A method for defining competency in Pediatrics

In 1972 the American Board of Pediatrics (ABP) initiated studies leading to a report which identifies the important components of competency needed in the practice of pediatrics. The development of the report involved a group process engaging ABP board members and examiners. The outcome has been (a) the delineation of a process for establishing definitions of competency in a medical discipline; (b) the development of a framework for specifying the abilities needed to perform the tasks required of pediatricians; (c) an elaboration of samples of pediatric subjects to which these abilities and tasks are relevant; and (d) the development of a basis for choice of methods to use for purposes of certification.     

The Modification of Epoxy/Metal Interphases by Adsorbed Contaminants

The interfacial region formed between an epoxy/polyamide adhesive and three metallic substrates has been investigated using x-ray photoelectron spectroscopy. The effect of adsorbed contaminants on the interfacial region has also been studied. The substrates studied were cold-rolled steel, electrogalvanized steel and 2024 aluminum. A “ship-out” oil was used to contaminate the cold-rolled steel and electrogalvanized steel whereas an aerospace hydraulic fluid was used to contaminate the 2024 aluminum. Preferential adsorption of the curing agent by the substrates was observed, the effect being most marked in the case of the electrogalvanized steel substrates. The interaction between the galvanized steel and the 2024 aluminum and the curing agent was primarily via the free amines in the polyamide curing agent. In the case of cold-rolled steel the interaction occurred via the amide component. Cold-rolled steel and 2024 aluminum protonated the curing agents. No protonation was detected in the case of the electrogalvanized steel substrates due to the formation of a zinc/amine coordination compound involving the lone pairs of electrons on the nitrogen atoms. When the contaminated cold-rolled steel substrates were studied, the adhesive displaced the majority of the ship-out oil, but no protonation of the curing agent was observed. This indicated that some residual contaminant remained associated with the cold-rolled steel substrate. The majority of the ship-out oil was not displaced from the electrogalvanized steel because the strong preferential adsorption of the curing agent by the substrates created an adhesive layer enriched in epoxy. As the epoxy resin was incompatible with the oil, this epoxy-rich layer acted as a barrier, preventing the absorption of the oil by the bulk adhesive. In the case of the 2024 aluminum substrate, the level of preferential adsorption of the curing agent was decreased, but protonation of the nitrogen groups was still observed. These results indicated that the hydraulic fluid was displaced from the 2024 aluminum in some areas.     

Plasma Metabolomics Analysis of Polyvinyl Chloride Workers Identifies Altered Processes and Candidate Biomarkers for Hepatic Hemangiosarcoma and Its Development

Background: High-level occupational vinyl chloride (VC) exposures have been associated with hepatic hemangiosarcoma, which typically develops following a long latency period. Although VC is genotoxic, a more comprehensive mode of action has not been determined and diagnostic biomarkers have not been established. The purpose of this study is to address these knowledge gaps through plasma metabolomics. Methods: Plasma samples from polyvinyl chloride polymerization workers who developed hemangiosarcoma (cases, n = 15) and VC exposure-matched controls (n = 17) underwent metabolomic analysis. Random forest and bioinformatic analyses were performed. Results: Cases and controls had similar demographics and routine liver biochemistries. Mass spectroscopy identified 606 known metabolites. Random forest analysis had an 82% predictive accuracy for group classification. 60 metabolites were significantly increased and 44 were decreased vs. controls. Taurocholate, bradykinin and fibrin degradation product 2 were up-regulated by greater than 80-fold. The naturally occurring anti-angiogenic phenol, 4-hydroxybenzyl alcohol, was down-regulated 5-fold. Top affected ontologies involved: (i) metabolism of bile acids, taurine, cholesterol, fatty acids and amino acids; (ii) inflammation and oxidative stress; and (iii) nicotinic cholinergic signaling. Conclusions: The plasma metabolome was differentially regulated in polyvinyl chloride workers who developed hepatic hemangiosarcoma. Ontologies potentially involved in hemangiosarcoma pathogenesis and candidate biomarkers were identified.     

Application of Smith Predictor Based on Single Neural Network in Cold Rolling Shape Control

Flatness is one of the most important criterion factors to evaluate the quality of the steel strip. To improve the strip' s flatness quality, the most frequently used methodology is to employ the closed-loop automatic shape control system. However, in the shape control system, the shape-meter is always installed at the down way of the exit of the cold rolling mill and can not sense the changes of the strip flatness in the rolling gap directly. This kind of installation results in the delay of the feedback in the control system. Therefore, the stability and response performance of the system are strongly affected by the delay. At present, there is still no mature way to design controllers for systems with time delay. Although the conventional PID controller used in most practical applications has the capability to comte the delay, the effect of the compensation is limited, especially for the systems with long time delay. Smith predictor, as a compensator for solving this problem, is now widely used in industry systems. However, the request of highly precise model of the system and the poor adaptive performance to the changes of related parameters limit the application of the Smith predictor in practice. In order to overcome the drawbacks of the Smith predictor, a new Smith predictor based on single neural network PID (SNN-PID) is proposed. Because the single neural network is employed into the Smith predictor to improve the controller's self-adaptability, the adaptive capability to the varying parameters of the system is improved. Meanwhile, for the purpose of solving the problems such as time-consuming and complicated calculation of the neural networks in real time, the learning coefficient of neural network is divided into several stages as usually done in expert control system. Therefore, the control system can obtain fast response due to the improved calculation speed of the neural networks. In order to validate the performance of the proposed controller, the experiment is conducted on the shape control system in a 300 mm four-high reversing cold rolling mill. The experimental results show that the SNN-PID with Smith predictor controller can effectively compeusate the delay effects and achieve better control performance than the conventional PIO controller.     

Use of cardiopulmonary bypass to salvage patients with multiple-chamber heart wounds

BACKGROUND: The need for cardiopulmonary bypass in the treatment of penetrating heart injuries is debated. OBJECTIVES: To review our experience with penetrating heart injuries and determine the indications and outcome for cardiopulmonary bypass. DESIGN: Retrospective review. SETTING: A university-based, level I trauma center. PATIENTS: All victims of penetrating heart injury presenting between July 1, 1989, and December 31, 1995. METHODS: Medical records were reviewed for demographic and physiological data, operative findings, and outcome. RESULTS: Overall survival for 106 patients with penetrating heart injury was 55%. In an effort to resuscitate the heart, 4 patients with unresponsive cardiogenic shock were placed on cardiopulmonary bypass; none survived. Of 30 patients with multiple-chamber injuries, 11 presented with signs of life and 7 survived. Cardiopulmonary bypass was essential to repair complex injuries in 2 of the 7 survivors. CONCLUSION: Cardiopulmonary bypass was ineffective in salvaging patients with cardiogenic shock but was essential in some patients with complex multiple-chamber cardiac injuries that could not be exposed and repaired by other means.     

Repeatability and reproducibility estimates from collaborative studies based on total concentration of trace analytes

In the process of validating a given analytical method for the total concentration of a trace analyte, the precision indicators, repeatability and reproducibility, are obtained from a collaborative study of the method based on a standard one-way completely randomized model. This report discusses the shortcomings of the statistical models used in such studies, defines the component makeup for estimates of the repeatability and reproducibility variances based on these models, and considers suggestions offered as new policy regarding method performance based on total concentration.     

Regulation of beta-adrenoceptors in the guinea-pig sinoatrial node

This study examined the changes of beta-adrenoceptors in the guinea-pig sinoatrial nodal region following 7 day (-)-isoprenaline (400 micrograms/kg/h s.c.) infusion and the relationship between beta-adrenoceptor desensitization and receptor down-regulation. Changes in beta 1- and beta 2-adrenoceptor density were measured using quantitative autoradiography and function in organ bath studies. (-)-Isoprenaline treatment produced a marked decrease in total (from 57.5 to 33.9 fmol/mg protein), beta 1- (from 49.4 to 32.8 fmol/mg protein), and beta 2-adrenoceptor density (from 8.1 to 1.05 fmol/mg protein) in the sinoatrial node. In adjacent right atrium, treatment produced no change in total (39.5 and 36.7 fmol/mg protein) or beta 1-adrenoceptors (35.9 and 36.4 fmol/mg protein) but did decrease beta 2-adrenoceptors (from 3.7 to 0.3 fmol/mg protein). Chronotropic effects were measured in spontaneously beating right atrium. Procaterol, a selective beta 2-adrenoceptor agonist, caused a biphasic chronotropic response in control right atria, the first part of which was abolished in the tissue from treated animals. The maximum increase in right atrial rate to RO363, a beta 1-adrenoceptor selective partial agonist, was reduced from 114 bpm in control to 43 bpm in treated animals. In electrically driven right atrium with the sinoatrial node removed procaterol failed to produce a positive inotropic response via beta 2-adrenoceptors, but the maximum response to RO363 was reduced from 0.75 g in the control tissue to 0.12 g in the treated tissue. This study showed that changes in beta 2-adrenoceptor density following 7 day (-)-isoprenaline infusion are compatible with reduced functional responsiveness in the SA node. The reduction of beta 1-adrenoceptor number in the SA node was also compatible with the reduced chronotropic response in this tissue. However the lack of effect on beta 1-adrenoceptor density in the right atrium was not consistent with the decrease in beta 1-adrenoceptor mediated inotropic response in this tissue. This suggests that beta-adrenoceptor desensitization is not always associated with receptor down-regulation but depends also on the changes in the cell signalling system beyond the level of the receptor which differ according to the cardiac location.     

The effect of an infusion of low molecular weight dextran on peripheral resistance in patients with arteriosclerosis

Low molecular weight dextran is frequently given to improve the flow of blood to the periphery, but its mode of action is uncertain. We measured the effect of an infusion of 500 ml of Dextran 40 on the peripheral resistance in 12 patients undergoing reconstructive surgery for atherosclerotic occlusion of the superficial femoral artery. After the infusion, values of packed cell volume and blood viscosity indicated haemodilution. There was a consistent increase in mean flow and a fall in peripheral resistance. There was no correlation between change in viscosity and change in peripheral resistance, but there was a good correlation between the percentage change in resistance and the initial resistance. This suggests that the increase in flow of blood was due to reflex vasodilatation rather than to any reduction in viscosity.