Taking dentistry to the top of the world on a Himalayan trek

In October 1996 the author, a dental officer, was part of a group of ten people serving in the Royal Navy who walked the Annapurna circuit in conjunction with Five Valleys Travel and Trek Aid. The Annapurna circuit is situated in the north of Nepal bordering the Kingdom of Mustang and the Peoples Republic of China. It is a grueling 20 day trek reaching the dizzy heights of 18,000 feet, passing through some of the most beautiful and immense scenery in the world. The following is a short account of his experiences.     

炉料堆尖的形成及炉顶设备的布料能力

在料堆的顶部会形成主要由小块料，粉料组成的炉料堆尖，炉料堆尖对高炉煤气流有很强的阻滞作用，不同的炉顶设备对炉料堆尖的展开能力是不一样的：双钟炉顶只能将炉料堆尖展开成一个扇形面，布料能力较弱；无钟炉顶虽具有灵活的布料方式，但在中小型高炉上很难做到多环布料，其布料能力得不到发挥，漏斗式炉可将炉料堆尖展开成一个很宽的环状带，布料能力较强。     

A framework for the economic evaluation of telemedicine

Alongitudinal study was conducted in four indicator villages of PHC Shankargarh, District Allahabad, U.P. from July 1991 to June 1992 to have information on seasonality of indoor resting anopheline species in silica sand/hard stone quarry area. Fourteen anopheline species namely, An. aconitus (0.35%), An. annularis (17.03%), An. barbirostris (0.09%), An. culicifacies (36.74%), An. fluviatilis (0.13%), An. nigerrimus (0.01%), An. pallidus (4.40%), An. splendidus (0.02%), An. stephensi (0.01%), An. subpictus (40.84%), An. tessellatus (0.15%), An. turkhudi (0.004%), An. vagus (0.20%) and An. varuna (0.02%) were collected. An. culicifacies, An. subpictus and An. annularis were found throughout the year. An. fluviatilis, An. pallidus, An. vagus and An. aconitus were also observed in all the seasons except extreme summer. However, An. barbirostris and An. splendidus were collected only in monsoon/post-monsoon and winter seasons. An. tessellatus and An. stephensi were recorded in winter and spring seasons. An. nigerrimus and An. varuna were recorded in winter, while An. turkhudi in spring. Prolonged high vector density may be attributed to the extended malaria transmission in this area.     

博采众家长敢争行业先——1998届炼铁专业校友、中特集团新冶钢有限公司副总审计师岳强

在新冶钢的舞台上,活跃着这样一批共产党员:他们是本单位运筹帷幄的领军人物.他们的名字与一个炉台、机组乃至一个分厂的指标、效益紧密相联.     

An adaptation of the theory of interpersonal behaviour to the study of telemedicine adoption by physicians

Physicians' acceptance of telemedicine constitutes a prerequisite for its diffusion on a national scale. Based upon the Theory of Interpersonal Behavior, this study was aimed at assessing the predictors of physicians' intention to use telemedicine in their clinical practice. All of the physicians involved in the RQTE, the extended provincial telemedicine network of Quebec (Canada) were mailed a questionnaire to identify the psychosocial determinants of their intention to adopt telemedicine. Confirmatory factor analysis (CFA) was performed to assess the measurement model and structural equation modelling (SEM) was applied to test the theoretical model. The adapted theoretical model explained 81% (P<0.001) of variance in physicians' intention to use telehealth. The main predictors of intentions were a composite normative factor, comprising personal as well as social norms (beta=1.08; P<0.001) and self identity (beta=-0.33; P<0.001). Thus, physicians who perceived professional and social responsibilities regarding adoption of telehealth in their clinical practice had stronger intention to use this technology. However, it is likely that personal identity had a suppression effect in the regression equation, indicating that physicians' intention to use telemedicine was better predicted if their self-perception as telemedicine users was considered. These results have several implications at the theoretical and practical levels that are discussed in this paper.     

Performance improvement in telemedicine: the essential elements

Performance improvement activities in telemedicine may be placed into five categories. (1) Licensing and credentialing. Telemedicine overcomes geographical boundaries, but its reach is constrained by state laws on licensing. Some states require a state license, whereas others grant "consultation exemptions" for out-of-state physicians. Simple renewable licenses do not guarantee quality. Potential solutions include a national telemedicine license or license reciprocity laws for telemedicine. (2) Data security and privacy. Telemedicine technology raises some security concerns. Differences in reporting requirements among states complicate the issue of privacy. Storage of telemedicine consultation records may help physicians document care decisions for risk management, but conventional long-term storage may not be feasible because of cost constraints and may not be required to document the encounter appropriately. (3) Informed consent. Potential failures in security and transmission are new, and should be communicated to the patient. (4) Peer review. Peer review findings encourage thorough, accurate, and legible documentation. Results should be recorded by provider and must be available during the recredentialing process. (5) Tailored performance improvement initiatives. By using established principles and techniques, performance improvement initiatives can gather, analyze, and communicate information about the cost-effectiveness of telemedicine. These performance improvement efforts are the heart of quality management and are critical to the justification of telemedicine. Walter Reed Telemedicine has put into effect a performance improvement plan in accordance with this outline. This article describes the plan and suggests it as a model for other telemedicine programs.     

使单轧钢板迈向更高水平

瑞典不锈钢生产厂商奥托昆普公司最近完成了一项1亿欧元的项目,用于升级其位于瑞典的迪戈夫斯不锈钢板生产厂设备。该项投资被称为“Bemd Beckers”,它不仅可以节约成本,而且还为不锈钢板用户带来一系列利好,同时还可以进一步强化公司的全球化钢板供应。不锈钢(包括钢板)在全球范围的消耗,比其它任何金属的消耗都快,这一点已经很好的体现在单轧钢板的需求上。     

Successful development of telemedicine systems--seven core principles

This article discusses seven core principles that underlie the development of successful telemedicine systems. These principles have been formulated from evidence in the literature and from the personal experience of setting up three telemedicine systems in Australia. Of particular importance has been the observation of failed telemedicine systems, of which there are many examples in the world literature. It is important to learn from history by studying both the successful and the unsuccessful components of these programmes. Telemedicine is still a relatively new area of interest, and while the technology is rapidly evolving, changing and fascinating, it is still the human factors that tend to determine the success or failure of telemedicine projects. These cannot be ignored.     

"Telestroke" : the application of telemedicine for stroke

BACKGROUND: Time is of the essence for effective intervention in acute ischemic stroke. Efforts including stroke teams that are "on call" around-the-clock are emerging to reduce the time from emergency room arrival to evaluation and treatment. SUMMARY OF COMMENT: Based on the results of the NINDS rt-PA Stroke Trial, which demonstrated both clinical effectiveness in reducing neurological deficits and disability and cost savings to health care systems, many community hospitals and managed-care organizations are exploring methods to enhance and expedite acute stroke care in their local communities. Only a small fraction of acute stroke victims is currently treated with thrombolytics (<1.5% nationally), and few benefit from the expertise and experience of the stroke teams. It is essential to develop new paradigms to improve acute stroke care in all settings, rural and urban. Rapid linkages to expert stroke care can help the underserved areas. Telemedicine for stroke, "Telestroke, " uses state-of-the-art video telecommunications that may be a potential solution and may maximize the number of patients given effective acute stroke treatment across the country and across the world. Telestroke could facilitate remote cerebrovascular specialty consults from virtually any location within minutes of attempted contact, adding greater expertise to the care of any individual patient. This model also has the potential to enhance patient entry into clinical trials. Telestroke would enhance stroke education through the use of Internet-based interactives for health-care professionals and patients. Education would be facilitated through the creation of telecommunication-linked classes providing interactive information on stroke care and prevention to places where they are otherwise not available. Health-care professionals will gain experience and expertise through the interaction with a remote expert--telementoring. Telestroke provides an excellent medium for data collection and an unprecedented opportunity for quality assurance. Monitoring of an entire tele-interaction can offer real-time assessments, which can then be analyzed in-depth at a later date for unique insights into health-care delivery. Prehospital use of telemedicine for stroke is already being piloted, linking patients in the ambulance to the emergency department. Legal and economic parameters must be established for telemedicine in the areas of reimbursement, liability, malpractice insurance, licensing, and credentialing. Issues of protection of privacy and confidentiality, informed consent, product liability, and industry standards must be addressed to facilitate the use of this new and potentially useful technology. CONCLUSIONS: Computer-based technology can now be used to integrate electronic medical information, clinical assessment tools, neuroradiology, laboratory data, and clinical pathways to bring state-of-the-art expert stroke care to underserved areas.