Interested Observers Research Articles

The American Association for Thoracic Surgery

T he American Association for Thoracic Surgery established the AATS Scientific Achievement Award in 1994, and John W. Kirklin, MD was the first awardee in 1995. At the 1998 AATS meeting in Boston, President Floyd D. Loop presented the second AATS Scientific Achievement Award to Norman E. Shumway from Stanford University Medical School. Dr Shumway was the president of the AATS in 1987. Dr Shumway’s accomplishments in cardiovascular surgery cover many parts of the discipline, but he perhaps is most widely renowned as the father of clinical heart transplantation. Even though he did not perform the first successful heart transplant in a human being, his experimental work in the laboratory going back to 1958 and his subsequent tenacity, diligence, and perseverance ultimately paved the way for the widespread clinical acceptance of cardiac transplantation. Interested observers from that early era, however, can recall that the road to eventual success was not completely smooth. A frenzied burst of activity in cardiac transplantation soon took place around the world, and despair in the early 1970s after discouraging early clinical results spawned plangent cries of protest and even outrage in the lay press (including the cover of Life magazine) and the medical community; all of this out-

Medical Society Relative Value Scales and the Medical Market

E CONOMISTS and other interested observers of the medical marketplace frequently speculate on the impact of voluntary health insurance and other mass purchasing of physicians' services on medical prices. Medical prices, such as are reflected in the Consumer Price Index, are made up of a host of individual determinations made by individual physicians as to the amounts to be charged individual patients. In the past, in this market, typical cost-price determinations hardly entered into establishing the charge because of the many imponderables involved. The nature of the demand for medical care sets it apart from ordinary goods and services. The longstanding custom of varying physicians' fees by vague yardsticks of ability to pay further removes the pricing of physicians' services from the area of direct cost-price relationships or the operation of the market. In the United States, however, a different kind of market structure is emerging in this field, a structure which lies somewhere between a system of administered prices and a system in which supply and demand affect but do not set prices. In the medical marketplace hospital charges are identical for all paying patients, regardless of income. Insurance payments, too, with few exceptions, are the same for all patients regardless of their financial situation. Early fee schedules were developed by purchasers of services in such programs as the Veterans Administration Home Town Medical Program and for workmen's compensation purposes. Their impact was not great because the volume of services was relatively small and either diffused or confined to a few physicians (in the case of workmen's compensation). In the early stages of voluntary health insurance plans, surgical-fee schedules covering most procedures were developed by the plans. These schedules bore little resemblance to the charges the physician might actually make. One characteristic of these early schedules was readily apparent; procedures that had a high incidence usually carried a fee in the schedule considerably below the best estimate of going charges; rarely performed procedures carried the top fee and gave the schedule its identification, such as a $150, $200, or $300 fee schedule. Even these fees bore little resemblance to actual charges. The few studies that were conducted relating insurance benefits to actual charges produced evidence that, overall, surgical benefits were meeting only between 60 to 65 percent of the amounts billed by surgeons. Raising all the items in the schedule by an identical proportion, such as the 50 percent increase that would change a $200 fee schedule to a $300 one, did not increase the proportion of the surgical bill met by insurance to a corresponding degree. Obviously, the change in purchasing power created by the new schedule influenced physicians' fees. A second influence operated simultaneously in this particular market. It was probably as influential in the changes that have since ocMrs. Brewster is branch chief and Miss Seldowitz is an economist, Health Economics Branch, Division of Community Health Services, Bureau of State Services, Public Health Service. This paper was presented at the 92d annual meeting of the American Public Health Association, October 1964, in New York City.

A brighter future for synchrocyclotrons?

On February 6, a group of physicists, accelerator specialists, and interested observers met in Williamsburg, Virginia, to discuss for two days the recent past and immediate future of that venerable accelerator, the synchrocyclotron. This conference on high‐energy cyclotron improvement, held at the College of William and Mary, was intended to provide opportunity for a pooling of information which might help determine the extent to which new experiments with 100–800‐MeV protons (and their secondary particles) will be possible in the next few years. In this “intermediate” energy region, the synchrocyclotron still reigns supreme, as it has since the Berkeley 184″ machine first demonstrated the success of the phase‐stability principle of McMillan and Veksler in 1946. Few changes have been made in any of these machines since they were built, and “one μamp” is still the standard guesstimate of internal proton currents for most of them. Recent events have caused a rustle of activity directed toward greater intern...

Some Reflections on the Economic History of Modern China (1840–1949)

The study of the economic history of modern China is underdeveloped. There is urgent need for original work both in ascertaining facts and in interpretations. Though investigations into the various phases of the Chinese economy had been made by the Chinese Maritime Customs since the 1860's, and by interested contemporary observers such as Morse and Wagel, statistical surveys on a large scale were not systematically conducted with any degree of reliability until the 1930's. They represented the efforts of the government, academic institutions, and individual scholars. A comprehensive survey on agriculture was made by John L. Buck and the National Agricultural Research Bureau of the National Government. An industrial census of Chinese-owned factories was planned and carried out by D. K. Lieu for the National Resources Commission of the National Government. Mining statistics were collected by government agencies under the direction of Ting Weng-chiang and Weng Wen-hao. Railway statistics have been published (since 1915) and a monumental collection of some 37 huge volumes on transportation and communications was compiled by the Ministry of Communications. The Nankai Institute of Economics—with which professors Franklin Ho, Fang Hsien-ting (H. D. Fong), C. M. Li and many others were associated—made significant contributions in the study of prices, terms of trade, modern industries, and handicrafts. Banking statistics were collected by various institutions, especially the Bank of China. The most comprehensive work on foreign investment was done by C. F. Remer and later by the Japanese East Asian Research Institute. The Japanese Manchuria Railway provided a great deal of economic information on Manchuria after the latter was taken by Japan in 1931. A few sample studies were made both by research institutions and by the government on the characteristics of the Chinese population.

Two Years of Pakistan's Second Plan (Review Article)

The publication by the Planning Commission of a Mid-Plan Review1 of progress in the first two years of the Second Five Year Plan (1960-65) gives interested observers a unique opportunity to reassess their thinking about economic development in Pakistan. Despite enormous difficulties because of data limitations, this document represents an admirable effort to measure the growth in the whole economy and in its major sectors in the recent past and to suggest what this implies with respect to the prospects for meeting the targets of the Second Plan. Inevitably, it also raises, though only by implication, some questions about longer-run growth pros¬pects in Pakistan. The document is divided into three parts : a general review, a sectoral review, and a statistical appendix. The appendix, which consumes more than half of the 119 pages, contains the basic raw material which is summarized and evaluated in the first two parts. Since data relating to privately financed development expenditure are generally lacking, most of the reported data refer to the government-financed sector. Nevertheless, attempts have been made to fill in the gaps with estimates for the private sector in order to give a rounded picture of development progress.

The Twentieth C.P.S.U. Congress: A Study in Calculated Moderation

The world listened attentively while the Twentieth Congress of the Communist Party of the Soviet Union was in session in the spacious vaulted white and gold Great Hall of the Kremlin palace from February 14 to February 25, 1956. This was the first congress since the death of Stalin, and in the interim events had prompted some bewilderment and much speculation among interested observers everywhere. Specifically, outside spectators looked to the congress to illuminate the pattern underlying a series of developments between March, 1953, and February, 1956: the resignation of Georgi M. Malenkov as Premier; the ascendancy of First Secretary Nikita S. Khrushchev; Soviet assent to a peace treaty with Austria, politically “neutralizing” that country; Soviet withdrawal from bases in Porkkala, Finland, and Port Arthur; the visits of Khrushchev and Premier Nikolai A. Bulganin to India, Burma, and other countries; the announced reduction of Soviet military forces and military budget; the attempted rapprochement with Yugoslavia; initiation of an unprecedented Soviet economic offensive; and many other “unexpected,” Soviet-instigated moves.

Liquid Assets and the Consumption Function

THE role of liquid assets as well as other assets has received considerable attention in the war and postwar years, as economists and other interested observers have watched with obvious fascination the ever-mounting totals of currency, bank deposits, and particularly, government securities.2 These vast hoards of money and near money must have had, it was argued, an appreciable effect on consumers' decisions to spend and save, as well as on producers' decisions to invest. Some even felt that these assets were bound to result in a runaway inflation after the war and the wartime controls were over. Others minimized their influence. Still others looked upon liquid assets as an automatic stabilizer from a cyclical as well as a secular standpoint. Excluding the question of the effect of liquid assets on post World War II economic activity, liquid assets have also been used by various economic theorists for a wide range of hypotheses concerning consumer behavior, raising the asset effect almost to the level of a deus ex machina. Some have argued that liquid assets are a stabilizing secular influence,3 implicit in the classical position.4 Others have argued that liquid assets are the major factor accounting for the constancy of the ratio of saving to national product.5 Contrasted with the reliance of liquid assets as a secular force is the dominant role they assume for others in the cyclical process.' Finally, liquid assets have even been proposed as the major influence determining the shape of the cyclical consumption function.7 The position of the author is as follows: whatever the effect of liquid assets in a priori reasoning as we have just seen this is manifold it must be grounded in empirical observations.8 A. P. Lerner has expressed this in another and perhaps more interesting way by saying that liquidity is a commodity and should be looked upon as any other good or service in analyzing decisions to spend or save. Before turning to the evidence, such as it is, let us recall briefly the mechanics of the impact of liquid assets on consumption and investment.

Operational and Developmental Functions of the International Agency

AbstractPresented in condensed form on the following pages are the six working papers, prepared by the Control Committee of the UN Atomic Energy Commission (sometimes called “Committee 2”). They give the detailed elaboration of a control plan. A majority vote of the Commission entrusted this Committee with this task, essentially on the basis of the American plan adopted on December 30, 1946, with Russia and Poland abstaining, although the Committee later was permitted to include the Soviet proposals of June 11 in its discussions. The U.S.S.R. representatives—usually Professor Skobeltsyn—assumed the role of interested observers rather than partners in the work. The Polish delegate's more active interest, particularly in attempting to reconcile international control and inspection with maximum stimulation of research of individual nations, followed that country's support for internationally sponsored research at a time when Soviet policy still opposed it. (Gromyko's June 11 speech reversed this policy.)The working papers printed below are thus the product of collective thinking in which the Russians have participated unwillingly and without attempting to influence specific conclusions. This first paper was prepared by the coordinating group consisting of Francois de Rose of France; Dr. John E. Vance of the United States; Sir George Thomson of Great Britain; General Andrew G. L. McNaughton of Canada; and Dr. Hsioh-ren Wei of China.

EFFECTS OF ANTERIOR PITUITARY PREPARATIONS IN EXPERIMENTAL PANCREATIC DIABETES

WHETHER OR NOT the diabetogenic effects of anterior pituitary preparations and the effect upon growth are related has interested several observers. Shipley and Long (i) and Young (a) found that fractions which had the greatest effect upon growth were also the most diabetogenic. Young (3) considered the possibility that only one pituitary factor is involved, and that the response of the pancreas to it could determine whether nitrogen storage or diabetogenic effects would result. In this connection he cited Mirsky’s experiments (4), which suggest that growth preparations may influence protein metabolism by way of the pancreas. Several studies in this laboratory have dealt with the metabolic effects of anterior pituitary growth preparations in normal, phlorhizinized, and depancreatized bitches. Single large injections were given to fed animals. The normal ones showed only “growth effects,” for example, rise in weight and marked nitrogen storage.

Carcinoma of the Breast in Homologous Twins

The role of heredity in disease has interested observers since early times. The recurrence of such diseases as hemophilia and peroneal atrophy in male members of certain families illustrates well the sex-linked hereditary character of these diseases. Likewise the direct inheritance of Huntington9s chorea seems well established. The part played by heredity in tumors has been less easy to trace, however. It is generally agreed that certain types of cancer can be hereditary in mice. Maud Slye (1) says: “That the occurrence of cancer has its basis in inherited susceptibility seems now to be satisfactorily established by the results obtained in many controlled breeding experiments.” Proof of the hereditary nature of the disease in man is less satisfactory. Macklin (2) gives a number of reasons why it is so difficult for observers to agree on this point. She reaches the conclusion that no matter what the mechanism of inheritance is, whether the tumor tendency is inherited as a single characteristic or whether it comes about by the influence of many factors, it is dependent on heredity. Among the arguments assumed to be in favor of the hereditary nature of tumors is the occurrence of similar tumors in similar positions in homologous twins. It is with this argument in mind that the following cases are reported.

The Microbiology of the Upper Air. II

The collection of micro-organisms from the air at various altitudes has interested observers for a considerable time. Pasteur, one of the first workers in this field, made investigations by climbing the Alps to obtain his samples. More recently the airplane has made it possible for others to make studies on the micro-organisms found in the upper air which occur in various regions. Stakman, Henry, Curran, and Christopher found numerous spores in airplane flights in Texas, Minnesota, Nebraska, and Wyoming.1 Mischustin reported results obtained over the Moscow experimental flying field.2 Craigie and Popp have used airplanes in collecting rust spores from the upper air in Canada.3 Brown made collections of living micro-organisms in the air of the arid section in southwestern United States.4 Meier, Stevenson and Charles have identified fungus spores collected on flights over eastern United States in 1932.5 The establishment in 1931 of a daily airplane flight service by the Division of Meteorology of the Department of Aeronautical Engi neering at the Massachusetts Institute of Technology suggested an opportunity to study the microbiology of the upper strata in the vicinity of Boston. The first flight on which studies of a biological nature were undertaken was on February 23, 1932. Through the courtesy and cooperation of the staff of the Division of Meteorology it has been possible to collect a considerable number of biological samples which were immediately taken to the laboratories of the Department of Biology and Public Health for biological examination.

The Relief Study of the Stomach and Colon

The study of the digestive relief has interested numerous observers. Much pioneer work has been done in this country, especially by Dr. Scott, Dr. Briggs and Dr. Vilvandre. Systematic work on the appearances of the gastro-intestinal mucosa was first carried out by Forssell, and the study of the subject has been successfully applied to clinical radiology within the last few years by Berg, Akerlund, Gutzeit, Chaoul, and other workers. The peculiar difficulties of the subject were enumerated at length by Dr. Cole, in Radiology, early this year: the methods of dealing with these may be roughly classified as follows:— I. The preparation of the patient and of the contrast medium. II. Elimination of secondary radiation. III. Graduated compression. IV. Reproduction of the required phase of a moving organ. V. Avoidance of optical distortion. For the demonstration of the relief the use of a watery solution of barium with the addition of tragacanth is generally recommended. A simple and efficient method, sometimes p...

Teacher Opinion on Ability Grouping

Ability grouping has been practiced in the schools of Reading, Massa chusetts, for several years, and this form of organization is now used in Grades I to IX. The grouping is done very carefully by the use of group achievement and intelligence examinations supplemented by school marks, teacher judgments, health records, personality characteristics, and other pertinent facts. The present paper reports the results of a questionnaire sent to the teachers of the junior high school and the intermediate school in an attempt to find out in what repute the plan was held by the teachers after a three-year trial. The authors are well aware of the difficulties and dangers involved in the use of the questionnaire, and realize the necessity of suspending judgment as to the general value of ability grouping until objective experimental evidence can be obtained regarding its advantages and disadvantages. The opinion of interested and com petent observers, however, is valuable and important, so the making and reporting of this study seems justified. The questionnaire was designed to gather information on several points. It was desired to discover how well the plan was realizing the general objectives for which it was set up, and also to get some light on the validity of some of the commonly mentioned objections to grouping. Incidentally, the opportunity was taken to discover how many pupils were, in the judgment of the teachers, misplaced in their groups, (Ques tion 1.), and to find out what was being done to foster social development (Question 10.), and leadership (Question 11.). The questionnaire is reproduced below. The teachers were urged to state their opinions frankly, and to describe conditions as they actually existed and not as they were theoretically supposed to exist.

THE HEMATOGENOUS PRODUCTION OF DERMATOMYCOSES

The fate of dermatophytes which have made their way into the organism interested observers long before it was known that they cause diseases of a general character. Beginning with the last decade of the past century, numerous authors (Quinke, 1 Elsenberg, 2 Truffi, 3 Citron 4 and others) attempted to elucidate the following points: 1. Are cutaneous fungi liable to vegetate in the visceral organs? 2. What toxic effects do they produce in such instances? The question also arose as to the role of the skin in cases in which fungi are introduced by way of the blood stream. For that purpose rabbits were inoculated intravenously, intraperitoneally or subcutaneously with cultures of Trichophyton or Achorion respectively, without, however, any resulting positive cutaneous or visceral lesions. In more recent publications, Bloch 5 emphatically stated that the subcutaneous or intravenous ways of infection with fungi do not immunize or reproduce the disease

BLOOD VOLUME IN EDEMA OF GLOMERULAR NEPHRITIS AND NEPHROSIS

The pathogenesis of edema of renal origin is concerned with changes in the blood, vessels and tissues. A review of the literature on the subject is confusing and unsatisfactory. Bright asserted that the depletion of albumin in the blood changed the physicochemical balance and edema resulted. Later Senator suggested the vascular element, and in recent years Fischer has implicated the tissue cells in the genesis of edema. The part played by the blood has interested many observers, but the exact significance of its volume in this connection has not been clear. The following brief excerpts from Loeb's1review of the subject of edema depict the prevailing confusion: Volhard2stated that in acute glomerular nephritis with edema there is no dilution of the blood, while without edema there may be dilution. In the latter, because of the renal block, water is retained in the blood; in the former, water and salts,

The Psychogenic Factor in the Causation of Mental Disorder

It is a truism that successful treatment in any branch of medical practice, or, indeed, in a wider sense, in any activity in which we may be engaged, depends on an adequate and exact knowledge of the relation of cause and effect, and the conscientious clinician who bears that fact in mind finds the present position of clinical psychiatry one of great difficulty. As a highly esteemed physician remarked a little while ago—during one of those outbursts of professional candour which seem to be necessary at times in the interest of our self-respect, so far as our capacity to really modify the condition of our patients is concerned, we are in the position of interested observers, for we may arrange conditions, we may guard against added stresses, but do what we will, and however hard our endeavour, our patients alter, some to improve, others to deteriorate, with an aggravating indifference to our efforts. It behoves us, then, to be extremely critical of our assumptions in any particular case, to be as precise and as adequate as possible in our description of the whole train of events, and to review very carefully any deductions we may make as to the relation of possible cause and effect.

Economic Entomology from the View Point of the Sanitarian

Economic Entomology from the View Point of the Sanitarian

The Effect of Certain Stimuli upon the Attention Wave

The dominant place of attention in consciousness gives great interest to all experiments along that line. This paper deals with one of the minor phases of the duration of the attention. Our more particular problem was to investigate the influence of certain stimuli upon the length of the attention waves in the hope that the results would throw some light upon the much disputed question as to whether the waves were of central or of peripheral origin. The Masson disk was used to give the minimal stimulus necessary, as it is at once more easily manipulated and the results obtained are less likely to be influenced by distracting stimuli than if a minimal sound or pressure is chosen. In these experiments the disk used was 32 2 cm. in diameter, and had drawn upon one radius 15 dots, each 5 mm. long, 4 mm. wide, and separated from each other by spaces of 5 mm. The fluctuations were recorded by a Marey tambour upon the horizontal drum described by Slaughter.' At the rate used a single record lasted 8 4 minutes. The time was recorded in fifths of seconds by a Jacquet-Verdin chronograph. The reagent sat at a distance of two meters from the disk. Pressure upon the receiving tambour marked the time of appearance of the gray lines, and relaxation of pressure the time of disappearance. The experiments were begun in February, I900, and continued until June of that year. Mr. Schiller (S.), Mr. Bair (B.) and Miss Earhart (E.) acted as subjects. All had had some previous psychological training, and were careful, interested observers. We shall consider the results obtained from S. first. The experiments were performed by taking a series of readings under normal conditions lasting over a period of three or four minutes, and then one or two series of readings under the influence of different kinds of stimulation during the last four or five minutes. The stimuli used for S. consisted of the pain from an induction current applied by dry electrodes to the left