The modified Evan's blue dye procedure fails to detect aspiration in the tracheostomized patient: Five case reports

The modified Evan's blue dye procedure (MEBD) is a method of performing tracheal suctioning of the patient through the tracheostomy tube after administration of color-contrasted food and liquid. The MEBD is done when radiographic or fiberoptic procedures are not available or practical. In 5 tracheostomized patients, the MEBD does not detect aspiration.     

A comparison of the speech acceptability of good and excellent esophageal and tracheoesophageal speakers

Thirteen esophageal speakers (8 male, 5 female) and 12 tracheoesophageal (t-e) speakers (7 male, 5 female) were placed into eight groups based on gender, voice type, and speaking proficiency (excellent or good). Audio recordings of each speaker reading the Rainbow Passage (Fairbanks, 1960) were made. The resultant samples were judged for acceptability of speech by 25 naive listeners trained in use of a five-point equal-appearing-interval scale. An analysis of variance of the listener data indicated that speaker proficiency but not voice type had a significant effect on judgments of acceptability, indicating that the listeners perceived no difference in the acceptability of esophageal and t-e speech.     

The Veterans Affairs Learners' Perceptions Survey: the foundation for educational quality improvement.

PURPOSE: The U.S. Department of Veterans Affairs (VA) supports 8,700 resident positions nationally to enhance quality of care for veterans and to educate physicians. This study sought to establish a yearly quality indicator to identify and follow strengths and opportunities for improvement in VA clinical training programs. METHOD: In March 2001, the VA Learners' Perceptions Survey, a validated 57-item questionnaire, was mailed to 3,338 residents registered at 130 VA facilities. They were asked to rate their overall satisfaction with the VA clinical training experience and their satisfaction in four domains: faculty/preceptor, learning, working, and physical environments using a five-point Likert scale. Questionnaires were received from 1,775 residents (53.2%). A full analysis was conducted using 1,436 of these questionnaires, whose respondents were categorized in four training programs: medicine (n = 706), surgery (n = 291), subspecialty (n = 266), and psychiatry (n = 173). RESULTS: On a scale of 0 to 100, residents gave their clinical training experience an average score of 79. Eighty-four percent would have recommended VA training to peers, and 81% would have chosen VA training again. Overall, 87% were satisfied with their faculty/preceptors, 78% with the learning environment, and 67% with the working and physical environments. The survey was sensitive to differences in satisfaction among the trainee groups, with residents in internal medicine (IM) the least satisfied. CONCLUSION: The VA Learners' Perceptions Survey is the first validated survey to address comprehensive satisfaction issues in clinical training. The survey highlights strengths and opportunities for improvement in VA clinical training and is the first step toward improving education.     

Testosterone Enhances GABA and Taurine but not N-Methyl-D,L-Aspartate Stimulation of Gonadotropin Secretion in the Goldfish: Possible Sex Steroid Feedback Mechanisms

The effects of gonadal steroids on GABA-, taurine (TAU)- and N-methyl-D, L-aspartate (NMA)-induced gonadotropin-II (GTH-II) release were investigated in male and female goldfish in vivo. In sexually regressed goldfish (both sexes mixed), intraperitoneal implantation for 5 to 10 days with solid Silastic pellets containing testosterone (100 μg/g), oestradiol (100 μg/g) or progesterone (100 μg/g) was previously shown to elevate serum sex steroid levels to values comparable to those in sexually mature animals, and to potentiate gonadotropin-releasing hormone-stimulated GTH-II release. In the present study, testosterone but not oestradiol or progesterone enhanced the stimulatory effects of exogenous GABA (100 μg/g) on GTH-II release in vivo. TAU (1 mg/g) stimulated GTH-II release in sexually regressed mixed sex and sexually recrudescent male goldfish, and both testosterone and oestradiol implantation enhanced GTH-II release induced by TAU. The glutamate agonist NMA (25 to 50 μg/g) was also found to stimulate GTH-II release; however it was relatively less effective in elevating serum GTH-II levels than GABA and TAU, and its effects were not modulated by sex steroid treatments. Pretreatment of goldfish with α-methyl-p-tyrosine to deplete brain and pituitary catecholam-ines did not affect NMA action on GTH-II release. Our results indicate that GABA, TAU and NMA are involved in the neuroendocrine regulation of GTH-II release in goldfish, and support the idea that testosterone participates in the positive feedback regulation of pituitary gonadotropin release in a non-mammalian vertebrate by enhancing GABA- and TAU-stimulated GTH release in vivo.     

Expression and activation of 15-lipoxygenase pathway in severe asthma: relationship to eosinophilic phenotype and collagen deposition

BACKGROUND: Although 15(S)-hydroxyeicosatetraenoic acid (15(S)-HETE), a product of 15-lipoxygenase (15-LO), may be involved in mild to moderate asthma, little is known about its potential roles in severe asthma. OBJECTIVES: This study was performed to evaluate 15(S)-HETE levels in bronchoalveolar lavage fluid (BALF) from severe asthmatics with and without airway eosinophils and from the control groups. In addition, 15-LO protein expression was examined in endobronchial biopsy, while its expression and activation were evaluated in BAL cells. RESULTS: While 15(S)-HETE levels in BALF were significantly higher in all severe asthmatics than normal subjects, severe asthmatics with airway eosinophils had the highest levels compared with mild, moderate asthmatics and normal subjects. 15(S)-HETE levels were associated with tissue eosinophil numbers, sub-basement membrane thickness and BALF tissue inhibitor of metalloproteinase-1 levels, and were accompanied by increased 15-LO expression in bronchial epithelium. In addition, activation of 15-LO was suggested by the increased proportion of 15-LO in the cytoplasmic membrane of alveolar macrophages from severe asthmatics. CONCLUSION: The data suggest that severe asthmatics with persistent airway eosinophils manifest high levels of 15(S)-HETE in BALF, which may be associated with airway fibrosis. It is likely that 15-LO expression and activation by airway cells explain the increased 15(S)-HETE levels.     

Sex differences in spatial ability in children

There is considerable evidence that sex differences in spatial ability exist in adults, with males outperforming females at every age after puberty. It is difficult, however, to find sex differences in children younger than 13. This is due in part to the lack of adequate measures of spatial ability for use with children. We report the use of spatial tests for children that are similar to those that have shown large sex differences in adults and may be measuring ability comparable to adult spatial ability. Four tests of mental rotation and spatial visualization were given to two samples of children. The first sample consisted of 81 children (39 males and 42 females) aged 9 to 12 years. The second sample consisted of 42 children (21 males and 21 females) aged 9 to 13 years. Sex differences of .4–.6 standard deviations were found on three tests in both samples. These results indicate that sex differences in spatial ability can be found in preadolescents if appropriate tests are used. Measurement of these abilities in children facilitates the investigation of possible biological and sociocultural contributors to the sex differences in spatial ability.This study was supported by National Institutes of Health Grant HD19644 and NIH Biomedical Research Support Grant S07 RR05366-24.