["Literally torn apart by coughing"]. / "Vom Husten buchstäblich zerrissen".

The present case reports on a 53-year-old patient with severe chronic obstructive pulmonary disease (COPD) and acute pneumonia who complained of massive right-sided chest pain and hemoptysis after a severe coughing fit. To the authors' great surprise, further clinical and radiological investigations revealed a rupture of the right intercostal muscles caused by the coughing fit, with herniation of parts of the right lower lobe of the lung down to the subcutaneous and below the M. latissimus dorsi. The patient was presented to the colleagues in thoracic surgery and needed to be operated twice, finally with a mesh insert.

Methodological troubles as problems and phenomena: ethnomethodology and the question of 'method' in the social sciences.

Across the disciplinary frontiers of the social sciences, studies by social scientists treating their own investigative practices as sites of empirical inquiry have proliferated. Most of these studies have been retrospective, historical, after-the-fact reconstructions of social scientific studies mixing interview data with the (predominantly textual) traces that investigations leave behind. Observational studies of in situ work in social science research are, however, relatively scarce. Ethnomethodology was an early and prominent attempt to treat social science methodology as a topic for sociological investigations and, in this paper, we draw out what we see as its distinctive contribution: namely, a focus on troubles as features of the in situ, practical accomplishment of method, in particular, the way that research outcomes are shaped by the local practices of investigators in response to the troubles they encounter along the way. Based on two case studies, we distinguish methodological troubles as problems and methodological troubles as phenomena to be studied, and suggest the latter orientation provides an alternate starting point for addressing social scientists' investigative practices.

Patients' uses of information as researchable domains of social practice.

In this article we argue that research into information for patients has to extend beyond an evaluation of particular information resources to studies of how those resources are engaged with, made sense of and used in practice. We draw on empirical data collected in the course of a study of a patient information resource designed for breast cancer patients in Liverpool and Newcastle in order to demonstrate the limitations of a restricted focus on information resources alone - namely, that it does not take into account the specific ways in which information is incorporated within what patients do as the grounds of 'further inference and action'. Our interest is less in discussing the strengths and weaknesses of this particular resource than in explicating some neglected aspects of the commonplace ways in which patients 'work' with information. We conclude by sketching some broad features of those 'reading' and 'linking' practices, the study of which, we believe, would help us as researchers to explicate the 'problem of information' as it is actually encountered and resolved by patients in realworld settings for their own practical purposes. Taking our lead from ethnomethodological studies and related research in various fields, we argue patients' uses of information are social practices that can and should be treated as researchable phenomena.

War-making and sense-making: some technical reflections on an instance of 'friendly fire'.

In this paper we analyse a 'friendly fire' incident from the second Gulf War and the controversy which came to envelop it during a coroner's inquest in 2007. Focusing on the cockpit video of the incident that was leaked to the media during that inquest, we examine what the military and civilian investigators were involved in reconstructing: the incident as it unfolded in real time. Our analysis is grounded in a praxeological perspective that draws on and links ethnomethodological studies of work, research into 'normal' accidents, disasters and risks, and recent ethnographies of the military. Based on our analysis, we suggest that the accounts offered after the event by the military and civilian inquiries should be treated less as competing descriptions than different ways of problematizing particular aspects of the military-political 'machineries' the pilots' actions were enmeshed within.

Comparison of left and right ventricular volume measurement using the Simpson's method and the area length method.

PURPOSE: To compare ventricular volume measurement using a volumetric approach in the three standard cardiac planes and ventricular volume estimation by a geometrical model, the Area-Length method (ALM). MATERIALS AND METHODS: Fifty-six healthy volunteers were examined (27 males, 29 females) on a 1.5T MR-unit with ECG-triggered steady state free precision (SSFP) Cine-MR sequences and parallel image acquisition. Multiple slices in standardized planes including the short-axis view (sa), 4-chamber view (4ch), left and right 2-chamber views (2ch) were used to cover the whole heart. End-systolic and end-diastolic ventricular volumes (EDV, ESV), stroke volume (SV), and ejection fraction (EF) were calculated with Simpson's rule in all planes and with ALM in the 2ch and 4ch planes. Global function parameters measured in the sa plane were compared with those obtained in the other imaging planes. RESULTS: A very good correlation is observed when comparing functional parameters calculated with Simpson's rule in all imaging planes: for instance, the mean EDV/ESV of the left and right ventricle of the female population group measured in sa, 4ch, and 2ch: left ventricle EDV/ESV 114.3/44.4, 120.9/46.5, and 117.7/45.3 ml; right ventricle EDV/ESV 106.6/46.0, 101.2/41.1, and 103.5/43.0 ml. Functional parameters of the left ventricle calculated with ALM in 2ch and 4ch correlate to parameters obtained in sa with Simpson's rule in the range of 5-10%: for instance, the EDV/ESV of the left ventricle of the male population group measured in the sa, 4ch, and 2ch: 160.3/63.5, 163.1/59.0, and 167.0/65.7 ml. Functional parameters of the right ventricle measured with ALM in 4ch are 40-50% lower and calculated in 2ch almost double as high as compared with the parameters obtained in sa with Simpson's rule: for instance, male right ventricular EDV/ESV measured in sa, 4ch, and 2ch: 153.4/68.1, 97.5/34.5, and 280.2/123.2 ml. The EF correlates for all imaging planes measured with the Simpson's rule in both ventricles and using ALM in the left ventricle except for males with an overestimation of less than 6%. The EF of the right ventricle is calculated higher using ALM in 4ch and 2ch compared to the EF calculated in sa: female/male EF of the right ventricle measured in the sa, 4ch, and 2ch: 56.8/55.7, 66.0/65.0, and 60.0/57.0%. CONCLUSION: In the setting of healthy volunteers the ALM method should not be used in 2ch and 4ch planes of the right ventricle because of lacking correlation of global functional parameters compared to those obtained in the sa plane. Using Simpson's rule functional parameters correlate well to each other in the different imaging planes.

Incentives for biodefense countermeasure development.

Therapeutics and vaccines are available for only a fraction of biological threats, leaving populations vulnerable to attacks involving biological weapons. Existing U.S. policies to accelerate commercial development of biodefense products have thus far induced insufficient investment by the biopharmaceutical industry. In this article, we examine the technical, regulatory, and market risks associated with countermeasure development and review existing and proposed federal incentives to increase industrial investment. We conclude with several recommendations. To increase industry's engagement in biodefense countermeasure development, Congress should expand BioShield funding, giving HHS the flexibility to fund a portfolio of biodefense countermeasures whose revenues are comparable to those of commercial drugs. Congress should establish tradable priority review vouchers for developers of new countermeasures. A National Academy of Sciences or National Biodefense Science Board should formally evaluate incentive programs and a government-managed "Virtual Pharma," in which HHS contracts separate stages of research, development, and production to individual firms.

Universal influenza vaccination: the time to act is now.

Annual influenza epidemics create a significant public health burden each year in the United States. That influenza continues to pose a public health threat despite being largely preventable through vaccination is indicative of continuing weaknesses in the U.S.'s public health system. Moreover, the burden of annual influenza epidemics and the fragility and instability of the capacity to respond to them underscore the U.S.'s ongoing vulnerability to pandemic influenza and highlights gaps in bioterrorism preparedness and response efforts. This article examines the burden of annual influenza epidemics in the U.S., efforts to combat that burden with vaccination, shortcomings of influenza vaccination efforts, and how those shortcomings exemplify weaknesses in pandemic influenza and bioterrorism preparedness efforts. We make the case for establishing an annual universal influenza vaccination program to assure access to influenza vaccination to anyone who can safely receive vaccination and desires it. Such a program could greatly reduce the annual burden of influenza while advancing and maintaining U.S. pandemic influenza and bioterrorism preparedness and response efforts.

Improving performance of HVAC systems to reduce exposure to aerosolized infectious agents in buildings; recommendations to reduce risks posed by biological attacks.

The prospect of biological attacks is a growing strategic threat. Covert aerosol attacks inside a building are of particular concern. In the summer of 2005, the Center for Biosecurity of the University of Pittsburgh Medical Center convened a Working Group to determine what steps could be taken to reduce the risk of exposure of building occupants after an aerosol release of a biological weapon. The Working Group was composed of subject matter experts in air filtration, building ventilation and pressurization, air conditioning and air distribution, biosecurity, building design and operation, building decontamination and restoration, economics, medicine, public health, and public policy. The group focused on functions of the heating, ventilation, and air conditioning systems in commercial or public buildings that could reduce the risk of exposure to deleterious aerosols following biological attacks. The Working Group's recommendations for building owners are based on the use of currently available, off-the-shelf technologies. These recommendations are modest in expense and could be implemented immediately. It is also the Working Group's judgment that the commitment and stewardship of a lead government agency is essential to secure the necessary financial and human resources and to plan and build a comprehensive, effective program to reduce exposure to aerosolized infectious agents in buildings.