Novel computer-based assessment of asthma strategies in inner-city children.

BACKGROUND: Childhood asthma continues to be a growing medical concern in the United States, affecting > 17 million children in 1998. The mortality rate from asthma in children aged 5 to 14 years has nearly doubled, from 1.7 deaths per million to 3.2 deaths per million between 1980 and 1993. OBJECTIVE: To evaluate the use of artificial neural networks (ANNs) to rate problem-based strategies for asthma management in a defined population of children. METHODS: The participants in our study were recruited from a local inner-city medical facility in Los Angeles. The majority of participants had received the diagnosis of mild-to-moderate-persistent asthma. Each participant was given 10 asthma-based problems and asked to manage them. Each management decision and its order were entered into a database. This database was used to train an artificial neural network (ANN). The trained ANN was then used to cluster the various performances, and outputs were evaluated graphically. RESULTS: Three hundred five performances were analyzed through our trained neural network. Our ANN classified five major clusters representing different approaches to solving an acute asthma case. CONCLUSIONS: ANNs can build rich models of complex phenomena through a training and pattern-recognition process. Such networks can solve classification problems with ill-defined categories in which the patterns are deeply hidden within the data, and models of behavior are not well defined. In our pilot study, we have shown that ANNs can be useful in automating evaluation and improving our understanding of how children manage their asthma.     

Fused umbilical arteries: prenatal sonographic diagnosis and clinical significance.

This report describes a series of 5 fetuses with fused umbilical arteries that had the prenatal feature of a single umbilical artery near the placental insertion and the normal 2 umbilical arteries at the fetal end of the cord. In 1 case this vascular anomaly was associated with unilateral renal agenesis in a fetus with a subsequent diagnosis of Hallermann-Streiff syndrome. No perinatal complications were identified in the remaining 4 fetuses. Postpartum examination of the cord revealed that the 2 umbilical arteries fused to form 1 artery for a long segment of the distal portion of the cord. Our findings suggest that the prenatal evaluation of the umbilical cord to document the number of vessels should include multiple views of the cord and demonstration of the 2 intra-abdominal umbilical arteries with color Doppler imaging for a confident diagnosis. Our observation also suggests that, at least in some cases, single umbilical artery may result from incomplete splitting of the single artery normally present in early human embryos.     

Complementary medicine: use and attitudes among GPs

BACKGROUND: Information about use and attitudes of GPs towards complementary medicine is required in order to inform the debate about its place within mainstream medicine. There is evidence that public use of complementary medicine is particularly high in the South-West of England. OBJECTIVE: This study aimed to determine the use of, and attitudes towards, complementary medicine among GPs. METHODS: A questionnaire survey was performed of all primary care physicians working in the health service in Devon and Cornwall. RESULTS: Replies were received from 461 GPs, a response rate of 47%. A total of 314 GPs (68%, range 32-85%) had been involved in complementary medicine in some way during the previous week. One or other form of complementary medicine was practised by 74 of the respondents (16%), the two most common being homoeopathy (5.9%) and acupuncture (4.3%). In addition, 115 of the respondents (25%) had referred at least one patient to a complementary therapist in the previous week, and 253 (55%) had endorsed or recommended treatment with complementary medicine. Chiropractic, acupuncture and osteopathy were rated as the three most effective therapies, and the majority of respondents believed that these three therapies should be funded by the health service. A total of 176 (38%) of respondents reported adverse effects, most commonly after manipulation. CONCLUSION: Over two-thirds of the GPs in Devon and Cornwall who responded to the survey had been involved with complementary medicine in some way during the previous week. This figure is higher than the national average. The majority of respondents believed that acupuncture, chiropractic and osteopathy were effective and should be funded by the NHS.      

红豆杉提取物中紫杉醇的反相高效液相色谱法测定

本文报道应用反相高效液相色谱法测定红豆杉提取物中紫杉醇的含量,以倍他米松作内标,在填充以10μm LiChrosorb RP-18固定相的250×4mm不锈钢柱上以甲醇-水(30:10v/v)作流动相。228 nm处检测。本法简便、快速、准确,适用于微量样品的测定。