The synchronization of respiration and swallow sounds with videofluoroscopy during swallowing

Simultaneous recording of adult subjects sipping small amounts of fluid from a cup have been obtained by videofluoroscopy together with feeding respiratory patterns and swallow sounds from the Exeter Dysphagia Assessment Technique (EDAT). These allowed visual representations of respiration and swallow sounds to be superimposed on a videofluoroscopy recording using a split-screen technique. Sequentially numbered, 1/50 sec, half-frame photographic prints were examined and schematic drawings of the relevant radiographs were made. These were superimposed on to the actual EDAT printed chart of the same swallow event, theri exact time relationship with respiration and cervical swallow sounds being preserved. The results allow events in the barium videofluoroscopy to be related to events in the feeding respiratory pattern and swallow sounds recorded by EDAT.     

The influence of clinical problems, age and social support on outcomes for elderly persons referred to regional aged care assessment teams

Abstract Background: Aged Care Assessment Teams (ACATs) have been established throughout Australia during the past seven years. Early studies of their effect have concentrated on their impact on the rate of institutionalisation of disabled elderly, the clinical characteristics of referred cases and the relationship between disability and recommended care plan. Aims: The aim of this study was to explore the relationship between age, clinical features and social characteristics of AC AT subjects with outcomes at 12 months after assessment. Methods: The examination of an arbitrary sample of persons referred to ACATs over a year by one generalist geriatrician with follow-up of all cases by the three ACATs associated with the study was carried out. All analyses were performed on raw data presented as categorical variables in the form of contingency tables. Results: The sample included 324 subjects who suffered from 2030 clinical problems with a mean of 6.5 per person aged 75 or over and 5.5 for those under 75. Cardiovascular and neurological disease were the commonest source of problems. Study of accommodation outcome at 12 months, for those subjects who survived this period revealed that, in the older group, over 60% of subjects with neurological disease were resident in nursing homes while the majority of all other groups remained in the community, as did two-thirds of those aged under 75. Admission to a nursing home was independent of social support for older subjects with neurological disease, but it played a significant role in those with cardiopulmonary or musculoskeletal disease. Conclusions: The study demonstrates that for one-year survivors there is an increased likelihood of admission to a nursing home of people aged 75 or over with neurological disease, while those under 75 were more likely to remain at home. The association was independent of whether spouse, family or friends were living with the subject. (Aust NZ J Med 1994; 24: 378–385.)     

淄博市实施世界银行贷款结核病控制项目效果评价

目的 对淄博市实施世界银行贷款结核病控制项目10年情况进行终期评价。方法 收集淄博市9个结核病项目区县的季报表、卫统14表和项目督导、调查资料。结果 10年累计接诊可疑肺结核症状80433人，发现、确诊登记活动性肺结核病人8795例，其中涂阳5554例。肺结核病例登记率1998年达到峰期，活动性、涂阳和新发涂阳分别为32／10万、20．9／10万和15．1／10万，涂阳病例所占比例平均为63．1％。新发涂阳平均治愈率达96．4％；复治涂阳平均治愈率达91．2％。结论 项目实施后，涂阳病人发现水平和治愈率明显提高，保护了健康人群，收到了巨大的社会和经济效益。     

Training and assessment of laparoscopic skills.

Laparoscopic surgery is gaining popularity among the surgical community. While its prevalence expands, the need for reliable training and assessment tools is becoming increasingly important. Laparoscopic skills are not an innate behavior, nor can they be easily mimicked, and can only be acquired through hands-on training. A consensus exists among physicians that establishment and evaluation of technical skill in surgical training programs are inadequate and in need of improvement. A validated, reliable bench model that could train and assess could be standardized and provide numerous benefits including determination of which medical students should consider a career in surgery, valuable feedback to residents, a tracking mechanism of resident performance, a possible certification and recertification tool, and to allow for interinstitutional comparison. To this end, several potentially successful bench models testing dexterity, hand-eye coordination, and depth perception have been developed. A few models have been proven to be both valid and reliable indicators of technical skill. Although the future remains uncertain, enough groundwork has been laid to begin incorporating technical skill training and assessment into surgical training programs.     

Ethical and metaethical criteria for an emerging technology: risk assessment

This paper examines ethical criteria for the shaping of an emergingtechnology applied internationally in environmental regulation:quantitative risk assessment-risk management. The role of thephysician in its application, especially in the genetic testingthat will be employed, underlines the importance of understandingthe nature and prospects for reshaping of this technology toenable ethical practice. The Cartesian or mechanistic model(which currently dominates the technology) excludes factorsof emotion, making the connection between assessment and managementunfruitful functionally and ethically, and makes the model unresponsiveto human needs. The emotional factors, nested and mediated inthe organic hierarchy of the ecologically-defined community,constitute key psychological, social, cultural and politicalelements of the total burden of risk. Ethical criteria consistentwith an open society are suggested for reshaping the model toenable effective management.     

特发性肺含铁血黄素沉着症二例

特发性肺含铁血黄素沉着症二例王永珍，李金鑫，刘建平，步惠英内蒙古自治区医院特发性肺含铁血黄素沉着症为一种少见的、病因尚不清楚的疾病，国内于１９６０年以来有近百例报导，其特征为肺毛细血管反复出血，渗出的血液发生溶血，含铁血黄素沉着于肺组织而起反应［１］...     

Mild atopic dermatitis lacks systemic inflammation and shows reduced nonlesional skin abnormalities

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Some notes on uncertainty; Federal policy and innovation

The legislative background and current responsibilities of the new National Center for Health Care Technology (NCHCT) are discussed. The NCHCT's charge is to consider the stage of development, the actual or potential risks, costs and rate of use of health care technology. The role of Government in supporting new technologies, stimulating innovation and encouraging application of research products is considered. These issues are discussed in the context of the uncertainty inherent in planning and the formulation of public policy.     

Effects of isolated and combined exposures to whole-body vibration and noise on auditory-event related brain potentials and psychophysical assessment

Summary Auditory event-related brain potentials (ERP) in response to two different tone stimuli (1.1 kHz or 1 kHz, 80 dB, 50 ms; given by headphones at a regular interstimulus interval of 5 s with a probability distribution of 70:30) were recorded from 12 healthy male subjects (Ss) during four different conditions with two repetitions: A - 60 dBA white noise (wN), no wholebody vibration (WBV); B - 60 dBA wN plus sinusoidal WBV in the a_z-direction with a frequency of 2.01 Hz and acceleration of 2 m ·s^–2 root mean square; C - 80 dBA wN, no WBV; D - 80 dBA wN plus WBV. Each condition consisted of two runs of about 11 min interrupted by a break of 4 min. During the break with continuing exposure, but without auditory stimuli, Ss judged the difficulty of the tone-detection task and intensity of noise by means of cross-modality matching (CMM). Vibration-synchronous activity in the electrocardiogram was eliminated by a subtraction-technique. Noise caused an attenuation of the N1 and P2 amplitudes and prolongation of P3 latencies. The WBV did not cause systematic ERP effects. Condition B was associated with higher N1 and smaller P3 amplitudes. The factor condition had a significant effect on the peak latencies of P3 to target stimuli and the task difficulty judged by CMM. Both effects exhibited significant linear increases in the sequence of conditions A, B, C, D. For the evaluation of exposure conditions at work, it can be suggested that noise has a strong systematic effect which can be enhanced by WBV. The P3 latency is considered as an advantageous measure for the detection of objective effects of physical environmental factors, correlating with relevant subjective responses.