplasia.
INTRODUCTION: The history of disqualified (DQ) subjects from 1973-1993 at Armstrong Laboratory, Wright Patterson AFB, is presented for both sustained and impact acceleration panels. METHODS: Candidate and subject medical records were reviewed for screening results, recommendation for panel duty, and any follow-up medical findings. The generation and interpretation of the medical screening criteria and DQ rates are discussed. MEDICAL SCREENING CRITERIA: The mechanisms for change, those factors influencing change, and the interpretation of the screening criteria for Armstrong Laboratory's acceleration panels determine the panel's composition, which is reflected in the DQ rates. RESULTS: The centrifuge had a 5% (7/132) disqualification (DQ) rate from 1973-93 with 29% (2/7) due to musculoskeletal and 71% (5/7) for medical reasons. All were DQ during 1973-88. The impact panel had a DQ rate of 18% (36/195) with 71% (24/34) DQ due to musculoskeletal and 29% (10/34) for medical reasons. Only 28% (10/36) were DQ during 1973-88, while during 1989-93, 72% (26/36) were DQ. CONCLUSIONS: The differences in DQ rates between the centrifuge and impact facility were due to the variability or conservatism of individual physicians, interpretation of the medical screening criteria, and the type of research being done. These factors effect the composition of the human subject panels. This determines to which target population the research data can be applied. If the subjects do not represent pilots due to inappropriate screening, then there is no benefit from the research and, therefore, there can be no risk incurred by the subjects.
Endoscopic management of a variety of benign and malignant biliary tract diseases is now a well-established alternative to surgery. Similar techniques are now applied to the pancreas and are being used in the setting of acute pancreatitis, chronic pancreatitis, complications of pancreatitis, and pancreas divisum. This review analyzes the current state of the art of these exciting applications of endoscopy. Selection of appropriate candidates for the various treatment modalities appears important for optimal results of therapy. However, definite recommendations are difficult to make because there are limited controlled studies, follow-up in most series is brief, and there are no comparison studies of endoscopic versus surgical therapy. At present, careful case selection and conservatism are the appropriate general rule in these therapeutic endeavors. Further prospective random studies are awaited.
Karyotypes of two species of genus Tachyoryctes from four localities in the Bale Mountains National Park, Ethiopia, were analyzed. T. splendens has 2n = 48, NFa = 65-86. Variations of the autosome arm number are determined by different numbers of autosomes with additional heterochromatin arms (7-17). Karyological analysis indicated that the cytogenetic structures of T. splendens from the localities studied was unique, which might result from formation of the karyotypes optimal for the given habitats. T. macrocephalus has 2n = 50, NFa = 62. A high conservatism of the number and size of C-positive heterochromatin blocks reflects the extreme specialization of T. macrocephalus endemic for the Bale province and occupying a limited ecological niche. Homology of G-banding patterns of several chromosomes and chromosome arms demonstrated that karyotypes of T. splendens and T. macrocephalus were formed from the common ancestral karyotype through different rearrangements in some chromosomes.
OBJECTIVES: To describe the personality traits and value systems of the population of residents in anesthesiology of a province in Andalusia and to analyze what the ideal profile of an anesthesiologist in training would be. SUBJECTS AND METHOD: Forty-four residents in anesthesiology were invited to participate, of whom 22 accepted. The participants voluntarily completed anonymous written questionnaires with 232 items: the sixteen personality factors questionnaire, form A (R.B. Cattell), and the survey of interpersonal values (L.V. Gordon). RESULTS: The residents scored high on primary factors of intelligence (B), self-sufficiency (Q2) and conservatism (Q1). High scores were also recorded on the secondary factors of anxiety (QI) and socialization (QIII); low scores were seen for independence (QIV). Four theoretical personality models (alpha, beta, gamma and delta) were established based on the data. Four residents were alphas (18%), 10 were betas (45%), 6 were gammas (27%) and 2 were deltas (10%). CONCLUSIONS: An ideal personal profile for residents in anesthesiology by American authors has been available since the 1960s. An ideal resident should be independent, calm, aware, stable, secure, self-disciplined and alert; moreover, he or she should enjoy team work. The residents with alpha personalities were ideal. At present, the training of residents and the selection criteria for access to specialized training based on a personality test are scarcely valued in our discipline.
We propose a group sequential method based on the sequential conditional probability ratio test and show that it has the conservatism desired in practice. We also propose calculating the discordant probability, that is, the probability that the sequential test concludes differently from a fixed-sample test at the planned end of the trial, recognizing that this probability could be substantial, even if the sequential test has the same size and power as the fixed-sample size test at the planned end of the study. In addition, we show that the proposed method can be used as a stochastic curtailing tool. Thus, the method accommodates unplanned interim analyses as well as those deemed necessary based on data trends, virtually without inflating the type I error, but it is less conservative than the usual stochastic curtailing. The method is implemented through an interactive computer program.