When a physician makes a mistake

Inevitably, doctors make mistakes in the normal course of providing care. Making a mistake often causes distress for the doctor involved, but it can also be an important source of knowledge and self-reflection. This article discusses central aspects with respect to mistakes and medical malpractice. The doctor's relationship to ethics and legislation is discussed, and an overview of the administrative action taken by the Norwegian health authorities is presented. The organisations and offices a physician may come into contact with when involved in a patient's complaint are briefly presented. "Meldesentralen" was formed in 1993 by the Norwegian Directorate of Health for the purpose of collecting reports on accidents in medical practice. We argue that the accidents reported to "Meldesentralen" do not reflect the true situation on this issue. We introduce a model for a systematic approach towards a colleague who has made a mistake or who is suspected of having made one.     

How a Bill Becomes a Law.

This reprinted article originally appeared in The Retired Officer Magazine, 1969, 25[3], 18-21. The first 2 lines of every bill introduced in Congress reads: "Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled . . ." Why this is so is stated in Article I, Section 1, of the Constitution of the United States, which provides that: "All legislative powers herein granted shall be vested in a Congress of the United States, which shall consist of a Senate and a House of Representatives." The article summarizes the legislative process in the US Congress, beginning with the introduction of a measure that may be either a bill or a resolution, action in Congressional Committees, committee hearings, action in the House, Senate action, conference action, Presidential action, and publication. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aspiration of a primary tooth in a patient with a tracheostomy

We report a clinical case of a patient affected by splenic non-Hodgkin lymphoma and virus C hepatitis. It seems that this kind of association is original because as far as we know the association between non-Hodgkin lymphoma and HCV did not include non-Hodgkin lymphoma involving the spleen. Indeed, in our patient, there was an increase of CD/57 lymphocytes. In our opinion this could be interesting in the disorders of the immune system associated with lymphoma.     

Can a chimpanzee make a statement?

Investigated, in 2 experiments conducted over a 7-yr period using 2 male chimpanzees, whether the gestural-referential complex can be developed. In Exp I, a test was designed to determine whether Ss could produce accurate requests for things they could not see and whether, as they produced these requests, they had an idea of the specific absent objects that corresponded to their symbolically encoded requests. In Exp II, a test was devised to eliminate all potential means of cuing and order strategies that might result in the S's selecting a symbol and giving the appropriate object without anticipating and planning the complete sequence in advance. Results demonstrate that the gestural-referential complex can be developed, with training, in the chimpanzee and that, consequently, naming with reference does appear. A review of the training that preceded the emergence of referential function in these chimpanzees suggests that symbolization is not a unitary skill but rather a combination of diverse productive and receptive skills. (57 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Flow Field in a Rectangular Basin with a Line Inlet and a Circular Outlet

An experimental study was conducted to investigate the flow field in a rectangular basin with a line inlet and a circular outlet. The basin has a length about four times of the water depth and the outlet level was varied in the study. The flow field in the basin can be characterized into three zones: the wall jet zone with an induced recirculation eddy, the outlet zone in the vicinity of the outlet, and the transition zone in between the two zones. The spreading of the wall jet was found to significantly exceed that of a classical wall jet. In the transition zone, the wall jet separated from the basin bed due to the adverse pressure gradient created by the jet impingement on the outlet wall. Upstream of the outlet, a special three-dimensional balloon-like flow pattern was observed. Within a distance of three times of the outlet diameter, potential flow theory predicts well the measured velocity.     

旋流器替代分级机的应用

在磨矿分级作业中，采用旋流器替代分级机进行分级是发展的趋势。这一举措能够与国外先进的磨矿分级工艺技术有效对接。特别是在大型选矿厂改扩建设计项目中旋流器有更广泛的应用价值。     

Valuing a practice for a partnership

The hot topic from Capitol Hill in Washington to Capitol Hill in Jefferson City is health care reform. President Clinton started the ball rolling during the campaign in 1992 by including health care reform in his platform. He continued the effort after his election by appointing his wife, Hillary, to chair a task force to present an outline for federal legislation. Since the package was presented to Congress, there has been much discussion, lobbying, and rumoring about the implications of health care reform and what it could mean to all of us as dentists. On the home front, Governor Carnahan has introduced legislation in Missouri to reform the health care system. This effort is known as the Missouri Health Assurance Plan (H.B. 1622). Missouri Dental Association members are vitally concerned about the impact of health care reform on their practice, their taxes, their relationship with their patients and employees, and on their ability to seek out health care services since each member is also a consumer of health care. This article represents answers to some of the questions being asked by MDA members in order that they might be more aware of the activities by the MDA, the ADA, and other levels of organized dentistry relating to health care reform.     

Vesico-uterine fistula occurring after a normal labor in a patient with a scarred uterus

Hodgkin's disease has rarely been reported to occur subsequent to a previous non-Hodgkin's lymphoma, usually of B-cell type and with a 5 to 7-year median interval between diagnoses. Even rarer is the finding of residual non-Hodgkin's lymphoma at the time of Hodgkin's disease diagnosis. Six such cases have been reported, with five of the six representing "discordant" lymphomas and the other one a "composite" lymphoma. Only four of the six cases (all discordant lymphomas) were supported by immunohistochemical studies; flow cytometric immunophenotyping has not been performed in any of the reported cases. We report a nodal composite lymphoma (B-cell non-Hodgkin's lymphoma and Hodgkin's disease, mixed cellularity), supported by flow cytometric immunophenotyping and immunohistochemical studies, occurring in a patient 5 years after a diagnosis of B-cell non-Hodgkin's lymphoma. This report emphasizes the application and usefulness of flow cytometric immunophenotyping and immunohistochemical studies in such cases.     

Repair of a deep digital tendon deficit in a horse using a polypropylene implant

A yearling horse was treated for a chronic wound with a 4 cm deficit in the deep digital tendon. The gap in the tendon was bridged with paired polypropylene braided implants designed for use as a ligament augmentation device. Uncomplicated healing and return to function occurred.     

Just a 'wee prick' with a needle

Difficulty with vascular access is a common problem in neonatal medicine and surgery. Recent advances in parenteral therapy/nutrition and manufacture of high quality intravenous lines have enabled smaller infants to survive. Thus, in the small surgical neonate, the insertion of an indwelling intravenous long line (either percutaneously or at cut down) is a frequent occurrence. This procedure is not without its complications and it is thus necessary for the clinician inserting these lines to be aware of this and fully understand the regional anatomy of the area being used. I wish to report an unusual complication which posed several diagnostic and management problems.     

Vascular anastomosis using a biodegradable device with a heat-shrinking sleeve: a preliminary report

PURPOSE: The objective of this study is to present a simple mechanical anastomosis system capable of uniting vessels of differing diameters and to evaluate its applicability. MATERIALS AND METHODS: A new mechanical system for anastomosis of small vessels was used in 30 rabbits to join 100 sectioned carotid arteries and jugular veins. The system is resorbable and consists of a cuff and a shrinkable sleeve. To carry out the anastomosis, one vessel end is pulled through the cuff and everted over it. The second vessel end is then slipped over the everted vessel end and the cuff. A heat-shrinking sleeve is positioned over the site and shrunk to produce permanent fixation. RESULTS: The overall patency rate of the anastomoses was 96.6% in the arteries and 93.3% in veins. Microscopically, the intima-to-intima contact sites were bridged by an endothelial layer in the first postoperative weeks. CONCLUSION: Advantages of the system include a short insertion time, simple instrumentation, a high patency rate, and resorbability. However, the method requires additional vessel length for eversion, and it cannot be used for end-to-side anastomoses.     

Hoarding: a symptom, not a syndrome

BACKGROUND: Hoarding behavior in humans spans a continuum from normal collecting to pathological self-neglect and can be associated with a variety of psychiatric disorders. METHOD: The authors summarize research in the past 15 years characterizing hoarding behavior in groups of college students, in nonclinical populations of self-named "pack rats," in outpatients treated for obsessive-compulsive disorder (OCD), and in individual pathological hoarders presented in psychiatric case reports. Two new case reports of pathological hoarding are presented here. RESULTS: The literature suggests, as do the 2 case reports presented, that certain factors may be common to all groups of hoarders, as they all show poor insight, lack of resistance to the compulsion to hoard, and poor treatment motivation. CONCLUSION: Possible biological and psychosocial determinants of pathological hoarding include association with schizophrenia, OCD, and tic disorders, as well as a possible link through the neurotransmitter dopamine. Management issues range from psychopharmacologic treatment with antipsychotic medication to behavioral therapy and environmental manipulation.     

Growth kinetics of a surface film during the annealing of a mixture of a metal powder and a decomposing oxide

Conclusions Equations have been derived describing the growth kinetics of surface films. Conditions have been determined under which surface films cease to be porous and become coherent. Values of the coefficient of oxygen diffusion in copper at a temperature of 850°C calculated using the equations proposed and experimental data are in good agreement with a value cited in the literature.Translated from Poroshkovaya Metallurgiya, No. 2(182), pp. 22–25, February, 1978.     

Mixing of a Rosette Jet Group in a Crossflow

Partially treated wastewater is often discharged into coastal waters through an outfall diffuser fitted with clustered ports on risers. On each riser the effluent is discharged through two to eight ports arranged circumferentially, in the form of a rosette-shaped buoyant jet group. The near field mixing of such a jet group in a tidal flow is determined by the merging and interaction of coflowing, oblique-flowing, cross-flowing, and counterflowing jets. Despite numerous studies, a general predictive method for such complex jet groups has not been reported; ocean outfall design is often based on comprehensive physical model experiments. The mixing of merging nonbuoyant and buoyant jets issuing from a rosette outfall riser into an ambient current is studied experimentally by using the laser-induced fluorescence technique. Detailed cross-sectional measurements of the scalar concentration field downstream of the bent-over jets are made. The trajectories of multiple and individual jets discharging at various angles are measured. For typical outfall designs, the dynamic interaction of adjacent jets is found to be negligible. The average dilution of the jet group can be predicted by accounting for jet merging and plume overlapping. Theoretical predictions using the Lagrangian VISJET model are in excellent agreement with the experimental data and also results of previous studies in a stratified crossflow. The model correctly predicts the changes in near field dilution as a function of the number of nozzles on a riser, or the number of risers on a diffuser, and helps to resolve observed anomalies in previous studies.     

Oocyte differentiation: a motor makes a difference

In a variety of developmental systems, asymmetric mitoses precede, and are essential for, cellular differentiation. Recent studies demonstrate a role for the motor protein cytoplasmic dynein in generating the mitotic asymmetries that lead to Drosophila oocyte differentiation.     

Precipitation of a cholegraphic contrast medium in a dog

Following intravenous injection of medium for cholegraphy, calcium salt was precipitated in the tubules of rats and a 'gallstone' containing contrast medium developed in a dog. A review is given of biotransformation of contrast media in the biliary and urinary tracts.     

Entrainment of a two-layer liquid through a taphole

Entrainment through a taphole of a two-layer system has been investigated. The results showed that for liquids with low viscosities, the minimum dimensionless clearance from the taphole before entrainment occurs can be predicted theoretically and was related to the Froude number as Fr^0.4. At low Froude numbers less than 1, fluids with low viscosities resulted in the entrainment showing a positive deviation from the critical Froude number. This allowed tapping to be carried out without entrainment occurring, even when the liquid-liquid interface was within the region of the taphole diameter. For liquids with appreciable viscosities, the entrainment showed a negative deviation from the critical Froude number. This occurs for the tapping of slag and results in entrainment at a higher liquid-liquid interface height than is predicted theoretically. Entrainment was more likely to happen for slag tapping than for matte tapping. A ledge below the taphole was found to reduce entrainment, enabling the liquid-liquid interface to be closer to the taphole during tapping. This resulted in improved slag removal efficiencies and reduced matte or metal entrainment, coupled with less slag left in the furnace after tapping. The length of the ledge from the taphole into the slag was found to be the controlling parameter for entrainment, while the ledge thickness had no effect on entrainment.     

Discharge Coefficient for a Water Flow through a Bottom Orifice of a Conical Hopper

Discharge coefficients for water flow through a vertical, circular orifice at the bottom of a conical hopper were experimentally studied in the present paper. The conical hopper consists of a cylindrical hopper of inside diameter of 48 cm and a bottom cone of side slope of 45°. Experiments were carried out under different orifice diameters and water heads. The dependence of the discharge coefficient on the orifice diameter and water head was analyzed, and then an empirical relation was developed by using a dimensional analysis and a regression analysis. The results show that the larger orifice diameter or higher water head have a smaller discharge coefficient and the orifice diameter plays more significant influence on the discharge coefficient than the water head does. The discharge coefficient of water flow through a bottom orifice is larger than that through a sidewall orifice under the similar conditions of the water head, orifice diameter, and hopper size.     

Addiction as a social construction: a postempirical view

I examined the role of society and psychology as its agent in the growing problem of addiction in America. The social institutions of a given society establish and maintain a character structure unique to a particular era. The quality of that character is reflected in its inhabitants' individual psychological natures as either health or pathology. I examined the philosophical roots of psychology, its theories and their effect on perpetuating current erroneous beliefs about addiction, and psychology's role in finding real solutions.     

Consolidation of a porous material in hot pressing in a closed mold fitted with a compensator

A method has been developed for calculating the compaction of a porous material in hot pressing in a closed mold fitted with a compensation slot. Simulation is reported for various initial porosities and compensating slot heights. The results from pressing in a closed mold with compensator and in an open mold are compared. Materials Science Institute, Ukrainian Academy of Sciences, Kiev. Translated from Poroshkovaya Metallurgiya, Nos. 5–6, pp. 14–18, May–June, 1998.