The Luria-Nebraska Neuropsychological Battery: Theoretical orientation and comment.

Since the introduction of the Luria-Nebraska Neuropsychological Battery (LNNB), issues related to its understanding, interpretation, and validity have generated much interest. In response to P. A. Spiers's (see record 1981-24833-001) criticism of the battery, the authors suggest that the controversy appears to arise from a divergence in theoretical orientation on the role of quantitative versus qualitative assessment as well as from differences in the understanding of measurement methodology and validity. The present article discusses the theoretical basis from which the LNNB was constructed and describes the process of test interpretation. Previous and current research on use and validity of the battery is presented as it relates to the theoretical and methodological concerns. While basic philosophical differences with other theoretical systems are not likely to be resolved, the authors of the LNNB will continue to emphasize the integration of quantitative and qualitative approaches, both in the use of the LNNB and in the field of neuropsychology in general. It is concluded that the LNNB will continue to be revised on the basis of research findings and experience with the test in different patient populations. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An experiential account of the psychology of art.

In this article, the authors consider the potential contribution of the concept “lived experience” to the psychology of art. From the perspective of “lived experience,” the self is always already engaged and comes to every situation with personal interests and ideologies, and the art object is, among other things, understood as “speaking to” or addressing interests and ideologies. This view situates art objects at the center of a variety of sense-making processes: embodied, felt, emotional, intellectual, and intersubjective. It also makes changes in identity that come about through aesthetic experience central to our analysis. In considering the potential of “lived experience,” the authors will examine the associated experiences of viewing and making art. The authors will argue that examining these experiences would benefit from a qualitative methodology and a focus on selfhood. The authors sketch the outlines of such an approach by examining relevant work from Dewey, Vygotsky, and Bakhtin. For these authors, creating an account of art also involves constructing an ontology of lived experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teaching Hydraulic Design Using Equation Solvers

Civil engineering graduates need to be competent in hydraulic theory, as well as in the application of that theory to the solution of practical problems. Teachers of hydraulic design are faced with the dilemma that most realistic hydraulics problems are too complex to solve by hand, while most commercially available software packages obscure the theoretical background for program algorithms. Equation solvers provide a valuable tool for bridging these gaps. Students can develop an appropriate linear or nonlinear mathematical model to depict a realistic system, then use an equation solver package to solve that model for any combination of input data desired. Computer-based studio classrooms further enhance the learning experience by allowing students to solve problems under the instructor's supervision during class periods. This paper will describe how effective equation solvers and the studio classroom can be in teaching hydraulic design for water distribution systems and open-channel flow. The theory is developed in class through the use of printed notes. Students then develop the nonlinear mathematical model for a simple example, solve the model using an equation solver, and check the correctness of the solution. Students are able to investigate the dynamic response and the sensitivity of the model by varying the equation solver input variable values. Next they apply the theory and solution methods to a practical applications exercise. The final step is to complete a comprehensive, realistic design problem. Students are required to present their results to the class at all stages of the process. Course-end evaluation scores have risen significantly since the class has been converted to the studio format. Student comments indicate that they think equation solvers are a valuable engineering design tool, not only for learning, but in professional practice as well. The instructor has observed that students learn and retain the theory much better when they can apply it immediately to realistic problems. Much more realistic and sophisticated quizzes can be given when the students have computers available to assist with the analysis.     

Education and training of medical informatics in the medical curriculum

The teaching of medical informatics is of importance for students in medicine and health care, realizing that they will be the health professionals of the future. Training in medical informatics is also of value for practicing clinicians who are overwhelmed by the avalanche of systems that are available on the market. Some examples of operational systems are presented here to indicate that health care has changed dramatically over the last decades. This paper intends to contribute to the drafting of IMIA guidelines for teaching medical informatics by (1) reporting on the experience at the Faculty of Medicine and Health Sciences of the Erasmus University Rotterdam as part of the curriculum, (2) reporting on the implementation of guidelines for teaching medical informatics in The Netherlands since these guidelines were drafted in 1986, and (3) by introducing the teaching material contained in the new Handbook of Medical Informatics and on its Web site.     

利用数学模型分析首钢京唐公司低碳物流体系

通过查阅首钢京唐公司规划阶段多种设计指标、投产运行后的多种生产统计数据,构建了低碳物流评价体系数学模型,对首钢京唐公司的低碳物流发展能力进行分析,并运用层次分析法对指标进行精简,最后运用多级模糊综合评价法实现对首钢京唐公司低碳物流体系的计算,得到首钢京唐公司的低碳物流能力综合评价为良好。     

The hadron therapy project

The neologism "hadrontherapy" means radiotherapy with hadrons, which are the particles constituted by quarks, such as protons, neutrons and ions. The theoretical considerations about the clinical advantages this treatment modality can yield and the results obtained at the centers where it has already been used justify the proposal to project a center of this kind also in our Country. To this purpose, two of the authors of this paper (U. Amaldi, G. Tosi) founded the TERA Group formed by physicists, engineers and radiotherapists who work in close collaboration on a feasibility study for a hadrontherapy facility. The first aim of the Hadrontherapy Project is to design a center equipped with a synchrotron which, at the beginning, will accelerate negative hydrogen ions (H-) which will first produce 70-250 MeV proton beams and, then accelerate light ions (up to 16O) to 430 MeV/amu. This accelerator will serve four or five treatment rooms where patients can be irradiated simultaneously. Two rooms will be equipped with a fixed horizontal beam for the treatment of eye, head and neck tumors; the others will be equipped with rotating gantries to administer, in any clinical situation, really adequate treatment. Such a unit, when enough experience is fained, will allow at least 1000 patients to be treated yearly. The synchrotron injector will be designed so as to allow, parallel to the radiotherapy activities, other applications of medical and biological interest such as: the production of radioisotopes for diagnostic use (especially positron emitters), the analysis of trace elements through the PIXE technique and the production of thermal and epithermal neutrons for boron neutron capture therapy.     

Liver assist systems: state of the art

Attempts to develop liver support systems for the treatment of patients with liver failure have ranged from use of plasma exchange to utilization of charcoal columns and extracorporeal devices loaded with liver tissue. However, no system has achieved wide clinical use and - in the absence of liver transplantation - severe hepatic failure continues to be associated with significant morbidity and mortality. In this paper, the authors review the current status of liver assist systems and summarize their clinical experience with a xenogeneic cell based-bioartificial liver.     

Cytological diagnosis of lung cancer and precancer using the principal rules]

Analysis of clinical and morphological findings in 306 patients making use of a complex of modern methods at tissue, cellular, and subcellular levels enabled the authors to define the early precancer changes in the bronchial epithelium. The diagnostic value of precancer changes in the lungs and lung cancer was assessed by successive statistical analysis and mathematical estimations. Medical mathematical decisive rules have been developed and are proposed for practical use, which permit the diagnosis of precancer and cancer of the lungs with a high degree of reliability (87 and 89%, respectively).     

Physician attitudes regarding telephone medicine

OBJECTIVE: To measure physicians' attitudes regarding telephone medicine and identify determinants of these attitudes. DESIGN: Cross-sectional survey. SETTING: Ten internal medicine residency programs in the United States. PARTICIPANTS: Graduates from 1988 through 1992. The response rate was 62% (n = 356). MEASUREMENTS AND MAIN RESULTS: Survey items were assigned to one of four types of variables: demographic, attitude, training, or system variables. We used factor analysis to consolidate information from the individual questions about attitudes. Six scales describing attitudes toward telephone medicine were identified. Cronbach's alpha was greater than 0.70 for all scales. One scale measured physicians' satisfaction and confidence with the management of patient calls. Other attitude scales measured the helpfulness of personal experience or informal education and the importance of formal training in telephone medicine. Three of the scales measured how comfortable the physician felt prescribing over the telephone. We used regression analysis to predict physician attitudes towards telephone medicine using the demographic, training, and system variables. Availability of the patient's chart, feeling prepared for telephone medicine by one's residency training, and being comfortable prescribing narcotics by telephone predicted satisfaction and confidence with the management of patient calls (R2 = .25). CONCLUSIONS: Several physician attitudes regarding telephone medicine can be measured reliably. Our findings suggest that improving systems for managing patient calls and improving telephone training for physicians will improve physician satisfaction and confidence with the practice of telephone medicine.     

Programmed heating of coke ovens for increased coke size

Abstract

Large, uniform sized coke is desirable for blast furnace use. It has previously been shown that the coke oven flue temperature in the first few hours of coking is a key determinant of coke size. In this paper, the authors present a new programmed heating approach, which is called pulsed heating, aiming to increase coke mean size at a given average flue temperature. The approach takes into account the charging sequence in coke oven batteries and the authors demonstrate how existing operating practice can be modified in batteries with suitable heating systems to achieve the desired heating programme. A mathematical model of fissure formation provides a prediction of the increase in coke mean size using pulsed heating, compared with standard heating. Pilot scale experiments have also been performed to validate the modelling approach. The results of the modelling indicate that the mean coke size can be increased by several millimetres in some cases, although results from the pilot scale show that pulsed heating increases coke size, but by a smaller amount than that predicted by the model. The potential advantages and limitations of pulsed heating are discussed, as well as opportunities for further investigation of the approach.     

Computerized archives in surgery. Our experience

In recent years, the necessity for a surgical department to obtain a wide range of clinical data in a short period is greatly increased. This necessity has been almost satisfied with widespread use of information systems in medicine using database programs and the integration of these database with other programs has allowed graphic representation of data. Anyhow, some difficulties are still present, such as low knowledge in using personal computers and lacking of a common program for all surgical departments. In the article the authors present a computerized program for the filing of medical records in a surgical department. Starting from January 1992, clinical data of all patients admitted in our department have been recorded in the described program. After three years of use, the system has shown to be easy to use, and able to give useful information for data analysis regarding the population observed, the clinical activity performed and the level of quality obtained. For these reasons, it can represent an attempt to diffuse and uniform computerized data recording in surgical departments.     

The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality

OBJECTIVE: To identify issues related to the quality of health care in the United States, including its measurement, assessment, and improvement, requiring action by health care professionals or other constituencies in the public or private sectors. PARTICIPANTS: The National Roundtable on Health Care Quality, convened by the Institute of Medicine, a component of the National Academy of Sciences, comprised 20 representatives of the private and public sectors, practicing medicine and nursing, representing academia, business, consumer advocacy, and the health media, and including the heads of federal health programs. The roundtable met 6 times between February 1996 and January 1998. It explored ongoing, rapid changes in health care and the implications of these changes for the quality of health and health care in the United States. EVIDENCE: Roundtable members held discussions with a wide variety of experts, convened conferences, commissioned papers, and drew on their individual professional experience. CONSENSUS PROCESS: At the end of its deliberations, roundtable members reached consensus on the conclusions described in this article by a series of discussions at committee meetings and reviews of successive draft documents, the first of which was created by the listed authors and the Institute of Medicine project director. The drafts were revised following these discussions, and the final document was approved according to the formal report review procedures of the National Research Council of the National Academy of Sciences. CONCLUSIONS: The quality of health care can be precisely defined and measured with a degree of scientific accuracy comparable with that of most measures used in clinical medicine. Serious and widespread quality problems exist throughout American medicine. These problems, which may be classified as underuse, overuse, or misuse, occur in small and large communities alike, in all parts of the country, and with approximately equal frequency in managed care and fee-for-service systems of care. Very large numbers of Americans are harmed as a direct result. Quality of care is the problem, not managed care. Current efforts to improve will not succeed unless we undertake a major, systematic effort to overhaul how we deliver health care services, educate and train clinicians, and assess and improve quality.     

Telecommunication in trauma surgery. Communication networks of hospitals in East Bavaria

The growing complexity of the performance processes in medicine makes it mandatory that the flow of information is faster and more consistent, especially when the sites of health care are far away from each other. The Regensburg model, a realization of lean telemedicine from a low-cost domain, using PC-based standard videoconferencing systems shows the use of modern telecommunications, especially in trauma surgery. In 203 prospectively evaluated teleconsultations between 15 participants a total of 697 images were transmitted via videoconferencing. In 95% of the trauma cases the transmitted material was judged as at least sufficient. In project-attending evaluations the efficacy of these systems and their use were clearly demonstrated. Savings in transportation costs of up to 4,400 DM per case were achieved. Through quicker flow of information quality improvements for all participants resulted; to some extent considerable costs for health care were avoided or reduced. Based on these thoughts, a new platform of communication will be established in Regensburg as a closed medical intranet for the region of eastern Bavaria.     

The motivation to use complementary medicine healing methods. Study of a general internal medicine and orthopedic patient sample

436 patients from two different clinics of internal medicine and one orthopaedic unit were asked to fill a questionnaire on their attitude towards and use of alternative medicine. Of the 272 questionnaires returned, 235 could be used for analysis. 42.6% of all analysed persons confirmed use of alternative medicine. About half of them were motivated to do so by their nursing staff. Homeopathy was by far the most frequently used method. Persons who used alternative medicine were characterised by a distinct environmental awareness and regular sports activity. They had also often had positive experience of alternative methods in childhood. On the other hand, age, sex, education, duration of the treated disease and success of conventional therapy did not correlate significantly with the use of alternative medicine. An essential motive for the need to seek help by alternative therapists was the opinion that conventional forms of treatment would concentrate too much on the purely physical side of a health problem. All in all, users of alternative medicine did not seek confrontation with conventional medicine but rather sought a real complement to conventional forms of treatment.     

Correction for the presence of cross-reactants in saturation assays: application to thyroxine cross-reactivity in 3,3',5'-(reverse)-triiodothyronine radioimmunoassay

Cross-reaction of anti-3,3',5'-triiodothyronine (rT3) antisera with thyroxine has proved problematical in the development of radioimmunoassays for rT3. Results of experimental work with two antisera with differing specificities are presented which illustrate certain aspects of cross-reacting assay systems. The mathematical theory of a single binding-site, two ligand assay is discussed and extended by use of a multiple binding-site computer model to a two binding-site, two ligand system. It is suggested that for the practical evaluation of the nature and extent of cross-reaction, a family of response curves for the hormone should be drawn, each curve representing the addition of a fixed mass of the cross-reactant to a set of standard incubation mixtures. Such curves will reveal whether the antiserum is (a) specific, implying that assay results require no correction, (b) behaves as a single binding site system, in which case measurement of the relative potency of the two ligands at the point on the response curve generated by the serum sample will enable an algebraic correction to be made, given that the T4 concentration is known or (c) behaves as a multiple binding-site system where correction necessitates the use of a nomogram.     

济钢物流成本核算现状及分析

济钢采购、生产、销售物流成本核算执行《企业会计准则》的要求,物流成本尚未进行专项的归集,物流成本信息均湮没在采购成本、制造费用等科目中,造成信息反映迟延、分散,不能真实地反映物流成本的实际水平,不利于降低成本。提出满足物流管理需要的物流成本核算设计思路,即以会计信息系统资料为主,物流相关业务部门的台账、报表等生产经营数据资料为辅,借助统计的方法展开。