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[Medical-naturopathy curriculum in education. Introduction and organization of the medical-naturopathy curriculum from the Middle Ages into the 19th century].

A source-oriented research study that began with medieval library catalogs, provided the material needed to establish the organization and structuring of the teaching of natural science in monastic/convent schools. The further development of natural science from here to present-day teaching of biology was then traced. The wealth of material available since the late Middle Ages enabled the individual phases of development of this new teaching subject to be identified and their adoption into the Latin education system determined. This process revealed a series of different establishment phases. From the Middle Ages onwards, the study is based on teachers' and pupils' books known to have been used in the Latin education system, and, from the 18th Century onward, on an additional 7,000 or so school annual reports as well as, from the second part of the 19th Century, teaching curricula.

Curriculum↗

Survey of functional assessment procedures used with individuals who display mental retardation and severe problem behaviors.

A survey was conducted to catalog the assessments used by practitioners to evaluate the problem behaviors displayed by clients with mental retardation. Questionnaires were mailed to 300 members of the Psychology Division of the American Association on Mental Retardation. Most practitioners rated functional assessment procedures as extremely or very useful. Indirect and descriptive assessments were considered more useful than experimental manipulation. Findings were discussed with emphasis on the difficulties in conducting functional assessments. These results may be useful for practitioners who are designing behavior training programs and directing further research to improve functional assessment strategies.

Attitude of Health Personnel↗

Rare lesions of the posterior fossa with initial retrocochlear auditory and vestibular complaints.

OBJECTIVE: To catalog a series of rare lesions of the posterior fossa that appeared with unusual initial retrocochlear symptoms and signs and to make the reader more aware of these unusual lesions with a view to improving initial assessment and treatment planning. STUDY DESIGN: The study was a retrospective case review of seven patients. SETTING: Multidisciplinary team evaluation in a tertiary hospital referral center. PATIENTS: Patients with unusual lesions of the cerebellopontine angle and posterior fossa with initial retrocochlear symptoms and signs were included. INTERVENTIONS: Diagnostic and therapeutic. MAIN OUTCOME MEASURES: Hearing preservation and balance function. RESULTS: The rare lesions presented include two aneurysms of the anterior inferior cerebellar artery, one giant basilar artery aneurysm, and one each of the following neoplasms: endodermal cyst, choroid plexus papilloma, cavernous angioma, and ependymoma. CONCLUSIONS: A close working relationship among the otolaryngologist, neurotologist, neurosurgeon, and neuroradiologist is necessary to accurately evaluate these unusual cerebellopontine angle lesions and effect the best treatment outcome.

Adult↗

Medicine and the Internet. What can I learn from the Internet?

What is the Internet? The Internet is the biggest network of information resources the world has ever seen and is growing rapidly each day. The Internet and the World Wide Web (The Web) represent the first technology to fully integrate the communications found on bookshelves, magazine racks, catalog files, fax machines, symposiums, in television/radio studios and the common mail system into a global infrastructure with extraordinary capabilities to deliver timely health care information. Unlike conventional media like newspapers or television, the Internet provides rapid one-to-one communication between millions of individuals. Television and newspapers communicate from "a few" (the writers and advertisers) to "many" (the readership). On the Internet, everyone is a "peer," being both an information provider and consumer on a 24-hour, 7-day a week basis. This article will discuss ways you can use the Internet's information resources in your own personal and professional life.

Communication↗

A review of the contribution of whole embryo culture to the determination of hazard and risk in teratogenicity testing.

Whole embryo culture appears to be an excellent method to screen chemicals for teratogenic hazard. Compared to in vivo testing it is cheap and rapid and does not involve experimentation on live adult animals. Also in the important area of risk estimation whole embryo culture offers distinct advantages over in vivo teratogenicity testing. Adverse embryonic outcomes (malformations or embryotoxicity) are directly related to the serum concentration of the compound being tested and can be compared to the serum concentration in the human. A similar comparison is not possible after in vivo testing because for most compounds there are major pharmacokinetic differences between humans and experimental animals. In vivo testing is also limited by the possibility that metabolites that occur in the human do not occur in the test animal. This problem can be overcome in the in vitro system by adding the metabolite directly at the desired concentration either with or without the parent compound. There is only one major disadvantage to in vitro testing and that is the limited period of embryogenesis that is undertaken in the commonly used culture system. This restricts the range of malformations that can be induced and may render the testing system unsuitable for compounds that are likely to exert their major toxicological effect late in gestation. Any evaluation of whole embryo culture for hazard and risk assessment in teratology must take into account the limited value of currently used in vivo methods. Over 2000 chemicals have been reported to be teratogenic in experimental animals exposed in vivo (Shepard, Catalog of Teratogenic Agents, 1989). In comparison only about 20 chemicals are known to cause birth defects in the human. This large number of in vivo false-positive cannot easily be distinguished from true-positives. In this respect in vivo testing is severely deficient. The embryo culture testing system would also be expected to produce many false-positives; but by comparing effective drug concentrations with human therapeutic concentrations they can be differentiated from true-positives. The most serious deficiency for an in vivo or in vitro teratogenicity testing system would be false-negatives. This has not been a problem in the validation of in vitro testing so far (except perhaps procarbazine), but difficult drugs such as thalidomide were not included. Thalidomide remains an important index chemical because it is not teratogenic in rats or mice but is teratogenic in the rabbit and human. It is likely that these species differences are due to metabolic differences between species and it is possible that if the proximate teratogen/s of thalidomide were identified they would be teratogenic in rat embryo culture. Whole embryo culture remains a very powerful technique that should continue to contribute to the determination of the safety of drugs and other chemicals during pregnancy.

Abnormalities, Drug-Induced↗

[Hepatitis B vaccination of children and adolescents].

In the 14 years that have passed since its introduction, the hepatitis B vaccine has proved to be highly immunogenic, effective and very well tolerated. The vaccination, previously performed only in persons at high risk of contracting hepatitis B, in particular medical personnel, has appreciably reduced the incidence of hepatitis B in this group. The incidence of the disease in the general population, however, has been reduced only marginally. Thus, the sole possibility of resolving the hepatitis B problem is to introduce general vaccination. To this end, the The Ständige Impfkommission (STIKO) has included hepatitis B vaccination in the catalog of vaccinations for children and adolescents. The greatest importance must probably attach to vaccination of young children, in whom hepatitis B vaccination is carried out along the same lines as the diphtheria, pertussis and tetanus vaccination, within the framework of which it can therefore be administered, thus making possible a wide application. However, the 12-15 year-old age group should also be involved in the vaccination program, for this is the group on the threshold of the periods of greatest danger of infection, which begins with the initiation of first sexual relationships.

Adolescent↗

[Implications of the federal government's austerity package in the field of intramural medical rehabilitation].

The austerity legislation passed September 13, 1996 as well as the additional austerity measures pending for the field of rehabilitation in the framework of legislation aimed at refocusing self-government and self-responsibility in the statutory health insurance scheme (1. und 2. Gesetz zur Neuordnung der Selbstverwaltung und Eigenverantwortung in der gesetzlichen Krankenversicherung-1st and 2nd GKV-NOG) are going to jeopardize insurees' provision with medical rehabilitation generally. For 1997 alone, economies totalling some 3.2 billion DM have been legislated. By drastically increasing the additional payments to be made, the insured are to an intolerable extent being subjected to contributing towards the cost of their medical treatment. What is more, the 2nd GKV-NOG is to enable health insurance funds to totally exclude rehabilitation benefits from the standard catalog of benefits to be provided. Along with these spending limitations in the social insurance schemes, additional burdens have been imposed on the insured in gainful employment under regulations in the field of labour law effective as of October 1, 1996 applicable in case of participation in an in-patient rehabilitation measure. Thus, the employer is entitled to make deductions with regard to an employee's claim to continued remuneration during sick leave as well as part of his annual paid recreational leave for the duration of the inpatient rehabilitation measure. The population most adversely affected by this policy are those with chronic illness and disability.

Cost Control↗

[Tasks of case managers in statutory accident insurance].

The present article gives an outline of vocational rehabilitation in the Federal Republic of Germany from the perspective of the statutory accident insurance scheme. Termed "Berufshilfe", occupational assistance, the services and benefits provided under the scheme also encompass elements of medical and social rehabilitation of persons who have incurred an industrial injury or occupational disease. Given the scheme's comprehensive catalog of benefits and services, a multitude of possibilities result for assistance to eligible workers and their relatives, which are illustrated by examples. Central to the presentation is the work of the "Berufshelfer", the accident insurance agency's case manager for vocational rehabilitation service provision. Along with competence of the accident insurance agency for medical, vocational and social rehabilitation, this case manager is the point of contact for all those involved in rehabilitation in the individual case, hence in particular for the individual affected, his or her relatives, physicians, rehabilitation facilities, employers as well as third parties, moreover being the point of liaison among these various parties and the administration. The primary objective of these entire efforts is to achieve lasting reintegration of people with physical or emotional disablement in employment, career, and society.

Accidents, Occupational↗

[Medical procedures in gunshot injuries].

In this paper the basic knowledge about the morphology of gunshot wounds is presented, which should help the physician to answer the most important questions imposed on a criminal case. The paramount measures to be taken are the documentation of the gunshot wounds, the excision of the injury and separate debridement of each lip of the wound, the careful observation of the projectile, the cataloging of the victim's clothes and the omission of cleaning the hands of the victim. Some forensic aspects are demonstrated, particularly the professional discretion respectively the obligation to notify the authorities.

Adult↗

Standardized representations of the literature: combining diverse sources of ribosomal data.

We are building a knowledge base (KB) of published structural data on the 30s ribosomal subunit in prokaryotes. Our KB is distinguished by a standardized representation of biological experiments and their results, in a reusable format. It can be accessed by computer programs that exploit the rich interconnections within the data. The KB is designed to support the construction of 3D models of the 30S subunit, as well as the analysis and extension of relevant functional and phylogenetic information. Most published information about the structure of the ubiquitous ribosome focuses on E. coli as a model system. At the same time, thousands of RNA sequences for the ribosome have been gathered and cataloged. The volume and complexity of these data can complicate attempts to separate structural data peculiar to E. coli from data of universal relevance. We have written an application that dynamically queries the KB and the Ribosome Database Project, a repository of ribosomal RNA sequences from other organisms, in order to assess the relevance of structural data to particular organisms. The application uses the RDP alignment to determine whether a set of data refer primarily to conserved, mismatched, or gapped positions. For a set of 16 representative articles evaluated over 211 sequences, 73% of observations have unambiguous translations from E. coli to the other organisms, 21% have somewhat ambiguous translations, and 6% have no translations. There is a wide variation in these numbers over different articles and organisms, confirming that some articles report structural information specific to E. coli while others report information that is quite general.

Artificial Intelligence↗

Summary of measured radiofrequency electric and magnetic fields (10 kHz to 30 GHz) in the general and work environment.

We have plotted data from a number of studies on the range of radiofrequency (RF) field levels associated with a variety of environmental and occupational sources. Field intensity is shown in units of volts/meter (V/m) for electric field strength and amps/meter (A/m) for magnetic field strength. Duty factors, modulation frequencies, and modulation indices are also reported for some sources. This paper is organized into seven sections, each cataloging sources into appropriate RF frequency bands from very-low frequency (VLF) to super-high frequency (SHF), and covers frequencies from 10 kHz to 30 GHz. Sources included in this summary are the following: Coast Guard navigational transmitters, a Navy VLF transmitter, computer visual display terminals (VDTs), induction stoves or range tops, industrial induction and dielectric heaters, radio and television broadcast transmitters, amateur and citizens band (CB) transmitters, medical diathermy and electrosurgical units, mobile and handheld transmitters, cordless and cellular telephones, microwave ovens, microwave terrestrial relay and satellite uplinks, and police, air traffic, and aircraft onboard radars. For the sources included in this summary, the strongest fields are found near industrial induction and dielectric heaters, and close to the radiating elements or transmitter leads of high power antenna systems. Handheld transmitters can produce near fields of about 500 V/m at the antenna. Fields in the general urban environment are principally associated with radio and TV broadcast services and measure about 0.1 V/m root-mean-square (rms). Peak fields from air traffic radars sampled in one urban environment were about 10 V/m, 300 times greater than the rms value of 0.03 V/m when the duty factor associated with antenna rotation and pulsing are factored in.

Electromagnetic Fields↗

[Laparoscopic hernia surgery--status of minimal invasive techniques in a spectrum of surgical indications].

Endoscopic surgery led in the nineties to a discussion on surgical treatment of hernias. At the present time there are three groups of operative procedures: the conventional procedure--Shouldice, Bassini--the open tension-free procedure with implantation of a mesh--Lichtenstein, Gilbert-Rutkow--and the endoscopic procedure (predominantly transabdominal preperitoneal hernioplasty (TAPP) and total extraperitoneal hernioplasty (TEP)). The debate on the optimal therapy of hernias is understandable in view of the large number of hernia operations which are carried out. Numerous studies, some randomized, have demonstrated both the advantages and the disadvantages of the individual operative procedures. In addition to the recurrence rate and the complications, the cost factor and the associated socio-economic aspects of the particular operation play an increasingly important role in the decision on the method that should be used. In December 1995 some Austrian surgeons, who concerned themselves with problems of hernia repair already before the definitive introduction of laparoscopic hernia repair in today's surgery, came together on the occasion of a "Consensus Conference". During the meeting a summary of all relevant aspects of the complex of problems was worked out and summarized in a catalog of indications for the different operative interventions. The main statement was that the traditional open surgery, which can be performed under local anesthesia is indicated for an unilateral primary hernia. In case of an unclear finding at the contralateral side, as well as in case of a recurrent hernia, an endoscopic procedure is indicated. Meanwhile the Hernia Forum of Zürs ("Zürser Hernienforum") was founded. The function of this forum is the realization of a prospective randomized study for hernia repair in Austria.

Hernia, Inguinal↗

[Follow-up of the introduction of medical-natural science curricula into education].

A source-oriented research study that began with medieval library catalogs, provided the material needed to establish the organization und structuring of the teaching of natural science in monastic/convent schools. The further development of natural science from here to present-day teaching of biology was then traced. The wealth of material available since the late Middle Ages enabled the individual phases of development of this new teaching subject to be identified and their adoption into the Latin education system determined. This process revealed a series of different establishment phases. From the Middle Ages onwards, the study is based on teacher's and pupils' books known to have been used in the Latin education system, and, from the 18th Century onward, on an additional 7,000 or so school annual reports as well as, from the second part of the 19th Century, teaching curricula.

Biology↗

An essay on reflection.

From the vantage point of her personal experience, the author examines milestones since the 1960s which have changed the medical library profession and helped shape the Medical Library Association. The advent of automation, including cataloging with OCLC and online literature searching through the SUNY Biomedical Communication Network, was a dramatic event that transformed the work and priorities of librarians, fulfilling the dreams of earlier visionaries. The application of technology in libraries led to an increased demand for education and training for librarians. The Medical Library Association responded with continuing education programs, and a series of important reports influenced how the association filled its role in professional development. Legislation providing federal funding, such as the Medical Library Assistance Act, resulted in a period of expansion for libraries and their services. The Medical Library Association has developed a legislative agenda to influence action in areas such as copyright. In the future, health sciences librarians must take a leadership role.

Education, Continuing↗

Chromosomal abnormalities in secondary MDS and AML. Relationship to drugs and radiation with specific emphasis on the balanced rearrangements.

BACKGROUND AND OBJECTIVE: In therapy-related myelodysplasia (t-MDS) or acute myeloid leukemia (t-AML) balanced chromosome aberrations to bands 11q23 and 21q22 have been significantly related to previous chemotherapy with DNA topoisomerase II inhibitors. The purpose of the present study was to evaluate to what extent other balanced chromosome aberrations show the same association, and to evaluate a possible relationship to patient age and subgroups of drugs. DESIGN AND METHODS: All previously published cases of t-MDS and t-AML with any type of balanced aberration identified from Felix Mitelman's Catalog of Chromosome Aberrations in Cancer were analyzed for age and type of previous therapy, and the results were evaluated in univariate and multivariate analyses. RESULTS: A total of 422 cases were recorded, 328 had previously received well specified types of chemotherapy; 254 presented one out of five characteristic balanced aberrations, whereas 168 cases presented different uncharacteristic balanced aberrations. In univariate analysis cases with translocations to 11q23 had most often received DNA topoisomerase II inhibitors, whereas patients with the uncharacteristic balanced rearrangements most often had received alkylating agents (p < 0.00000001). Inv(16), t(15;17), and t(9;22) were likewise significantly associated with previous therapy with DNA topoisomerase II inhibitors and to almost the same extent as translocations to 21q22. Patients with translocations to 11q23 were significantly younger as compared to all other groups of patients. Translocations to 11q23 predominated following therapy with epipodophyllotoxins, whereas patients with translocations to 21q22, inv(16), t(15;17), and t(9;22) most often had received anthracyclines. In a multivariate analysis taking age into consideration, however, these drug-specific associations were no longer significant. INTERPRETATION AND CONCLUSIONS: Specific balanced chromosome aberrations in t-MDS and t-AML involving chromosome bands 11q23 and 21q22, inv(16), t(15;17), and t(9;22) are all significantly associated with previous therapy with DNA topoisomerase II inhibitors, as compared to the uncharacteristic balanced aberrations most commonly observed after therapy with alkylating agents. Younger age and not a specific type of DNA topoisomerase II inhibitor seems to predispose specifically to development of t-MDS and t-AML with translocations to chromosome band 11q23.

Acute Disease↗

Visual elements in flight simulation.

Flight simulators have been in use for many years and their value has been amply proven. Many of today's simulators are very expensive, but they can pay for themselves by decreasing cost and increasing safety in training pilots to fly complex and expensive modern aircraft. Some aspects of aircraft control depend on an exterior view from the aircraft to the outside visual world. Training in these aspects of flight in a simulator requires simulation of the visual world to the extent that cues derived from it need to be employed by the pilot. A number of maneuvers cannot be performed without direct visual contact under normal circumstances in commercial as well as in military aviation. The importance of including a simulation of the external world is not acknowledged. Unfortunately, there is currently no solid scientific basis for cataloging visual cues with respect to their importance in aircraft control. This report recommends research topics, techniques, and strategies that should receive more attention.

Aerospace Medicine↗

Environment-influenced expression of polygene mutations isolated from a natural population of Drosophila melanogaster.

Quantitative trait loci (QTLs) affecting sternopleural bristle number in Drosophila melanogaster have been mapped using phenotypic markers and progeny testing. The loci were found on four of the third chromosomes isolated from a natural population. All four loci showed large effects at the standard 25 degrees C culture temperature, but they responded in different ways when developmental temperature was lowered or raised. These data support the hypothesis that genotype x environment interactions have important influences on polygene expression, and some loci might be silent, or phenotypically neutral, under some conditions but play a large phenotypic role under others. Thus, a full cataloging of the loci contributing to mutational variance for QTLs cannot be done at just a single, controlled environmental condition.

Animals↗

The Internet and education in surgery.

The purpose of this review is to explain the developing role of the Internet and the World Wide Web (WWW) in promoting education in surgery. Internet sites relevant to surgery are appearing rapidly. Remote literature searches can query for surgery trials and results. Societies are using the WWW for transmission and review of publication materials. News groups interactively discuss current developments and trends. Surgeons are using personal and institutional sites to advertise services. Conventional slide shows migrate to the WWW for convenient downloading for surgeons and patients. Multimedia capabilities of the WWW expand the depth of information transmission, enabling education emanating from remote sites with narration and video depiction of procedures. These sophisticated tools can be demonstrated today with real online applications. One site facilitates surgical education using the WWW for program information, symposium coordination, links to regional subspecialty societies, residency cataloging, patient question and answer forums, and multimedia procedure descriptions. The principles of WWW communication used in this website can adapt to meet any educational need. The specialty of surgery is well suited to incorporation of online multimedia education over the Internet to follow new developments in our field.

Audiovisual Aids↗