ABSTRACT
BACKGROUND: In Germany, about 5 million people of all ages suffer from dysphagia. Due to demographic change and improved medical care, the incidence of swallowing disorders is expected to increase. Dysphagia is associated with an increased morbidity and mortality and leads to a considerable financial burden on the health systems. The two most common causes of dysphagia are neurological disorders and head and neck cancer. Diagnostics and therapy have developed continuously over the past decades. In particular, the flexible endoscopic evaluation of swallowing (FEES) has become an established part of dysphagia diagnostics. RESULTS: The certificate "Diagnostics and Therapy of Oropharyngeal Dysphagia, incl. FEES" was developed by the German Society for Phoniatrics and Pedaudiology (DGPP) and the German Society for Otolaryngology, Head and Neck Surgery (DGHNO KHC) in cooperation with the German Professional Association for Phoniatrics and Pedaudiology and the German Professional Association of Otolaryngologists.It consists of three parts: the modules (A, B and C), the indirect supervision and a practical examination. Structure, detailed contents and requirements for obtaining the certificate are described in the following article. The qualification of the lecturers and auditors are also defined. CONCLUSION: The systematic training serves the quality assurance and establishment of standards in the diagnostics and therapy of oropharyngeal dysphagia in the area of phoniatrics and ear, nose and throat medicine.
Subject(s)
Deglutition Disorders , Curriculum , Deglutition , Germany , Humans , OtolaryngologyABSTRACT
In 2010 the Federal Government announced funding over two years to create a Personally Controlled Electronic Health Record (PCEHR) for Australians. One of the wave 2 implementation sites is the Cradle Coast in Tasmania. A PCEHR Program Benefits and Evaluation Partner (BEP) has been appointed to undertake evaluation activities with the e-health lead implementation sites. In addition to this implementation a comprehensive research plan has been developed and commenced through the Rural Clinical School at the University of Tasmania. The overarching aim of the research agenda is to evaluate the outcomes of various elements of the 4C project as it evolves and is implemented, from multiple perspectives. The research agenda is important as it expands upon the NEHTA mandated evaluation and provides an holistic overview of the PCEHR implementation process and outcomes for clinicians, patients and family members. This paper will detail the planned evaluation and its progress to date.
Subject(s)
Electronic Health Records , Program Evaluation , Advance Care Planning , Humans , Medical Record Linkage , TasmaniaABSTRACT
Seed production may be limited because flowers do not get enough suitable pollen or because plants lack the resources to make seeds. We used replicated plantings to test factors that influence effects of bumblebee behavior on pollen limitation, as measured by the difference in seed set between hand- and naturally pollinated flowers, of Penstemon digitalis in patches of four to 41 flowering individuals. Seed set per flower was 376% higher in the largest as compared with the smallest Penstemon patches. This positive density dependence reflects activity of long-tongued bees, which (1) have higher effective density as patch size increases, (2) visit greater proportions of plants as patch size increases, and (3) visit smaller proportions of flowers per visited plant as patch size increases. Our results suggest that economics of flight and maneuverability of large, long-tongued bumblebees lead them to transfer more pollen between than within Penstemon plants in large patches. Density of smaller, short-tongued bumblebees was not positively associated with Penstemon seed set, but these bees may be important pollinators at low plant densities. Our experimental system indicates a clear positive relationship between activity of effective pollinators and seed set in a species capable of pollinating itself.
ABSTRACT
Pentachlorophenol (PCP) is a persistent organic pollutant (POP) previously used as a timber treatment chemical to prevent sap stain and wood rot. Commonly used in wood treatment industries for the last 50 years, there are now many sites worldwide that are contaminated with PCP. Although persistent, PCP is a mobile contaminant and therefore has a propensity to leach and contaminate surrounding environments. Both willow (Salix sp., 'Tangoio') and poplar (Populus sp. 'Kawa') growing in an open-ended plastic greenhouse were found to tolerate soil PCP concentrations of 250 mg kg(-1) or less and both species stimulated a significant increase in soil microbial activity when compared to unplanted controls. Both poplar and willow could not survive PCP concentrations above 250 mg kg(-1) in soil. Pentachlorophenol degradation occurred in both planted and unplanted pots, but a higher rate of degradation was observed in the planted pots. Soil contaminated by wood-treatment activities often contains co-contaminants such as B, Cr, Cu and As, that are also used as timber preservatives. An additional column leaching experiment, done along side the potted trial, found that PCP, B, Cr, Cu and As were all present in the column leachate. This indicates that although Cu, Cr and As are generally considered immobile in the soil, they were mobilised under our column conditions. If a contaminated site were to be hydraulically 'sealed' using plants, a reticulation irrigation system should be installed to capture any contaminant leachate resulting from heavy rains. This captured leachate can either be independently treated, or reapplied to the site. Our data demonstrate a reduction in soil hydraulic conductivity with repeated application of leachate containing PCP and metal compounds but the soil did not become anaerobic. This would need to be considered in site remediation design.
Subject(s)
Metals, Heavy/metabolism , Pentachlorophenol/metabolism , Populus/metabolism , Salix/metabolism , Soil Pollutants/metabolism , Soil MicrobiologyABSTRACT
We ask whether vole herbivory in experimental grassland plots is sufficient to create an unpalatable community. In a six-year experiment, meadow voles (Microtus pennsylvanicus) reduced plant standing crop between 30% and 72%, well within the range of ungulate effects. Moreover, meadow voles reduced their available forage species by changing the plant community composition: four grass species and a legume upon which they foraged declined sharply in cover and/or number of individuals, five forbs avoided by voles increased, and two forbs neither declined nor increased with either measure. Reductions of diversity occurred when voles first defoliated the plots in 2000 but disappeared as plant species avoided by voles replaced vulnerable plants. Within six years, meadow voles created plant communities dominated by species that they did not eat.
Subject(s)
Arvicolinae , Ecosystem , Food Preferences , Poaceae , Animals , BiomassABSTRACT
BACKGROUND: Androgen excess may provoke or aggravate acne by inducing seborrhea. In women, androgen disorders are frequently suspected when acne is accompanied by hirsutism or irregularities of the menstrual cycle. In men, however, acne may be the only sign of androgen excess. OBJECTIVE: Our aim was to investigate whether male patients with acne display pathologic androgen blood values. METHODS: This case-control study at a university dermatology department with referred and unreferred patients investigated male acne patients (n = 82, consecutive sample) in whom the diagnosis of mild to severe acne was made, as well as a control group of men without acne (n = 38). The main outcome measures were androgen parameters including morning values of testosterone, luteinizing hormone, follicle-stimulating hormone, dehydroepiandrosterone sulfate, androstenedione, and 17-hydroxyprogesterone; as well as a corticotropin stimulation test. RESULTS: 17-Hydroxyprogesterone levels were significantly higher (P = .01) in acne patients than in the control group, whereas the other parameters did not differ significantly. In addition, the corticotropin stimulation test revealed abnormal 17-hydroxyprogesterone induction values in 10 of 82 patients. LIMITATIONS: The analysis is limited to a selection of androgen parameters. CONCLUSION: The results suggest that in men irregularities of adrenal steroid metabolism may be a factor contributing to acne.
