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PubMed2002

Role of the international organisation for animal health (Office International des Epizooties: OIE) in the control of foot and mouth disease.

The author describes activities conducted by the International Organisation for Animal Health (OIE: Office International des Epizooties) to control foot and mouth disease (FMD) world-wide. These activities fall within the framework of the principal missions of the OIE. The first of these missions is the collection and dissemination of epidemiological information and of scientific knowledge on animal diseases, the socio-economic or disease implications of which can be particularly serious. The implementation of the measures required to control the disease and to protect countries threatened by FMD depends on the quality and rapidity of the transmission of this information. The co-ordination of studies, research and control programmes against FMD is equally important for the OIE. This work is based, in particular, on work conducted by the OlE foot and mouth disease and other epizootics Commission. OIE Member Countries not only have access to the most recent data on the diagnosis, surveillance and control of FMD but also have recourse to the official recognition procedure for disease-free status provided by this Commission. Finally, through the standardisation of health recommendations, diagnostic tests, manufacture protocols and the control of biological products, made available by the OIE International Animal Health Code Commission in regard to the former and by the OIE Standards Commission in regard to the latter, the OIE provides the reference for international trade in animals and animal products, and is recognised in this role by the World Trade Organization.

Animal Welfare↗
PubMed1999

The International Health Program: the fifteen-year experience with Yale University's Internal Medicine Residency Program.

The purpose of this study was to assess the impact of international health electives on physicians-in-training. A retrospective study was conducted using an anonymous, self-administered mailed survey to internal medicine residents who trained at Yale from 1982 to 1996 based on their experience with our International Health Program (IHP). The response rate was 61%, with 96 completed surveys in the participant group and 96 completed surveys in the nonparticipant group. Participants were more likely than nonparticipants to care for patients on public assistance (77 versus 49; P < 0.001) and immigrant patients (41 versus 23; P = 0.006). Among residents who changed their career plans, participants (22) were more likely than nonparticipants (14) to switch from subspecialty medicine to general medicine (P = 0.02). Participants were significantly more likely to have a positive view of health care delivery in developing countries. Compared with nonparticipants (64), IHP participants (74) believed that the physical examination is under-used by physicians from the United States as a diagnostic skill (P = 0.03). International health experiences appeared to have an important impact on the decisions and attitudes of residents.

Adult↗
PubMed1989

International migration, international relations and foreign policy.

Recent literature on migration, international relations, and foreign policy is reviewed in this article, stressing applications of global systems paradigms, studies of state entry and exit rules, and anatomies of domestic policy-setting processes on migration. After a concise assessment of the contemporary theory of global political economy, the paper argues for seeking mid-range generalizations on the international relations of migration. It also suggests that analysis begin with the policy-setting processes of the state. Especially through the use of comparative perspectives available from domestic policy making studies and from the field of international comparative public policy, this approach offers the opportunity to fix empirically the political roles of transnational social forces, which often present themselves as participants in domestic policy contests. Promising future directions in the study of state-to-state relations are also evaluated, with the anticipation that verifying regional or other intermediate patterns of world migration politics may contribute to more general theories of international political economy.

Demography↗
PubMed1963

THE INTERNATIONAL REFERENCE PREPARATION OF SMALLPOX VACCINE. AN INTERNATIONAL COLLABORATIVE ASSAY.

A purified, concentrated sheep vaccine, prepared from a vaccinia strain in use in the United Kingdom for more than 60 years, has been established as the International Reference Preparation of Smallpox Vaccine, intended to permit comparative assay with national reference vaccines.Before its establishment as the International Reference Preparation, the proposed international reference vaccine was tested in seven laboratories in as many countries together with four other distributed vaccines and one local vaccine in each country. All laboratories used the scarification test on rabbits; four used the pock count method; the intracutaneous test in rabbits, the plaque count in tissue culture and the LD(50) test in eggs, cultures and newborn mice were used by one to three of the participants.The proposed international reference preparation met all the requirements laid down by the WHO Study Group on Requirements for Smallpox Vaccine in six laboratories when the scarification test was used and in all laboratories when the pock count test was used.

Animals↗
PubMed2000

Hepatitis A immunoglobulin: an international collaborative study to establish the second international standard.

A collaborative study was carried out to assess the suitability of a candidate replacement material for the International Standard for hepatitis A immunoglobulin, which was found to be reactive for HCV RNA, and to calibrate it in International Units. The candidate standard, coded 97/646, was derived from a bulk of 16% immunoglobulin supplied by the Central Laboratory of the Netherlands Red Cross, Amsterdam, and diluted 1 in 2 in H2O resulting in a final immunoglobulin concentration of 8%. Sixteen laboratories from 11 countries participated in the study and contributed data from 64 assays performed using six commercial assay kits and four in-house methods. All assays were analysed as parallel line bioassays comparing assay response with log concentration. The overall mean potency of the candidate replacement immunoglobulin standard, 97/646, relative to the International Standard for hepatitis A immunoglobulin, was 98.6 IU/ml. A freeze-dried serum preparation, 97/648, was also calibrated in this study and had a potency of 22.64 IU/ml. The Second International Standard for hepatitis A immunoglobulin, human, was established by the World Health Organisation Expert Committee on Biological Standardisation in 1998 with a potency of 49 IU per ampoule when reconstituted in 0.5 ml.

Biological Assay↗
PubMed2001

International collaborative study: evaluation of proposed International Reference Reagent of pertussis antiserum (mouse) 97/642.

A freeze dried preparation of mouse serum in vials coded 97/642 containing antibodies to five pertussis antigens [pertussis toxin (PT), filamentous hemagglutinin (FHA), pertactin (PRN), fimbriae type 2 and 3 (Fim 2 and 3)] has been assessed for its suitability as an international reference reagent in an international collaborative study by thirteen laboratories in nine countries. This serum has been compared with U.S. Standard Pertussis Antiserum (mouse) Lot No. 1 (US Lot 1), which has been in use since 1995, for antibodies for each antigen. Calibration of the proposed International Reference Reagent of Pertussis Antiserum (pIRR) in terms of US Lot 1 gives results which are broadly consistent between laboratories for antibodies to each antigen, although the between-laboratory differences are larger than those seen for comparison of identical sera. Calibration of two positive control sera in terms of the pIRR gave similar between laboratory variability of estimates to that obtained when the same sera were calibrated in terms of US Lot 1. Overall continuity of estimates is maintained if units are assigned to the pIRR based on its calibration in terms of US Lot 1 in this study. Data presently available indicate that the pIRR is sufficiently stable to serve as a reference reagent. It was therefore recommended, with the agreement of all participants, that the preparation in vials coded 97/642 be established as the First International Reference Reagent for Pertussis Antiserum, mouse, with assigned unitages 16 units of anti-PT per vial, 143 units of anti-FHA per vial and 30 units of anti-PRN per vial based on its calibration in terms of US Lot 1. These unitages are also consistent with calibration of 97/642 in terms of the Japanese preparations JNIH-11 for anti-FHA and of JNIH-12 for anti-PT. Purified antigens for Fim 2 and Fim 3 are not readily available and an arbitrary value of 32 units per vial is suggested for anti-Fim 2 and 3 mixture. These recommendations were agreed by the Expert Committee on Biological Standardization of the World Health Organization.

Adhesins, Bacterial↗
PubMed1983

[Stenosis of the internal carotid artery with contralateral occlusion--primary vascular operation of externo-internal bypass?].

Among 2135 patients undergoing vascular surgery of the carotid artery, 144 revealed a stenosis of the internal carotid in combination with an occlusion on the contralateral side. Temporary inlying bypass shunts to support cerebral circulation during the endarterectomies were employed when technically feasible. The mortality among the in-patients amounted to 3.47%. Postoperative permanent neurologic deficits did not appear. During the follow-up period lasting between 1 month and 9 years 6.5% had further TIA's or strokes. Approximately 90% of the patients remained without neurologic symptoms. Neurosurgeons generally recommend a prophylactic external-internal bypass, prior to the removal of the stenosis of the internal carotid artery. According to our experience the primary objective should be the reconstruction of the stenosed artery, particularly since complications in primary external-internal bypassed occur in an average of 3-4%.

Arterial Occlusive Diseases↗
PubMedDate not supplied

The successes and limitations of international law and the International Court of Justice.

The first two sections of this article deal with the irony that international law has severe limitations, yet it also has a good record for compliance. The third section introduces the International Court of Justice (ICJ), and the fourth section deals specifically with the limitations of the ICJ. The article concludes with some ideas for action. Its main point is that international law is often a neglected topic, even by non-governmental organisations (NGOs). International law needs to be brought in from the cold, and there should be more support from the NGO community for the ICJ.

Global Health↗
PubMed1988

A program to help interns cope with stresses in an internal medicine residency.

A program in personal and professional development for interns was developed six years ago for the residency program in internal medicine of the University of Connecticut Affiliated Hospitals to reduce maladaptive responses to the stresses of medical training. The principal goals of the program are to provide a supportive atmosphere in which interns can discuss common concerns, build mutual trust among themselves, promote deeper self-understanding and sensitivity, develop coping strategies, and examine difficult situations in training. Sessions are scheduled regularly throughout the year and take place outside the hospital; interns are excused from their service responsibilities for the duration of the meeting. Participants focus equally on issues of professional concern (for example, relationships with staff members, peers, and attending physicians or bureaucratic problems such as lack of ancillary help) and personal concern (for example, making necessary life-style adjustments and handling family crises). A variety of techniques are used in the program, but small-group discussions and individual tasks are particularly emphasized. Participants have generally reported satisfaction with the program and positive effects upon their behavior at work and at home.

Adaptation, Psychological↗
PubMed2005

Participation of internal medicine department chairs in the internal medicine clerkship--results of a national survey.

PURPOSE: To characterize the involvement of internal medicine department chairs in the core third-year internal medicine clinical clerkship. METHOD: In 2003, the Clerkship Directors in Internal Medicine (CDIM) surveyed its membership. Along with demographics, clerkship directors were asked if the department's chair participated in the clerkship, the number of hours per month the clerkship director and chair discussed clerkship issues, and if published job expectations were discussed. RESULTS: The response rate was 62% (158/254): 103 responses (89 clerkship directors) represented unique medical schools, which formed the basis of the analysis. Eighty-two percent (84/103) reported the chair taught in the clerkship: 54% as teaching attending, 53% as ward attending, 13% as ambulatory attending, and 20% other (e.g., lectures, student rounds, morning report). Of them, 36% performed two activities; 14% three activities; and 2% four activities. Thirty-six percent of the clerkship directors discussed published expectations with their chair. They spent 1.7 (SD 2.2) hours per month with the chair discussing clerkship issues. However, 17% spent zero hours per month with the chair, and 29% spent zero hours per month with a dean's office representative. Chairs who taught spent more time each month with the clerkship director compared with chairs who did not teach (1.9 versus .82 hours, p = .01, Mann-Whitney). There was no association between the chairs' teaching and clerkship directors' demographics. CONCLUSIONS: Internal medicine department chairs are significantly involved in the clinical education of medical students, both administratively and through direct teaching. Chairs who teach spend more time discussing clerkship issues with the clerkship director. Chairs and clerkship directors should discuss expectations, and chairs should continue to visibly demonstrate their commitment to students' education.

Adult↗
PubMed1987

Recommendations for reference method for haemoglobinometry in human blood (ICSH standard 1986) and specifications for international haemiglobincyanide reference preparation (3rd edition). International Committee for Standardization in Haematology; Expert Panel on Haemoglobinometry.

Scientific symposia on haemoglobinometry were held at the 9th Congress of the European Society of Haematology, Lisbon, 1963 (ESH 1964) and the 10th Congress of the International Society of Haematology (ISH), Stockholm, 1964 (ISH 1965). The International Committee for Standardization in Haematology (ICSH) made recommendations endorsed by the General Assembly of ICSH in Sydney on 23 August 1966 (ICSH 1967), for a reference method for haemoglobinometry and for the manufacture and distribution of an international reference preparation. Further symposia were held at the 12th Congress of the ISH, New York, 1968 (Astaldi, Sirtori & Vanzetti 1979) and at the 13th Congress of ISH, Munich, 1970 (Izak & Lewis 1972). The recommendations were reissued in 1978 (ISH 1978). On the basis of continuing experimental studies, the reference method and the specifications for the international reference preparation have been modified. The revised recommendations are described in this document.

Drug Stability↗
PubMed1989

International Standards for human prolactin: calibration by international collaborative study.

Three ampouled preparations of purified human prolactin were assessed by 20 laboratories in eight countries for their suitability to serve as International Standards for the estimation of human prolactin in serum. Bioassays (pigeon crop sac assays and NB2 cell assays) were carried out in two laboratories, radioreceptor assays by one laboratory and radioimmunoassays by 17 laboratories. By physicochemical analysis the preparations appeared similar. Each preparation contained small amounts of contaminants and/or prolactin variants. No major differences among the three preparations were detected by immunoassay although, in one radioreceptor assay system, one of the preparations was found to differ from the other two. On the basis of all the available information, the Expert Committee on Biological Standardization of the World Health Organization (ECBS) in 1986 established the preparation in ampoules coded 83/562 as the Second International Standard for Prolactin and in October 1988 established the preparation in ampoules coded 84/500 as the Third International Standard for Prolactin. A value of 0.053 IU (53 mIU) prolactin activity/ampoule was assigned to both the Second and Third IS on the basis that this unitage would, insofar as possible, maintain continuity of the IU defined by the First International Reference Preparation of Prolactin, human, for Immunoassay (coded 75/504).

Amniotic Fluid↗
PubMed1992

Internal medicine and the training of international medical graduates: a time for open discussion and new approaches.

The number of foreign national medical graduates entering internal medicine residency training programs in the United States has doubled since 1986. A rigorous, standardized preresidency evaluation of the basic clinical skills and language abilities of international medical graduates should be implemented. Those found to have significant deficits should undertake a preparatory curriculum designed to meet special educational needs before entry into the formal training program. A relevant curriculum might include formal lectures, reading assignments, physical diagnosis sessions, language classes, patient encounter sessions, and a tutorial on U.S medical culture that includes medical ethics and the basics of the our health care system. All or only some of these may be required for any given individual. The Educational Commission for Foreign Medical Graduates (ECFMG) could provide many of the methods needed for an evaluation program and work collaboratively with program directors. This new approach to training of international medical graduates will require an evaluation system to to measure its effectiveness. Important questions about the funding of graduate medical education for international medical graduates must also be addressed.

Clinical Competence↗
PubMed1975

[A giant aneurysm of the internal carotid artery treated by intracranial direct surgery--with a special reference to the anatomical relationship between the cavernous sinus and the internal carotid artery (author's transl)].

There have been a few reports about intracranial giant aneurysms treated by intracranial direct approaches. Especially, for giant aneurysms of the internal carotid artery, direct operation has been thought to be difficult to perform because of the anatomical particularity and the danger of rupture during surgery. So the cervical carotid ligation has frequently been indicated. However, the carotid ligation does not relieve the symptoms caused by the giant aneurysm as an "intracranial mass lesion". The authors have reported here, a cured case of a giant aneurysm of the intracavernous portion of the internal carotid artery, to which, as the first step, ligation of the internal carotid artery in the cervical region was performed, and as the second step, endaneurysmorrhaphy was carried out for the remaining symptoms caused by the "intracranial mass lesion". Furthermore, the surgical techniques for treatment of giant aneurysms of the internal carotid artery were discussed citing literatures, and the authors concluded that the combined operation of carotid ligation and endane-urysmorrhaphy could be effective to giant aneurysms in this region. Meanwhile, a new concept concerning the anatomy of the carotid-cavernous region already proposed by Bedford, was confirmed by our observation at operation. It may be considered that the intracranial direct approach to aneurysms in this region and also to carotid cavernous fistulae should more frequently be indicated than ever performed, according to the new concept of the anatomy in this region.

Adult↗
PubMed2004

Which primary care specialty? Factors that relate to a choice of family medicine, internal medicine, combined internal medicine-pediatrics, or pediatrics.

BACKGROUND AND OBJECTIVES: This study was conducted to examine factors used by medical students to select a primary care specialty that may differentiate students who choose the primary care specialties of family medicine, internal medicine, pediatrics, and combined internal medicine-pediatrics. METHODS: A questionnaire was sent to all family physicians and an equal number of other primary care physicians graduating from one of 24 medical schools in 1997-1999. Twelve schools had increasing proportions of graduates choosing family medicine in this study period, and 12 had decreasing proportions. The questionnaire asked about factors related to choice of specialty, which could be grouped into the specialty domains of type of patients, process, content, and setting. RESULTS: For family physicians, the most important factor was patient relationships, and the second most important was wanting an approach to the practice of medicine similar to that of family physicians. Internists indicated as most important wanting to work with adults and as the next most important an "internal medicine approach" to the practice of medicine. Most important for pediatricians was working with children and next most important was having patient relationships like other pediatricians. Those in combined internal medicine-pediatrics most often indicated a desire to work with children and next most important was an approach to medicine like others in their specialty. CONCLUSIONS: The most important reasons for choice of specialty were similar for all primary care specialties and related to congruence between the graduate and the physicians in the specialty or the process of providing care within that specialty. The factors that differentiated the four specialties related to the content of the specialty.

Adult↗
PubMed1988

[Two cases of spontaneous occlusion of the internal carotid artery due to a giant intracranial internal carotid artery aneurysm].

Although spontaneous thrombosis of a giant intracranial aneurysm is comparatively common, its parent artery occlusion is rare. Recently we experienced two cases in which spontaneous thrombosis of giant intracranial internal carotid artery aneurysm and occlusion of its parent artery were occurred. Case 1. A 49-year-old man, complaining esotropia was referred to us by an ophthalmologist. He had no particular past history. Neurological examination revealed left oculomotor, abducens palsy and disturbance of left trigeminal first branch. CT scan revealed a round high density mass in the left middle fossa. The size was 3 cm in diameter. Left CAG revealed severe stenosis of left internal carotid artery and in delayed phase, faint shadow was seen near posterior clinoid process. MRI revealed a high intensity mass of the intraaneurysmal thrombus in the left middle fossa with small low intensity area indicating residual lumen. With conservative treatment, the symptom was gradually improved and one month after admission, complete occlusion of the left internal carotid artery was seen by angiography. The patient returned to his previous occupation. Case 2. A 21-year-old man was admitted to our hospital complaining dysarthria and left hemiparesis. He had been diagnosed as left internal carotid giant aneurysm 5 years before when he had suffered from right visual disturbance. Neurological examination revealed left hemiparesis and dysarthria. CT scan revealed high density mass which extended from the base of the right middle fossa to the third ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

The First International Standard for Somatropin: report of an international collaborative study.

Following an earlier decision to move away from the in vivo bioassay for determination of the potency of therapeutic somatropin (recombinant DNA human growth hormone), 18 laboratories in 12 countries participated in an international collaborative study designed to establish an international standard for somatropin, calibrated both by bioassay and by physicochemical assays of somatropin content. The mean in vivo biological potency of preparation studied, coded 88/624, was 6.75 IU/ampoule (fiducial limits 6.30-7.23). Determination of the protein content by quantitative amino-acid analysis yielded a mean estimate of 1.98 mg protein per ampoule. (Relative standard deviation = 2.88%). Data from the study also yielded mean values of 97.2% +/- 0.8% for the monomer content of the preparation, and 8.18 (RSD = 4.00%) for A1% at 276 nm. At its 45th meeting, in October 1994, the ECBS of WHO formally established the preparation 88/624 as the First International Standard for Somatropin, with a defined content of 2.0 mg protein per ampoule, and a defined specific activity of 3.0 International Units per milligram.

Animals↗
PubMed1993

Predicting the first-year performances of international medical graduates in an internal medicine residency.

BACKGROUND: Recent growth in the number of international medical graduates (IMGs)--i.e., graduates of non-U.S. and non-Canadian medical schools--who fill positions in internal medicine residencies requires examination of the predictive validity of selection criteria. METHOD: Data were analyzed for 46 foreign-born IMGs who entered the internal medicine residency at Wright State University School of Medicine between January 1985 and January 1991. The t-test and Pearson correlation were used to relate ten selection variables (age, gender, foreign clinical experience, U.S. clinical experience, clinical experience in the two years prior to residency, time between medical school graduation and residency, performance on the Foreign Medical Graduate Examination in the Medical Sciences--FMGEMS--Parts I and II, interview language skill, and interview rank category) to performance ratings the IMGs received in the first year of residency. RESULTS: Only performance on the FMGEMS Part I (p = .045) and clinical experience in the two years prior to residency (p = .005) were related significantly to subsequent performance in residency. CONCLUSION: The results suggest that recent clinical experience and performance on standardized examinations are the two selection criteria most predictive of foreign-born IMGs' first-year performances as internal medicine residents.

Adult↗