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Generalized Poisson distribution: the property of mixture of Poisson and comparison with negative binomial distribution.

We prove that the generalized Poisson distribution GP(theta, eta) (eta > or = 0) is a mixture of Poisson distributions; this is a new property for a distribution which is the topic of the book by Consul (1989). Because we find that the fits to count data of the generalized Poisson and negative binomial distributions are often similar, to understand their differences, we compare the probability mass functions and skewnesses of the generalized Poisson and negative binomial distributions with the first two moments fixed. They have slight differences in many situations, but their zero-inflated distributions, with masses at zero, means and variances fixed, can differ more. These probabilistic comparisons are helpful in selecting a better fitting distribution for modelling count data with long right tails. Through a real example of count data with large zero fraction, we illustrate how the generalized Poisson and negative binomial distributions as well as their zero-inflated distributions can be discriminated.

Binomial Distribution↗

[Restructuring of the specialized job market for people with disabilities through legislative reform of the Rehabilitation Act--consequences for the workshops for the disabled].

The legal basis for employment of people with disabilities in sheltered Workshops for the Disabled (Werkstätten für Behinderte, WfB) had hitherto been shaped by the 1961 Federal Social Assistance Act, the 1969 Employment Promotion Act, the 1974 Severely Disabled Persons Act with the related Workshop Ordinances of 1980 and 1996. The Act on Combating Unemployment of Severely Disabled Persons, effective as of Oct. 1, 2000 has now created a new legal foundation, which also is aimed at enhancing Workshop employees' horizontal mobility into the general job market, inter alia providing for access to Supported Employment arrangements and for availability of selective placement and support services (Integrationsfachdienste, IFD) throughout Germany. These Services also are intended as points of contact in the counselling of severely disabled school leavers in relation to placement opportunities in competitive jobs and/or integration projects or firms. Discussed from a legal perspective are the differences in sociolegal respects between such projects for severely disabled persons and employment in Workshops for the Disabled, as well as implications for the Workshops' own economic activity, also making reference to the forthcoming Book 9 of the Social Code.

Persons with Disabilities↗

Characteristics of a productive research environment: literature review.

What environmental factors stimulate and maintain research productivity? To answer this question, the authors conducted an extensive review of articles and books on research productivity published from the mid-1960s through 1990. This review revealed that a consistent set of 12 characteristics was found in research-conducive environments: (1) clear goals that serve a coordinating function, (2) research emphasis, (3) distinctive culture, (4) positive group climate, (5) assertive participative governance, (6) decentralized organization, (7) frequent communication, (8) accessible resources, particularly human, (9) sufficient size, age, and diversity of the research group, (10) appropriate rewards, (11) concentration on recruitment and selection, and (12) leadership with research expertise and skill in both initiating appropriate organizational structure and using participatory management practices. Some of these characteristics are not surprising, although some findings were unexpected, such as that participative governance correlated consistently with research productivity. The differential impact of each of these 12 characteristics is unclear. It is clear, however, that the leader has a disproportionate impact through his or her influence on all of the other characteristics. Yet, an overarching feature of these characteristics is their interdependency. These factors do not operate in research groups as isolated characteristics. Rather, they are like fine threads of a whole fabric: individual, yet when interwoven, providing a strong, supportive, and stimulating backdrop for the researcher. The authors conclude that while at a distance the productive research enterprise looks like a highly robust entity, upon closer inspection it is revealed to be a delicate structure highly dependent on the existence and effective working of numerous individual, organizational, and leadership characteristics.

Attitude↗

Home and hospital confinement in Newcastle upon Tyne, 1960 to 1969.

During the decade 1960 to 1969, perinatal mortality rates in Newcastle upon Tyne fell in parallel with national trends, in association with a marked reduction of domiciliary midwifery. Analysis of the records of women booked for confinement at home or in specialist hospitals showed that the reduction of mortality occurred with unexpected uniformity in both categories, in low risk as well as high risk patients, and in all causes of mortality except congenital malformations. It could not be attributed to improvements in maternal characteristics nor to increased size of babies at birth. The most probably explanation seems to be a combination of many improvements in the quality of care, with increased awareness of risks, better selection of high-risk groups, and improved supervision and management throughout. There is no indication that single factor in obstetric management, such as more intervention during labour, had a dominant effect.

Birth Weight↗

[Hospital morbidity statistics: the accuracy of the diagnosis reported in the discharge registry book].

BACKGROUND: The registry book of admission and discharges (RBD) is operative in most public and private hospitals of this country. Currently its reformation is contemplated, consisting in a modification of the minimal set of basic data and its computerization. The aim of the present study was to evaluate the accuracy of the discharge diagnosis recorded in the RBD and to analyze the possible factors implicated in the current quality level. METHODS: In a sample of 9 hospitals from the Seville province, 2,634 discharges were selected with a stratified sampling process which was proportional to the number of discharges in each stratum during 1985. The accuracy of the diagnosis recorded in the RBD was estimated by comparing it with that in the clinical record (CR). RESULTS: The accuracy indexes showed that, for the large diagnostic groups, only in 45% of discharges the diagnosis coincided in both documents. The accuracy increased to 89% when the estimation was made after excluding those discharges where the diagnosis was not recorded in the RBD and/or in the CR (n = 1303). CONCLUSIONS: The fulfillment of the RBD appears as the main error source, followed by the selection of the major diagnosis and its transcription in the different documents of the circuit. It is concluded that a precondition for the success of a reformed RBD is to guarantee the fulfillment of data.

Diagnosis↗

Training appropriate laboratory workers for rural health centres in Papua New Guinea.

Many rural health centres in developing countries continue to treat patients without the help of any laboratory tests. The result is often inaccurate diagnosis, wasteful use of multiple drugs, and increasing drug resistance of pathogens. It is unlikely that there will ever be sufficient funds to employ a full-time laboratory worker at each of the many small remote health centres in Papua New Guinea. It is also doubtful whether staff and health extension officers who run such centres have the appropriate knowledge to adequately utilize full-time laboratory personnel. It is feasible, however, to train selected health workers in courses of three to four months' duration to perform a few simple laboratory tests part-time, in addition to their clinical duties. Suitable tests are those where the result does not require skilled interpretation. For most such tests, the result is the diagnosis. After the clinical staff have received the laboratory diagnosis, they are free to decide whether it fits the clinical picture. If so, they can then find the appropriate treatment to prescribe in standard treatment books. The present paper describes the experience in setting up and operating laboratory training for health centre staff in Milne Bay Province, Papua New Guinea. Costs and initial results of the program are discussed.

Allied Health Personnel↗

Glaucoma admissions and surgery in public sector tertiary care hospitals in pakistan: results of a national study.

PURPOSE: To assess the annual number of glaucoma operations and admissions in the public sector tertiary care hospitals in Pakistan. METHODS: Eye departments in all 18 public tertiary care centers in the country were requested to provide data on the number of glaucoma operations and admissions during 1998. Of these, 13 hospitals agreed to participate. Eye departments' log books or patients' records were used to collect data retrospectively on the total number of eye admissions, the total number of glaucoma admissions, the type of glaucoma, and the total number and type of glaucoma operations. RESULTS: Glaucoma accounted for 8.1% (1,942/23,931) of all eye admissions. Open-angle glaucoma was responsible for 37.6% or 731 glaucoma admissions followed by secondary glaucoma (35.0%) and angle-closure glaucoma (18.2%). During 1998, 1,407 glaucoma-related operations were performed in the selected hospitals. The mean (+/-SD) and the median number of operations performed were 108.2 (+/-59.6) and 112 (range: 17-206), respectively. Trabeculectomies accounted for 1,043 (74.1 %) of all procedures. Their number ranged from 16 to 170 (median: 84) in the selected hospitals. CONCLUSIONS: We believe that the annual number of glaucoma operations performed in the public tertiary care hospitals in Pakistan is far less than required. In-depth research is therefore needed to explain if this is because of gaps in service provision or a genuine shift to medical management of glaucoma on an outpatient basis.

Filtering Surgery↗

[Prevalence rate and factors of myopia in preschool children].

PURPOSE: This study was aimed at providing basic data for developing a nursing intervention program which enables systematic and correct visual acuity care by discovering out visual acuity conditions, prevalence rate of myopia, and the factors related to myopia with Preschool children. METHOD: The subjects of this study consisted of 519 children between 3 and 6 years of age from 12 kindergartens in Seoul which were selected through multiple cluster sampling. Myopia was defined as the spherical equivalent (SE) of more than -0.5 diopters (D) in the right eye. The data was analyzed by t-test, chi(2)-test, ANOVA, and logistic regression by using the SAS program. RESULT: The prevalence rate of myopia was 8.7%. the odds ratio of child myopia when one parent had myopia was 2.2 times higher than when neither parent had myopia. The odds ratio of child myopia when reading more than three books per week was 0.27 times higher than reading less than three books. CONCLUSION: Myopia should be continuously and intensively managed from the age of 3.

Child↗

Methylphenidate selectively improves story retelling in children with attention deficit hyperactivity disorder.

OBJECTIVES: The goal of this study was to determine stimulant effects on story grammar, comprehension, and errors in the narratives of children with attention deficit hyperactivity disorder (ADHD) with and without comorbid language impairment. Previous research has demonstrated impairments in the narrative abilities of children with ADHD, but the effect of the primary treatment modality (methylphenidate) is unknown. METHODS: Fifty children with ADHD (7 to 12 years of age) were stratified for language impairment that might influence performance. In an acute, randomized, placebo-controlled crossover trial with two single doses (10 and 20 mg) of methylphenidate, the children listened to an audiotaped story while viewing a wordless picture book of the study, then retold the story and answered comprehension questions. The narratives were transcribed and coded for story grammar, length, and errors. RESULTS: Methylphenidate only increased children's reporting of the story characters' internal responses and attempts. It had no effect on story length or responses to comprehension questions. Responses to the factual questions were significantly more accurate than the inferential questions, irrespective of medication dose. Comorbid language impairment had no effect on performance or stimulant response. CONCLUSION: Story grammar analysis was sensitive to drug effects, which were subtle but specific and clinically meaningful. Results provide evidence for the theoretical linkage between internal responses and attempts.

Attention Deficit Disorder with Hyperactivity↗

Paper and whey as a feedstuff for ruminants.

Eleven papers were compared for absorption of whey and for digestibility in vitro. Papers were squared, ground, and soaked in whey for 1, 5, and 15 min and for 1, 6, 24, 48, and 72 h. Digestibility in vitro was determined on minimum and maximum whey absorption of each squared and ground paper sample. Whey absorption by squared papers increased with time. Ground samples absorbed more whey than squared ones and maximum quantities were absorbed with 1 to 5 min. Mean percent absorptions for ground telephone book covers, glossy magazines, computer cards, computer printout sheets, daily newsprint, telephone directory yellow pages, cardboard box, feedsacks, brown bags, telephone directory white pages, and coasters were: 31.0, 35.2, 35.4, 36.5, 43.9, 47.9, 51.0, 51.4, 51.7, 55.6, and 67.4. For seven papers, addition of whey increased digestibility. Four papers were either unchanged or decreased in digestibility. This depression of digestibility may have resulted from the high fat content of whey used. Based on in vitro digestibilities, we conclude that it is possible to recycle selected paper/whey combinations through ruminants.

Animal Feed↗

Functional role of VLA-1 (CD49A) in adhesion, cation-dependent spreading, and activation of cultured human T lymphocytes.

The functions of VLA-1 (CD49a, alpha 1 beta 1 integrin), a potential ECM protein receptor on activated human T lymphocytes in vivo, were investigated. Within a panel of 25 long-term cultured IL-2-dependent T cell lines, tau delta and CD8+ alpha beta cells expressed significantly higher levels of alpha 1 beta 1 than CD4+ alpha beta cells. While VLA-1-high tau delta or CD8+ cells adhered to plastic wells coated with collagen IV, collagen I, or fibronectin, moAb 1B3.1 to VLA-1 only inhibited the adherence to collagen IV. tau delta and CD8+ VLA-1-high T cells layered upon collagen IV in the presence of Mg2+ also spread elongated cytoplasmic extensions, which were abrogated by moAb 1B3.1. In contrast, spreading on fibronectin or spontaneous non-ECM-related spreading were not inhibited. Crosslinking of surface VLA-1 molecules with plastic-bound moAb 1B3.1 selectively induced expression of IL-2R on two of six VLA-1+ clones, both of which expressed tau delta TCR. Thus, CD49a is a specific collagen IV receptor in VLA-1-high tau delta and CD8+ alpha beta cells and can transmit signals to these lymphocytes to spread and express IL-2R.

Antibodies, Monoclonal↗

Ambulance services. Get your kit off.

An ambulance trust with a deficit of 1 m Pounds in 2000 and poor response times has balanced its books and exceeded response-time targets. A hierarchical, military culture has been changed into a more participative one. Union representatives now sit on the interviewing board for management jobs. These changes have allowed the trust to become more integrated with the NHS as a whole.

Ambulances↗

Are Darwinian principles now extinct?

Darwin's theory of evolution is one book long, and contrary to popular representation The Origin of Species nowhere contains a succinct statement of the theory. To avoid fundamental misunderstandings, any critique of this hypothesis has to commence with what the writer understands to be the fundamental premise on which the theory is based. The essence of Darwin's theory is that there is a struggle for existence: organisms possess stable patterns of inheritance, but can develop occasional variations that interact with the environment. Those organism possessing fitter variations are naturally and specifically selected for a greater chance of surviving in order to reproduce so that, over several generations, gradual but cumulative natural selection 'filters out' the less advantageous variations of the ancestral organisms. As a consequence, new species (descendants that could only breed amongst themselves) develop.

Biological Evolution↗

Monitoring trends in waiting periods in Canada for elective surgery: validation of a method using administrative data.

BACKGROUND: Provincial governments require timely, economical methods to monitor surgical waiting periods. Although use of prospective procedure-specific registers would be the ideal method, a less elaborate system has been proposed that is based on physician billing data. This study assessed the validity of using the date of the last service billed prior to surgery as a proxy for the beginning of the post-referral, pre-surgical waiting period. METHOD: We examined charts for 31,824 elective surgical encounters between 1992 and 1996 at an Ontario teaching hospital. The date of the last service before surgery (the last billing date) was compared with the date of the consultant's letter indicating a decision to book surgery (i.e., to begin waiting). RESULTS: Several surgical specialties (but excluding cardiac, orthopedic and gynecologic) had a close correlation between the dates of the last pre-surgery visit and those of the actual decision to place the patient on the waiting list. Similar results were found for 12 of 15 individually studied procedures, including some orthopedic and gynecological procedures. CONCLUSION: Used judiciously, billing data is a timely, inexpensive and generally accurate method by which provincial governments could monitor trends in waiting times for appropriately selected surgical procedures.

Analysis of Variance↗

Selected reference aids for small medical libraries.

This annotated list of 178 items is compiled as a guide to the development of the reference collection in a small medical library.Arrangement, following the pattern of the previous revision, is by broad subject groups. Titles are chiefly in English. Textbooks in subject fields have been omitted since these are covered adequately in several comprehensive guides to the literature.

Libraries, Medical↗

Stressors in five client populations: Neuman systems model-based literature review.

AIM: This paper reports a literature review identifying and categorizing client system stressors in Neuman systems model-based studies. BACKGROUND: To date, literature reviews related to the Neuman systems model have focused broadly on all concepts of the model. The concept of stressors has been selected by the Neuman Systems Model Research Institute as the focus for an initial collaborative research project. METHOD: Cooper's five-stage integrative review method was used: problem formulation, data collection, data evaluation, analysis and interpretation, and dissemination. The Neuman systems model research literature from 1983 to February 2005 was searched using Fawcett's Neuman systems model bibliography and a follow-up review of the CINAHL database using the keywords 'Neuman systems model' and 'stressors'. A total of 87 studies published as journal articles or book chapters between 1983 and 2005 were reviewed; 13 of the 87 studies met the definition of 'stressor studies'. FINDINGS: Stressors were identified in five client populations: caregivers, cancer survivors, ICU patients in intensive care units, care receivers, and parents whose children were undergoing day surgery. The most common data collection method was the interview, and investigator-developed interview guides were most often used. Evidence of categorization of intra-, inter- and extra-personal stressors was present. The following overall stressors were identified: burden of responsibility (caregivers); awareness of vulnerability (cancer survivors); being overwhelmed (patients in intensive care units); loss of control (parents); and frustration with role changes (care receivers). CONCLUSIONS: These data could form the basis for nursing practice as well as future research within a collaborative environment. Given the existing body of knowledge concerning Neuman system model-derived middle range theory concepts in the caregiver population, the middle-range theory of caregiver role strain could be tested empirically.

Caregivers↗

Health sciences librarians and mental health laws.

Two U.S. Supreme Court decisions, O'Connor v. Donaldson and Bounds v. Smith, hold important implications for health sciences librarians serving in mental health facilities. The first, O'Connor, with its many ancillary holdings, puts mental health personnel on notice that patients have certain basic rights, which courts all over the country will now be required to enforce. In Bounds the court has ruled that prison authorities must assist prison inmates in preparing and filing legal papers. The ruling will most likely benefit all mentally disabled prisoners, and future litigation may expand this category to include: (1) persons committed under the criminal code, (2) persons under involuntary commitment not related to the criminal code, and (3) persons voluntarily committed. A selective annotated bibliography, consisting of background readings in mental health and the law, basic rights, law library materials, and mental health legal services, has been compiled to help librarians establish and develop legal collections in anticipation of court decisions that will expand the conditions of Bounds to include all mentally disabled patients.

Bibliographies as Topic↗

Face lift postoperative recovery.

The purpose of this paper is to describe what I have studied and experienced, mainly regarding the control and prediction of the postoperative edema; how to achieve an agreeable recovery and give positive support to the patient, who in turn will receive pleasant sensations that neutralize the negative consequences of the surgery.After the skin is lifted, the drainage flow to the flaps is reversed abruptly toward the medial part of the face, where the flap bases are located. The thickness and extension of the flap determines the magnitude of the post-op edema, which is also augmented by medial surgeries (blepharo, rhino) whose trauma obstruct their natural drainage, increasing the congestion and edema. To study the lymphatic drainage, the day before an extended face lift (FL) a woman was infiltrated in the cheek skin with lynfofast (solution of tecmesio) and the absorption was observed by gamma camera. Seven days after the FL she underwent the same study; we observed no absorption by the lymphatic, concluding that a week after surgery, the lymphatic network was still damaged. To study the venous return during surgery, a fine catheter was introduced into the external jugular vein up to the mandibular border to measure the peripheral pressure. Following platysma plication the pressure rose, and again after a simple bandage, but with an elastic bandage it increased even further, diminishing considerably when it was released. Hence, platysma plication and the elastic bandage on the neck augment the venous congestion of the face. There are diseases that produce and can prolong the surgical edema: cardiac, hepatic, and renal insufficiencies, hypothyroidism, malnutrition, etc. According to these factors, the post-op edema can be predicted, the surgeon can choose between a wide dissection or a medial surgery, depending on the social or employment compromises the patient has, or the patient must accept a prolonged recovery if a complex surgery is necessary. Operative measures which prevent extensive edemas are: avoiding transection of the temporal pedicle, or to realizing platysma plication too tight by using strong aspirative drainage instead of elastic bandages. In the post-op, the manual lymphatic drainage is initiated on the third or fifth day, but must be done by a trained professional, in a method contrary to that specified in the books for non-operated individuals. An aesthetician washes the hair and applies decongestive cold tea on the face the second day, and on the fifth, moisturizes the skin and cosmetically conceals any signs of bruising. The psychological support provided by the staff keeps the patient calm and relaxed. Five years experience with this protocol has enabled us to minimize post-op pain. The edema can be predicted with certain consistency (in which surgery there will be more or less edema) and the proper technique can be selected, permitting the patient to choose the best moment for a FL while the surgeon can avoid intra and postoperative measures that increase the edema. After surgery, the patient receives the daily assistance of the staff, which rapidly and efficiently improves this condition. We can predict and control the post-op recovery and the patient feels fine, unlike the past when recovery was abandoned to its natural evolution. If the patient perceived an intensive, positive support on behalf of the entire staff that kept him or her content, then we have succeeded in doing an excellent marketing. This may encourage others to undergo aesthetic surgery, especially those who are convinced that after surgery they might have to endure considerable suffering.

Edema↗