Health visiting and the case manager role

In 1990 East Berkshire health authority jointly with Berkshire social services carried out a 15 month project on five sites to pilot case management in preparation for the implementation of the community care reforms. Health visitor Catherine Squire describes her experience of working as a case manager in one of the pilots and argues for better career opportunities for health visitors in this field.     

Pediatric malignant glioma with tubuloreticular inclusions and MYCN amplification. Report of a case with immunohistochemical, ultrastructural, flow cytometric, karyotypic, and Southern blot analysis

BACKGROUND: The authors described unusual pathologic features in a left frontal lobe malignant glioma in a 31/2-year-old boy. The pathology was similar in the initial excision and two subsequent recurrences at 9 and 11 months and at autopsy, when extensive subarachnoid spread was noted. METHODS: The tumor was studied by conventional histology, immunohistochemistry, flow cytometry, transmission electron microscopy (TEM), immune electron microscopy (IEM), and cytogenetic and Southern blot analysis. RESULTS: The tumor revealed two different histologic patterns. One component showed large cells with eosinophilic cytoplasm, vesicular nuclei with prominent nucleoli, eosinophilic perinuclear inclusions, and immunoreactivity for glial fibrillary acidic protein (GFAP) and vimentin. The other component consisted of undifferentiated cells with hyperchromatic nuclei and scanty cytoplasm. By TEM, the perinuclear aggregates were composed of tubuloreticular inclusions, which were also observed in endothelial cells within the tumor vasculature. By IEM, the intermediate filaments in the tumor cell cytoplasm were decorated with GFAP. Flow cytometric results revealed a marked increase in the S-phase (48%), whereas cytogenetic analysis of short-term cultures showed an abnormal karyotype containing marker chromosomes and double minutes. In the second resection, additional karyotypic abnormalities were noted, including 1p- and several additional markers. The first and second resections showed MYCN amplification by Southern Blot analysis in the 60- to 80-fold range. CONCLUSIONS: This tumor presents unique histologic, ultrastructural, and cytogenetic findings as well as MYCN amplification that is notable for a pediatric malignant glioma. Tubuloreticular inclusions were a prominent feature in this tumor, which again is unique for a glioma.     

VEST: Abstract vector calculus simplification in Mathematica

We present a new package, VEST (Vector Einstein Summation Tools), that performs abstract vector calculus computations in Mathematica. Through the use of index notation, VEST is able to reduce three-dimensional scalar and vector expressions of a very general type to a well defined standard form. In addition, utilizing properties of the Levi-Civita symbol, the program can derive types of multi-term vector identities that are not recognized by reduction, subsequently applying these to simplify large expressions. In a companion paper Burby et al. (2013)  [12], we employ VEST in the automation of the calculation of high-order Lagrangians for the single particle guiding center system in plasma physics, a computation which illustrates its ability to handle very large expressions. VEST has been designed to be simple and intuitive to use, both for basic checking of work and more involved computations.     

Carcinogenic potency and risk assessment

An overview of carcinogenesis risk assessment is presented. The nature of evidence for carcinogenic potential in humans is discussed, including possible carcinogenic mechanisms, genotoxicity and laboratory animal data. Emphasis is given to the importance of including all pertinent evidence in risk assessment, rather than placing total reliance on mathematical extrapolations from animal tumour data. An approach to ranking animal carcinogens according to the weight of evidence is described briefly.     

A neostriatal habit learning system in humans

Amnesic patients and nondemented patients with Parkinson's disease were given a probabilistic classification task in which they learned which of two outcomes would occur on each trial, given the particular combination of cues that appeared. Amnesic patients exhibited normal learning of the task but had severely impaired declarative memory for the training episode. In contrast, patients with Parkinson's disease failed to learn the probabilistic classification task, despite having intact memory for the training episode. This double dissociation shows that the limbic-diencephalic regions damaged in amnesia and the neostriatum damaged in Parkinson's disease support separate and parallel learning systems. In humans, the neostriatum (caudate nucleus and putamen) is essential for the gradual, incremental learning of associations that is characteristic of habit learning. The neostriatum is important not just for motor behavior and motor learning but also for acquiring nonmotor dispositions and tendencies that depend on new associations.     

A Model for Total Phosphorus in Saginaw Bay

Data are presented which define the distribution of chloride and total phosphorus in Saginaw Bay. The loading of chloride and total phosphorus during 1974 has been calculated on the basis of data collected from the Bay tributaries and from dustfall and rainfall. A simple two-dimensional steady state model has been developed for the concentrations of chloride and total phosphorus. The model incorporates the effects of fluid transport, external loading, and resuspension of particulate matter. The model has been calibrated and verified using measured chloride data from samples collected during September and November 1974. The model has been used to make preliminary estimates of the effect of the control of point, tributary non-point, and airborne non-point sources of phosphorus. The calculations indicate that control of the point and non-point sources of phosphorus which enter the Bay through the tributaries can cause dramatic improvements of water quality. Although the model has inherent limitations due to the steady state assumption and finite segmentation, practical considerations may not warrant more detailed analysis unless additional field data become available.     

An efficient iterative method for numerical evaluation of integrals over a semi-infinite range

A procedure for numerical quadrature over a semi-infinite range is described which does not require storing weights or nodes. It is applicable to a wide variety of integrands including oscillatory functions and forms with integrable singularites. A computer program and numerical examples are presented.     

Communication Network Availability Predictions Based on Measurement Data

Published data describing the probability distributions of data communication system reliability parameters such as availability are very sparse. This paper describes a set of data collected in order to model communication line availability by monitoring operational communication systems. Probability distribution functions for single line availabilities and for the durations of failures are given. A heuristic model for estimating availabilities for more complex systems is presented along with computer simulation data validating the accuracy of the model. The results presented make possible more realistic availability predictions for common types of networks than have previously been computable.