Medical aspects of fitness to drive. What do public hospital doctors know and think?

Background: In Australia medical practitioners are often required to assume the responsibility for assessing fitness to drive. However the clinical practice, knowledge and attitudes of doctors with regards to this responsibility are unknown. The aim of this study was to determine the clinical practice, knowledge and attitudes of public hospital doctors in the area of fitness‐to‐drive decision‐making. Methods: A survey of public hospital doctors in Adelaide, South Australia was undertaken in 2003, shortly after the promulgation nationwide of guidelines to assist in the assessment of patients’ fitness to drive. The survey sought details on medical practitioners’ clinical practice in this regard, as well as their knowledge of the guidelines. In addition, it sought their attitudes to undertake this responsibility. Results: Eighty‐four per cent of respondents had at some time in their working career at least discussed the issue of fitness to drive with their patients. Seventy per cent acknowledged that they had received the recently published guidelines on fitness to drive. Despite this, knowledge of the contents of the guidelines was poor. Attitudes to the responsibility were equivocal with several significant reservations expressed. Conclusion: Public hospital doctors in Australia have poor knowledge of the content of published guidelines in the area of fitness to drive. If this situation is to be improved, alternative approaches to the education of this group with respect to this significant public health problem should be considered. Many doctors are uncomfortable with their responsibilities in this area and alternative models of decision‐making should be considered.     

护理干预对糖尿病患者从医行为的影响研究

目的探讨护理干预对提高糖尿病患者从医行为的影响。方法将2006年1月-2007年8月收住的100例糖尿病患者按住院顺序随机分为实验组和对照组各50例,对照组采用常规护理和一般健康教育,实验组在常规护理和一般健康教育的基础上,对患者实施全程健康教育综合护理干预。结果通过全程健康教育和综合护理干预,实验组患者从医率及生化指标达标率明显高于对照组（P〈0.01）。结论对糖尿病患者实施护理干预可提高糖尿病患者的从医行为。     

永磁直驱式风力发电机三相不平衡的补偿控制算法

提出了一种用于电网侧三相电压不平衡情况下的永磁直驱式风力发电机的逆变控制算法。通过对不平衡三相瞬时电压的矢量变换、分解并形成负序电流分量,与通过锁相环单位归一化的逆变输出电流相加,可以保证永磁直驱式风力发电机逆变输出的电流具有良好的正弦及三相平衡特性。该控制算法解决了永磁直驱式风力发电机在电网侧三相电压不平衡情况下的输出畸变问题,算法简单有效,计算量小,硬件采用分立元件即可实现,方便且可靠。     

Investigation of the washout effect in a magnetically driven axial blood pump

For a long-term implementation of the magnetically driven CircuLite blood pump system, it is extremely important to be able to ensure a minimum washout flow in order to avoid dangerous stagnation regions in the gap between the impeller and the motor casing as well as near the pivot-axle area at the holes in the impeller's hub. In general, stagnation zones are prone to thrombus formation. Here, the optimal impeller/motor gap width will be determined and the washout flow for different working conditions will be quantitatively calculated. The driving force for this secondary flow is mainly the strong pressure difference between both ends of the gap. Computational fluid dynamics (CFD) and digital particle image velocimetry (DPIV) will be used for this analysis.     

Respiratory muscle metabolic activity on PET/CT correlates with obstructive ventilatory defect severity and prognosis in patients undergoing lung cancer surgery

Background and Objective

Respiratory muscle activity is increased in patients with chronic respiratory disease. ¹⁸F-FDG-PET/CT can assess respiratory muscle activity. We hypothesized that respiratory muscles metabolism was correlated to lung function impairment and was associated to prognosis in patients undergoing lung cancer surgery based on the research question whether respiratory muscle metabolism quantitatively correlates with the severity of lung function impairment in patients? Does respiratory muscle hypermetabolism have prognostic value?

Methods

Patients undergoing ¹⁸F-FDG-PET/CT and pulmonary function tests prior to lung cancer surgery were identified. Maximum Standardized Uptake Value (SUVm) were measured in each respiratory muscle group (sternocleidomastoid, scalene, intercostal, diaphragm), normalized against deltoid SUVm. Respiratory muscle hypermetabolism was defined as SUVm >90th centile in any respiratory muscle group. Clinical outcomes were collected from a prospective cohort.

Results

One hundred fifty-six patients were included, mostly male [110 (71%)], 53 (34%) with previous diagnosis of COPD. Respiratory muscle SUVm were: scalene: 1.84 [1.51–2.25], sternocleidomastoid 1.64 [1.34–1.95], intercostal 1.01 [0.84–1.16], diaphragm 1.79 [1.41–2.27]. Tracer uptake was inversely correlated to FEV1 for the scalene (r = −0.29, p < 0.001) and SCM (r = −0.17, p = 0.03) respiratory muscle groups and positively correlated to TLC for the scalene (r = 0.17, p = 0.04). Respiratory muscle hypermetabolism was found in 45 patients (28.8%), who had a lower VO₂ max (15.4 [14.2–17.5] vs. 17.2 mL/kg/min [15.2–21.1], p = 0.07) and poorer overall survival when adjusting to FEV1% (p < 0.01).

Conclusion

Our findings show respiratory muscle hypermetabolism is associated with lung function impairment and has prognostic significance. ¹⁸F-FDG/PET-CT should be considered as a tool for assessing respiratory muscle activity and to identify high-risk patients.     

A KLEINIAN THEORY OF SEXUALITY

abstract    The author examines claims made some years ago by Green (1995 ), but still referenced today by others, that the theoretical and clinical emphasis given by British Object Relations theorists – Balint, Fairbairn, Winnicott and especially Klein – to the pregenital dimension of the mother–infant relationship has reduced the importance of sexuality in psychoanalysis resulting in a desexualization of classical theory and practice. The author notes that, except for Parsons (2000 ) and Litowitz (2002 ), these charges have gone unchallenged and he wishes to contribute to this 'debate' by presenting a Kleinian theory of sexuality. Meltzer's (1973 ) book Sexual States of Mind will be used as a primer for such a theory since the explicit goal of this text is a structural revision of psychoanalytic sexual theory from an Object Relations perspective. Through Meltzer's concept of 'sexual states of mind', and his sub-theory of 'aesthetic reciprocity' as a theory of primal seduction, the author will demonstrate how the diverse features of infantile and adult sexuality are given a very detailed, comprehensive understanding within an Object Relations paradigm. In fact, if there has been a turning away from sexuality in psychoanalysis, as Green and others contend, it is not because of Object Relations theory but because of the great complexity brought to our understanding of sexuality by Object Relations paradigms. The author presents this paper as a tribute to Donald Meltzer who died in August 2004.     

Low rates of homogenization of the DBC-150 satellite DNA family restricted to a single pair of microchromosomes in species from the Drosophila buzzatii cluster

A satellite DNA family, termed DBC-150, comprises slightly GC-rich repeat units of approximately 150 bp that were isolated (by DNA digestions or PCR) from the genome of all seven Drosophila species from the buzzatii cluster (repleta group). The presence of subrepeats suggests that part of the extant DBC-150 monomer originated by the duplication of small sequence motifs. The DBC-150 family is compared to the previously described pBuM satDNA family, an abundant component of the genome of five species of the cluster. The two families are different in several aspects, including primary structure, A + T content, intraspecific and interspecific variability and rates of homogenization (or nucleotide spread). The data indicate a lower rate of homogenization (and absence of complete concerted evolution) of the DBC-150 compared to the pBuM family. FISH on metaphase chromosomes revealed that the DBC-150 family is located exclusively in the microchromosomes. To our knowledge this is the first record of a complex Drosophila satDNA restricted to a single pair of microchromosomes. The observed low rates of homogenization of the DBC-150 family might be related to a presumed reduction or suppression of meiotic recombination in the microchromosomes.     

功能性食管病微机综合专家诊断系统的研究及临床应用

本文介绍一种数据驱动与人工干预相结合的功能性食管病微机综合专家诊断系统。该系统采用计算机神经网络技术和模式识别方法，对食道动力学信号进行识别、分析和处理，能准确地判断功能性食管病的性质、类别和部位。再通过人机界面模块，输入患者的临床表现、２４小时食道ＰＨ值检测结果、钡餐检查特征、内窥镜检查特征、病因病理特征和食道压力检查特征等六类医学诊断信息，系统经多级模糊评判推理分析后能自动显示和打印出诊断结果。经临床实际使用，具有良好较果。     

The ventilation,lactate and electromyographic thresholds during incremental exercise tests in normoxia,hypoxia and hyperoxia

These experiments examined the effect of hypoxia and hyperoxia on ventilation, lactate concentration and electromyographic activity during an incremental exercise test in order to determine if coincident chances in ventilation and electromyographic activity occur during an incremental exercise test, despite an enhancement or reduction of peripheral chemoreceptor activity. In addition, these experiments were completed to determine if electromyographic activity and ventilation are enhanced or reduced in response to the inspiration of oxygen-depleted and oxygen-enriched air, respectively. Seven subjects performed three incremental exercise tests, until volitional exhaustion was achieved, while inspiring air with a fractional concentration of oxygen of either 66%, 21% or 17%. In addition, another single subject completed two tests while inspiring air with a fractional concentration of either 17% or 21%. During the tests, ventilation, mixed expired oxygen and carbon dioxide, arterialized venous blood and the electromyographic activity from the vastus lateralis were sampled. From these values ventilation, electromyographic and lactate thresholds were detected during normoxia, hypoxia and hyperoxia. The results showed that although ventilation and lactate concentration were significantly less during hyperoxia as compared to normoxia or hypoxia, the carbon dioxide production values were not significantly different between the normoxic, hypoxic and hyperoxic conditions. For a particular condition, the time, carbon dioxide production and oxygen consumption values that corresponded to the ventilation and electromyographic thresholds were not significantly different, but the values corresponding to the lactate threshold were significantly less than those for the electromyographic and ventilation thresholds. Comparisons between the three conditions showed that the time, carbon dioxide production and oxyen consumption values corresponding to each of these thresholds were not significantly different. These findings have led us to conclude that the changes in lactate concentration observed during exercise may not be directly related to the fractional concentration of inspired oxygen, and that the peripheral chemoreceptors may not be the sole mediators of the first ventilatory threshold. It is suggested that this threshold may be mediated by an increase in neural activity originating from higher motor centers or the exercising limbs, induced in response to the need to progressively recruit fast twitch muscle fibers as exercise power output is increased and as individual muscle fibers begin to fatigue.     

The Relation Between Sex Drive and Sexual Attraction to Men and Women: A Cross-National Study of Heterosexual,Bisexual, and Homosexual Men and Women

Recent research suggests that, for most women, high sex drive is associated with increased sexual attraction to both women and men. For men, however, high sex drive is associated with increased attraction to one sex or the other, but not to both, depending on men's sexual orientation (Lippa, R. A., 2006, Psychological Science, 17, 46–52). These findings were replicated in a very large BBC data set and were found to hold true in different nations, world regions, and age groups. Consistent with previous research, lesbians differed from other women in showing the male-typical pattern, that high sex drive is associated with attraction to one sex but not the other. Bisexual women and men were more similar to same-sex heterosexuals than to same-sex homosexuals in their pattern of results. The correlation between same-sex and other-sex attraction was consistently negative for men, was near zero for heterosexual and bisexual women, and negative for lesbians. Thus, same-sex and other-sex attractions were, in general, more bipolar and mutually exclusive for men than for women. The current findings add to evidence that sexual orientation is organized differently in women and men and suggest a biological component to this difference.