Bench- and field-scale evaluation of chromium and cadmium extraction by electrokinetics

The results of bench-scale laboratory tests and in situ, pilot-scale demonstration of electrokinetic extraction of chromium and cadmium from contaminated soil are presented. The laboratory tests were conducted using 10 cm long samples under current density of 5A/m(2) for 1200 h. Tests were conducted with and without citric acid amendment at the cathode. The results showed that citric acid improved extraction, especially in the sections near the cathode. However, processing was not enough to result in complete cleanup. The field demo was conducted at the Naval Air Weapon Station (NAWS), Point Mugu, California. Three cathodes were centered between six anodes. The anode-cathode spacing was 4.45 m (15 ft). Constant voltage of 60 V ( approximately 13 V/m) was applied for 20 days and then was reduced to 45 V (10 V/m) for 6 months. Citric acid was used to maintain the cathode pH at 4. After 6 months of treatment, 78% of the soil volume has been cleared of chromium or treated to below natural background levels. The results also indicated that 70% of the soil between the electrodes had been cleared of cadmium contamination. A comparison between the bench-scale and field demo showed that the field process was more effective than the lab tests. This indicated that small sample size will induce a negative effect on the efficiency of the process due to an increased impact of the boundaries on the overall process.

Treatment of trinitrotoluene by crude plant extracts

Crude plant extract solutions (spinach and parrotfeather) were prepared and spiked with 2,4,6-trinitrotoluene (TNT) (20 mgl(-1)). 90-h TNT removal by these solutions was compared to controls. Spinach and parrotfeather extract solutions removed 99% and 50% of the initial TNT, respectively; TNT was not eliminated in the controls or in extract solutions where removal activity was deactivated by boiling. A first-order removal constant of 0.052 h(-1) was estimated for spinach extract solutions treating 20 mgl(-1) TNT concentrations, which compared favorably to intact plant removal. Concentration variation was described by Michaelis-Menton kinetics. Detectable TNT degradation products represented only a fraction of the total TNT transformed, and the transformation favored the formation of 4-aminodinitrotoluene. The results indicated that crude plant extracts transform TNT, without the presence of the live plant.

Decolorization of alkaline TNT hydrolysis effluents using UV/H(2)O(2)

Effects of H(2)O(2) dosage (0, 10, 50, 100 and 300 mg/l), reaction pH (11.9, 6.5 and 2.5) and initial color intensity (85, 80 and 60 color unit) on decolorization of alkaline 2,4,6-trinitrotoluene (TNT) hydrolysis effluents were investigated at a fixed UV strength (40 W/m(2)). Results indicated that UV/H(2)O(2) oxidation could efficiently achieve decolorization and further mineralization. Pseudo first-order decolorization rate constants, k, ranged between 2.9 and 5.4 h(-1) with higher values for lower H(2)O(2) dosage (i.e., 10 mg/l H(2)O(2)) when the decolorization occurred at the reaction pH of 11.9, whereas a faster decolorization was achieved with increase in H(2)O(2) dosage at both pH 6.5 and 2.5, resulting in the values of k as fast as 15.4 and 26.6 h(-1) with 300 mg/l H(2)O(2) at pH 6.5 and 2.5, respectively. Difference in decolorization rates was attributed to the reaction pH rather than to the initial color intensity, resulting from the scavenging of hydroxyl radical by carbonate ion. About 40% of spontaneous mineralization was achieved with addition of 10 mg/l H(2)O(2) at pH 6.5. Efficient decolorization and extension of H(2)O(2) longevity were observed at pH 6.5 conditions. It is recommended that the colored effluents from alkaline TNT hydrolysis be neutralized prior to a decolorization step.

Depressive disorder as a long-term antecedent risk factor for incident back pain: a 13-year follow-up study from the Baltimore Epidemiological Catchment Area sample

BACKGROUND

The co-occurrence of affective distress and back pain is well documented but the relationship between them is less certain. This study examines the relationship between lifetime occurrence of depressive disorder and incident back pain reported over a 13-year period.

METHOD

The Baltimore Epidemiologic Catchment Area Study is a prospective study of a household-residing cohort, selected probabilistically from East Baltimore in 1981. Between 1982-3 (wave 2) and again between 1993-6 (wave 3), a follow-up study of the original cohort was conducted. Questions on depressive disorder and back pain were drawn from the Diagnostic Interview Schedule. Logistic regression analyses were used to evaluate whether depressive disorder acts as a risk factor for incident back pain.

RESULTS

In cross-sectional analyses, lifetime occurrence of depressive disorder was a significant correlate of lifetime prevalence of back pain at wave 1 (OR = 1.6, P = 0.01). During the 13-year follow-up, across three data collection points, there was an increase in the risk for incident back pain when depressive disorder was present at baseline (OR = 1.9, 95% CI 1.03, 3.4). However, during the short-term follow-up period of 1 year, between baseline and wave 2, depressive disorder at baseline was unrelated to first-ever reports of back pain. Lifetime depressive disorder in both waves 1 (baseline) and 2 (1 year later) was associated with a more than three times greater risk for a first-ever report of back pain during the 12 to 13 year follow-up period, in comparison to those who did not have depressive disorder at waves 1 or 2 (OR = 3.4, 95% CI 1.4, 7.8). Back pain at wave 1 was not significantly associated with an increased risk for depression in the longitudinal analysis (OR = 0.8, 95% CI 0.5, 1.4).

CONCLUSIONS

Depressive disorder appears to be a risk factor for incident back pain independent of other characteristics often associated with back pain. Back pain is not a short-term consequence of depressive disorder but emerges over periods longer than 1 year. Moreover, in this study the alternative pathway of back pain as a risk factor for depressive disorder could not be supported.

UV-VIS spectroscopy of 2,4,6-trinitrotoluene-hydroxide reaction

Contamination of groundwater, surface water and soil by explosives has occurred at military sites throughout the world as a result of manufacture of explosive compounds, assembly of munitions, and deployment of explosives containing devices. Due to the adverse effects of explosives on humans and other natural receptors, a low cost means of decontaminating these areas of contamination is needed. Base-induced transformation of explosives has shown promise as a rapid, low cost, and minimally resource-intensive technology for detoxifying explosives in soil and water. In order to understand the reaction mechanism, a reaction mixture of 2:1:1 (water:2,4,6-trinitrotoluene (TNT):1 N KOH) was analyzed by UV/VIS spectrometry from 190 to 1,100 nm. Time course measurements were conducted at 25, 20, 15, and 12 degrees C. A factor analysis program was used to analyze the spectral data. Principal component analysis indicated that six principal components explained the spectra to within experimental error, with four factors explaining the majority of the variance. Test spectral vectors for four components were developed, including TNT, two intermediates, and the final product, and were tested against the abstract vectors. Two possible reaction mechanisms were suggested and tested to explain the spectral data.

Analysis of CL-20 in environmental matrices: water and soil

Analytical techniques for the detection of 2,4,6,8,10,12-hexanitro-2,4,6,8,10,12-hexaazatetracyclo(5.5.0.05,9.03,11)dodecane (CL-20) in water and soil are developed by adapting methods traditionally used for the analysis of nitroaromatics. CL-20 (a new explosives compound) is thermally labile, exhibits high polarity, and has low solubility in water. These constraints make the use of specialized sample handling, preparation, extraction, and analysis necessary. The ability to determine the concentrations of this new explosive compound in environmental matrices is helpful in understanding the environmental fate and effects of CL-20; understanding the physical, chemical, and biological fate of CL-20; and can be used in developing remediation technologies and determining their efficiency. The toxicity and mobility of new explosives in soil and groundwater are also of interest, and analytical techniques for quantitating CL-20 and its degradation products in soil and natural waters make these investigations possible.

Treatment of munitions in soils using phytoslurries

Phytoremediation is an established technology for the treatment of explosives in water and soil. This study investigated the possibility of using slurried plants (or phytoslurries) to treat explosives (TNT and RDX). The degradation of TNT in solution using intact and slurried parrotfeather (Myriophyllum aquaticum), spinach (Spinicia oleracea), and mustard greens (Brassica juncea) was evaluated. Phytoslurries of parrotfeather and spinach removed the TNT faster than the intact plant. Conversely, the removal rate constants for slurried and intact mustard greens were about the same. A study using pressurized heating to destroy enzymatic activity in the phytoslurries was also conducted to compare removal from released plant chemicals to adsorptive removal. Aqueous phase removal of TNT by autoclaved spinach phytoslurry was compared with nonautoclaved spinach phytoslurry. The autoclaved phytoslurry did remove TNT, but not as completely as nonautoclaved slurry. This suggests that some removal is due to adsorption, but not all. Phytoslurries of mustard greens and parrotfeather had higher RDX removal rates compared with intact plant removal, but the rates for parrotfeather in either case were relatively low. Phytoslurries of spinach had relatively modest increases in RDX removal rates compared with intact plant. Studies were then conducted with phytoslurry/soil mixtures at two scales: 60 ml and 1.5 l. In both cases, phytoslurries of mustard greens and spinach removed TNT and RDX at higher levels than control slurries.

A critical assessment of proximal macrotexturing on cemented femoral components

We analyzed the cement-metal interface of 3 different types of femoral components that had proximal macrotexturing after in vitro insertion and after fatigue testing designed to produce debonding and micromotion. These components were compared with clinical retrieval specimens. The cement did not flow into the macrotexturing; rather, hollow, brittle volcanoes or calderas were formed. These fragile protrusions of cement become worn down or abraded by debonded components. This abrasion of cement may contribute to the early and aggressive osteolysis seen in some of these early failures with proximal macrotextured components. The formation of these volcanos and calderas can be aborted by placing bone-cement onto the macrotexturing before stem insertion. This simple technique allows the macrotexturing to be filled with cement.

Preventable adverse patient outcomes: a closed claims analysis of respiratory incidents

Closed claims analysis of adverse anesthesia outcomes was initiated through the AANA Foundation in 1995 to examine adverse outcomes of anesthesia care provided by Certified Registered Nurse Anesthetists (CRNAs). A research team of 8 CRNAs using an instrument incorporating more than 150 variables undertook document analyses of closed claim files. All files reviewed involved incidents in which the CRNA named in the policy was potentially involved in the adverse patient outcome. Thirty-eight percent (58/151) of CRNA-related claims involved a respiratory incident as the primary cause of the negative patient outcome. Patient outcomes involving respiratory incidents were more likely to result in death or permanent injury compared with nonrespiratory incidents (P < .01). Reviewers found that respiratory claims were more likely to have involved inappropriate anesthesia management (P < .01), more likely to have involved a lack of vigilance (P < .01), and more likely to have been judged by the reviewer as preventable (P < .01). A higher percentage of respiratory incidents occurred in emergency cases (75% vs 34%, P < .01) and in cases involving general anesthesia (44% vs 17%, P < .01). Adverse respiratory incidents are largely preventable and frequently result in serious patient morbidity and mortality.

Depressive disorder, dysthymia, and risk of stroke: thirteen-year follow-up from the Baltimore epidemiologic catchment area study

BACKGROUND AND PURPOSE

This study examined depressive disorder as a risk factor for incident stroke in a prospective, population-based design.

METHODS

The Baltimore Epidemiologic Catchment Area Study is a prospective 13-year follow-up of a probability sample of household residents from Baltimore, Md. Depressive disorder was measured with the diagnostic interview schedule, and stroke was assessed by questions from the health interview survey or by documentation on a death certificate.

RESULTS

During the 13-year follow-up of 1703 individuals, 66 strokes were reported and 29 strokes were identified by death certificate search. Individuals with a history of depressive disorder were 2.6 times more likely to report stroke than those without this disorder after controlling for heart disease, hypertension, diabetes, and current and previous use of tobacco. Medications used in the treatment of depressive disorder at baseline did not alter this finding. A history of dysthymia demonstrated a similar relationship to stroke, although the estimate was not statistically significant.

CONCLUSIONS

Depressive disorder is a risk factor for stroke that appears to be independent of traditional cardiovascular risk factors. Further research on mechanisms for the association and the impact of treatment for depressive disorder on subsequent stroke is needed.

Tolerance towards explosives, and explosives removal from groundwater in treatment wetland mesocosms

A short-term study was performed to determine the feasibility of using constructed wetlands to remove explosives from groundwater, and to assess accumulation of parent explosives compounds and their known degradation compounds in wetland plants. Tolerance towards explosives in submersed and emergent plants was screened over a range of 0 to 40 mg L(-1). Tolerance varied per compound, with TNT evoking the highest, 2NT the lowest, and 24DNT, 26DNT, and RDX an intermediate growth reducing effect. Submersed plants were more sensitive to TNT than emergent ones. A small-scale 4-month field study was carried out at the Volunteer Army Ammunition Plant, Chattanooga, TN. In this surface-flow, modular system, the influent contained high levels (>2.1 mg L(-1)) of TNT, 2,4DNT, 2,6DNT, 2NT, 3NT, and 4NT, and the HRT was 7 days. The performance criteria of US EPA treatment goals for local discharge of 2,4DNT concentration <0.32 mg L(-1), and 26DNT concentration <0.55 mg L(-1) were not met at the end of the experiment, although explosives levels were greatly reduced. Low levels of 2ADNT and 4ADNT were transiently observed in the plant biomass. Results of two other, older, constructed wetlands, however, indicated that in these systems treatment goals were met most of the time, residues of explosives parent compounds and known degradation compounds in plant tissues were low and/or transient, and in substrates were low.

Interruption and bizarreness effects in the recall of script-based text

Recall of script, script-irrelevant, and script-interruptive actions in script-based stories was examined in four experiments. By varying the plausibility of the script-irrelevant and the script-interruptive actions, the bizarreness effect (i.e., enhanced recall for bizarre, implausible actions) was assessed within the context of script-based text. In addition, presentation of script-interruptive actions actions allowed for an assessment of the interruption effect (i.e., enhanced recall for interruptive actions). A bizarreness effect was found, to the extent that implausible script-irrelevant actions were better recalled than their more plausible counterparts and script actions. However, implausible actions were not better recalled than script-interruptive actions, nor did bizarreness significantly enhance recall of script-interruptive actions. These results are discussed in terms of recent assumptions underlying interruptions underlying interruption and bizarreness effects, and in terms of recent assumptions about how scripted and nonscripted actions are retained in memory.

Environmental behavior of explosives in groundwater from the Milan Army Ammunition Plant in aquatic and wetland plant treatments. Uptake and fate of TNT and RDX in plants

Uptake and fate of TNT and RDX by three aquatic and four wetland plants were studied using hydroponic, batch, incubations in explosives-contaminated groundwater amended with [U-14C]-TNT or [U-14C]-RDX in the laboratory. Substrates in which the plants were rooted were also tested. Plants and substrates were collected from a small-scale wetland constructed for explosives removal, and groundwater originated from a local aquifer at the Milan Army Ammunition Plant. This study demonstrated rapid uptake of [U-14C]-TNT derived 14C, concentration at the uptake sites and limited transport in all plants. Per unit of mass, uptake was higher in submersed than in emergent species. Biotransformation of TNT had occurred in all plant treatments after 7-day incubation in 1.6 to 3.4 mg TNT L-i, with labeled amino-dinitrotoluenes (ADNTs), three unidentified compounds unique for plants, and mostly polar products as results. Biotransformation occurred also in the substrates, yielding labeled ADNT, one unidentified compound unique for substrates, and polar products. TNT was not recovered by HPLC in plants and substrates after incubation. Uptake of [U-14C]-RDX derived 14C in plants was slower than that of TNT, transport was substantial, and concentration occurred at sites where new plant material was synthesized. As for TNT, uptake per unit of mass was higher in submersed than in emergent species. Biotransformation of RDX had occurred in all plant treatments after 13-day incubation in 1.5 mg RDX L-1, with one unidentified compound unique for plants, and mostly polar products as results. Biotransformation had occurred also in the substrates, but to a far lower extent than in plants. Substrates and plants had one unidentified 14C-RDX metabolite in common. HPLC analysis confirmed the presence of RDX in most plants and in three out of four substrates at the end of the incubation period.

Influence of fast-track anesthetic technique on cardiovascular infusions and weight gain

OBJECTIVE

To evaluate whether cardiac surgical patients receiving conventional versus fast-track anesthetic management are statistically significantly different with regard to cardiovascular drug infusions, weight gain, cardiac and pulmonary morbidity, length of intubation, and length of stay.

DESIGN

Retrospective, (partially) sequential, cohort design.

SETTING

Surgical suite and intensive care unit (ICU) at a community hospital.

PARTICIPANTS

Two hundred seven patients who presented for coronary artery bypass graft and/or cardiac valve replacement.

INTERVENTIONS

None

MEASUREMENTS AND MAIN RESULTS

Group comparisons of the seven individual cardiovascular drug infusions showed less frequent use in the fast-track patients for lidocaine (9% v 28%; p = 0.00046) only. However, the fast-track group received fewer combinations of cardiovascular drug infusions overall for the first 24-hour postoperative period (p < 0.0005). Hourly comparisons of inotropes showed significantly fewer combinations of dobutamine, norepinephrine, and epinephrine for the first postoperative hour and for postoperative hours 7 through 12 (p < 0.01 for each hour). Fast-track patients had less postoperative weight gain for days 1 through 4 (p < 0.01 for each day), shorter length of ICU stay (p < 0.00005), and shorter total length of postoperative hospital stay (p = 0.0004). No differences were found with respect to myocardial infarction, death, pulmonary complications, rate of reintubation, or length of hospital stay once discharged from the ICU.

CONCLUSIONS

Fast-track anesthetic management may be associated with decreased need for inotropic and antiarrhythmic drug infusions and decreased weight gain.

Environmental behavior of explosives in groundwater from the Milan Army Ammunition Plant in aquatic and wetland plant treatments. Removal, mass balances and fate in groundwater of TNT and RDX

Phytoremediation of 2,4,6-trinitrotoluene (TNT) and hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) in groundwater using constructed wetlands is a potentially economical remediation alternative. To evaluate Explosives removal and fate was evaluated using hydroponic batch incubations of plant and substrate treatments with explosives-contaminated groundwater amended with [U-14C]-TNT or [U-14C]-RDX. Plants and substrates were collected from a small-scale wetland constructed for explosives removal, and groundwater originated from a local aquifer at the Milan Army Ammunition Plant. The study surveyed three aquatic, four wetland plant species and two substrates in independent incubations of 7 days with TNT and 13 days with RDX. Parent compounds and transformation products were followed using 14C and chemical (HPLC) analyses. Mass balance of water, plants, substrates and air was determined. It was demonstrated that TNT disappeared completely from groundwater incubated with plants, although growth of most plants except parrot-feather was low in groundwater amended to contain 1.6 to 3.4 mg TNT L-1. Highest specific removal rates were found in submersed plants in water star-grass and in all emergent plants except wool-grass. TNT declined less with substrates, and least in controls without plants. Radiolabel was present in all plants after incubation. Mineralization to 14CO2 was very low, and evolution into 14C-volatile organics negligible. RDX disappeared less rapidly than TNT from groundwater. Growth of submersed plants was normal, but that of emergent plants reduced in groundwater amended to contain 1.5 mg RDX L-1. Highest specific RDX removal rates were found in submersed plants in elodea, and in emergent plants in reed canary grass. RDX failed to disappear with substrates. Mineralization to 14CO2 was low, but relatively higher than in the TNT experiment. Evolution into 14C-volatile organics was negligible. Important considerations for using certain aquatic and wetland plants in constructed wetlands aimed at removing explosives from water are: (1) plant persistence at the explosives level to which it is exposed, (2) specific plant-mass based explosives removal rates, (3) plant productivity, and (4) fate of parent compounds and transformation products in water, plants, and sediments.

Do parent practices to encourage academic competence influence the social adjustment of young European American and Chinese American children?

The predominant early childhood education philosophy in the United States views formal academic instruction as inappropriate and harmful to the social development of young children. Chinese American immigrants to the United States, however, have been found to teach their young children in more formal ways, to be more directive, and to structure their children's use of time to a greater degree (C. S. Huntsinger, P. E. Jose, F.-R. Liaw, & W.-D. Ching, 1997). Forty European American (20 boys, 20 girls) and 36 2nd-generation Chinese American (18 boys, 18 girls) 1st- and 2nd-grade children and their mothers, fathers, and teachers participated in the Time 2 data collection of this longitudinal study to assess whether the formal academic environment provided by Chinese American parents is linked to poorer social adjustment in their children. Regressions showed that parents' work-oriented methods influenced academic performance but not social adjustment of their children.

Screening of aquatic and wetland plant species for phytoremediation of explosives-contaminated groundwater from the Iowa Army Ammunition Plant

The results of this study indicate that the presence of plants did enhance TNT and TNB removal from IAAP groundwater. Most effective at 25 degrees C were reed canary grass, coontail and pondweed. Groundwater and plant tissue analyses indicate that in presence of the plants tested TNT is degraded to reduced by-products and to other metabolites that were not analyzed. TNT removal was best modeled using first order kinetics, with rate constants at 25 degrees C incubations ranging from 0.038 microgram L-1 h-1 for reed canary grass to 0.012 microgram L-1 h-1 for parrot-feather. These kinetics predict hydraulic retention times (HRTs) ranging from 4.9 days to 19.8 days to reach a TNT concentration of 2 micrograms L-1. Decreasing incubation temperature to 10 degrees C affected reed canary grass more than parrot-feather, increasing estimated HRTs by factors of four and two, respectively. The plant species tested showed a far lower potential for RDX removal from the IAAP groundwater. Most effective at 25 degrees C were reed canary grass and fox sedge. Analyses of plant material indicated the presence of RDX in under-water plant portions and in aerial plant portions, and RDX accumulation in the latter. RDX removal was best modeled using zero order kinetics, with rate constants for the 25 degrees C incubation ranging from 13.45 micrograms L-1 h-1 for reed canary grass to no removal in four species. Based on these kinetics, estimated HRTs to reach 2 micrograms L-1 RDX increased from 39 days. Decreasing the temperature to 10 degrees C increased HRT 24-fold for reed canary grass. By using the biomass-normalized K value, submersed plants are identified as having the highest explosives-removing activity (microgram explosive L-1 h-1 g DW-1). However, biomass production of submersed plants is normally five to ten times less than that of emergent plants per unit area, and, thus, in plant selection for wetland construction, both, explosives removal potential and biomass production are important determinants.

Fate of explosive contaminants in plants

A great deal of interest has been generated recently in the determination of explosives and explosives by-products in exotic matrices including composts, bioslurries, and plants. The methods traditionally utilized for the analysis of organic and inorganic contaminants in these types of environmental samples are not adequate owing to the unique properties of the material being studied. The methods used to detect the nitramines and their degradation products in a variety of environmental samples requires matrix-specific sample preparation, separation by reversed phase high performance liquid chromatography, and ultra-violet detection. Knowledge of the concentration of the contaminants and the molecular state of their degradation products is helpful in assessing the environmental risks associated with the contaminants as well as the design of remediation technologies. Data that are obtained using analytical methods not designed for the specific matrix encountered may lead to incorrect quantitation. Examples of remediation technologies that necessitate the analysis of other than standard matrices for explosives include composting, aerobic and anaerobic microbial degradation, and plant-assisted degradation. The toxicity and mobility of explosives in the food chain are also of interest, and analytical techniques for studying explosives in plant and animal tissues that provide valid information regarding trace levels in these matrices are also required. The report will address three important points in connection with the problem. The extraction of the contaminants from the matrix requires a different set of extraction techniques than those utilized for standard water and soil extractions. These exotic matrices contain much higher organic content than soil or water and, as a result, are prone to interference from biological molecules.

Alerting effects on choice reaction time and the photic eyeblink reflex

To test the possibility that a common mechanism might be responsible for alerting effects on voluntary and reflexive reactions, choice reaction times (RT) to intense flashes of light were compared with eyeblink reflexes simultaneously evoked by those stimuli. An acoustic accessory stimulus, irrelevant to the RT task, facilitated both voluntary and reflexive reactions. A time uncertainty manipulation also generated facilitation of both responses under conditions in which phasic arousal was presumably greatest. However, there were several dissociations between alerting effects on voluntary and reflexive reactions and between effects on the early and late subcomponents of the photic orbicularis oculi reflex. In conjunction with other research in humans and animals, these data support the assumption that alerting involves the activation of multiple neuromodulatory (e.g. monoamine) systems, each of which is characterized by a distinct behavioral, neuropharmacological, and electrophysiological profile.

Computer-assisted scheduling of radiology resident call

The difficulties inherent in assigning an entire residency group fair and equivalent daily call prompted the development of a computerized scheduling program at The University of Texas at Houston. Written in COBOL, the program is run on a CDC mainframe computer. Logic parameters restrict the number and frequency of calls per month, and each resident is coded for five available call types at two university hospitals. The foundation of the program's operation is an arbitrary point scale applied to each call type determined by its difficulty and time commitment. Residents' point totals each month are roughly balanced within a prescribed range, with call exchanges made by the computer if necessary. The computer-generated schedules are flexible and equitable, require little manual correction, and save time for the chief resident and the residency secretary.