Standards for Approval of Hospitals for Graduate Training

The assessment program for approval of hospitals for training in specialties has been augmented by survey visits. Surveyors for the Canadian Council on Hospital Accreditation have acted on behalf of the Royal College of Physicians and Surgeons of Canada and have assisted in the formulation of standard criteria for evaluation of teaching programs. Areas where considerable variation in program exists and where further standardization might profitably be developed are suggested. It is recommended that periodic on-the-site visits be made to all specialty training hospitals. Standards should be further elucidated to guide teachers, students and Royal College surveyors alike. It is emphasized that standards cannot be used to assess the calibre of teaching and learning, but can be employed to assist in evaluating the teachings and learning media that are likely to produce good (or poor) results.     

Model adequacy: A bayesian viewpoint

We present a BAYEsian theory for testing model adequacy which provides exact results whether the model is linear or nonlinear in the parameters. We consider two cases: (a) replicated data exists, and (b) no replicated data exists but an external estimate of the variance is available. Furthermore, we derive a useful approximation for testing model adequacy when the model is nonlinear in the parameters.     

Neonatal jaundice: the surgical viewpoint.

There is good evidence that neonatal hepatitis, biliary hypoplasia, biliary atresia and choledochal cyst are different stages of one disease process for which the term infantile obstructive cholangiopathy has been suggested. Thanks to the work of Kasai and the operation of hepatic portoenterostomy the surgical outlook has greatly improved, although in North America it still leaves much to be desired. One cannot procrastinate too long in the hope that the patient''s condition will improve spontaneously, because the surgical results are much better when the operation is performed before the patient is 10 weeks old. This article outlines the steps that should be followed in investigating neonatal jaundice, the nonsurgical measures that can be taken in an attempt to reverse or alleviate the underlying condition, and the specific role of the pediatric surgeon in the management of choledochal cyst and biliary atresia.     

A review of WHO International Standards for botulinum antitoxins.

Clostridium botulinum produces the most potent known toxins, with seven distinct serotypes currently defined (A-G). These toxins can cause a life threatening systemic toxicity whether through natural causes such as food poisoning, infant botulism, wound botulism, or through use as bio-terror agents (e.g. inhalational botulism). It was realised early on that standard reference botulinum antitoxins were required to reduce the variation between assays and ensure a consistent potency of therapeutic antitoxins and vaccines, and to define the serotype. This led to the International Unit being defined by the World Health Organisation (WHO) in the 1960s with the establishment of the first International Standards (IS) for serotypes A-F. Since then botulinum antitoxin ISs have been used world wide as the 'yard stick' to measure the neutralising potency of antitoxins. These primary WHO ISs are used to calibrate in house working reagents that are more extensively utilised. A definition of the International Unit for serotype G antitoxin has yet to be defined or accepted by the WHO and urgently needs addressing. However, before September 11th 2001 there was very little interest in botulinum antitoxin IS and as a result stocks of most of the original preparations are now completely exhausted or depleted and replacements long overdue. We have reviewed the extensive history and availability of the primary WHO ISs and interim materials. All type A and B antitoxin materials were recently assayed and their relative activities confirmed against the original IS preparations. The recent increase in demand for these materials has further exacerbated the shortage. We describe here the production and characterization of stable freeze dried potential candidate replacements along with a new prospective first IS for type G antitoxin. Available toxin A reference preparations are also briefly reviewed.     

On oxygen production by photosynthesis: A viewpoint

In this brief communication we provide an estimate of the part of the incident solar energy used for oxygen evolution as well as the time, in years, needed for the generation of the present amount of molecular oxygen in the biosphere by photosynthesis on land and in the ocean. We find this to be ≈3,000 yr. We also find that the ocean produces 22% more oxygen than the land surface.     

Standards for intravascular brachytherapy dosimetry.

The dosimetry of intravascular brachytherapy sources is quite difficult due to the small size of the sources and the close proximity at which measurements are necessary. The development of National Standards for the dosimetry of these sources is described in this paper as well as predictions of how these standards will be changed and improved upon in the future.