Misuses of Computers by Adolescents

One subject that has been a topic of much recent publicity and concern has been that of computer misuse. Teenage computer programmers gaining entry into the systems of universities, hospitals and businesses have caused the most concern . The duplication of copyrighted programs and information has also been reported to cause loss of considerable money. There seems to be a subpopulation of people who spend considerable time working with computers. These individuals may do so to the exclusion of other aspects of life such as human interaction . This paper will present both my observations of this behavior and my speculations about the motivations behind this behavior

A History of Bishop Clarkson Memorial Hospital

The evolution of Bishop Clarkson memorial Hospital from a fragile, limited undertaking in 1869 to its present substantial status occurred in the most productive and inventive era so far experienced in medical care. The hospital flourished, resulting in accomplishments worthy of recording, which is the purpose of this chronicle. H.J.L.https://digitalcommons.unmc.edu/hist_books/1003/thumbnail.jp

Atovaquone Compared with Dapsone for the Prevention of Pneumocystis carinii Pneumonia in Patients with HIV Infection Who Cannot Tolerate Trimethoprim, Sulfonamides, or Both

BACKGROUND Although trimethoprim–sulfamethoxazole is the drug of choice for the prevention of Pneumocystis carinii pneumonia, many patients cannot tolerate it and must switch to an alternative agent. METHODS We conducted a multicenter, open-label, randomized trial comparing daily atovaquone (1500-mg suspension) with daily dapsone (100 mg) for the prevention of P. carinii pneumonia among patients infected with the human immunodeficiency virus who could not tolerate trimethoprim–sulfamethoxazole. The median follow-up period was 27 months. RESULTS Of 1057 patients enrolled, 298 had a history of P. carinii pneumonia.P. cariniipneumonia developed in 122 of 536 patients assigned to atovaquone (15.7 cases per 100 person-years), as compared with 135 of 521 in the dapsone group (18.4 cases per 100 person-years; relative risk for atovaquone vs. dapsone, 0.85; 95 percent confidence interval, 0.67 to 1.09; P=0.20). The relative risk of death was 1.07 (95 percent confidence interval, 0.89 to 1.30; P=0.45), and the relative risk of discontinuation of the assigned medication because of adverse events was 0.94 (95 percent confidence interval, 0.74 to 1.19; P=0.59). Among the 546 patients who were receiving dapsone at base line, the relative risk of discontinuation because of adverse events was 3.78 for atovaquone as compared with dapsone (95 percent confidence interval, 2.37 to 6.01; P CONCLUSIONS Among patients who cannot tolerate trimethoprim–sulfamethoxazole, atovaquone and dapsone are similarly effective for the prevention ofP. carinii pneumonia. Our results support the continuation of dapsone prophylaxis among patients who are already receiving it. However, among those not receiving dapsone, atovaquone is better tolerated and may be the preferred choice for prophylaxis against P. cariniipneumonia

Criminal Law - Insane Persons - Competency to Stand Trial

Mental unsoundness in a person accused of a crime raises two distinct legal questions. One is the question of the individual\u27s responsibility for his behavior and the other is the question of the individual\u27s competency to enter into the legal procedures of trial or punishment. In recent years considerable attention has been given to matters of responsibility, but relatively little attention has been paid to the problem of incompetency and especially to the consequences of incompetency proceedings. In order to analyze and evaluate the operations of the Michigan law in the area of incompetency to stand trial, two psychiatrists joined two law students to conduct field research at Ionia State Hospital to which all persons found incompetent to stand trial are committed. This comment reports and analyzes the results of this field research. Attention is given also to the merits of alternative procedures for the commitment and treatment of incompetents

An Agreement of Two Tonometers: Goldmann Applanation and Non-Contact Scheimflug Technology in Healthy, Ocular Hypertension and Open-angle Glaucoma Patients

Objective: The primary objective was to find an agreement of intraocular pressure (IOP) assessed by Goldmann applanation tonometry (GAT) and Corvis in healthy, ocular hypertension (OHT) and primary open-angle glaucoma (POAG). The secondary objective was to find a reliability of intra-examiner and inter-examiner IOP measurement by GAT and Corvis. Methods: Fifty three eyes from 53 participants were included and were divided into healthy (N=20), OHT (N=13) and POAG group (N=20). Only right eyes were selected for further statistical analysis except one patient with only left eye eligible. The eyes with corneal pathologies, greater than 2.5 diopters astigmatism, or recent ocular surgery were excluded. Randomized examining sequence between GAT and Corvis was applied. To minimize an after measurement IOP fluctuation, five minutes and two minutes gap between measurements were strictly applied for Corvis and GAT respectively. The first ten patients had 3 measurements per measurer and two measurers were assigned per machine to evaluate intra-examiner and inter-examiner reliability. Intraclass correlation coefficient was used to analyze the reliability of the IOP measuring machine. Bland & Altman plot was used to analyze an agreement between the machines. Results: High ICCs were found in both measurers using GAT (ICC of measurer 1 = 0.954, measurer 2 = 0.977) and Corvis (ICC of measurer 1 = 0.920, measurer 2 = 0.927) which indicated excellent intra-examiner reliability. High ICCs were found when comparing IOP between 2 measurers who used the same machine (GAT ICC = 0.928, Corvis ICC = 0.915) which indicated excellent inter-examiner reliability. GAT tends to yield higher IOP reading. The mean IOP were 13.93±3.849 by GAT and 12.15±4.030 by Corvis. The mean IOP differences were 1.8, 1.7, 1.4 and 2.2 mmHg in total, healthy, OHT and POAG group respectively. POAG had highest mean difference and widest standard deviation which might result from poor agreement between 2 machines. According to Bland & Altman plot the values were scattered and no trend was found indicating higher or lower average IOP would result in higher or lower difference between the two machines. From the clinical point of view, 71.7% and 47.2% fall into IOP difference range of ±3 and ±2 mmHg respectively. Conclusion: Corvis-IOP is a good parameter with excellent intra-examiner and inter-examiner reliability. In clinical practice, the usefulness of Corvis-IOP is limited especially in POAG patients according to the poor agreement with gold standard GAT-IOP

Capture-mark-recapture to estimate the number of missed articles for systematic reviews in surgery

Abstract BACKGROUND: Systematic reviews are an important knowledge synthesis tool, but with new literature available each day, reviewers must balance identifying all relevant literature against timely synthesis. METHODS: This study tested capture-mark-recapture (CMR), an ecology-based technique, to estimate the total number of articles in the literature identified in a systematic review of adult trauma care quality indicators. RESULTS: The systematic review included 40 articles identified from online searches and citation references. The CMR model suggested that 3 (95% confidence interval [CI]: 0 to 6) articles were missed and the database search provided 93% (one-sided 95% CI: R83%) of known articles for inclusion in the systematic review. The search order used for identifying the articles was optimal among the 24 that could have been used. CONCLUSIONS: The CMR technique can be used in systematic reviews in surgery to estimate the closeness to capturing the total body of literature for a specific topic. Ó 2013 Elsevier Inc. All rights reserved. Systematic reviews are increasingly used in surgery to synthesize knowledge so that evidence can inform clinical practice (eg, guideline development). Exhaustive searching in multiple large bibliographic databases is time consuming and resource intensive, but it needs to be efficient so the results are presented before the information becomes outdated. However, this is difficult because the amount of literature that exists on any given topic is unknown. Capture-mark-recapture (CMR) is a technique originating in ecology that has been applied to systematic reviews of randomized controlled trials of interventions in osteoporosis, gastroenterology, and hematology 1-3 to estimate The project was supported by a Synthesis Grant (KRS-91770) from the Canadian Institutes of Health Research. Dr. Stelfox is supported by a New Investigator Award from the Canadian Institutes of Health Research and a Population Health Investigator Award from Alberta Innovates. Funding sources had no role in the design, conduct, or reporting of this study and we are unaware of any conflicts of interest. None of the authors have financial or professional conflicts of interest that would influence the conduct or reporting of this study. Drs. Stelfox, Foster, and Goldsmith had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Presented at the Cochrane Canada Symposium May 9, 2012, Winnipeg, Canada. * Corresponding author. The American Journal of Surgery (2013) 206, 439-440 the number of articles in the literature. The technique has not been evaluated in observational studies or surgical studies. We therefore tested CMR to estimate the total number of articles in the literature identified in a systematic review of adult trauma care quality indicators. We performed a scoping review to identify quality indicators for evaluating trauma care 4 and subsequently systematically reviewed the evidence. 5 Horizon estimates (estimated total population of articles) were calculated for full text review and final inclusion using the 4 step CMR technique: (1) capture an initial sample from a population of interest (eg, catch fish in lake); (2) mark the elements in the sample (eg, tag the fish); (3) release the sample back into the population (eg, release tagged fish back into lake); and (4) resample the population (catch fish from same lake to see how many are tagged). Articles found in our 1st database (MEDLINE) were marked as being retrieved from that search and compared with articles retrieved through subsequent searches (eg, Embase was the 2nd database). Articles identified through bibliography reviews were attributed to the originating electronic database. Poisson regression models were used to calculate fitted estimates of the cell counts (number of articles missed) and estimate the total horizon of articles (SAS v 9.2; SAS, Cary, NC). The results of the horizon estimate are shown in We repeated the process for articles selected for inclusion in the systematic review. The final horizon estimate was 43 (40 to 46) articles, representing a difference of 3 (0 to 6) articles between the projected total literature and the number of articles captured (40 articles). Thus, selection of articles for inclusion in the systematic review represents the capture of 93% (87% to 100%) of the estimated pool of available articles. The search order used for identifying the articles was optimal among the 24 that could have been used. CMR is a technique that can be applied to estimate the total number of relevant articles for a given topic. This study demonstrates that CMR can be successfully used for systematic reviews of observational studies in surgery. Future systematic reviews may consider including horizon estimates as possible stopping rules (eg, search until 80% of articles captured) to identify when a sufficient literature search has been completed. CMR may help improve the completeness and efficiency of systematic reviews

Reduction in intraoperative bacterial contamination of peripheral intravenous tubing through the use of a novel device

Background: Hand hygiene is a vital intervention to reduce health-care associated infections, but compliance remains low. The authors hypothesized that improvements in intraoperative hand hygiene compliance would reduce transmission of bacteria to surgical patients and reduce the incidence of postsurgical healthcare-associated infections. Methods: The authors performed a controlled before-andafter study over 2 consecutive months. One hundred fourteen operative cases were enrolled. Two predesignated sites on the anesthesia machine were selected, decontaminated, and cultured via aseptic technique. These sites and the peripheral intravenous stopcock were cultured again after completion of the surgery. The treatment phase used a novel personal handdecontamination device capable of recording hand-decontamination events. Results: There were no significant differences in patient location, age, or case duration and procedure type between groups. Use of the Sprixx GJ device (Harbor Medical Inc., Santa Barbara, CA) increased hourly hand decontamination events by 27-fold as compared with baseline rates (P < 0.002; 95% confidence interval, 3.3-13.4). Use of the device was associated with a reduction in contamination in the anesthesia work area and peripheral intravenous tubing. Intravenous tubing contamination was identified in 32.8% of cases in the control group versus 7.5% in the treatment group (odds ratio, 0.17; 95% confidence interval, 0.06 -0.51; P < 0.01). Healthcare-associated infections rates were reduced in the device group (3.8%) as compared with the control group (17.2%) (odds ratio, 0.19; 95% confidence interval, 0.00 -0.81; P ‫؍‬ 0.02). Conclusions: Improved hand hygiene compliance through the use of a novel hand sanitation strategy reduces the risk of intraoperative bacterial transmission. The interventio

Self Consistent Molecular Field Theory for Packing in Classical Liquids

Building on a quasi-chemical formulation of solution theory, this paper proposes a self consistent molecular field theory for packing problems in classical liquids, and tests the theoretical predictions for the excess chemical potential of the hard sphere fluid. Results are given for the self consistent molecular fields obtained, and for the probabilities of occupancy of a molecular observation volume. For this system, the excess chemical potential predicted is as accurate as the most accurate prior theories, particularly the scaled particle (Percus-Yevick compressibility) theory. It is argued that the present approach is particularly simple, and should provide a basis for a molecular-scale description of more complex solutions.Comment: 6 pages and 5 figure