Initial results in the development of a guidance system for a powered wheelchair.

This paper describes the development of an automatically guided powered wheelchair for individuals with severe disabilities. The navigation and control of the wheelchair is based the accurate estimation of the location of the wheelchair within its operating workspace. A novel method used to generate and track reference paths which take the user to and from various destinations within the wheelchair's environment is presented. The paper also provides a qualitative description of the restrictions and requirements that are specific to the wheelchair application as well as the way in which the current system addresses these restrictions and requirements. Finally, actual experimental runs of the wheelchair system are presented.

Managing change in the era of health reform: organized delivery systems of public health.

As U.S. Medicaid managed care programs proliferate, it appears that traditional clinical training and practice often provide insufficient preparation for physicians to meet the care requirements of Medicaid beneficiaries adequately. State and local health departments have extensive experience with this population's need for preventive care, social support services, care coordination, and referral. Organized delivery systems of managed care can merge the expertise of primary care practitioners, public health professionals, and other community resources to deliver comprehensive care. Although the described model includes Medicaid as the payer, it would remain viable should Medicaid be terminated and universal coverage enacted.

How to interpret fish consumption advisories.

The goal of this paper is to explain the guidelines used in Louisiana to issue advisories against consumption of chemically contaminated seafood or fish and explain some of the uncertainties encountered. In the absence of federal regulations the State had to develop its own approach. The concentrations resulting from Louisiana policies are generally low in comparison with the FDA tolerances and, thereby, well within reasonable limits justified by the need to protect populations with high fish consumption.

Hawaii's near-universal health insurance--lessons learned.

To date, Hawaii is the only state to have implemented near-universal health insurance. The cornerstone of this program is the country's only requirement that employers provide health insurance for all employees who work at least 20 hours per week. Combined with low unemployment, voluntary modified community rating by health insurers, and expanded Medicaid and Medicare, this employer mandate has been part of a patchwork mechanism that insures upwards to 95 percent of the state's population. Indeed, by adding a state-sponsored gap group-insurance program, Hawaii may now insure in excess of 95 percent of its population. The program has generated good health outcomes, good consumer satisfaction, and relatively modest overall health care expenditures. But for all that near-universal insurance provides, there is still a great need for community-based preventive and primary care programs with outreach and family support services. In addition, traditionally underserved populations continue to be at increased risk. Both funding reform and continued infrastructure development must occur to achieve universal access to care.

Bacterial meningitis in older neonates.

During a five-year period, 24 patients' conditions (age range, 2 to 6 weeks) were diagnosed, and they were treated for bacterial meningitis. Organisms recovered from the CSF included group B Streptococcus (n = 6), Escherichia coli (n = 5), Listeria monocytogenes (n = 5), Hemophilus influenzae (n = 4), Streptococcus pneumoniae (n = 2), and group D and group A Streptococcus (one each). Initial antimicrobial therapy must include antibiotics that are effective across this spectrum of potential pathogens. Symptoms and signs were often subtle. Six children (25%) experienced major neurologic residua, including five patients (21%) in whom hydrocephalus developed. Ultrasound examination of the head at the end of therapy was an effective technique for early assessment of neurologic sequelae.