Measurements of electromagnetic fields radiated from communication equipment and of environmental electromagnetic noise: impact on the use of communication equipment within the hospital

The increasing use of all types of cellular telephones requires the formulation of new standards to ensure the immunity of electronic medical equipment to electromagnetic radiation. It will be many years before all hospital medical equipment conforms to new and higher standards. Until that time, the medical, security, maintenance, and other staff will need to be ever vigilant regarding restrictions on the use of wireless equipment within the hospital, to prevent potential danger to the lives of the patients. A comprehensive hospital policy must be formulated to reduce risks to patients from equipment susceptible to electromagnetic interference (EMI). Such an aim should address the following needs: To devise a uniform policy for the instruction of hospital staff, visitors, and patients, thereby reducing confusion regarding the use of cellular telephones, beepers, and portable transceivers. To implement a policy that avoids unwarranted restrictions but does not ignore statistical evidence regarding potential EMI problems. To allow comparison, with other clinical facilities, of the benefits derived from such a policy.     

我国实施稀土资源储备的现实困境与出路

基于国内外稀土资源形势、国家安全和增强国际市场话语权的需要,我国有必要实施稀土资源储备战略,但我国稀土资源储备面临着相关法律制度缺失、与地方经济发展矛盾、缺少资金支持以及稀土进口国对“出口配额管制”反对等困境.为此,应从构建稀土资源储备法律制度、完善储备方式、加强稀土资源储备资金保障和建立稀土资源矿产地储备补偿制度等方面寻找出路.      

Non-smoking policy in the hospital: insight into policy-relevant social research

This article reports on long-term activities of the social research group SALSS which have been supported by the Federal German Health Education Authority. Work started in 1989/90 with a representative survey among hospital managers in West Germany which--soon after reunification--was completed by similar action in East Germany. In both cases, the subjects were regulations and actual situation of non-smokers' protection in hospitals as well as plans for improvement. Based on the data gathered, handy information material and campaign aids were developed for "frontline" activists. Professional support has been given to persons engaged in devising and implementing measures to improve the situation. This includes assisting concerned hospitals in patient and staff surveys (design and data processing) which are meant to detect the weak spots of non-smokers' protection as well as the demands for changes. This contribution contains the findings of patient and staff surveys conducted in four establishments which may be regarded as typical of German hospitals. There is clear evidence that the rate of smokers is higher among staff members than among patients, and that conflicts about smoking are most likely to occur within the group of hospital employees. Especially non-smoking staff members demand that the hospital management shows more commitment to smoking restrictions. The findings support the notion that only a broad, careful step-by-step approach has reasonable chances to reduce smoking and improve non-smokers' protection in hospitals by combining structural measures (better separating smokers from non-smokers) with optimized regulations and health education.     

Release of DNA template restrictions in rabbit spermatozoa and rat liver nuclei

The effects of disulfide reduction on DNA template activity of rabbit sperm and rat liver nuclei are compared. After treatment of rabbit spermatozoa with 5 mM dithiothreitol and 1% Triton X-100 for 90 minutes at room temperature, sperm nuclei decondense and nuclear template restrictions for DNA synthesis are released. By contrast, similar thiol treatment of isolated rat liver nuclei fails to release DNA template restrictions. These results suggest a significant difference in the control of template activity in mammalian sperm and somatic cell nuclei.     

The rights of children in hospitals. A questionnaire study of rights of hospitalized children in 14 Norwegian hospitals

The rights of children in hospitals in Norway are protected by regulations based on the hospital statute: Regulations covering children in hospital, signed in 1989. These regulations cover matters such as the schooling of hospitalized children, the housing of parents, the economic rights of parents and information. We interviewed hospital management at two different levels of administration to find out how they put these regulations into practice. We found a certain gap between what the law demands and what the hospitals actually provide e.g. with regard to children on adult wards, firm point of contact, activity areas and provisions for education, clarification of parents' duties and respite facilities, reimbursement of expenses and issue of regulations. We conclude that the time has come for hospitals to report on the actions taken to ensure children's rights and for amendment to the law.     

The diagnosis and treatment of abduction deficiencies

Deficient abduction can be due to both innervational deficiencies and/or mechanical restrictions. Innervational deficiencies include lateral rectus weakness or paralysis, myasthenia gravis, progressive external ophthalmoplegia nd Duane's syndrome with aberrant innervation to the lateral rectus muscle. Mechanical causes include restrictions on the medial side of the globe (a tight medical rectus due to endocrine ophthalmopathy, a contractured medial rectus muscle as a result of a lateral rectus paralysis, excessive resection of the medial rectus muscle, scarring and hemorrhage due to multiple previous operations upon the medial rectus), as well as a posteriorly inserted lateral rectus. This latter condition may result from a traumatically disinserted lateral rectus muscle, an excessively recessed lateral rectus muscle or a lateral rectus that has slipped from its attachment following strabismus surgery. Insufficient force for full abduction is caused by posterior insertion of the lateral rectus. The diagnosis of these various conditions is considered with reference to the forced duction, force generation and saccadic velocity tests. The treatment of these different causes of abduction deficiency is discussed noting that the approach to treatment depends upon the etiology of the abduction deficiency.     

Nonoperative treatment of widely displaced patella fractures

Eighteen patients with displaced patellar fractures were treated nonoperatively. All of the fractures were displaced by at least 1 cm. Ambulation and knee flexion were encouraged as soon as pain permitted. Twelve of the patients were limited in their activities by medical illnesses. Six of these patients died, and the remaining patients underwent follow-up for 2 years. No patient had severe pain, and only three had acquired significant limitations in their activities from their fractures. Nine patients had either minimal or moderate activity restrictions. There were no complications from treatment. Nonoperative treatment is a reasonable option for displaced fractures of the patella, particularly in patients whose activities are limited by chronic illness. Better results, however, are possible with operative treatment.     

Controlling varicella in the healthcare setting: the cost effectiveness of using varicella vaccine in healthcare workers

OBJECTIVE: To determine if varicella vaccination of healthcare workers would result in a net cost savings. DESIGN: A Markov-based decision analysis. SETTING: The analysis was based on a hypothetical population of healthcare workers. Data were obtained from exposure records of a tertiary-care hospital and from the literature. Workers were considered potentially susceptible if they had no past history of varicella. RESULTS: Vaccination of potentially susceptible workers would result in a net cost savings of $59 per person. Serological testing prior to vaccination resulted in smaller net savings. The results were robust across a wide range of assumptions. Importantly, however, the result was very dependent on infection control policy regarding work restrictions for vaccine recipients. If more than 3% of vaccinees were removed from work due to vaccine-associated rash, vaccination no longer would result in a net cost savings. CONCLUSION: Varicella vaccination of potentially susceptible healthcare workers can reduce costs and decrease morbidity. Infection control policy regarding work restrictions for vaccine recipients will play a key role in the feasibility of vaccination.     

Review of Canadian mental health law and policy.

Reviews the book, Canadian Mental Health Law and Policy by John E. Gray, Margaret A. Shone, and Peter F. Liddle (2000). The authors of this book have produced a multidisciplinary text that succinctly summarizes the main points of Canadian mental health laws and the variability across provinces and territories in these laws and in their typical interpretation and application. This book offers a concise guide to the laws dealing with key issues such as involuntary hospital admission, authorization of psychiatric treatment, and treatment refusal. Although not always an easy read for those unfamiliar with legal terms and writing, the book is geared to a wide audience that includes legal and policy specialists, mental health professionals, and advocates for the mentally ill. These authors are to be congratulated for their efforts to disseminate and explain information on Canadian mental health law and to promote a more humane and scientifically grounded set of legal standards and interpretations that are pertinent to the disposition and treatment of Canadian citizens with severe mental disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Provision of taxoids in 1996: inequality of care

OBJECTIVE: To inventory the utilization of taxoids in 1996. METHODS: A survey was conducted in february 1997 among the medical heads of 130 Dutch hospitals. The questions about the use of taxoids (paclitaxel and docetaxel) in 1996 concerned indications, numbers of patients treated, the funding and possible financial restrictions on the treatment. Three weeks after the mailing of the questionnaire, a reminder was sent to hospitals that had not responded. The data from 120 hospitals where oncological care was administered were analysed. RESULTS: Of the 120 hospitals, 111 (92.5%) returned the questionnaire, from 114 locations. Twelve locations reported not having used taxoids, four of them partly for financial reasons. Taxoids had been used at 102 locations: at the expense of the hospital budget at 101 locations, and exclusively at the expense of sickness insurers at one location. At 27 locations, paclitaxel and docetaxel had also been issued in the context of trials, and at 7 locations also via special agreements with the insurers and (or) at the expense of the patient himself. Fifty-three of the 102 taxoid using hospitals had a financial upper limit or a maximum number of patients to be treated. Eighteen of the 102 locations where paclitaxel or docetaxel was issued reported that for financial reasons not all patients eligible for taxoids had been given these drugs. The indications varied from one hospital to another: 67 locations used them for first-phase treatment of patients with ovarian carcinoma, 96 locations for second-phase treatment of patients with ovarian carcinoma and at 91 locations, patients with mammary carcinoma were given taxoids when anthracyclines were no longer indicated. CONCLUSION: Hospitals in 1996 varied greatly with regard to issuing of taxoids. This diversity in part had financial causes. Restrictions on the issuing of taxoids for financial reasons lead to unequal access to care.     

Ambiguities in the legal meaning and significance of mental illness.

The law uses the term mental illness as a prerequisite for legal interventions, but it rarely defines the term with precision. In Foucha v. Louisiana (1992), the Supreme Court held that it would be unconstitutional for a state to retain in a psychiatric hospital an insanity acquittee thought to be dangerous whose only diagnosis was antisocial personality disorder. This article examines the opinion's ambiguities and unresolved questions. It analyzes how mental illness should be defined for legal purposes and explores the constitutional limits that Foucha appears to place on state power to impose civil commitment and involuntary mental health treatment. Foucha appears to apply a newly crystallized constitutional limit on state power—the therapeutic appropriateness principle—whereby involuntary hospitalization or intrusive treatment may be imposed only when therapeutically appropriate. The legal and therapeutic implications of this new principle and of Foucha's narrow concept of mental illness are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hospital privileges and the Americans with Disabilities Act

The Americans with Disabilities Act provides protection for equal access to services and employment opportunities for qualified persons with disabilities. Because hospital privileges are essential to physician practice, this article investigates the role of the Americans With Disabilities Act in acquiring and maintaining these privileges. Recent findings from the Act's case law support the concept that: 1) an employer employee relationship exists between the hospital and the non-staff physician for purposes of the Act's analysis, and thus, 2) the Act is applicable to questions of hospital privileges for non-staff physicians. Suggestions for ensuring patient welfare while maintaining compliance with the Act are discussed.     

The ontological basis of strong artificial life

In 1973, the United States Congress enacted legislation requiring physicians to initiate Peer Review Organizations to monitor utilization and quality of hospital and physician services in the federally funded Medicare program. A hardly noticed provision of the statute intimated the desirability of formulating guidelines for medical treatment. What was originally intended to simplify and universalize general standards by which quality of care could be objectively measured has more recently escalated into formalized projects, subsidized by government, to create "practice parameters". The impetus to define clinical conditions and methods of treatment for specific medical conditions (practice parameters) and standards of practice to avoid or defend malpractice claims (risk management protocols) are part of the movement in the United States for tort reform. If the vague "reasonable man" standard of care in negligence law can be supplanted by a scientifically developed, particularized medical practice standard, it is anticipated that spurious claims and defensive medical practice will be discouraged, quality improved, iatrogenic injury and malpractice litigation diminished. Many U.S. states undertook tort reform in the last decade. A few have embarked on medical-legal reform. One state is conducting a five-year medical liability project that calls for the development of practice parameters and risk management protocols in four medical specialties. The parameters will have the effect of law and may be introduced as evidence in medical malpractice trials. How the parameters are established, their effect on the strategies of litigation, the resultant trial problems in the introduction of evidence and in the burden of proof and their potential for acceptance by a significant number of jurisdictions-are the issues to be explored in this paper.     

Legal aspects of epilepsy and coexisting psychiatric disorders

Major advances in understanding the neurobiology of epilepsy have led to more precise diagnosis, early rational treatment with new drugs, useful new neurosurgical techniques, etc. This has led to significant control of seizures, a marked reduction in concurrent psychopathology, improved quality of life of the epileptic patient, the almost complete abolition of old-style institutions for these patients, etc. However in spite of greater scientific knowledge about epilepsy, this has not led to an equally great advance socially. Old-fashioned restrictions and limitations based on mistaken ideas as to the nature of epilepsy still remain. Epilepsy is still considered in the same light as the psychopathological disorders seen in some epileptics, as a result of different variables which are not necessarily related to seizures. Current legal rulings on epilepsy, with or without co-existing mental disorder, are reviewed in relation to their effect on driving motor vehicles, carrying out military service, the condition of minusvalia, the possibility of legal incompetence, and the nullity of marriage and of priesthood. It is concluded that although the limitations maintained by some statutory requirements are reasonable, it would be fairest to abolish restrictions which, in view of present scientific knowledge, are out of date and prevent the return to normal and full social integration which should prevail for people with epilepsy.     

Quality indicators using hospital discharge data: state and national applications

BACKGROUND: Demand for information about the quality of health care has escalated. Yet many organizations lack well-specified quality measures, statistical expertise, or the requisite data to produce such information. The Healthcare Cost and Utilization Project Quality Indicators (HCUP QIs) represent one approach to measuring health care quality using readily available data on hospital inpatients. METHODS: The HCUP QIs, developed in 1994, address clinical performance rather than other dimensions of quality such as satisfaction or efficiency. The 33 indicators produce rates that represent measures of outcomes (mortality and complications), utilization, and access. In lieu of complex multivariate techniques, two methods were used: (1) restrictions in defining patient subgroups to isolate homogeneous at-risk populations and (2) standardization when populations are diverse. Stratified analyses are recommended when patient or hospital factors are believed to influence the outcome. A simple method for making statistical comparisons to national rates was developed. The HCUP QI software, available in both mainframe and microcomputer applications, have enabled organizations to use their own data to produce comparative statistics and examine trends over time. Results summarized at the individual hospital or aggregate level are being used to stimulate continuous quality improvement initiatives. CONCLUSIONS: The HCUP QIs offer a low-cost alternative for organizations that have access to administrative data. Current users include hospital associations, state health departments, statewide data organizations, and individual hospitals. Although the HCUP QIs are intended to serve as indicators, not definitive measures, of quality, they were designed to highlight quality concerns and to target areas for more intensive study.     

Vancomycin-resistant enterococci

Vancomycin-resistant enterococci (VRE) are a major problem in numerous institutions in the United States. Most VRE are resistant to all available antimicrobial agents, resulting in serious therapeutic dilemmas. The resistance genes are transmitted on transposons, so the potential for dissemination to other species is significant. Risk factors associated with VRE infection and colonization are vancomycin and cephalosporin use, but numerous patient-related factors also contribute. Although resistant strains appear to arise from the patient's endogenous flora, VRE may be spread through direct contact with contaminated environmental surfaces and hands of caregivers. Published guidelines for preventing such spread suggest implementing infection-control practices and vancomycin restrictions. The ideal drug regimen for the treatment of VRE is unknown. Various drug combinations have been studied in the laboratory, but patient treatment data are scarce. There is an urgent need for new antimicrobial agents.     

Modelling and design of cross-over trials

There are many diseases and conditions that can be studied using a cross-over clinical trial, where the subjects receive sequences of treatments. The treatments are then compared using the repeated measurements taken 'within' subjects. The actual plan or design of the trial is usually obtained by consulting a published table of designs or by applying relatively simple rules such as using all possible permutations of the treatments. However, there is a danger is this approach because the model assumed for the data when the tables or rules were constructed may not be appropriate for the new trial being planned. Also, there may be restrictions in the new trial on the number of treatment sequences that can be used or on the number of periods of treatment particular subjects can be given. Such restrictions may mean that a published design of the ideal size cannot be found unless compromises are made. A better approach is to make the design satisfy the objectives of the trial rather than vice versa. In this paper we describe an approach to constructing such tailor-made designs which we hope will lead to ill-fitting 'off the peg' designs being a thing of the past. We use a computer algorithm to search for optimal designs and illustrate it using a number of examples. The criterion of optimality used in this paper is A-optimality but our approach is not restricted to one particular criterion. The model used in the search for the optimal design is chosen to suit the nature of the trial at hand and as an example a variety of models for three treatments are considered. We also illustrate the construction of designs for the comparison of two active treatments and a placebo where it can be assumed that the carry-over effects of the active treatments are similar. Finally, we illustrate an augmentation of a design that could arise when the objectives of a trial change.     

De novo mutations of the growth hormone gene: an important cause of congenital isolated growth hormone deficiency?

OBJECTIVES: To determine the epidemiological features of injuries associated with fireworks. DESIGN: A retrospective study of reported cases. SUBJECTS: Subjects were those who attended selected Victorian hospital emergency departments (n = 17) and those admitted for firework related injuries (n = 16). RESULTS: The mean (SD) age of attenders at emergency department between January 1988 and June 1996, was 8.9 (6.2) years and most (88%) were under 18 years of age. Males accounted for 71% of the cases. The most common anatomical sites and types of injury were head (47%) and burns (88%), respectively. About 53% of the injuries were caused by firecrackers, the remainder by sparklers and penny bangers. Among those admitted to hospital between July 1987 and June 1996, the mean (SD) age was 22.9 (14.8) years and 50% were under 18 years of age. Males accounted for 87% of the cases. There was a significant difference in mean age between those admitted and not admitted to hospital, the former being significantly older. CONCLUSIONS: Although relatively rare, injuries from fireworks still occur in Victoria after legislative restrictions on their sale in 1985. Consequently, there is a potential risk for injuries among children, particularly from firecrackers. More enforcement of the regulations, education, and parental supervision are needed to prevent injuries from fireworks.     

Compliance with antismoking laws in official institutions

The prevention of nicotine addiction involves a wide range of measures, including writing laws to preserve public health by protecting nonsmokers from smoke and discouraging smokers from consumption. Also important are campaigns to educate both parties (smokers and nonsmokers) about the negative effects of tobacco. The main antismoking law in Spain is the Health and Consumer Ministry's Royal Decree 192/1988 limiting the sale and use of tobacco with the aim of protecting public health. Other regulations have since been enacted by public administrations to complement that law. Research finding published in recent years have been the basis for major legal changes leading in two directions; toward standardizing laws existing in different countries and toward increasing restrictions on the advertising and sale of tobacco. Various scientific and social groups have demanded that current laws be made stricter. Little has been done, however, to assess the degree of vigilance and compliance, and consequently the efficacy, of current legislation. The aim of this study was to determine the level of compliance with the law in governmental institutions in Salamanca. We visited 30 centers and saw that while notices prohibiting smoking were visible in 80%, the number of smokers was high: 43% among workers (none of whom was in educational or medical centers) and 37% among the public. No posters warning of the dangers of tobacco were seen in any of the centers visited. It appears necessary to further restrict the sale and use of tobacco in public places, to enforce compliance with existing regulations and to increase the amount of information on the toxic effects of tobacco in order to gain the cooperation of both smokers and nonsmokers toward achieving smoke-free environments.     

Hot rolling pre-heating furnace model optimization technology

Furnace area is regarded as looper between casting and hot rolling,which is very important for material flow balance and production organization as well as temperature regulation etc.In particular,when dealing with energy saving and emission reduction and heating quality improving,pre_heating furnace is paid more attention.The radical target for preheating furnace is to transfer heating energy at the least cost. As we know,the preheating furnace is a dissipation system to obey conservation of energy law,that is to say that input energy always equals to output energy,in the meantime,the whole energy consuming is not reversible.Therefore increasing the efficiency of using energy is uppermost.In this paper,heating transfer efficiency is analysed and mathematical expression is given based on conservation of energy law.Typical optimal methods to improve preheating furnace transfer efficiency coming from foreign factories are presented.According to these methods,every furnace zone temperatures as control variable,target discharging temperature and temperature difference in slab thickness and the temperature between neighbouring zones as well as zone temporary temperature as restrictions,minimal energy consuming as optimizing target.Baosteel preheating furnace model structure and the complicated mapping relation of control parameter set and state set and aim set are presented.Important basic models in the preheating furnace model system are analysed including temperature tracking model and temperature forecasting model and discharging pacing model and slab heating curve.First slab temperature model structure and its peripheric parameter are introduced;second two pacing models are given including timing pacing mode using fixed discharging interval and mill pacing control mode using mill rolling pacing while Baosteel pacing forecasting model using long term and short term forecasting mode) is given;third a heating curve mathematical model considering heating quality and rolling pace and energy consuming is presented;in the end summary is done and the future way is lighted.Baosteel heating model including slab and billet and steel ingot have been developed,the actual applications show a good effect.The future woks include working procedure saving energy and system saving energy considering " Oder and rule" to achieve system harmony and rhythmization.Baosteel Blooming furnaces scheduling system is very useful for smooth production and saving energy.