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PubMed2003

[Analysis of TSH screening results of 42,979 newborns in Zhejiang Province].

OBJECTIVE: Document the prevalence of congenital hypothyroidism in Zhejiang Province, by neonatal screening of TSH. METHODS: DELFIA neonatal TSH kit was applied for the quantitative determination of thyrotropin in blood specimens dried on filter paper. RESULT: Among the 42 979 newborns, 112 had elevated hTSH concentration in blood. All had T3, T4 and TSH concentrations measured in serum and 29 were diagnosed as congenital hypothyroidism. The diagnosis time was 13 to 59 days and mean time was (27.9+/-9.2) days. CONCLUSION: The incidence of congenital hypothyroidism in Zhejiang Province is not low. The TSH screening in newborns is significant in eugenics and the improvement of population quality.

Congenital Hypothyroidism↗
PubMed2000

Introduction. Time and medicine.

Although historians work with the record of events in public time, they have not developed an explicit understanding of lived time. To set the stage for the other essays in this issue of Annals, this introductory essay explores how an understanding of lived or "private" time began to emerge in the early 20th century in the works of that era's major thinkers: Henri Bergson's philosophy of duration, Emile Durkheim's social time, Sigmund Freud's five psychoanalytic temporal narratives, and Eugene Minkowski's exploration of lived time. This essay then considers the reaction against the burden of history that began with the great 19th-century historicizers: Comte, Hegel, Marx, Darwin, and Spencer. It reflects on the effort, beginning in those years, of modern artists and intellectuals to focus on the personal past in place of the overbearing burden of the historical past. New ways of experiencing the present, made possible by new communication technologies, including the telephone and telegraph, have centered on the experience of simultaneity. Norbert Wiener's cybernetics, Marshall McLuhan's globalism, and the Internet have further transformed how both the medical and lay communities experience past, present, and future, as well as near and far. The discussion concludes with consideration of Eurotransplant, an Internet-based information and action network used by physicians to coordinate organ transplantation; it is a system that integrates cybernetics, globalism, and the Internet in an everyday, real drama of the electronic age of simultaneity.

Cybernetics↗
PubMedDate not supplied

Ethical issues at the start of life.

In this article the fundamentals of a Jewish ethic are set out, through which today's pressing medical ethical questions are then broached. Ethics derive from a basic view of humanity. The Bible teaches that man is created in God's image, and every life is therefore sacrosanct. Second, since life is God-given we are its guarantors, not its owners. Finally, monotheism sees God as above nature and not in it, so nature itself is not holy--man can, and indeed should, try to improve upon it. With reference to specific medical issues, the need to be wary of the erosion of the family unit and of personal identity is stressed. Concerning abortion and stem cell research, the point is made that an embryo is not a person but is a potentiality and therefore not an object to be used. Regarding genetic intervention, a line is drawn between the therapeutic and the eugenic. Every technology carries with it the possibility of diminishing or enhancing human dignity. What matters is how we use it. The way to use it is in a covenant with God, honouring his image that is mankind.

Ethics↗
PubMed1983

[Pre-verbality in focusing and the need for self check. An attempt at "focusing check"].

Though the Focusing process is not entirely non-verbal, in Focusing, careful attention is paid by the Focuser and the Listener to the pre-verbal experiential process. In other words, Focusing involves attending to the felt sense that is not easily expressed in words immediately. Hence, during the process of learning to Focus, the Focusing teacher attempts to communicate the experiences of Focusing to the student which are not easily done by words. Due to such difficulties, the Focusing student may (and quite frequently does) mistake the experiential process in Focusing with other processes. Often, the felt sense can be confused with other phenomena such as "autogenic discharge". Also the Focuser may not stay with the felt sense and drift into "free association" or frequently, certain processes in "meditation" can be confused with Focusing. Therefore, there is a need for a "check" by which the Focusing student can confirm the Focusing experience for himself. For the Focusing student, such a "check" serves not only to confirm the Focusing process, but also an aid to learning Focusing. We will report here a "Focusing Check" which we developed by translating Eugene Gendlin's "Focusing Check" and making several modifications in it so that it will be more understandable to the Japanese. Along with the "Focusing Check" we developed, the authors discuss the need for such a check.

Attention↗
PubMed1999

Fluorescent labeling of blood cells for evaluation of retinal and choroidal circulation.

BACKGROUND AND OBJECTIVE: To develop a method of staining and tracking cells in vivo with a scanning laser ophthalmoscope (SLO) to evaluate the retinal and choroidal circulations. MATERIALS AND METHODS: Twelve pigmented male rats were used. Staining of leukocytes. Two commercially available nucleic acid stains SYTO 16 and SYTO 59 (Molecular Probes, Eugene, OR) were used to stain leukocytes. Blood (0.5 mL) was withdrawn from the subject animal and placed in a heparinized tube to which phosphate buffered solution was added (1.0 mL buffer/0.5 mL blood). Ten microliters of solution of SYTO 16 or SYTO 59 in alcohol (5 mM) was added. Staining of Erythrocytes. The lipophilic carbocyanine dye indocarbocyanine (D-307, Molecular Probes) was used to stain erythrocytes. Blood (0.1 mL) was withdrawn from the subject and handled as above; plasma and leukocytes were removed with a pipette. HEPES buffer was added to the remaining erythrocytes (1.4 mL buffer added to 0.1 mL blood). Ten microliters of D-307 in alcohol (5 mM) was added to the 1.5 mL buffered blood. The final concentration of dyes in the buffered blood mixtures was 0.03 mM. The stained cells were injected intravenously in the subject animal. The eyes were observed with SLO; the resident helium-neon laser was used to excite the SYTO 59 and the resident argon laser for SYTO 16. The He-Ne laser was used to excite the D-307-stained erythrocytes. RESULTS: The movement of the leukocytes and erythrocytes in the retinal and choroidal vessels was clearly distinguishable from the surrounding tissue. CONCLUSION: By selecting different dyes for staining leukocytes or erythrocytes and choosing appropriate laser wavelengths, the hemodynamics of blood cells can be observed and evaluated in the retina and choroid.

Affinity Labels↗
PubMedDate not supplied

Health care administrator: heal thy organizational self.

Many problems in today's group practice marketplace exist because organizations are confused about what constitutes the "business" side of health care in relationship to its philanthropic past. Eugene Dawson Jr., Ph.D., examines some of these problem conditions and offers suggestions on coping with the changing environment.

Administrative Personnel↗
PubMed1993

Network unites payers, physicians, hospitals. System participants work together to improve access to care and to design cost-saving incentives.

Through Sacred Heart Health System (SHHS), Eugene, OR, physicians, payers, and hospitals are designing a network that will integrate care and improve access by reducing healthcare costs. Together, system members design cost-saving incentives and the products the system offers the community. They promote managed care as the most efficient means to coordinate care and reduce costs. All participants share in the risks of a capitated payment system. Since the system pulled together the payers, physician groups, and hospitals, many of these entities' management functions were consolidated at the system level to avoid duplication and reduce administrative costs. Bringing in physicians was the most difficult yet important aspect of forming a successful network. Working with two physician groups in the community, the system's sponsor-the Sisters of St. Joseph of Peace, Health and Hospital Services-developed the Physician Practice Board. The board, representing 300 physicians, meets weekly and makes recommendations on issues that affect physicians. SHHS also added innovative new functions such as an integrated medical cost management and continuous quality improvement program. Another key to success is a clinically oriented information system, which will allow the system to track patients once they leave the hospital. It also will provide a better understanding of what things have an impact on outcomes and will reduce paperwork. A portion of the system's revenue is designated for initiatives to improve access. And the system recently appointed a tack force on access to explore what they can do in cooperation with others in the community.

Capitation Fee↗
PubMed1997

Tracking capitation: necessary for success.

Eugene Hoekendorf's column explores the range of new information-gathering needs a PHO, IPA, or medical group must consider under capitation and what kinds of internal systems need to be put in place to manage the contract. This is the second of two parts. The first part, which discussed core competencies, ran in the July issue.

Capitation Fee↗
PubMed1998

Nitric oxide synthase and the acetylcholine receptor in the prefrontal cortex: metasynaptic organization of the brain.

Nitric oxide synthase (NOS) and the nicotinic acetylcholine receptor (nAChR) immunoreactivity of the cerebral cortex was studied in adult Macaca fascicularis monkeys at light- and electron microscopic levels. NOS was located by means of the polyclonal antibodies developed by Transduction Laboratories (Lexington, KY, USA), as primary serum, in a dilution of 1:1000, and nAChR was located by means of biotinylated alpha-bungarotoxin (BTX) obtained from Molecular probes (Eugene, Oregon, USA) in a dilution of 1:2000. While endothelial eNOS outlined blood vessels in the brain, brain-derived (neural) bNOS labelled three well-defined cell types in area 46 of the prefrontal cortex, viz. (a) bipolar cells, scattered through layers III to V, equipped with long dendrites which pass over the thickness of the cortex in a right angle to the pial surface, establishing dendritic bundles closely reminiscent of a columnar organization; (b) large multipolar cells, located mainly in layers V and VI, with axons which interconnect dendritic bundles of the bipolar cells and establish synapses with dendritic shafts and spines of the former; and (c) stellate cells, located in lamina II and III, which establish an axonal network in lamina zonalis (lamina I). This arrangement is most characteristic in area 46 of the prefrontal cortex; areas 10 and 12 display similar features. In contrast, the primary visual cortex (area 17), is lacking any sign of columnar organization. Localization of bNOS immunoreactivity is at marked variance to that of NADPH-diaphorase which labels large pyramidal cells in the primate cortex. Binding of alpha-bungarotoxin (BTX) which labels the alpha 7 subunit of nAChR is located in somata, dendrites and axons of interneurons scattered over the entire width of the prefrontal cortex; on the other hand, the monoclonal antibody mAb 35 which labels subunits alpha 1, alpha 3 and alpha 5 in the main immunogenic region of the receptor, visualizes apical dendritic shafts similar to those like bNOS. Strategic localization of bNOS in the primate prefrontal cortex fulfills criteria of producing a freely diffusing retrograde messenger molecule operative in signal transduction routes subserving topography and columnar organization of the cortex, as well as long-term potentiation and long-term depression phenomena underlying mnemonic and gnostic functions. Common occurrence of bNOS and nAChR in identical or similar structures in the prefrontal cortex suggests that interactions between nitrogen oxide and presynaptically released acetylcholine might be involved in the metasynaptic organization of the cerebral cortex, operating in a non-synaptic manner in maintaining optimal performance on cognitive tasks.

Animals↗
PubMed1998

[Infertility and some of its psychosocial aspects].

The paper gives account of several psychosocial aspects of infertility. Firstly, the author deals with a fact that infertility impede the desire to produce a child and the socially created need to become a parent. The M. Hunter's model of biopsychosocial aspects of reproductive problems is used as a framework for analysing the complexity of factors which influence single person's reactions to infertility and its treatment. Secondly, the authors gives a summary of feminist critique of reproductive technologies. These technologies are widely used and accepted as a way to overcome infertility, but they create some additional problems. These problems are discussed using four types of arguments: anti-biological, anti-medical, eugenic and those considering women's reactions to reproductive technologies. All of these arguments are based on feminist publications. Thirdly, the author discusses the similarities and differences in male and female reactions to infertility. It is argued that two tendencies are observed while reactions to infertility are researched: the first is see those reactions as entirely different while the second is to see them as very similar. These controversy can be explained on the ground of different research methodology, the notion of infertile persons as a homogeneous group, the lack of proper theoretical model to contain all aspects of gender differences in reactions to infertility.

Female↗
PubMed1976

[Genetic counselling. I. Definition and present status (author's transl)].

Genetic counselling is a medical action which must be carried out by a M.D. specialized in genetics. Genetic counselling is peculiar in that couples rather than individuals are involved. Furthermore it is not concerned with the health of the consultants but with that of their expected children. Genetic counselling is not restricted to the statistical estimation of a risk; it raises important problems of psychology and behaviour. Finally, eugenic considerations about the diffusion of deleterious genes should not be taken into account in genetic counselling, which is given in the interest of individuals, not of the society. The increasing demand for genetic counselling is due to the change of the reproductive pattern. People do not want only to fix the size of their family, but also to avoid any accident of procreation.

Family Planning Services↗
PubMed1998

Molecular diseases and diseased molecules: ontological and epistemological dimensions.

In 1949, Linus Pauling and collaborators published in Science a paper provocatively titled: 'Sickle cell anemia, a molecular disease'. What was actually meant by 'molecular disease'? We interpret the concept of molecular disease in the frame of the traditional positions about the nature of diseases, the ontological and the physiological positions. We conclude that the physiological does not give an adequate account of what molecular diseases are. The ontological position, when correctly reinterpreted, leads to an understanding of molecular diseases where the macromolecule is seen as a symptom or as a part of a mechanism leading to the symptoms of the disease. We then show that the concept of molecular disease leads to a particular view of therapy, emphasizing eugenics as a way of eliminating disease. On the individual level, this concept leads to an increased power of diagnosis, and especially predictive diagnosis, but has little therapeutic consequence. Lastly, we examine how this concept of disease unifies two contemporary classifications of diseases, one based on the location of the diseases, the other on the cause of the diseases.

Anemia, Sickle Cell↗
PubMedDate not supplied

Examination of cyanine intercalation dyes for rapid and sensitive detection of DNA fragments by capillary electrophoresis.

Recently, a series of cyanine dyes has been developed that are reported to offer superior fluorescence upon intercalation relative to ethidium bromide (EB). The dimeric cyanine dyes, such as POPO-3 (Molecular Probes, Eugene, OR, U.S.A.), are reported to offer the highest fluorescence enhancement of the cyanine dyes. Although POPO-3 does offer an improvement in sensitivity, achieving reproducible, high-efficiency results by employing pre-column, on-column, and postcolumn labeling strategies proved to be problematic. Evaluation of the labeling rate of these dimeric dyes indicates that perhaps the most limiting factor to using this dye for rapid CE analysis of DNA fragments is the apparent slow rate at which the dye fully intercalates into the DNA structure. Use of the monomeric analog PO-PRO-3 (Molecular Probes) resulted in much better separations and low limits of defection when employed for on-column intercalation. However, we find that the kinetics are too slow to employ this dye in a sheath flow cell for postcolumn derivatization.

Benzoxazoles↗
PubMed1999

[Cloacal exstrophy, ultrasonic diagnosis].

This study aims to underline the importance of transvaginal ultrasonography in the first three months of pregnancy. The authors report a case which was referred to their attention for preliminary tests performed prior to amniocentesis, recommended by the general physician because of the mother's age. The primapara woman and father of the fetus were healthy and the family history excluded hereditary diseases or congenital pathologies. Transvaginal ultrasonography permitted the diagnosis at the start of the fourth month of pregnancy of a polymalformed fetus with cloacal exstrophy, sacral myelomeningocele, clubfoot, single umbilical artery. In this case, the mother decided to undergo eugenic abortion in view of the severity of the pathology.

Cloaca↗
PubMed1999

[Is it possible to die a good death?].

Is there any sense in wondering if one can "die a good death" Indeed, the word "euthanasia" as such offers food for thought. Obviously, human beings must die. The only real question is: Can help and assistance be given (through others) to a person when facing this ineluctable issue; and, if so, in which way and how far? To make things clearer, two points may be taken into consideration. On the one hand, it is a fact that the roman-catholic tradition has been able to set up a practice of a "good death piety", or even a "good death pastoral". But, on the other hand, we must not forget that when we consider what "euthanasia" means for the end of life and bear in mind what "eugenism" means for the beginning of life as well as the way it has been used, then it can only put us on the alert for possible serious abuse.... Considering all this, the question may be put as follows: not: is it possible, under certain circumstances, to give someone his or her death; but: how must I help and assist a person to live his or her life to the very end, if possible up to death?

Attitude to Death↗
PubMed1999

A2E, a lipofuscin fluorophore, in human retinal pigmented epithelial cells in culture.

PURPOSE: To study A2E, a component of retinal pigmented epithelial (RPE) cell lipofuscin, after its internalization by cultured human RPE cells. METHODS: A2E was synthesized and incubated with an adult RPE cell line devoid of native lipofuscin. To investigate the cellular compartmentalization of A2E, cells were incubated simultaneously with A2E and a fluorescent acidotropic probe, (Lysotracker Red DND-99; Molecular Probes, Eugene, OR). Plasma membrane integrity was evaluated by assaying for leakage of the cytoplasmic enzyme lactate dehydrogenase (LDH), by fluorescence nuclear staining with a membrane-impermeant dye and by morphologic criteria. The emission spectrum of internalized A2E was also determined. The levels of A2E accumulated by the cultured cells were quantified by high-performance liquid chromatography and compared with amounts present in RPE isolated from human eyes. RESULTS: Internalization of A2E by the RPE cells was evidenced by the acquisition of intracellular granules detectable by fluorescence confocal imaging. Internalized A2E had an emission maxima of 565 to 570 nm. The levels of A2E accumulating in cells incubated with 10 to 25 microM A2E were comparable to the amounts of A2E present in equal numbers of RPE cells harvested from human eyes. Colocalization of A2E and the Lysotracker probe revealed a preferential accumulation in acidic organelles. The elevated LDH levels that were measured after exposure to 50 and 100 microM A2E were attributable to membrane damage in a subpopulation of the A2E-accumulating cells, determined by fluorescence nuclear labeling. CONCLUSIONS: Internalized A2E has an affinity for acidic organelles. The membrane damage exhibited by A2E-accumulating RPE is dependent on the concentration of A2E and reflects the ability of this amphiphilic compound to exert detergent-like effects.

Aged↗
PubMed2000

[Ethical aspects of prenatal screening for Down's syndrome].

Trisomy 21, the chromosomal base of Down's syndrome, results in severe mental and physical handicap. Owing to the development of medical genetics reliable screening and diagnostic procedures for the detection of the disorder are available in Hungary. To achieve the goals of prenatal screening it is important to address the main ethical issues arising through the application of technical-professional skills. The core objective of prenatal screening for Down's syndrome is to give information about the genetic condition of the fetus in order to enhance the autonomy of the parents in family planning. Screening programs should respect the ethical requirements of the principles of "do no harm", beneficence and autonomy of the patients, which are the most important ethical norms of doctor-patient relationship. Regarding the social aspects of screening it is essential to claim that voluntary participation and nondirective genetic counselling can exclude eugenic purposes. Though introduction of prenatal tests does not imply the discrimination of the disabled, anxiety of handicapped people deserves more attention. Abortion of affected fetuses isn't among the objectives of prenatal genetic screening but patient's autonomy is supported in decisions concerning the future of the pregnancy. Social justice can be taken into consideration by providing the test to all women without respect to their social position, educational level or their age. An open debate about the issues of prenatal screening for Down's syndrome could promote the formation of a consensus between professionals and the public.

Abortion, Therapeutic↗
PubMed2001

Authors, editors, policy makers, and the impact factor.

Some aspects of the "impact factor", a quantitative measure of journals' influence on journals in scientific fields, were discussed in the preceding issue of the Croatian Medical Journal by Dr Eugene Garfield, one of its devisers. This factor can be of interest to authors, journal editors, and policy makers, but they should keep in mind the complexity of the determinants of impact factors while using them in coming to their particular kinds of decisions. A clearer picture of the influence a journal may have in its own scientific field rather than among all scientific journals could come from a variant of the impact factor, "the scope-adjusted impact factor". The calculation of this variant impact factor is described. A table presents some sample data from this calculation and shows how the relative positions of some major journals shift when they are ranked by this factor rather than the unadjusted impact factor. The possible value of this variant factor may merit further testing.

Authorship↗