Hemoglobin: normal values

Hematologists are not in agreement as to the "normal" amount of hemoglobin in the blood, nor is there agreement as to what amount of hemoglobin can be considered "a hemoglobin value of 100 per cent." Different hospitals base reports of hemoglobin on different standards, which obviously can be misleading. By biometric study of the great mass of data on hemoglobin content that has become available as a result of the blood procurement program, it should be possible to determine what "normal" values are and to provide a basis for uniformity in reporting.     

The Canadian influenza decision, 1976.

This paper explains the Canadian decision process following the isolation and identification of A/New Jersey/8/76 at Fort Dix, New Jersey in February 1976. The cause for concern was the emergence of a swine-like strain related to that which caused the 1918-19 pandemic, together with proved man-to-man transmission. This concern was reinforced since all new influenza A strains known to have infected the number of persons involved at Fort Dix have become strains of epidemic importance. The Fort Dix outbreak gave sufficient warning to allow implementation of a national vaccination program, to prevent and protect against influenza. In the past such an opportunity had not occurred, and vaccine use had, at best, constituted an intervention in the course of an outbreak. The National Advisory Committee on Immunizing Agents had all available information when it reached its decision to recommend vaccination with bivalent (A/Victoria and A/New Jersey) or with monovalent (A/New Jersey) vaccine for selective, high-risk groups. This was an independent, scientifically based decision.     

Patient-physician sexual involvement: a Canadian survey of obstetrician-gynecologists.

OBJECTIVE: To determine obstetrician-gynecologists'' (ob-gyns'') awareness of and experience with sexual abuse of patients and former patients and their opinions about appropriate consequences. DESIGN: Mailed survey. SETTING: Canada. PARTICIPANTS: All 792 members of the Society of Obstetricians and Gynaecologists of Canada (SOGC); 618 (78%) responded. Approximately half of all ob-gyns in Canada belong to the SOGC. MAIN OUTCOME MEASURES: Knowledge of sexual involvement by an ob-gyn colleague with a patient or former patient (as defined by the respondents and by the College of Physicians and Surgeons of Ontario [CPSO]), self-report of such involvement, attitudes toward physician sexual abuse, desirable length of time a physician should wait before seeing a former patient in a situation that could lead to a sexual encounter, suggested consequences of sexual abuse. RESULTS: Overall, 10% of the respondents indicated that they knew about another ob-gyn who at some time had been sexually involved with a patient. In all, 3% of the male respondents and 1% of the female respondents reported sexual involvement with a patient; the corresponding proportions of those who reported having been accused of sexual abuse by a patient were 4% and 2%. Significantly more of the female ob-gyns than of their male counterparts (37% v. 19%) reported awareness of a colleague''s sexual involvement with a patient that would meet the CPSO''s definition of sexual impropriety, transgression or violation. Most of the respondents felt that the consequence of proven sexual impropriety should be reprimand and fine (chosen by 33%) or rehabilitation without loss of licence (28%). Most of the physicians supported loss of licence for proven sexual transgression (57%) or proven sexual violation (74%), but fewer felt that loss of licence should be permanent for these types of abuse (4% and 24% respectively). The female ob-gyns supported stronger sanctions against sexual transgression and sexual violation than the male ob-gyns. A wide range of opinion was seen regarding the propriety of sexual relationships with former patients. CONCLUSIONS: Ob-gyns have varied opinions about how sexual abuse of patients should be defined and how it should be sanctioned. There is a discrepancy between proposed public policy and the beliefs of physicians to whom the policy is to be applied.     

Canadian survey of thyroid cancer

We report the results of a multicentre retrospective chart review of 2214 patients with thyroid cancer registered at 13 radiotherapy centres between 1958 and 1978. The data analysed included sex, age at the time of diagnosis, pathological diagnosis, extent of disease before treatment, types of treatment and their complications, and the rates of recurrence and survival up to 24 years after diagnosis. Although papillary cancers were most common, anaplastic and miscellaneous tumours were more frequent than expected, which reflects the type of patients referred by endocrinologists and surgeons to radiotherapy centres. There were marked differences in patterns of referral to the centres. Some patients with papillary and follicular thyroid cancers died of these cancers up to 20 years after diagnosis. The clinical manifestations, treatment and outcome of the rarer types of thyroid malignant tumours were of particular interest. The influence of age at the time of diagnosis on survival rates for patients with papillary or follicular thyroid cancer was highly significant, indicating much more aggressive behaviour of these cancers in older patients, particularly those beyond the age of 60 years. A more detailed analysis of tumour subtypes should provide new information on their natural history and lead to better management.     

Oildroplets in the eyes of adult anuran amphibians: a comparative survey.

Oildroplets in the eyes of terrestrial vertebrates are spherical cellular organelles that stain for lipids, have no discernible internal structure, and often contain carotenoids and possibly other chemicals. A survey of 97 species of anuran amphibians (frogs and toads) revealed that all species of 16 families surveyed possessed yellow oildroplets of varying size in the cells of the pigment epithelium, except for three species that appear to have secondarily lost them during evolution. Furthermore, 25 species of six families also possess colorless oildroplets at the distal end of the inner segments of single cones and principal cones of the double-cone system; two species of the Ranidae appear to have secondarily lost such retinal oildroplets. Every species possesses epithelial or retinal oildroplets or both. Lastly, small oildroplet-like inclusions were discovered in the red blood cells of two species. All of Walls' ('42) summary generalizations about anuran oildroplets are incorrect: oildroplets are not restricted to the Ranidae, are not yellow when found in the cones, and do not correlate with photoactic behavior in 87 species. Evidence is reviewed suggesting that the primary function of anuran oildroplets is chemical storage, perhaps related to the visual pigment cycle. Oildroplets in the cones may additionally act as filters of ultraviolet radiation.     

Attitudes toward vaccination: a survey of Canadian chiropractic students

BackgroundAlthough the Canadian Chiropractic Association and the Canadian Memorial Chiropractic College (CMCC) endorse vaccination, the prevalence of anti-vaccination attitudes among Canadian chiropractors is unknown. This study describes the prevalence of anti-vaccination attitudes among Canadian chiropractic students.MethodsAn 11-item questionnaire about attitudes toward vaccination was distributed to students enrolled at CMCC during the 1999/2000 academic year. The responses for the 11 items were then summed to arrive at a total score ranging from 0 (most negative attitude toward vaccination) to 22 (most positive attitude toward vaccination). Respondents'' perceptions of sources of vaccine information were also investigated.ResultsOver 75% of the students (467 of 621) completed the questionnaire. Most students (53.3%) reported that in general they agreed with vaccination. This was especially true among first-year students (60.7%). However, among fourth year students, only 39.5% agreed with vaccination. The proportion of respondents who stated that they were against vaccination in general was 5 (4.5%) of 112 first-year students, 10 (8.3%) of 121 second-year students, 16 (13.9%) of 115 third-year students and 35 (29.4%) of 119 fourth-year students. The mean scores on the questionnaire were progressively lower with each higher year of study at the College. The mean survey scores for each year of study were first year, 15.9 (95% confidence interval [CI] 15.2–16.6); second year, 16.1 (95% CI 15.3–17.0); third year, 14.5 (95% CI 13.5–15.4); and fourth year, 12.8 (95% CI 11.7–13.9). The mean scores varied among year of study and were statistically significant using one-way ANOVA (p < 0.0001). Among students who relied primarily on informal sources of vaccine information, such as the chiropractic literature and informal talks at CMCC, anti-vaccination attitudes were more prevalent in later years. InterpretationMost CMCC students reported pro-vaccination attitudes, but there appeared to be an increase in anti-vaccination attitudes as students progressed through the CMCC program. This pattern was seen almost exclusively among students who relied primarily on informal sources of vaccine information rather than on core CMCC lectures or prior lectures at university. Chiropractic is the third-largest regulated health care profession in North America, after allopathic medicine and dentistry, and it is growing rapidly.^1,2 A 1997 Angus Reid poll revealed that 25% of all Canadians use, or have made use of, chiropractic.³ Additional studies have reported a substantial pediatric sample within this population.^4,5,6 Chiropractors are therefore likely to play an increasingly influential role in the formulation of societal perceptions on public health issues such as vaccination. Vaccination, however, remains a contentious issue for a vocal subpopulation of the Canadian chiropractic profession,^7,8,9 despite the positive official stance of the Canadian Chiropractic Association (CCA).¹⁰Currently there are approximately 5000 practising chiropractors in Canada, of whom 4000 are members of the CCA.¹¹ Furthermore, approximately 80% of Canadian chiropractors are graduates of the Canadian Memorial Chiropractic College (CMCC),⁶ the only English-language chiropractic college in Canada. It is possible that attitudes formed during the 4-year program at CMCC will be indicative of attitudes held by practising chiropractors.¹² This study reports the findings of a survey of students attending CMCC during the 1999/2000 academic year, which was designed to investigate their attitudes toward vaccination.     

Morbidity and mortality of car occupants: comparative survey over 24 months.

The severity of injuries sustained by 2577 car occupants in road traffic accidents in the catchment area of one district accident service during February 1982 to January 1984 inclusive was assessed using the injury severity score system. In the first 12 months the mean injury severity score for front seat occupants injured in a road traffic accident was 4.94 and in the second 12 month period, after the implementation of the seat belt law, the mean injury severity score of all injured front seat occupants was 2.80. These figures indicated a reduction in injury severity of front seat occupants of 53.4% on the previous 12 month figures. The severity of injury sustained by unbelted front seat occupants and back seat passengers showed no significant change over the two years. The number of front seat occupants killed or sustaining serious injuries (injury severity score greater than 12) showed a reduction of 54% in the 12 months beginning February 1983. Front seat occupants requiring admission for injuries sustained showed a decline of 42% in the 12 months after the introduction of the seat belt law, and deaths among front seat occupants fell by 27% compared with the previous 12 months. After the implementation of seat belt legislation those front seat occupants killed or sustaining serious injuries included a significantly higher proportion of victims who were not wearing their seat belts or showed positive evidence of alcohol intake at the time of the accident. This series suggests that the incidence of serious injury or deaths among front seat occupants of cars has decreased substantially since the seat belt law became effective on 31 January 1983.     

Hemoglobin types in saanen goats and Barbary sheep: Genetic and comparative aspects

By the use of the Immobiline technique at pH ranges 7.0–7.6 and 6.9–7.9, 16 different hemoglobin (Hb) phenotypes were observed in 61 English Saanen goats. They are explained in this breed by a genetic theory of five β-globin genes (A ₄,A ₆,A ₈,E, andD) and two closely linked α-globin loci (′α and ″α) of which the ″α has a variant allele, provisionally called ″α ^X . Family data together with observed and expected Hb frequencies were in agreement with the genetic theory. Among six Barbary sheep there were three Hb phenotypes explained by the occurrence of the β-chain allelesB andC ^na.     

Laryngotracheal morphology of Afro-Madagascan geckos: a comparative survey

The structural variation of the gekkonid larynx and trachea is examined within a representative subset of 17 species of Afro-Madagascan gekkonines to determine if there are underlying morphological correlates of vocalization. The documented morphology is compared to that of the tokay (Gekko gecko), which has previously been described. Data were obtained from gross anatomical observations, scanning electron microscopy, histological examinations and computer-generated, three-dimensional, skeletal reconstructions. Although there is limited variation among most Afro-Malagasy gekkonids, the larynges of Ptenopus garrulus and Uroplatus fimbriatus exhibit marked degrees of differentiation, suggesting that laryngeal and tracheal morphology may account for the documented vocal variability of gekkonid lizards. Cladistic analyses indicated that parallel adaptive trends characterize the laryngeal morphology of the examined taxa. Alternate designs and refinements to a model of gekkonid phonation are presented, and the evolution of acoustic communication in the Gekkonidae is considered.     

Paraphalangeal elements of gekkonid lizards: A comparative survey

Paraphalanges of gekkonid lizards are cartilaginous structures associated with interphalangeal joints. Their form and structure have been investigated by dissection, cleared-and-stained specimens, routine histoloty, and radiography. A family-wide survey revealed that paraphalangeal elements occur in at least 57 species in 16 genera of the subfamily Gekkoninae. The distribution and structure of these elements suggests multiple origins among gekkonine geckos. In most instances, they are present in species with expanded subdigital climbing pads, divided scansors, and a markedly raised penultimate phalanx that is elevated from, or free of, the pad. Thus, they seem to be associated with placement of the scansors onto the locomotor substrate. In two genera, Uroplatus and Palmatogecko, paraphalanges at the more proximal interphalangeal joints are associated with muscles that run between them. In these cases, the paraphalanges appear to be involved in grasping abilities of the foot associated with digging and climbing modifications.     

A survey of Canadian rheumatology training programs, 1968 to 1978.

The committee on manpower of the Canadian Rheumatism Association retrospectively surveyed Canadian rheumatology training programs for the period 1968 to 1978. There were 133 trainees during that period, who accounted for a total of 201 trainee-years. Most trainee-years were taken up by first-year trainees, especially in the first half of the decade under study. Although three training centres accounted for two thirds of all the trainee-years, there was a progressive increase in the proportion of trainees attending other centres. The majority of trainees were Canadian medical graduates. More than one third of the alumni of these programs held full-time academic positions, and more than three quarters had some academic affiliation. One third were spending at least half of their professional time in teaching and research, but only 71 were spending half or more of their practice time in rheumatology in Canada. The remainder had established residence abroad or were spending at least half of their practice time in areas other than rheumatology. The rapid expansion of Canadian training programs has not been paralleled by a proportionate increase in rheumatologic manpower in Canada.     

Need and demand for primary health care: a comparative survey approach.

OBJECTIVE--To develop general practice profiles of needs and demand for primary health care. DESIGN--Postal survey of a stratified random sample of 3478 people registered with five general practices. Data from a single practice were compared with data from the remaining four to identify areas of comparative need. SETTING--Five general practices in Lothian. MAIN OUTCOME MEASURES--Differences between the single practice and the comparison practices in terms of social and economic circumstances, limiting long term illness, specific ongoing conditions, minor illness or symptoms, psychosocial problems, discussion of lifestyle, associated use of services. RESULTS--Respondents from the single practice reported higher rates than those in the four comparison practices of ongoing mental health and respiratory problems and use of antidepressants, tranquillisers, or sleeping tablets. Although rates of limiting long term illness and other specific ongoing conditions were comparable, the rates of minor illness or symptoms and psychosocial difficulties were higher in the single practice. Respondents from the single practice were more likely to consult frequently, to have contacted the practice out of normal working hours, and to have discussed psychosocial difficulties with a general practitioner. For any specific ongoing condition or "minor" illness, respondents from the single practice were no more likely to consult. CONCLUSIONS--A comparative survey approach is a useful method of developing an understanding of patterns of need and demand among general practice populations. It has the potential to inform planning within individual general practices and the process of commissioning among general practices within a given area.