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2.  President Clinton's managed competition proposal. 
In the search for fairness of access to health care, value for the money spent, and high quality of patient care, the United States has vacillated between advocacy of government regulations (the 1970s) and of market-driven, pro-competitive (1980s) approaches. The possible enactment of President Clinton's health reform plan with a managed-care strategy (1990s) calls for paying physicians and other providers in a manner that often induces them to minimize the provision of services to patients per episode of illness. This article discusses the impact of such legislation on patients, physicians, and other providers. It then argues that the President's managed competition approach, which micromanages health-care services, will fail except by concurrently implementing his proposed National Health Board's global budgetary concept. The major reason is that health reform for the 36.6 million uninsured Americans, who are mostly the working poor and their dependents, is only practical and affordable if stringent policies are adopted that reorganize available health-care resources and simultaneously implement cost-containment constraints.
PMCID: PMC2571896  PMID: 8478966
3.  Factors predisposing to the development of progressive massive fibrosis in coal miners. 
Altogether 238 759 miners employed by the National Coal Board were examined in the third of the Board's radiological surveys from 1969 to 1973 inclusive. Excluding those diagnosed as having progressive massive fibrosis (PMF) on that occasion, 210 847 were in collieries still operating at the time of the fourth survey four to five years later 132 728 attended for radiography at the same colliery on the second occasion, and were used to study the attack rate of PMF. In all groups in the age range 35-54 and having category 2 simple pneumoconiosis (SPN) or less, 80% or more had a second radiograph. It was found that the probability of developing PMF increased sharply with rising category of SPN; however, half the cases occurred in men having SPN categories 0 or 1, who were in the majority. Current coalface work had no significant effect on the attack rate. Age increased the attack rate of PMF within each major SPN category (0, 1, 2, and 3), especially the higher categories. All or part of this effect may have been due to the fact that SPN in younger men with categories 1 and 2 tends to lie in the lower range within these categories. Similarly, a lower distribution of SPN within each category associated with a low overall local prevalence may account wholly or in part for the great difference between the attack rates of PMF supervening on each category of SPN in Scotland and South Wales. The rank (quality) of coal mined had no effect on the attack rate.
PMCID: PMC1069281  PMID: 7317294
4.  Radon and monocytic leukaemia in England. 
The relationship between the standardised registration ratio (SRR) for monocytic leukaemia and the radon concentration by county in England was investigated. Leukaemia data were obtained from the OPCS and cover the age range 0-74 years and the period 1975-86. Radon concentrations were obtained from a recent National Radiological Protection Board report. A significant correlation was observed between the SRR for monocytic leukaemia and the radon concentration by county.
PMCID: PMC1059868  PMID: 8120509
5.  Radiation-induced chromosome damage in human lymphocytes 
ABSTRACT Analysis for chromosome aberrations in human peripheral blood lymphocytes has been developed as an indicator of dose from ionising radiation. This paper outlines the mechanism of production of aberrations, the technique for their analysis and the dose-effect relationships for various types of radiation. During the past ten years the National Radiological Protection Board has developed a service for the UK in which estimates of dose from chromosome aberration analysis are made on people known or suspected of being accidentally over-exposed. This service can provide estimates where no physical dosemeter was worn and is frequently able to resolve anomalous or disputed data from routine film badges. Several problems in the interpretation of chromosome aberration yields are reviewed. These include the effects of partial body irradiation and the response to variations in dose rate and the intermittent nature of some exposures. The dosimetry service is supported by a research programme which includes surveys of groups of patients irradiated for medical purposes. Two surveys are described. In the first, lymphocyte aberrations were examined in rheumatiod arthritis patients receiving intra-articular injections of colloidal radiogold or radioyttrium. A proportion of the nuclide leaked from the joint into the regional lymphatic system. In the second survey a comparison was made between the cytogenetic and physical estimates of whole body dose in patients receiving iodine 131 for thyroid carcinoma.
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PMCID: PMC1008276  PMID: 338021
6.  The Study of Observer Variation in the Radiological Classification of Pneumoconiosis 
In a long-term investigation such as the National Coal Board's Pneumoconiosis Field Research (P.F.R.), it is essential to establish satisfactory and stable procedures for making the necessary observations and measurements. It is equally important regularly to apply suitable methods of checking the accuracy and consistency of the various observations and measurements. One aspect of vital importance in the P.F.R. is the classification of the series of chest radiographs taken, at intervals, of all the men under observation. This is inevitably a subjective process, and (as with other similar fields of work) it is desirable to obtain some understanding of the basic process behind the operation. This can usefully be done by the help of “models” designed to describe the process, if necessary in simplified terms. The problem of the radiological classification of pneumoconiosis has been studied hitherto in terms of coefficients of disagreement (inter-observer variation) and inconsistency (intra-observer variation), but for various reasons the method was not considered entirely satisfactory. New methods of approach were therefore developed for studying the performance of the two doctors responsible for the film reading in the Research, and two distinct “models” were derived. The advantages and disadvantages of each are described in the paper, together with the applications of the two models to the study of some of the problems arising in the course of the investigation.
The first model is based on the assumption that if a film is selected at random from a batch representing a whole colliery population, and that if the film is of “true” category i, the chance of its being read as another category (j) is a constant, Pij, which depends upon the observer concerned, the particular batch of films being read, and the values of i and j. This model enables the performance of the readers to be monitored satisfactorily, and it has also been used to investigate different methods for arriving at an agreed, or “definitive”, assessment of radiological abnormality. The Pij model suffers from the disadvantage of applying only to “average” films, and the assumptions made are such that it manifestly does not provide an entirely realistic representation of the reading process on any particular film.
The second “improved” model was therefore developed to overcome this criticism. Briefly, it is considered that each film is representative of a unique degree of abnormality, located on a continuum, or abnormality scale, which covers the whole range of simple pneumoconiosis. The scale of abnormality is then chosen in such a way that, whatever the true degree of abnormality of the film, the observer's readings will be normally distributed about the true value with constant bias and variability at all points along the scale. The very large number of readings available has been analysed to determine the optimum positions of the category boundaries on the abnormality scale and in this way the scale has been unambiguously defined. The model enables the routine reading standards to be monitored, and it has also been used to investigate the underlying distribution of abnormality at individual collieries. Its chief disadvantage is the extensive computational work required.
The “fit” of both models to the data collected in the Research is shown to be satisfactory and on balance it appears that both have applications in this field of study. The method chosen in any given circumstance will depend upon the particular requirement and the facilities available for computational work.
PMCID: PMC1038082  PMID: 13698433
7.  County Differences in Mortality among Foreign-Born Compared to Native Swedes 1970–1999 
Nursing Research and Practice  2012;2012:136581.
Background. Regional variations in mortality and morbidity have been shown in Europe and USA. Longitudinal studies have found increased mortality, dissimilarities in mortality pattern, and differences in utilization of healthcare between foreign- and native-born Swedes. No study has been found comparing mortality among foreign-born and native-born Swedes in relation to catchment areas/counties. Methods. The aim was to describe and compare mortality among foreign-born persons and native Swedes during 1970–1999 in 24 counties in Sweden. Data from the Statistics Sweden and the National Board of Health and Welfare was used, and the database consisted of 723,948 persons, 361,974 foreign-born living in Sweden in 1970 and aged 16 years and above and 361,974 matched Swedish controls. Results. Latest county of residence independently explained higher mortality among foreign-born persons in all but four counties; OR varied from 1.01 to 1.29. Counties with a more rural structure showed the highest differences between foreign-born persons and native controls. Foreign-born persons had a lower mean age (1.0–4.3 years) at time of death. Conclusion. County of residence influences mortality; higher mortality is indicated among migrants than native Swedes in counties with a more rural structure. Further studies are needed to explore possible explanations.
doi:10.1155/2012/136581
PMCID: PMC3458277  PMID: 23029609
8.  Utilization of In-Hospital Care among Foreign-Born Compared to Native Swedes 1987–1999 
Nursing Research and Practice  2012;2012:713249.
In previous longitudinal studies of mortality and morbidity among foreign-born and native-born Swedes, increased mortality and dissimilarities in mortality pattern were found. The aim of this study is to describe, compare, and analyse the utilization of in-hospital care among deceased foreign- and Swedish-born persons during the years 1987–1999 with focus on four diagnostic categories. The study population consisted of 361,974 foreign-born persons aged 16 years and upward who were registered as living in Sweden in 1970, together with 361,974 matched Swedish controls for each person. Data from Statistics Sweden (SCB) and the National Board of Health and Welfare Centre for Epidemiology, covering the period 1970–1999, was used. Persons were selected if they were admitted to hospital during 1987–1999 and the cause of death was in one of four ICD groups. The results indicate a tendency towards less health care utilization among migrants, especially men, as regards Symptoms, signs, and ill-defined conditions and Injury and poisoning. Further studies are needed to explore the possible explanations and the pattern of other diseases to see whether migrants, and especially migrant men, are a risk group with less utilization of health care.
doi:10.1155/2012/713249
PMCID: PMC3504430  PMID: 23213496
9.  Child Health and Nutrition: Getting better and facing new challenges in China 
The Australasian Medical Journal  2011;4(3):123-132.
Background
Child healthcare practices in China over the last 60 years have extensively improved children's health and growth, yet new challenges lie ahead. This review aims to summarise the successful experiences and the newly identified problems in child healthcare in China.
Method
Information, available to the public, was obtained from Chinese databases and Chinese Government websites,chiefly the Chinese National Knowledge Infrastructure database, the Chinese Biomedical Literature database, the Ministry of Health website and the National working committee on children and Women website
Results
During its poverty-stricken 1950s-1970s, China protected children's health mainly through prevention and control of common infectious diseases and severe malnutrition within a comprehensive healthcare system. After the subsequent 30 years of rapid socio-economic development, China has achieved great success in reducing childhood mortality rates and promoting child growth, meeting the Millennium Development Goal 4 targets and the WHO child growth standards. Meanwhile, new challenges for children's healthcare emerged, including: large disparities in the health, growth and nutritional status of children,and in the accessibility and quality of child healthcare, between urban and rural areas and across different regions of China; the nutritional and healthcare concerns of the fast-expanding population of migrant children and rural left-behind children; the burgeoning epidemic of childhood obesity in urban and economically developed areas; micronutrient deficiencies such as calcium, iron, zinc and vitamin A; and increasing prevalence of mental and behavioural disorders.
Conclusion
Under poor economic conditions, healthcare plays a key role in protecting children against diseases. With the development of social economy, new challenges present to healthcare services, specifically, to comprehensively promote and optimise childrens' health and nutrition.
doi:10.4066/AMJ.2011.584
PMCID: PMC3562959  PMID: 23390460
Child Health; nutrition; China; health inequality; micronutrient deficiency; childhood obesity; migrant workers
10.  Violence, mental illness, and the brain – A brief history of psychosurgery: Part 3 – From deep brain stimulation to amygdalotomy for violent behavior, seizures, and pathological aggression in humans 
In the final installment to this three-part, essay-editorial on psychosurgery, we relate the history of deep brain stimulation (DBS) in humans and glimpse the phenomenal body of work conducted by Dr. Jose Delgado at Yale University from the 1950s to the 1970s. The inception of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1974-1978) is briefly discussed as it pertains to the “determination of the Secretary of Health, Education and Welfare regarding the recommendations and guidelines on psychosurgery.” The controversial work - namely recording of brain activity, DBS, and amygdalotomy for intractable psychomotor seizures in patients with uncontrolled violence – conducted by Drs. Vernon H. Mark and Frank Ervin is recounted. This final chapter recapitulates advances in neuroscience and neuroradiology in the evaluation of violent individuals and ends with a brief discussion of the problem of uncontrolled rage and “pathologic aggression” in today’s modern society – as violence persists, and in response, we move toward authoritarianism, with less freedom and even less dignity.
doi:10.4103/2152-7806.115162
PMCID: PMC3740620  PMID: 23956934
Psychosurgery; violence; functional neurosurgery; deep brain stimulation; amygdalotomy; temporal lobe seizures
11.  The ethics of interrogation and the American Psychological Association: A critique of policy and process 
The Psychological Ethics and National Security (PENS) task force was assembled by the American Psychological Association (APA) to guide policy on the role of psychologists in interrogations at foreign detention centers for the purpose of U.S. national security. The task force met briefly in 2005, and its report was quickly accepted by the APA Board of Directors and deemed consistent with the APA Ethics Code by the APA Ethics Committee. This rapid acceptance was unusual for a number of reasons but primarily because of the APA's long-standing tradition of taking great care in developing ethical policies that protected anyone who might be impacted by the work of psychologists. Many psychological and non-governmental organizations (NGOs), as well as reputable journalists, believed the risk of harm associated with psychologist participation in interrogations at these detention centers was not adequately addressed by the report. The present critique analyzes the assumptions of the PENS report and its interpretations of the APA Ethics Code. We demonstrate that it presents only one (and not particularly representative) side of a complex set of ethical issues. We conclude with a discussion of more appropriate psychological contributions to national security and world peace that better respect and preserve human rights.
doi:10.1186/1747-5341-3-3
PMCID: PMC2248202  PMID: 18230171
12.  Electronic imaging of the human body. 
The Human Engineering Division of the Armstrong Laboratory (USAF); the Mallinckrodt Institute of Radiology; the Washington University School of Medicine; and the Lister-Hill National Center for Biomedical Communication, National Library of Medicine are sponsoring a working group on electronic imaging of the human body. Electronic imaging of the surface of the human body has been pursued and developed by a number of disciplines including radiology, forensics, surgery, engineering, medical education, and anthropometry. The applications range from reconstructive surgery to computer-aided design (CAD) of protective equipment. Although these areas appear unrelated, they have a great deal of commonality. All the organizations working in this area are faced with the challenges of collecting, reducing, and formatting the data in an efficient and standard manner; storing this data in a computerized database to make it readily accessible; and developing software applications that can visualize, manipulate, and analyze the data. This working group is being established to encourage effective use of the resources of all the various groups and disciplines involved in electronic imaging of the human body surface by providing a forum for discussing progress and challenges with these types of data.
PMCID: PMC2248098  PMID: 1482896
13.  Poul Erik Andersen's radiological work on Osteochondrodysplasias and interventional radiology 
World Journal of Radiology  2011;3(8):210-214.
Poul Erik Andersen is a Professor and Interventional Radiologist at the University of Southern Denmark, Odense and Odense University Hospital, Denmark. His innovative and expertise is primarily in vascular interventions where he has introduced and developed many procedures at Odense University Hospital. His significant experience and extensive scientific work has led to many posts in the Danish Society of Interventional Radiology, the European Society of Radiology and the Cardiovascular and Interventional Radiological Society of Europe, where he is a fellow and has passed the European Board of Interventional Radiology - The European qualification in Interventional Radiology.
doi:10.4329/wjr.v3.i8.210
PMCID: PMC3198263  PMID: 22022640
Biography; Clinical competence; Education; Interventional; Radiology
14.  Community involvement in the ethical review of genetic research: lessons from American Indian and Alaska Native populations. 
Environmental Health Perspectives  2002;110(Suppl 2):145-148.
The National Bioethics Advisory Commission has proposed that regulatory oversight for research with human subjects be extended beyond the protection of individual research participants to include the protection of social groups. To accomplish this, the commission recommends that investigators and ethics review boards a) work directly with community representatives to develop study methods that minimize potential group harms, b) discuss group implications as part of the informed consent process, and c) consider group harms in reporting research results. We examine the utility of these recommendations in the context of research with American Indian and Alaska Native communities. Because much attention has been given to the question of how best to consult with members of these communities in the design and conduct of research, we believe it behooves investigators to consider the lessons to be learned from research involving American Indians and Alaska Natives. After describing several difficulties surrounding the application of the commission's approach to these research contexts, we propose a research agenda to develop best practices for working with local communities in the ethical assessment of epidemiologic and environmental health research.
PMCID: PMC1241157  PMID: 11929722
15.  Should Society Allow Research Ethics Boards to Be Run As For-Profit Enterprises? 
PLoS Medicine  2006;3(7):e309.
Background to the debate: An important mechanism for protecting human research participants is the prior approval of a clinical study by a research ethics board, known in the United States as an institutional review board (IRB). Traditionally, IRBs have been run by volunteer committees of scientists and clinicians working in the academic medical centers where the studies they review are being carried out. However, for-profit organizations are increasingly being hired to conduct ethics reviews. Proponents of for-profit IRBs argue that these IRBs are just as capable as academic IRBs at providing high-quality ethics reviews. Critics argue that for-profit IRBs have a conflict of interest because they generate their income from clients who have a direct financial interest in obtaining approval.
Emanuel argues that for-profit ethics review boards can provide high quality reviews, but Lemmens and Elliot believe that such boards have a conflict of interest.
doi:10.1371/journal.pmed.0030309
PMCID: PMC1518668  PMID: 16848618
16.  Prostate cancer mortality risk in relation to working underground in the Wismut cohort study of German uranium miners, 1970–2003 
BMJ Open  2012;2(3):e001002.
Objective
A recent study and comprehensive literature review has indicated that mining could be protective against prostate cancer. This indication has been explored further here by analysing prostate cancer mortality in the German ‘Wismut’ uranium miner cohort, which has detailed information on the number of days worked underground.
Design
An historical cohort study of 58 987 male mine workers with retrospective follow-up before 1999 and prospective follow-up since 1999.
Setting and participants
Uranium mine workers employed during the period 1970–1990 in the regions of Saxony and Thuringia, Germany, contributing 1.42 million person-years of follow-up ending in 2003.
Outcome measure
Simple standardised mortality ratio (SMR) analyses were applied to assess differences between the national and cohort prostate cancer mortality rates and complemented by refined analyses done entirely within the cohort. The internal comparisons applied Poisson regression excess relative prostate cancer mortality risk model with background stratification by age and calendar year and a whole range of possible explanatory covariables that included days worked underground and years worked at high physical activity with γ radiation treated as a confounder.
Results
The analysis is based on miner data for 263 prostate cancer deaths. The overall SMR was 0.85 (95% CI 0.75 to 0.95). A linear excess relative risk model with the number of years worked at high physical activity and the number of days worked underground as explanatory covariables provided a statistically significant fit when compared with the background model (p=0.039). Results (with 95% CIs) for the excess relative risk per day worked underground indicated a statistically significant (p=0.0096) small protective effect of −5.59 (−9.81 to −1.36) ×10−5.
Conclusion
Evidence is provided from the German Wismut cohort in support of a protective effect from working underground on prostate cancer mortality risk.
Article summary
Article focus
Prostate cancer mortality in the Wismut cohort of German uranium miners in relation to time spent working underground and the time worked at high physical activity.
Key messages
Evidence is provided from the German Wismut cohort in support of a protective effect from working underground on prostate cancer mortality risk.
Strengths and limitations of this study
The Wismut study is currently the largest Uranium miner cohort.
There is detailed information on the time spent working underground and on other relevant occupational covariables.
However, there is no information on whether the shifts worked were early, late or at night.
doi:10.1136/bmjopen-2012-001002
PMCID: PMC3371580  PMID: 22685223
17.  Spectrum of diagnostic errors in radiology 
World Journal of Radiology  2010;2(10):377-383.
Diagnostic errors are important in all branches of medicine because they are an indication of poor patient care. Since the early 1970s, physicians have been subjected to an increasing number of medical malpractice claims. Radiology is one of the specialties most liable to claims of medical negligence. Most often, a plaintiff’s complaint against a radiologist will focus on a failure to diagnose. The etiology of radiological error is multi-factorial. Errors fall into recurrent patterns. Errors arise from poor technique, failures of perception, lack of knowledge and misjudgments. The work of diagnostic radiology consists of the complete detection of all abnormalities in an imaging examination and their accurate diagnosis. Every radiologist should understand the sources of error in diagnostic radiology as well as the elements of negligence that form the basis of malpractice litigation. Error traps need to be uncovered and highlighted, in order to prevent repetition of the same mistakes. This article focuses on the spectrum of diagnostic errors in radiology, including a classification of the errors, and stresses the malpractice issues in mammography, chest radiology and obstetric sonography. Missed fractures in emergency and communication issues between radiologists and physicians are also discussed.
doi:10.4329/wjr.v2.i10.377
PMCID: PMC2999012  PMID: 21161023
Diagnostic radiology; Medical negligence; Medico-legal problems; Observer performance; Radiological error
18.  Late effects of air pollution with special reference to lung cancer. 
The Department of Environmental Hygiene of the National Swedish Environment Protection Board and of the Karolinska Institute have prepared an extensive review on health effects of air pollution, to be used by the Swedish Parliamentary Committee on Energy and the Environment. This report forms the basis for one part of the review, that on late effects. Much of the work on the review, is the result of a team effort involving researchers from numerous organizations.
PMCID: PMC1637156  PMID: 348461
19.  Use of history science methods in exposure assessment for occupational health studies 
Aims: To show the power of history science methods for exposure assessment in occupational health studies, using the dry cleaning industry in Denmark around 1970 as the example.
Methods: Exposure data and other information on exposure status were searched for in unconventional data sources such as the Danish National Archives, the Danish Royal Library, archives of Statistics Denmark, the National Institute of Occupational Health, Denmark, and the Danish Labor Inspection Agency. Individual census forms were retrieved from the Danish National Archives.
Results: It was estimated that in total 3267 persons worked in the dry cleaning industry in Denmark in 1970. They typically worked in small shops with an average size of 3.5 persons. Of these, 2645 persons were considered exposed to solvents as they were dry cleaners or worked very close to the dry cleaning process, while 622 persons were office workers, drivers, etc in shops with 10 or more persons. It was estimated that tetrachloroethylene constituted 85% of the dry cleaning solvent used, and that a shop would normally have two machines using 4.6 tons of tetrachloroethylene annually.
Conclusion: The history science methods, including retrieval of material from the Danish National Archives and a thorough search in the Royal Library for publications on dry cleaning, turned out to be a very fruitful approach for collection of exposure data on dry cleaning work in Denmark. The history science methods proved to be a useful supplement to the exposure assessment methods normally applied in epidemiological studies.
doi:10.1136/oem.2004.016493
PMCID: PMC1741048  PMID: 15961618
20.  Residential mobility among foreign-born persons living in Sweden is associated with lower mortality 
Clinical Epidemiology  2010;2:187-194.
There have been few longitudinal studies on the effect of within-country mobility on patterns of mortality in deceased foreign-born individuals. The results have varied; some studies have found that individuals who move around within the same country have better health status than those who do not change their place of residence. Other studies have shown that changing one’s place of residence leads to more self-reported health problems and diseases. Our aim was to analyze the pattern of mortality in deceased foreign-born persons living in Sweden during the years 1970–1999 in relation to distance mobility. Data from Statistics Sweden and the National Board of Health and Welfare was used, and the study population consisted of 281,412 foreign-born persons aged 16 years and over who were registered as living in Sweden in 1970. Distance mobility did not have a negative effect on health. Total mortality was lower (OR 0.71; 95% CI 0.69–0.73) in foreign-born persons in Sweden who had changed their county of residence during the period 1970–1990. Higher death rates were observed, after adjustment for age, in three ICD diagnosis groups “Injury and poisoning”, “External causes of injury and poisoning”, and “Diseases of the digestive system” among persons who had changed county of residence.
PMCID: PMC2943194  PMID: 20865116
residential mobility; health; foreign-born; immigrant; Sweden; mortality
21.  A Survey of the Methods Developed in the National Coal Board's Pneumoconiosis Field Research for Correlating Environmental Exposure with Medical Condition 
The correlation of the medical and environmental data (i.e. the derivation of the dosage-response relationship) in a study such as the National Coal Board's Pneumoconiosis Field Research (P.F.R.) is subject to many complicating factors compared with the more conventional types of biological assay. Several methods have been developed within the Research to overcome these difficulties, and the new procedures are described. Each is concerned with the estimation of the direct relation between the radiological abnormality associated with simple pneumoconiosis and some single measure of the past hazard, but the basic techniques are sufficiently general to be applicable in other fields of study.
The first development involves the definition of an underlying continuous scale of radiological abnormality. This prepares the way for the derivation of the “quantitative” relation between exposure and response, to replace the “semi-quantal” relation which is inherent in the use of a small number of discrete categories of radiological abnormality. The effect of errors of observation of dosage and response on the corresponding quantitative and quantal relationships is then determined.
The second development concerns the use of a “multi-dimensional” representation of past hazard. Most of the men under observation had worked in a number of different mining occupations before their first chest radiograph was taken, but this exposure cannot be assessed in terms of dust concentrations, for which reliable data are not available. Nevertheless, it is shown that past hazard can usefully be represented by three “dimensions” corresponding to the periods spent in three main types of environment—(a) the coal-face (coal-getting shift), (b) the coal-face (preparation shift) and (c) elsewhere underground. Each man's past exposure up to the time of his first chest radiograph can be expressed in terms of these three dimensions and the effect of each environment separately can be determined.
The third development extends the multi-dimensional approach to cover not only the working history before the first medical examination, but also the recorded exposure (in terms of measured dust concentrations), to which each man has been subject between the first and subsequent “follow-up” surveys. This measured exposure is regarded as one dimension of the man's total exposure up to the time of his second (or later) examination, and it is possible in this way to determine the direct relation between radiological abnormality and measured exposure, even when this component represents only part of the total hazard to which the man has been subject.
The application of the methods is illustrated by the analysis of some of the data which have been obtained in the Pneumoconiosis Field Research.
PMCID: PMC1038147  PMID: 13698432
22.  i The institutional review board is an impediment to human research: the result is more animal-based research 
Biomedical research today can be generally classified as human-based or nonhuman animal-based, each with separate and distinct review boards that must approve research protocols. Researchers wishing to work with humans or human tissues have become frustrated by the required burdensome approval panel, the Institutional Review Board. However, scientists have found it is much easier to work with the animal-based research review board, the Institutional Animal Care and Use Committee. Consequently, animals are used for investigations even when scientists believe these studies should be performed with humans or human tissue. This situation deserves attention from society and more specifically the animal protection and patient advocate communities, as neither patients nor animals are well served by the present situation.
doi:10.1186/1747-5341-6-12
PMCID: PMC3127833  PMID: 21649895
23.  Developing an ‘integrated health system’: the reform of health and social services in Quebec 
The Quebec health care system, founded in 1970 as a public, single payer, state run system had by 2004 reached a turning point. Rising costs, working in silos, difficulty accessing physicians, increased waiting time for diagnostic imaging and surgical intervention led policy makers and politicians to propose a new model for the organisation and delivery of care.
Based on populational responsibility and the clear distinction between a community primary care and specialised services a new model was proposed to develop integrated health networks. The 7.2 million population of Quebec was divided into 95 territories. 95 Health and social service centres were created by merging a community hospital, rehab centre, long-term care centres, home care and primary care services into a single institution with a new CEO and board of directors. These new networks received the mandate to manage the health and well being of their population, to manage the utilisation of services by their population and to manage all primary care services on their territory.
The implementation of a chronic care model, the development of primary care multidisciplinary teams, empowering the population and performance management, are the key elements of Montreal's vision in implementing the Reform.
After three years of operation the results are promising.
PMCID: PMC2430285
chronic care model; integrated health care networks; Canada
24.  Family practice in the United States of America: the first 10 years 
Family medicine was officially recognized as an independent discipline and as the twentieth specialty in the USA in 1969, when the American Board of Family Practice was established.
The main achievements of the first 10 years has been the establishment of departments of family practice in two thirds of the medical schools and the growth of graduate training has advanced rapidly from a total of 290 residents in 1970 to over 6,000 in 1978. Developments in group practice, team work, and medical records have been considerable and research is expanding.
In 1976, the 50-year trend of falling numbers of family physicians in the USA was reversed for the first time and excellent progress is also being made in countering the geographical maldistribution of physicians.
The challenges for the future of family practice are different from those in the past and are discussed.
PMCID: PMC2159067  PMID: 541798
25.  Psychiatric Pharmacy Residency Training* 
The role of the psychiatric pharmacist in the care of the mentally ill has continually evolved since the late 1960s and early 1970s. Pharmacists in the field of psychiatric pharmacy work to improve the health, safety, and welfare of those impacted by one or more psychiatric conditions. Specialty residency training programs are accredited to establish minimum training standards and a board-certification process ensures that individuals provide a high level of quality of care. It is the position of the College of Psychiatric and Neurologic Pharmacists (CPNP) that Psychiatric Pharmacy residency programs obtain American Society of Health-System Pharmacy (ASHP) accreditation and help the profession move forward as a recognized specialty.
PMCID: PMC2996753  PMID: 21301597
psychiatric pharmacy; residency; postgraduate education; American Society of Health-System Pharmacists (ASHP)

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