P‐15COMPARISON OF RESULTS FOR A NON‐GYNAECOLOGICAL CYTOLOGY EQA SCHEME

The problems encountered with a glass slide circulation are legion but timely circulation is a major problem and is an inherent deficiency of our Non‐gynaecological EQA scheme. This applies not only to consultants but also to specialist registrars (SpRs) and technical staff that are not formally included in the circulation list. In 2005 only 7 technical staff and 4 out of 47 SpRs took part on a formal basis, their participation being dependant on access to slides during their cytology attachment. The results for the 2005 circulation have been analysed and despite the small numbers of participating technical staff and SpRs their answers concur with the consultant body. To address the issues of timeliness and circulation problems a pilot teaching set has been developed by SlidePath into a virtual microscope web based circulation and sent to all SpRs in our region. They have recorded their answers and been given immediate access to the consensus consultant opinion with illustrations of follow up histology. A questionnaire was completed to evaluate the scheme. The facility of immediate feedback of consultant consensus is particularly pertinent to the educational element of the scheme and use of virtual microscopy addresses the issue of timely circulation. If further funding was made available technical staff could also be given the opportunity to try this web‐based circulation.     

Posters. P3 North west non‐gynaecological cytology EQA pilot CD ROM scheme 2002–2003

The 8th circulation of this scheme was preceded by a CD ROM circulation of selected digital images and presented as individual JPEG file images in a single folder on the CD ROM. The number of images per case ranged from three to eight. The delegates will have an opportunity to assess these themselves prior to uncovering the consensus diagnosis provided by the participants. Of the 76, 29 participants of the scheme provided a completed answer sheet for the image‐based circulation. To date, 19 have now also supplied answers on the actual slide circulation. The same diagnosis on image and slide circulation varied from 5/19 to 19/19 with a mode of 14/19. The case that provided the poorest correlation was because of a generalized undercall of suspicious in a case which achieved almost complete consensus on the slide circulation. It had been the most difficult to photograph. The case that provided the next poorest correlation 11/19 was the case that had the poorest consensus diagnosis on the slide circulation. The two cases that provided the best correlation 18/19 and 19/19 were two cases that provided 100% consensus diagnosis on the slide‐based circulation. Comments were received from 20 participants about the image circulation ranging from ‘great’ to ‘awful’ with the majority of 12 participants not happy for their diagnostic capability to be assessed on such images alone. Two stated that the CD was easier to use on their home computer than their NHS one. In conclusion an image circulation overcomes many of the inherent problems with a slide circulation for EQA purposes and can provide an overall 70% correlation with a slide circulation but a significant number of pathologists do not find this an acceptable method for EQA.     

A computer-assisted personalized approach in an undergraduate plant physiology class

We used Computer-Assisted Personalized Approach (CAPA), a networked teaching and learning tool that generates computer individualized homework problem sets, in our large-enrollment introductory plant physiology course. We saw significant improvement in student examination performance with regular homework assignments, with CAPA being an effective and efficient substitute for hand-graded homework. Using CAPA, each student received a printed set of similar but individualized problems of a conceptual (qualitative) and/or quantitative nature with quality graphics. Because each set of problems is unique, students were encouraged to work together to clarify concepts but were required to do their own work for credit. Students could enter answers multiple times without penalty, and they were able to obtain immediate feedback and hints until the due date. These features increased student time on task, allowing higher course standards and student achievement in a diverse student population. CAPA handles routine tasks such as grading, recording, summarizing, and posting grades. In anonymous surveys, students indicated an overwhelming preference for homework in CAPA format, citing several features such as immediate feedback, multiple tries, and on-line accessibility as reasons for their preference. We wrote and used more than 170 problems on 17 topics in introductory plant physiology, cataloging them in a computer library for general access. Representative problems are compared and discussed.     

Toward implementation of a regional quality assurance program in cytopathology: the Hong Kong experience

OBJECTIVE: To develop a local quality assurance program in cytopathology based on circulation of patient specimens on glass slides, with limited resources. STUDY DESIGN: A working group was set up for design and running of the program. Participation is on a laboratory basis. The scope and frequency of testing are defined. Well-documented cases (including gynecologic, nongynecologic and fine needle aspiration cytology) with commonly encountered diagnoses are collected. Consensus concerning the diagnosis, interpretive menu and scoring system is sought before the actual slide circulations using express mail. After returning their answers to the program organizer, the participating laboratories receive immediate feedback on their scores, with reference answers, explanatory notes, "whole-mount" images of glass slides and cumulative responses of peer laboratories for on-site checking. At the end of each year, an electronic file containing representative photomicrographs of all cases examined is provided to individual laboratories for their permanent records and training purposes. RESULTS: The program was launched in mid-2003. There were 24 and 27 participating laboratories from Hong Kong (and Macau) in 2003 and 2004, respectively. To date, >150 well-documented cytology cases are available in the slide pool and ready for circulation. As the revenue is mainly to cover the expenses of express mail, the program can be carried out at a relatively low cost. CONCLUSION: In order to have any cytology quality assurance program accepted by local laboratories, it has to be fair and practical. Strict confidentiality needs to be observed throughout the process. This program emphasizes both performance assessment and educational value. Adequate representation from experienced local cytology workers, detailed documentation support from authorities and assistance from dedicated staff are essential to the success of any external proficiency testing scheme. Regular review and evaluation are also necessary for continuous improvement. The Hong Kong experience can serve as an example of running a glass slide-based cytology quality assurance program in a small region with limited resources.     

P-20DIAGNOSTIC ACCURACY OF CONVENTIONAL SMEARS AND THINPREP SAMPLES IN CERVICAL SCREENING

Thyroid fine needle aspiration (FNA) is the first choice procedure for differentiating between benign and malignant/suspicious lesions. Despite being highly sensitive and specific, it unfortunately has high inadequacy rates, with false-negatives reported in most series. The fundamental contribution of the aspirator's skill, experience and expertise to inadequacy rates is well documented, differing between both individuals and aspirator groups. We performed a retrospective audit comparing inadequacy rates of cytopathologists and clinicians for all thyroid FNAs performed from 2002–2005 within the Hammersmith Hospitals Trust. A crude cost-effectiveness was estimated, and using histological data where available, positive and negative powers (65.5% and 87.9% respectively), sensitivity (61.5%) and specificity (89.7%) were calculated. Pathologists were found to have significantly ( P  = 0.001) lower inadequacy rates (2.8%) than clinicians (16.1%) and were also more cost-effective (non-significant), with micropapillary carcinomas and lymphomas being identified as the main sources of false-negatives. We thus propose updated protocols to reduce inadequacy and false-negative rates, improve thyroid cancer diagnosis and the quality of patient care within our centre.     

Cost savings through use of the Internet: a case study

Introduction of a LIMS can bring immediate cost-savings and efficiency improvements to a Laboratory. However, peripheral problems can often prevent the full benefits from being realised. For example, in our case, reports generated on paper are subject to postal delays. They are also sent initially to an intermediary, for comments and recommendations to be added (this often means re-typing the report) causing a further delay. Within the Laboratory itself, telephone requests from clients for information on sample progress can consume a considerable amount of staff time. We have addressed both of these problems by use of the Internet. An e-mailing program takes ASCII reports produced from the LIMS and attaches them automatically to e-mail messages. Each can be configured to the specific requirements of the recipient (e.g., the use of encryption, digital signatures, and the document format). World-Wide-Web access to appropriate LIMS databases allows clients to determine progress of samples without involving Laboratory personnel. Read-only access is available to a limited sub-set of data determined by the LIMS manager. Both applications have been created in portable languages, in a way that is suitable for many different environments.     

Access by general practitioners to physiotherapy department of a district general hospital.

There has been much opposition, voiced most notably in the Tunbridge Report, to general-practitioner access to hospital rehabilitation services. Co-operation between general practitioners, physiotherapists, and the consultant with responsibility for the physiotherapy department at a general district hospital has provided an efficient open-access service. This service has been welcomed by the general practitioners because it supplies prompt treatment for their patients and by the physiotherapists because it enables them to minimise disability by treating musculoskeletal problems at an early stage.     

Foetal Blood Sampling in the Regional Hospital

Several difficulties arise in the introduction of foetal blood sampling in a regional hospital. Ideally there should be a unit sufficient to provide continuous registrar cover (anaesthetic cover and medical cover) of the labour suite. In our hospital duties have been reallocated in an attempt to attain this standard. Both consultant and registrar staff must take adequate study leave to understand the principle and practice of blood sampling. Regular lectures and demonstrations must be given to nursing and resident staff. The cost of the initial equipment is abut £1,000.‡Foetal blood sampling has been employed in the unit since January 1968. Its principal use has been the assessment of “foetal distress” Except for one case no low pH value has been found in a “high risk” patient unless the foetus showed signs of clinical distress.     

The Yorkshire slide exchange external quality assessment (EQA) scheme

A slide circulation scheme measuring cervical screening performance of individual cytologists in 15 laboratories in Yorkshire Regional Health Authority is described. The advantages and disadvantages are compared with the current National Proficiency Testing (NPT) scheme. The results indicate that a slide circulation scheme can be successfully used in cervical cytology external quality assessment (EQA). Levels of participation are better than those currently achieved by regional variations of the NPT scheme, and the use of laboratory consensus in the selection of scoring slides appears to be no less valid than the use of a pre‐selected slide pool assembled by an expert panel. The volume of data accumulated in one round is considerably greater than that achieved by proficiency testing and the educational value is regarded as high. However, the scheme is very time consuming for participants and consequently expensive for laboratories. The lack of external supervision increases the risk of unfair practices within individual laboratories. Because of these problems, Yorkshire has now switched to an NPT scheme.     

印尼爪哇动物群与周口店地区及华南动物群对比

Recently the vertebrate faunal succession established by von Koenigswald in 1930s was replaced by a new one which was proposed by Sondaar (1984), which arose some problems in regional correlations, because the relationship between the two schemes are not very clear,and some of the guide fossils mentioned by von Koenigswald were not included in the new scheme. In China, we used to compare the Jetis Fauna with Gongwangling fauna, Trinil Fauna with Zhoukoudian and Yanjinggou Faunas, but at the present time, both of the faunal names were given up. The new dating works changed the old scheme of faunas, the oldest mammalian fossil record in Java is only 1.5 Ma, which had been thought to be Middle Pliocene in the past half century. The new results from the dating works are not well correlated yet with the turnover of faunal assemblages. It's sure that the Java Faunas have close relationship with that of China, but how we can correlate them precisely is still to be done in the future.
     

PHYSIOLOGY AND MANAGEMENT OF THE CLIMACTERIC

Women in the climacteric should have a thorough medical investigation, reassurance, and endocrine therapy when indicated.Estrogens give prompt relief to the large number of women with sympathetic nervous system symptoms during the climacteric.Estrogens are most effective when given parenterally followed by short periods of oral administration.Estrogens should be given only for actual need and withdrawn after symptoms disappear.Androgens are useful in the immediate control of functional bleeding and also for alleviating symptoms in patients who respond poorly to estrogens or for whom estrogens are contraindicated.The addition of vitamin B to parenteral endocrine therapy apparently enhances the effect of the hormone.     

Import and export of biological samples from tropical countries–considerations and guidelines for research teams

‘Biodiversity’ is increasingly perceived as an important resource for research and conservation, but also for economy. Conservation, access and sustainable use of biodiversity (genetic resources, species, samples) are negotiated on different political levels, resulting in an internationally binding legal framework. Resulting legislation is binding for all parties involved in biological sampling, i.e. researches and (and in italics) countries, and especially applies for tissue or DNA samples and dervied products thereof. Understanding and awareness of export and import permits for biological samples is increasingly important for biologists to perform research projects legally and timely. Nevertheless, some biologists are still exporting and importing biological samples ignoring or non-compliant with national and international legislation, conventions, and regulations. Resulting difficulties may not only cause serious problems during field work, but may also delay the export, import or exchange of samples. Comprehensive a priori information regarding legal requirements helps to avoid or at least diminish potential problems. We identified four major factors facilitating export/import permits: (1) good personal (mutually trusted) contacts in the country of origin, (2) understanding and compliance with all relevant laws and regulations; (3) access to information regarding knowledge on permits, regulations and laws including their circulation within the researcher communities; and (4) access to consistent and up to date regulations     

openPDS: Protecting the Privacy of Metadata through SafeAnswers

The rise of smartphones and web services made possible the large-scale collection of personal metadata. Information about individuals'' location, phone call logs, or web-searches, is collected and used intensively by organizations and big data researchers. Metadata has however yet to realize its full potential. Privacy and legal concerns, as well as the lack of technical solutions for personal metadata management is preventing metadata from being shared and reconciled under the control of the individual. This lack of access and control is furthermore fueling growing concerns, as it prevents individuals from understanding and managing the risks associated with the collection and use of their data. Our contribution is two-fold: (1) we describe openPDS, a personal metadata management framework that allows individuals to collect, store, and give fine-grained access to their metadata to third parties. It has been implemented in two field studies; (2) we introduce and analyze SafeAnswers, a new and practical way of protecting the privacy of metadata at an individual level. SafeAnswers turns a hard anonymization problem into a more tractable security one. It allows services to ask questions whose answers are calculated against the metadata instead of trying to anonymize individuals'' metadata. The dimensionality of the data shared with the services is reduced from high-dimensional metadata to low-dimensional answers that are less likely to be re-identifiable and to contain sensitive information. These answers can then be directly shared individually or in aggregate. openPDS and SafeAnswers provide a new way of dynamically protecting personal metadata, thereby supporting the creation of smart data-driven services and data science research.     

Projects Come,Projects Go: Lessons from Participatory Monitoring in Southern Laos

This paper examines how a biodiversity monitoring system based on data collected by protected area staff and local communities was established and maintained in Xe Pian national protected area, Laos. Monitoring activities commenced with project support in 1998. Protected area staff, district forestry staff and villagers continued the monitoring work after 2001 when the external advisers left. More than 2500 records of wildlife, natural resource use and threats to the protected area were collected by villagers and protected area staff, mainly through use of patrols, village discussions and village logbooks. The management interventions that followed the monitoring activities were a reaction to immediate threats or perceived trends in biodiversity rather than to trends revealed by analyses of the collected data. Patrols and village discussions came to a virtual standstill when external funding ceased, probably because of lack of supporting national policies. The annual running cost of the monitoring system was only about US$ 4000 or 0.02 per ha of forest habitat.     

INHIBITION OF ACETYLCHOLINESTERASE IN THE BRAIN AND DIAPHRAGM OF RATS BY A TERTIARY ORGANOPHOSPHOROUS ANTICHOLINESTERASE AND ITS QUATERNARY ANALOGUE; IN VIVO AND IN VITRO STUDIES

Abstract— Pinacolyl S -(2-dimethylaminoethyl)methylphosphonothioate (compound I) and its quaternary analogue (compound II), are potent anticholinesterases, that form a very stable phosphonylated AChE and differ in their in vitro anticholinesterase potency by a factor of two, but have widely differing lipid solubilities.
In vitro , compound I diffused through a cerebral cortex slice when applied to the intact surface at twelve times the rate of compound II and through a diaphragm segment at four times the rate. When applied to the intact surface of a cerebral cortex slice or a diaphragm segment for 10 min, compound I gained access to AChE sites more readily than compound II but the difference was much less than the difference in their lipid solubilities. There was no discontinuity in the percentage AChE inhibition versus logarithm of the concentration of compound II, indicating that there was no clear separation of AChE into two fractions which differed greatly in their accessibility to quaternary compounds. Both compounds gained access to AChE sites in cerebral cortex slices more readily than in diaphragm segments.
In vivo , the peak plasma levels and the rates of removal from the plasma of free inhibitor were similar for both compounds, given subcutaneously in equimolar amounts. Compound I in high doses inhibited over 90 per cent of the AChE in the cerebral cortex and the diaphragm; compound II even in lethal doses produced only marginal inhibition of AChE in the cerebral cortex and only 50–60 per cent inhibition of AChE in the diaphragm.
These results indicate that the in vivo distribution of quaternary compounds is different from that observed in vitro . The implications of this are discussed.     

General practitioners' responsibilities to their patients.

The views of general practitioners about their responsibilities for patient care have not been canvassed. A survey of general practitioners was therefore carried out to determine their views. A postal questionnaire, in which general practitioners were asked what they saw as their responsibilities, was sent to 525 principals in Avon and completed by 424, giving a response rate of 81%. The doctors generally agreed that their responsibilities for patient care included problems related to internal medicine, such as managing diabetes and hypertension. Less consensus was found in the replies to questions about technical procedures, such as resection of ingrowing toenails, and gynaecological, orthopaedic, or psychosocial problems. The results supported the view that general practitioners are gradually abandoning technical aspects of medicine to specialists without a compensating role having been defined. In the light of this trend the responsibilities of general practitioners should be clearly defined by the profession.     

组织学与胚胎学全英语教学实践

顺应医学教育国际化趋势,我们进行组织学与胚胎学全英文教学实践活动已有八年。作为一门医学基础课程,组织学与胚胎学全英文教学改革之初也遇到教材、师资、授课方法等诸多困难,通过学校的政策扶持以及教研室全体教师的努力,目前组织学与胚胎学全英文课程教学体系已日趋完善、成熟,在教学内容、教学方法、教材编写、师资建设等方面取得了长足的进步,为医学生进行后续全英文课程的学习打下坚实的基础。     

Control of diarrhoeal disease in Tonga 1978-83.

Tonga, like many developing countries, suffers from a shortage of medical staff and a high morbidity and mortality from paediatric diarrhoeal disease. In 1980 a programme was started to train medical assistants and village administrators in the correct use of oral rehydration salt solution for rehydration. The effect on morbidity, mortality, and admission to hospital over the six years 1978-83 was assessed. After the introduction of the scheme the number of deaths due to diarrhoea fell considerably and the state of hydration in children admitted to hospital with diarrhoea greatly improved. It is recommended that similar programmes be adopted where clinical problems of diarrhoea with dehydration persist. Instruction in the use of oral rehydration fluid was most effectively given by non-medical staff to groups of mothers, rather than by paediatricians in their inevitably brief, although important, explanation given in hospital.     

Reengineering an Information System: A Case Study in Risk Reduction

Business-process reengineering (BPR), like computer information systems development (ISD), deals primarily with process and contains only weak facilities for addressing structure and culture. Manufacturing and ISD have strong roots in the functionalist traditions of natural science, and in a cultural environment their engineering stance deals poorly with obstacles to change. While the structured, or “hard,” engineering approaches have given rise to successful developments, they have not always proved effective. In ISD, the hard engineering methods have a tendency to redefine information systems problems as problems of technical development, and similarly in engineering contexts, BPR risks becoming too focused on technical processes. However, failure to gain commitment and a sense of ownership in new processes is a cause of failure in both BPR and ISD. This article explores a case study where both technical and human issues must be addressed—the extension of student record processing within a university. In this study, the BPR requirement is seen to arise from the users of the information system rather than as an imposed managerial imperative. The use of total systems intervention (TSI) and interactive planning (IP) enabled the immediate technical problems to be separated from underlying BPR requirements and from the need to gain commitment to change. Thus, unnecessary technical effort and the risks of failure from resistance to change were avoided. From the findings of this intervention, it is argued that the wider application of TSI provides a framework within which managerially perceived needs can be translated into a grassroots commitment.