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-ACTS 17:26 (NLT) I still remember the look the gal at the bank had when she asked my occupation and I proudly said, "I run cows." Thank you for city people, country people and people of every walk of life you have placed in your creation. We wouldn't have banks if everyone were like me, and there would be no food if we were all like my banker gal. [Extracted from the article]

Ultra-low dose computed tomography (ULD-CT) assessed by non-radiologists in a medical Emergency Department (ED) has not been examined in previous studies. To (i) investigate intragroup agreement among attending physicians caring for ED patients (i.e., radiologists, senior- and junior clinicians) and medical students for the detection of acute lung conditions on ULD-CT and supine chest X-ray (sCXR), and (ii) evaluate the accuracy of interpretation compared to the reference standard. In this prospective study, non-traumatic patients presenting to the ED, who received an sCXR were included. Between February and July 2019, 91 patients who underwent 93 consecutive examinations were enrolled. Subsequently, a ULD-CT and non-contrast CT were performed. The ULD-CT and sCXR were assessed by 3 radiologists, 3 senior clinicians, 3 junior clinicians, and 3 medical students for pneumonia, pneumothorax, pleural effusion, and pulmonary edema. The non-contrast CT, assessed by a chest radiologist, was used as the reference standard. The results of the assessments were compared within each group (intragroup agreement) and with the reference standard (accuracy) using kappa statistics. Accuracy and intragroup agreement improved for pneumothorax on ULD-CT compared with the sCXR for all groups. Accuracy and intragroup agreement improved for pneumonia on ULD-CT when assessed by radiologists and for pleural effusion when assessed by medical students. In patients with acute lung conditions ULD-CT offers improvement in the detection of pneumonia by radiologists and the detection of pneumothorax by radiologists as well as non-radiologists compared to sCXR. Therefore, ULD-CT may be considered as an alternative first-line imaging modality to sCXR for non-traumatic patients who present to EDs.

Allogeneic stem cell transplantation is commonly used in the treatment of high-risk acute myeloid leukemia (AML). This intensive treatment has a high early transplant-related mortality, and an additional significant cause of death in these patients is later AML relapse. Retransplantation can be considered for a minority of patients, but only 10-20 of selected patients then achieve long-term survival. Donor lymphocyte infusion (DLI) has an antileukemic effect, but the effect of this treatment usually lasts for only 3-4 months. A possible strategy to improve the prognosis could be to combine antileukemic T-cell therapy (i.e. DLI) with AML-targeting therapy. Several aspects have to be considered for such approaches: (i) the therapy should have immunomodulatory rather than immunosuppressive effects; (ii) the regimen should have a low hematological toxicity to preserve residual normal bone marrow function; and (iii) the treatment should have a documented antileukemic effect. DLI elicit both graft versus host and graft versus leukemia effects, and could be added to pharmacological treatment. Epigenetic targeting should be considered in these patients because both demethylating agents as well as the histone deacetylase inhibitors have documented antileukemic effects and have a relatively low hematological toxicity. Other drugs to consider are thalidomide, lenalidomide, antiangiogenic agents, tyrosine kinase inhibitors and heat shock protein 90 inhibitors, which all have both antileukemic and immunomodulatory effects. Relatively few clinical studies are available for patients with this high-risk disease. The designs of future clinical trials have to carefully consider the antileukemic and immunomodulatory effects together with the risk of especially hematological toxicity.

This paper highlights what needs to happen to make near-field communication (NFC) contactless mobile payments at the point of sale a mass-market reality. The paper demonstrates how, as NFC technology continues to gain momentum, stakeholders can assess different implementation options, define the business case and roles that will meet their requirements, and establish a clear go to market strategy with essential partnerships. The ultimate aim of analysing the different implementation models available is to speed up the development and use of NFC technology for payments. The work that Mobey Forum has done within this area evaluates the current ecosystem and showcases different types of technology and deployment strategies, explaining how these can be assessed to identify the implementation model that best aligns with a stakeholder’s commercial needs. Finally, the paper demonstrates how, if the industry fails to come together in a collaborative and interoperable manner, NFC contactless mobile payments may never achieve mass-market deployment.

A personal narrative is presented which explores the author's experience of almost losing her horse named Lady.

During the past year many financial services companies have been preoccupied with a very specific portion of the Emergency Economic Stabilization Act, which was passed in October 2008. This ‘bailout’ law not only set up a facility to purchase ‘distressed’ assets and make capital injections into ‘troubled’ financial institutions, it modified the current information reporting scheme to include cost basis on 1099B returns and that has left many financial institutions ‘troubled and distressed’ once again. Leading consulting organisations and well-known industry pundits have offered their views on the new cost-basis reporting requirements and have contrasted them against the current 1099B proceeds of sale reporting scheme. The course of this paper will differ from these writers as the focus will not be so much on what the new law says but rather how financial institutions are dealing with the monumental task of preparing to comply with it. At the time of writing this paper, the Internal Revenue Service (IRS) has yet to issue any preliminary regulations, let alone final ones, and the law takes effect on 1st January, 2011. Subsequent to a solicitation for responses to 36 questions the IRS posed in February 2009, communications to and from the IRS have reduced significantly and many financial services firms have begun major Project Management Programs to accommodate tracking, transferring, presenting and reporting cost-basis information while left to fill in the blanks as far as what final cost-basis regulations will look like. This paper will provide a comprehensive understanding of how some industry participants are going about preparing for the implementation of cost basis in light of the issues that are known to be presented as well as the issues that cannot be known until the regulations have been issued and finalised.

Five conversion routes in winter wheat to first and secondgeneration ethanol production systems under north European conditions are analyzed subject to energy efficiency, feed energy production, feed protein production and land use. The impact of integrating a bioethanol plant with combined heat and power generation, taking advantage of excess heat available, is analyzed for the same five scenarios. They are based on empirical data from largescale processing of starch and lignocellulose to ethanol. We show that integrating technologies can improve the system energy efficiency by more than 30 percentage points. A technologyintegrated wheattoethanol system may exhibit energy efficiencies almost comparable to those seen for conversion of petroleum into gasoline. We also show that it is possible to utilize crops for energy purposes without substantially changing the global appropriation of land for agriculture. © 2009 Society of Chemical Industry and John Wiley & Sons, Ltd

ABSTRACTWe have evaluated the Platelia Aspergillusenzyme immunoassay for detection of galactomannan in bronchoalveolar lavage (BAL) specimens in solid organ transplant patients with aspergillosis. The precision and reproducibility in serum or BAL to which galactomannan was added were similar. Sensitivity was 81.8% in patients with aspergillosis, and specificity was 95.8% in lung transplant patients who underwent BAL for surveillance for infection or rejection. Among transplant controls, positive results were more common in patients (i) who underwent diagnostic BAL performed for evaluation of symptoms or chest computed tomographic abnormalities, (ii) who had undergone lung transplantation, or (iii) who were colonized with Aspergillus. Galactomannan testing in BAL is useful for diagnosis of aspergillosis in transplant patients. The significance of positive results in patients without confirmed aspergillosis requires further evaluation.

The galactomannan (GM) assay is an approved noninvasive test for detection of invasive aspergillosis (IA) that has been validated in adult patients with hematologic malignancies who are undergoing bone marrow transplantation. There have been few studies with this assay in pediatric patients, but early reports suggest that there may be differences in the performance such that false-positive GM tests in pediatric patients are more common than in adult patients.

The clinical utility of Platelia Aspergillusenzyme immunoassay (EIA) for galactomannan (GM) antigen detection in bronchoalveolar lavage (BAL) for the diagnosis of invasive aspergillosis (IA) in lung transplant recipients is not known.

Some myasthenia gravis (MG) patients have antibodies against skeletal muscle antigens in addition to the acetylcholine receptor (AChR). Two major antigens for these antibodies are the Ca2release channel of the sarcoplasmic reticulum, the ryanodine receptor (RyR), and titin, a gigantic filamentous muscle protein essential for muscle structure, function, and development. RyR and titin antibodies are found in MG patients with a thymoma and in a proportion of late-onset MG, and they correlate with severe MG disease. The RyR antibodies recognize a region near the N-terminus important for channel regulation. They inhibit Ca2release from sarcoplasmic reticulum in vitro. There is electrophysiological evidence for a disordered excitation-contraction coupling in MG patients. The presence of titin antibodies, which bind to key regions near the AI junction and in the central I-band, correlates with myopathy in MG patients. However, so far, there is no direct evidence that antibodies against the intracellular antigens RyR and titin are pathogenic in vivo.

The aim of this study was to evaluate whether distraction induced by video glasses had an effect on the perceived intensity of pain and unpleasantness during dental scaling compared with the effect of nitrous oxide (N 2O) analgesia. The pain stimulus was dental scaling (removal of dental calculus) with an ultrasonic scaler. As a standardised, non-dental painful stimulus, Von Frey filaments were used. A total of 26 patients with superficial chronic periodontitis were enrolled in this randomised, controlled clinical study. The effect of video glasses was compared with N 2O in one session and the effect of video glasses versus a control situation in another. The patients rated the intensity of pain and unpleasantness evoked by dental scaling and Von Frey filament stimulation on 100-mm visual analogue scales (VAS). For dental scaling, there was no effect of video glasses on the perceived pain ( p=0.85) or unpleasantness ( p=0.73) nor of N 2O ( p=0.69 and p=0.51, respectively) compared with the control situation. Similarly, no significant difference was found between VAS scores in the video glasses and N 2O session ( p=0.48, p=0.58). A significant effect of video glasses and N2O(p<0.008) was found on the perceived pain intensity produced by Von Frey filament stimulation compared with the control situation, but no significant difference was seen between these methods ( p=0.07). Post-treatment interviews of the patients revealed that 81% of the patients in the video and 65% in the N 2O session stated that the method had some beneficial effect on their overall experience of the treatment situation. In conclusion, administration of video glasses or N 2O did not affect the perceived intensity of pain and unpleasantness evoked by dental scaling.

Previous studies on modulation of anxiety, pain and unpleasantness have documented a positive effect of video glasses (I-Glasses™, Virtual i-O™, Seattle, USA) on the perceived pain and unpleasantness under different laboratory and clinical conditions. The aim of this study was to evaluate whether distraction induced by video glasses also had an effect on the perceived intensity of pain and unpleasantness during dental treatment. Pain and unpleasantness was evoked by the preparation (drilling) of a minor dental cavity (class I). Twenty-three patients (17 female and six male, age range 20–49 years) with a need for an occlusal dental restoration in two homologous teeth participated in the study. In this split-mouth design, the patient received the dental treatment wearing 3D video glasses and without video glasses (control situation) in a randomized order. The tooth cavities were prepared in accordance with conventional techniques after mounting the video glasses. The patient rated the intensity of pain and unpleasantness on 100mm visual analogue scales (VASs) after preparation of the first cavity; immediately after, the opposite tooth was prepared and again the volunteer rated the intensity of pain and unpleasantness. The cavities were then filled using a routine composite technique. Eventually, the patient indicated whether she would prefer video glasses or not if she were to have another filling and what the expectations of the effect had been. Differences in VAS ratings in the video and control situation were tested by Student's t-test. There was no statistically significant effect on the perceived pain (p=0.90) or unpleasantness (p=0.39), but the majority (74%) of the patients would still prefer to wear video glasses if they were to have another dental filling, and 73% had expected a positive effect of the video glasses. These findings suggest that perceived intensity of dental pain is resistant to a simple distraction technique.

Rudder roll damping research has mainly focused on achieving roll reduction around the ship’s natural roll resonance, or at the peak encounter frequency described by standard spectra. This paper demonstrates that sea motions of ships in inner Danish waters differ so much from these anticipations that first generation RRD designs failed to achieve the desired damping. One reason was that motion with very low encounter frequency occurs much more frequently than standard wave models predict. The paper shows results from extensive sea trials with several sister ships to substantiate these observations. A hypotheses offered about the origin of the observed phenomena is coast and bank reflections. The paper shows that new RRD design objectives were needed, and it presents the results of an RRD autopilot redesign to cope with both model uncertainty and the wide envelope of sea conditions.

Here we report the first three-dimensional structure of a phosphoribosylpyrophosphate (PRPP) synthetase. PRPP is an essential intermediate in several biosynthetic pathways. Structures of the Bacillus subtilis PRPP synthetase in complex with analogs of the activator phosphate and the allosteric inhibitor ADP show that the functional form of the enzyme is a hexamer. The individual subunits fold into two domains, both of which resemble the type I phosphoribosyltransfereases. The active site is located between the two domains and includes residues from two subunits. Phosphate and ADP bind to the same regulatory site consisting of residues from three subunits of the hexamer. In addition to identifying residues important for binding substrates and effectors, the structures suggest a novel mode of allosteric regulation.

Tabu search is a well-established metaheuristic framework for solving hard combinatorial optimization problems. At its core, the method uses different forms of memory to guide a local search through the solution space so as to identify high-quality local optima while avoiding getting stuck in the vicinity of any particular local optimum. This paper examines characteristics of moves that can be exploited to make good decisions about steps that lead away from recently visited local optima and towards a new local optimum. Our approach uses a new type of adaptive memory based on a construction called exponential extrapolation. The memory operates by means of threshold inequalities that ensure selected moves will not lead to a specified number of most recently encountered local optima. Computational experiments on a set of one hundred different benchmark instances for the binary integer programming problem suggest that exponential extrapolation is a useful type of memory to incorporate into a tabu search.

COOP/WONCA Functional Assessment Charts are widely in use in research and clinical work. They originally evolved from Dartmouth COOP Functional Assessment Charts. Our objective is to describe our experiences with COOP/WONCA Charts and to provide data on reliability and reference data from a normal population.

A prospective, randomized investigation.

A review is presented of recent experimental data on the effect of microstructural and compositional het erogeneity on the thermal diffusivity/conductivity of structural materials for high-temperature applications. These materials include nitrides, carbides, oxides, and various composites. The microstructural and compositional variables include microcracking, solid solution alloying, densification aids, im purities, and the amount, type, distribution, and orientation of dispersed phases. Such variables can be used to tailor the heat transfer properties of a material for specific require ments.

On the basis of questionnaires answered by the parents of 90 children with cystic fibrosis (CF) an analysis has been made of the education situation and the professional activity of the mothers of children with CF. The findings are compared with those obtained from mothers without CF children and with those of the fathers of CF children. There are striking differences between the CF mothers and the controls with regard to their possibility of having a career. Even greater differences are evident when the mothers in families with CF children are compared with the fathers in the same families. The education and professional career of the fathers of CF children are generally not influenced by having a chronically disabled child to care for, whereas the mothers to a large extent have felt compelled to give up their education or their professional career.

The economic status of families with a child with cystic fibrosis is compared with the situation for control families. The housing situation for the two groups is also evaluated. The study is based on questionnaires. The families with children with cystic flbrosis have a higher income than the controls, but they also have greater expenses. The increase is not only in expenses related to the treatment of cystic fibrosis but also in the general expenses related to having children, in the group of families with cystic fibrosis. The housing expenses are also greater in the families with children with cystic fibrosis; this is probably due to the fact that home treatment of cystic fibrosis adds certain demands to the quality of the housing conditions for these families.

The families of 90 children with cystic fibrosis and the families of 1977 control children have answered extensive questionnaires, which are the basis for this study. In the first part of the study the two groups are compared for some important factors, to detect differences that would make further analysis of the material questionable. The two groups were commensurable concerning their economic situation, standard of housing, ages of children, and the family situation in general. The educational level of the parents in the two groups did differ, the parents of children with cystic fibrosis having less education. The parents of children with cystic fibrosis were more dissatisfied with their situation than those in the control group. These differences are probably a result of having cystic fibrosis in the family; consequently, it is concluded that the two groups can well be compared.

The aminoterminal propeptide of type III procollagen (PIIINP) is a marker of type III collagen metabolism. The serum concentration of PIIINP is increased during inflammation, probably reflecting stimulated biosynthesis of type III collagen. Serum PIIINP decreases during glucocorticoid treatment. This has been interpreted as an inhibited biosynthesis of type III collagen. However, circulating PIIINP is extracted by the liver, and the decrease in serum PIIINP may also be caused by an increased hepatic elimination. In the present study we investigated the influence of intravenous methylprednisolone on the serum PIIINP level in pigs combined with a simultaneous determination of the hepatic extraction of PIIINP. The serum level of PIIINP decreased by approximately 30% within 2 h following glucocorticoid injection (p<0.01). The initial hepatic extraction ratio of PIIINP was 0.15 (range 0.05––0.33) and neither changed after administration of methylprednisolone nor differ from that of the controls. Injection of methylprednisolone did not influence the gel filtration profile. The results of this study confirm the previous finding of serum PIIINP being decreased following glucocorticoid administration, but disprove the hypothesis that alterations in the liver extraction of PIIINP explain the decrease.

1. The plasma concentration of hyaluronate (hyaluronic acid; HA) was measured in different vascular beds in order to determine regional kinetics of endogenous HA in fasting, supine subjects with normal (n = 6) or moderately decreased kidney function (n = 9). 2. In both groups hepatic venous HA was significantly below the value obtained in plasma from pulmonary artery, inferior vena cava, and renal veins (P < 0.001), giving a net hepato-splanchnic extraction ratio of HA about 33%. 3. The concentration of HA in renal veins was significantly below that of the pulmonary artery and inferior vena cava (P < 0.05). Average net renal extraction ratio of HA in normal kidneys was approximately 20%. Unilateral kidney function was assessed by 131I-hippuran renography, and the kidney with better function had a significantly higher extraction ratio when compared with the kidney with the lower function (P < 0.025). HA was inversely correlated to glomerular filtration rate (r = − 0.59, P < 0.02). 4. Assuming a plasma flow of 800 and 600 ml/min in normal liver and kidneys, respectively, the average normal plasma clearances of HA in these organs in the resting subject may be estimated to be 250 and 120 ml/min, respectively. 5. The results indicate that the hepato-splanchnic region normally plays a major role in the bio-degradation of endogenous circulating HA. The kidneys also eliminate the compound, presumably the low-molecular-weight fraction of the material. The results may explain abnormally high values of circulating HA in patients with diseases in these organs.

Objectives. Knowledge of what predicts relatives' expressed emotion (EE) may contribute to improved family work in schizophrenia. In the present study we examined locus of control (LOC) beliefs as determinants of EE components.

258 alcohol-abusing men, free from cirrhosis on primary liver biopsy, were followed for 10-13 years during which cirrhosis developed in 38, corresponding to a rate of 2% per year. The likelihood of cirrhosis developing proved to be independent of duration of abuse and of daily consumption before the primary biopsy. This indicates that the effect of alcohol abuse is not cumulative over time, but rather establishes conditions for the development of cirrhosis. The rate of cirrhosis increased stepwise with degree of steatosis in the primary biopsy, and in those with alcoholic hepatitis was nine times higher than in those with no steatosis. This finding, together with the results on alcohol abuse, indicates that steatosis and alcoholic hepatitis, despite their reversibility, are causally associated with cirrhosis rather than epiphenomena of alcohol abuse. In the alcohol-abusing man, a liver biopsy provides more information than alcoholic history about the likelihood of future cirrhosis.

In order to examine the intestinal expression of the recently cloned H+/di-tripeptide transporter (PepT1), oligonucleotide probes were synthesized and their specificity confirmed by Northern blot analysis of rabbit jejunal RNA. In situ hybridization studies, using these probes, show that PepT1 is expressed all along the small intestine and at a very much reduced level in the colon. In contrast, PepT1 mRNA was not detected in the stomach, sacculus rotundus or caecum. Microscopic examination of tissue sections showed PepT1 expression to be restricted to intestinal epithelium with no detectable expression in the lamina propria, muscularis mucosae, muscularis or serosa. The accumulation of PepT1 mRNA along the crypt-villus axis was also investigated. In all regions of the small intestine (in duodenum, jejunum and ileum), PepT1 mRNA was undetectable in deeper epithelial cells of the crypts. Expression was first detectable at or near the crypt-villus junction, the amount of PepT1 mRNA increasing rapidly in the lower villus to a maximum approximately 100–200 µm from this point. Along the length of the small intestine PepT1 mRNA was most abundant in duodenal and jejunal enterocytes, with lower levels in the ileal epithelium. PepT1 expression is greatly depressed in the follicle-associated epithelium of the Peyer's patch relative to both interfollicular and adjacent “normal” villi. These data are discussed in the context of the known physiological role of PepT1 in the gastrointestinal tract.

1. The use of computerised tomography (CT) to predict body composition of chickens has been evaluated. Prediction equations were constructed by regression analyses with CT-observations as independent variables. The accuracy of prediction was evaluated on separate sets of birds, not included in the regression analyses.2. Different methods of generating CT-observations were evaluated. The most robust CT-variables for prediction purposes were obtained from a principal component analysis of the distribution of CT-values. The accuracy of prediction depended on the traits and the material analysed.3. The correlation between observed and predicted values for the amount of abdominal fat or breast cut in grams were in the range of 0.70 and 0.90 where the principal component method was applied. The bias was 1 to 2% of the standard deviation for the trait.4. The amount of abdominal fat relative to carcase weight was predicted with similar accuracy, whereas the relative amount of breast cut seemed to be more difficult to predict. The increase in accuracy of prediction for amount of abdominal fat was considerable when compared to an equation including only body weight and sex.5. The results from a small scale experiment, where a wide range of compositional traits were determined by more laborious and precise methods, indicated that the accuracy of prediction may be increased further and that CT-observations may in addition provide important information about the chemical composition of the tissues analysed.

The traditional strategies for management and preservation of wild populations have focused on genetic properties that may be characterized in terms of allelic variation. Studies on Norwegian strains of Atlantic salmon indicate that this theoretical framework may be too restricted to provide appropriate management strategies. It is suggested that the concepts of quantitative genetics should be applied as an additional source of information to improve the strategies.

In a preceding paper the vulnerability-stress model of schizophrenia was presented, and it was stated that practically all patients with schizophrenia should receive a neuroleptic maintenance therapy at lowest efficient dosage. In the present paper psychologic and psychosocial treatment modalities are discussed. Good empirical data on the effects of the treatment are focused on. Therapeutic alliance is the basis of all therapy, be it biologic or psychosocial. Continuity of care is essential. All patients should be offered some kind of supportive psychotherapy. Psychoeducational family intervention should always be considered when patients live in close contact with their relatives and should be introduced as soon as possible. Social skills training should be tried when deficits in specific skills are clearly and chronically disabling. Insight-oriented psychotherapy should in general not be offered to patients with schizophrenia because of the high cost/benefit ratio and the risk of deterioration and because there are still no empirically founded criteria for deciding which schizophrenic patients could benefit from this treatment. Both articles are summarized in the conclusion, and priorities are suggested.

Genetic, neuropathologic, neuroimaging, neurochemical, and psychophysiologic data give strong evidence for a biologic diathesis of schizophrenia. Environmental factors in the family of origin, especially communication deviance, is also related to an increased risk of developing schizophrenia. Physical stressors include drug abuse, coffeine, and possibly certain fatty acids. The most important psychosocial factor contributing to relapse is high level of expressed emotion. The consequences of understimulation have been much less studied. Despite the heterogeneity of this group of patients, practically all should receive neuroleptic maintenance therapy as early as possible in the course. The relapse rate when using neuroleptics is about half that when using placebo. The lowest effective dosage should be given. Continuous low-dose treatment should be tried for stable patients, and this is much safer than intermittent medication. The article suggests how to manage poor compliance, insufficient efficacy, and side-effect problems.

"Health for all by year 2000" was the subject of the WHO Conference at Alma-Ata in 1978. It was evident that good primary care was a requirement to reach this goal. However, knowledge about this was scanty, and the instrument, an acceptable classification for analyses of primary care, was lacking. Since 1978 a WHO Working Party on Classifications of Primary Care has been working on a Reason for Encounter Classification. A RFEC test form was produced. In 1983 a feasibility study was conducted in nine countries: Australia, Barbados, Brazil, Hungary, Malaysia, The Netherlands, Norway, the Philippines, and the USA. The results of this were changing the original proposal very much. In addition, the WONCA/WHO Classification of Health Problems in Primary Care was included in the final version. In 1984 this final version was accepted by WONCA Classification Committee. This is called ICPC = The International Classification of Primary Care. ICPC is biaxial with the chapters of organ/organ systems along the one axis, in addition of three chapters: General, Mental, and Social problems. The other axis comprises seven components: Complaints, Process and Diagnosis. An alphanumeric code is used. The feasibility study of RFEC comprised ten test sites, and 138 primary care professionals recorded a total of 100452 reasons for encounter. The English version of the RFEC was translated into five other languages, and these versions were used during the study. ICPC is a comprehensive, simple and practicable classification which can be used in medical records and in different areas of primary care research.

Routines of medical record keeping were studied in a random sample of 50 out of 228 general practitioners in two counties, Möre & Romsdal and Sör-Tröndelag. One doctor refused to participate and one had retired. The 48 physicians were interviewed and a questionnaire was completed with details about their record keeping. The standard of the records was assessed according to legibility, quality of notes, past history and tidiness using a score system.All general practitioners had records for every patient, but the quality of the records varied considerably. More than 50 per cent used handwriting in progress notes, which varied from diagnostic labels to extended reports. Few records contained accessible background information about the patient concerned, and many records contained large amounts of old and irrelevant papers. The record-scores varied from 3 to maximum 10 with an average of 6.7.Higher Standards of recording in general practice are called for, since the quality of records does not only affect the individual patient, but, in the end, the quality of medical care in general.

In many countries there is a recognized specialist education for general practice, corresponding to those offered for organ specialities. Why, then, is general practice not recognized everywhere as a full speciality?It has been suggested that general practice is characterized by an easily available, continuous, personal, binding and comprehensive care. However, there are also other aspects which characterize this discipline.Firstly it is based on an overall view of health and disease, in which physical, mental, and social factors must be taken into account simultaneously.Secondly the epidemiological world, as seen by the primary physician, is different from those of all traditional specialities. This gives rise to considerable consequences in diagnostic and therapeutic work, as reflected in the predictive values of tests and for symptoms in general practice, when contrasted with specialist practice.Thirdly, the approach to problem solving is also very different. In general practice, it is characterized by thinking in terms of possibility or probability, whereas in specialist practice the reductionistic method is used.A fourth factor can also be pin-pointed. Although the primary physician is responsible for the greater part of diagnosis and treatment of illness in the population, he also co-ordinates the patient's contact with the second and third line services in the hospital and in specialized medicine. Therefore, general practice is an independent medical discipline, which demands its own specialist education.