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TRULY comparative studies of residential health care systems for mentally retarded are virtually nonexistent. This situation exists despite the fact that all mentally retarded comprise perhaps 5 per cent of the national population, and in the face of the fact that over 200,000 mentally retarded are in public residential facilities, cared for by nearly 100,000 staff members at a cost of over $500,000,000. The research from which this paper is drawn addressed this research lacuna, and was perhaps the first to collect comparative data on a broad range of health care system components in residential centers for mentally retarded and the technological bases influencing them. The present paper presents findings on certain indexes of comprehensiveness of health care in these institutions and their technological influences at five public facilities in widely different locations in this country. It need only be mentioned that care to the youth and adults in these institutions influences the pattern of services for mentally retarded children and youth in the community, and for those who will be admitted to these facilities in the future.

This paper attempts to establish a background against which the balance between basic and applied research and the mechanisms needed for effective research and development can be considered. It examines the nature of the medical task in the light of the requirements for health and of the contribution of medical science and technology to past improvements. The author concludes that conceptualization of the medical task has hitherto been inadequate and has led to deficiencies in the approach to both medical science and medical services. The needs of research and development are therefore unlikely to be met fully by strengthening the traditional research framework, or by investigation of problems thrown up by the day–to–day experience of the executive government department. Against this background the paper considers briefly the mechanism of research and development. It suggests that at the highest level, all problems of medical research and development should be examined together.

Lime has become the world’s leading reagent for use in the treatment of both water and air pollution and, after sulfuric acid, is the No. 2 basic chemical in commercial use. As a result, the production capacities of the manufacturing plants are being rapidly expanded to meet the increasing demand for liming materials. This paper describes the achievements of the lime industry in developing methods of handling and controlling the various finely divided products which they produce. An extensive survey provides useful data on the availability and performance of many of the control devices that are currently in use, and an analysis is made of the operating efficiencies and costs of this equipment. The environmental control programs which are currently underway in this industry are described and an evaluation is made of these programs. The ultimate goals that are believed to be attainable are presented from the standpoint of emission control from individual processes as well as from operating plant complexes. ...

There is currently a wide divergence of opinion as to whether in the year 2000 there will be sufficient food supplies to feed a prospective world population of 7 billion. The pessimists warn that even before that time there may be widespread outbreaks of famine, complete exhaustion of our natural resources, a hopelessly deteriorated physical environment, and a world ruled by virtual chaos. The optimists trust that somehow man's intelligence will meet the challenges as they arise. Somewhere between stand the realists, who are aware of the growing threats, but who believe that positive measures taken now can forestall the predicted disaster. The principal thrust of my remarks today is that the ways and means to provide enough food for the world's people, even at the present rate of population growth, are known and are available; there is no need for panic unless man's intelligence, imagination, and enterprise choose to retreat or abdicate in the face of seemingly insurmountable problems. My conviction is, however, predicated on the faith that nations will not fail to take effective steps to lower birth rates, that they will intensify and multiply all efforts to stabilize their numbers. More than half the world suffers from extreme shortages of food. If we were to add to this figure all the people who have a barely sufficient diet but who are not severely undernourished so much as malnourished, the percentage would be much greater. Just to provide the more than 3.5 billion people alive today with a minimally adequate diet would require twice the amount of food now produced. Yet in spite of the existence of such enormous food deficits, the population of the globe is each year increasing at the rate of 70 million. At this growth rateabout 2% a year-the number of human beings will double by the end of this century. Thus even if by herculean efforts the world does succeed in doubling its agricultural production by the year 2000, the food/population ratio would be no closer to being equalized than it is now; more than half of the world would still be underfed. And, in terms of actual numbers of hungry people, there would be at least 2 billion more than there are now. Absolute food deficits, however, are not the only cause of world hunger. There are other factors which complicate the problem of global food supply. In theory, the total calories contained in the 1.088 billion metric tons of food grains which the world now produces are more than enough to provide its 3.5 billion inhabitants with the minimal nutritional requirement of 2500 calories a day. This remains, however, merely a paper-and-pencil exercise -for several compelling reasons. The most important is the great disparity in the distribu

The participation of the national rail networks in the European corridors requires certain modifications and their redefinition. Because the railway stations are special parts of the railway networks, they should be modernized, especially in south-eastern Europe. The main issue in the process of construction or reconstruction of railway stations is dimensioning (projection) of infrastructure facilities. The dimensioning of the infrastructure capacity is in direct correlation with the projected technology of work and the planned volume of traffic. This paper presents the simulation model which allows sizing facilities of border rail stations on the basis of the defined work and traffic technology.

NO SUBJECT calls more insistently than social medicine for a disclaimer of omniscience. Medicine as a social institution is peculiarly complex both in structure and in function. This paper essays o...

Many radiographic lesions are difficult to recognise, yet audiences and readers are often expected to see an abnormality on a reproduction of a film with only a verbal description to aid them. Visual guidance, which directs and educates the eye, is likely to be more helpful than words; it is quicker and more certain, because radiology is a visual art and its appreciation can only be acquired visually. Nevertheless, the usefulness of explanatory diagrams is often disregarded in radiological literature. This paper describes a method of making a diagram which attempts to give: 1. Indication of important normal structure. 2. A clear statement of lesions. 3. Subordination of irrelevant structure. 4. Easy visual comparison by size. 5. Easy visual translation by having a white image on a black field; so that when placed beside a reproduction of the film, the diagram gives an immediate indication of what is significant, and the viewer can then see the lesion for himself.

The aim of this paper is to report a new method of bronchography, which has been developed at University College Hospital during the past 18 months. The essential of the method is that the bronchogram is performed through a polyethylene catheter which has been introduced into the trachea through the crico-thyroid membrane by the Seldinger technique (Seldinger, 1953), and which is afterwards directed into a main bronchus under screen control. The usual preliminaries to bronchography are carried out, i.e. infection is treated, and any retained bronchial secretions are cleared by postural drainage and assisted coughing. On the day of the examination food and drink are withheld for four hours, and the patient is given a premedication of butobarbitone gr 3 (200 mg) one hour beforehand. With the patient sitting the crico-thyroid membrane is infiltrated with 2 ml. of 1% Lignocaine.The needle is then pushed into the trachea and, after withdrawal of air, 2–3 ml. of 1% Lignocaine are injected rapidly at the end of ...

As an economic technique for evaluating specific projects or programs in the public sector, cost-benefit analysis is relatively new. In this paper, the theory and practice of cost-benefit analysis in general are discussed as a basis for considering its role in assessing technology in the health services. A review of the literature on applications of cost-benefit or cost-effectiveness analysis to the health field reveals that few complete studies have been conducted to date. It is suggested that an adequate analysis requires an empirical approach in which costs and benefits are juxtaposed, and in which presumed benefits reflect an ascertained relationship between inputs and outputs. A threefold classification of benefits is commonly employed: direct, indirect, and intangible. Since the latter pose difficulty, cost-effectiveness analysis is often the more practicable procedure. After summarizing some problems in predicting how technologic developments are likely to affect costs and benefits, the method of cost-benefit analysis is applied to developments of health systems technology in two settings-the hospital and automated multiphasic screening. These examples underscore the importance of solving problems of measurement and valuation of a project or program in its concrete setting. Finally, barriers to the performance of sound and systematic analysis are listed, and the political context of decision making in the public sector is emphasized.

In this paper, data collected in a community in which the major employer is a highly automated chemical-processing firm are compared with data from studies dealing with earlier stages in the process of inustrialization. These data suggest that the effects of contemporary technological changes upon the occupational structure and, consequently, upon, class, status, and power arrangements may be quite dirrerent from the effects of technological changes observed in earlier studies.

An account is given of the construction and use of a comparatively inexpensive whole-body counting room, designed primarily for clinical applications. Bulk shielding is provided by about 16 tons of chalk, loaded into polythenelined paper bags, to form a layer 2 ft. thick, the room being lined inside with 0·25 thick aged lead sheets. Comparative studies of the background of scintillation counters in this room, and in other shielded rooms, are presented; it is noted that for γ energies > 250 keV the background was reduced from 50 to 4·2 cps when a particular counter was taken from a brick-walled laboratory into the chalk-bag shielded room, but only by a further 2·6 cps if instead the counter was shielded by 4 in. of lead. Illustrations of clinical applications of the room are given, these, using three 3 in. diameter × 2 in. long NaI (TI) crystals as detectors, including studies of the retention and redistribution of 47Ca following the administration of about 1 μc of this nuclide, and measurements of the ret...

This paper discusses the new relationship between Government and the Scientific Estate, and the three urgent tasks facing the Scientific Community, including the role of the Scientist in meeting the awesome and challenging social problems of our time. Many of these problems are directly attributable to the development and abuse of modern technology.

This paper describes some of the folk norms or so-called “rules of thumb” that governed the making of tools and implements up to middle of the nineteenth century. These norms were established on the bases of intuition or through a long process of development by trial and error. In many instances dimensions arrived at on the basis of these norms have agreed with those established as optimal by means of biomechanical analysis.

The disadvantages of performing fistulography and sinography by catheterisation are only too well known. They consist of leaking-back of contrast medium from the sinus, difficulty in successfully demonstrating all the ramifications of the sinus tracts, and also the inevitable exposure of the radiologist to radiation during the procedure. Recently, a method of performing fistulography by a vacuum technique was described by Brekkan (1962). We have modified his technique so as to simplify the application of the suction device, and we have had suction cups of different sizes made to overcome certain anatomical difficulties to be described later, which were not mentioned in Brekkan's article. This paper describes our experience of the technique in 15 cases of fistula or sinus. This consists, essentially, of a circular suction cup made of Perspex. The cup has slightly bevelled edges, and between the outer rim and a central cylindrical projection, is a space 1·5 cm in diameter. This space communicates with side ...

This paper is a report on experiences with an electronic photographic printer, placed in the Western Infirmary, Glasgow, by courtesy of Rank Cintel Ltd., to permit a study of the various problems encountered when producing miniature and full size copies of radiographs. The main reason for further photographic work on radiographs is to establish a simple and satisfactory method of carrying out the following procedures: (1) Compensating for over or under exposure of films. This is of value where films are difficult or impossible to repeat, e.g., ward films on very ill patients, or where additional radiation is to be avoided. (2) Making copies of interesting films, which for all practical purposes are identical to the original, for radiographic museums, clinical departments, and teaching purposes. (3) Selectively emphasising certain features, e.g., calcification in soft tissues or heart valves, gas shadows and fractures. We believe that for all these purposes electronic printing can offer great advantages. C...

The importance of fluid and electrolyte balance studies in modern medicine cannot be overestimated. In almost all fields of medicine, some application of the principles of this science is known. Calculations and imbalances are most satisfactorily worked out in milliequivalents per liter. Unfortunately, laboratory results are most often reported in volumes per cent and milligrams per 100 cc. To convert these values to milliequivalents per liter requires much time and effort. A simple modification of an ordinary slide rule that can be effected in a few minutes facilitates the conversion to such an extent that what once took arduous hours can be done in seconds. The calculator is an ordinary slide rule or two opposed logarithmic scales (logarithmic graph paper will do) with marks made on the D scale so that, when the number 1 on the C scale is opposed to a mark, the C scale is related to