In May 1946, Project RAND released its first report, Preliminary Design of an Experimental World-Circling Spaceship. It discussed the potential design, performance, and use of manmade satellites. A year later, Project RAND moved from the Douglas plant to new offices in downtown Santa Monica. Project RAND also held a symposium in New York as a first step in enlisting social scientists.
The Jarisch-Herxheimer reaction is an acute febrile reaction frequently accompanied by headache, myalgia, and fever that can occur within the first 24 hours after the initiation of any syphilis therapy; it is a reaction to treatment and not an allergic reaction to penicillin. Patients should be informed about this possible adverse reaction and how to manage it if it occurs. The Jarisch-Herxheimer reaction occurs most frequently among persons who have early syphilis, presumably because bacterial loads are higher during these stages. Antipyretics can be used to manage symptoms; however, they have not been proven to prevent this reaction. The Jarisch-Herxheimer reaction might induce early labor or cause fetal distress in pregnant women; however, this should not prevent or delay therapy (590) (see Syphilis During Pregnancy).
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Evaluating children for sexual assault or abuse should be conducted in a manner designed to minimize pain and trauma to the child. Examinations and collection of vaginal specimens in prepubertal girls can be extremely uncomfortable and should be performed by an experienced clinician to avoid psychological and physical trauma to the child. The decision to obtain genital or other specimens from a child to evaluate for STIs should be made on an individual basis. However, children who received a diagnosis of one STI should be screened for other STIs. History and reported type of sexual contact might not be a reliable indicator, and urogenital, pharyngeal, and rectal testing should be considered for preverbal children and children who cannot verbalize details of the assault (1438,1449). Factors that should lead the physician to consider testing for STIs include the following (1449):
The expression of pain provides a crucial signal, which can motivate caring behaviors in others. Because there is extensive behavioral and neurophysiological knowledge about the experience of pain, studying the perception of pain in others constitutes a valuable paradigm for investigating the neural mechanisms underpinning empathy. A single-neuron recording study in neurological patients has documented pain-related neurons in the anterior cingulate cortex (ACC) that respond both to actual stimulation (thermal stimuli) and also to the observation of the same stimuli delivered to another individual [54]. A first fMRI study demonstrated that the ACC, the anterior insula, cerebellum, and brainstem were activated when healthy participants experienced a painful stimulus, as well as when they observed a signal indicating that another person was receiving a similar stimulus. However, only the actual experience of pain resulted in activation in the somatosensory cortices and in dorsal ACC [55]. Similar results were also reported by Morrison and collaborators [56] in a study in which participants were scanned during a condition of feeling a moderately painful pinprick stimulus to the fingertips and another condition in which they witnessed another person's hand undergo similar stimulation. Both conditions resulted in common neuro-hemodynamic increased activity in the right dorsal ACC. This common activity in response to noxious tactile and visual stimulation was restricted to the right inferior Brodmann's area 24b. In contrast, the primary somatosensory cortex showed significant activations in response to noxious tactile, but not visual, stimuli. The different response patterns in the two areas are consistent with the ACC's role in coding the motivational-affective dimension of pain, which is associated with the preparation of behavioral responses to aversive events. These findings are supported by an fMRI study conducted by Jackson, Meltzoff and Decety [57] in which participants were shown still photographs depicting right hands and feet in painful or neutral everyday-life situations, and asked to imagine the level of pain that these situations would produce. Significant activation in regions involved in the affective aspects of pain processing, notably the dorsal ACC, the thalamus and the anterior insula was detected, but no activity in the somatosensory cortex (see Figure 2). Moreover, the level of activity within the dorsal ACC was strongly correlated with participants' mean ratings of pain attributed to the different situations.
Rather than attempt to sort out semantic nuances between these terms, the utility of systems thinking can be better appreciated by a brief look at some of its more commonly used theories, methods, and tools (Table 1). The theories and methods in systems thinking are each designed to address complex problems. They are complex because they involve multiple interacting agents, the context in which they operate keeps changing, because the manner in which things change do not conform to linear or simple patterns, or because elements within the system are able to learn new things, sometimes creating new patterns as they interact over time. Many of the challenges in global health are now recognized as complex problems where simple blueprint approaches have limited success [5, 6].
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