Primary aldosteronism - actual epidemics or false alarm?

The prevalence of "primary aldosteronism" (PAL) cannot be precisely determined at this time, given 1) lack of a universally accepted definition, and 2) normotensive as well as normokalemic phases in the evolutionary development of a disease eventually characterized by hypertension and hypokalemia. The exception is fully genetically characterised forms such as glucocorticoid-suppressible hyperaldosteronism, the true prevalence of which could be proven today by universal screening using a single blood sample, but this is neither practical nor appropriate. Controversy has arisen regarding the rareness, or otherwise, of PAL because of 1) rediscovery in the last 12 years of the normokalemic phase described by Conn, 2) application of widely available methods for measurement of aldosterone and renin to "screening", 3) variable quality of these methods, and of their application, and 4) lack of the necessary "diagnostic", in addition to "screening", tests in some studies. PAL is significantly more common than previously thought, and a very important potentially curable form of hypertension. Early diagnosis and specific treatment avoids morbidity. The current focus on increased detection is essential, and will help to resolve the question of prevalence.

Is the effect of reading misspellings context dependent?

In 48 university students performing single-item spelling recognition, prior exposure to misspelled words improved slightly the accuracy on correctly spelled words and increased markedly the 'false alarm' rate (classifying a misspelling seen at study as correct). In a group given a dictation test (N = 24) the only effect of exposure to misspellings was a small increment in the number of misspellings that matched the misspelling seen at study. The two test groups showed no advantage of having the same display format at study and test (AA or BB vs AB or BA). Experiment 2 (in progress) investigated a format match at study and test against a condition with a new test context (AA or BB vs AC or BC). The results to date suggest an influence of memory of the study trial rather than simply an updating by the study exposures of abstract lexical representations. [ABSTRACT FROM AUTHOR]

Tailoring reveals information requirements: the case of anaesthesia alarms

We discuss the phenomenon of system tailoring in the context of data from an observational study of anaesthesia. We found that anaesthetists tailor their monitoring equipment so that the auditory alarms are more informative. However, the occurrence of tailoring by anaesthetists in the operating theatre was infrequent, even though the flexibility to tailor exists on many of the patient monitoring systems used in the study. We present an influence diagram to explain how alarm tailoring can increase situation awareness in the operating theatre but why factors inhibiting tailoring prevent widespread use. Extending the influence diagram, we discuss ways that more informative displays could achieve the results sought by anaesthetists when they tailor their alarm systems. In particular, we argue that we should improve our designs rather than simply provide more flexible tailoring systems. because users often find tailoring a complex task. We conclude that properly designed auditory displays may benefit anaesthetists in achieving greater patient situation awareness and that designers should consider carefully how factors promoting and inhibiting tailoring will affect the end-users' likelihood of conducting tailoring. (C) 2004 Elsevier B.V. All rights reserved.

Tympanometric findings in children at school entry: A normative study

This study presents tympanometric normative data for Australian children at school entry in view of the lack of age-specific population-based data for this group. Participants were 327 children (164 boys, 163 girls) aged between 5 and 6 years, who had no history of middle ear infection, and passed pure-tone screening at 20 dB HL. Normative values for static admittance (SA), ear canal volume (ECV), tympanometric peak pressure, tympanometric width (TW) and tympanometric gradient were established. Based on these normative data, the use of the ASHA (1997) guidelines for medical referral, in which ECV > 1.0 ml in the presence of a flat tympanogram, SA < 0.3 ml, or TW > 200 daPa may not provide the best criteria for Australian children aged between 5 and 6 years. If SA < 0.3 ml were used instead of SA < 0.16 ml, a greater proportion of Australian children would have failed tympanometry, thus increasing the false alarm rate.

Testing new alarms for medical electrical equipment

This paper reports the first of several tests of new auditory alarms originally proposed by Block et al. [1] and formalized in IEC 60601-1-8 for use in medical electrical equipment. We test whether participants who are supplied with the IEC-recommended mnemonics while learning label-alarm associations can more accurately identify the alarms after short periods of learning. Results for 18 participants strongly indicate that there is a mutual confusability between certain alarm pairs in both learning conditions, but that mnemonics may strengthen rather than diminish certain key confusions.

Reasoning about timeouts

In real-time programming a timeout mechanism allows exceptional behaviour, such as a lack of response, to be handled effectively, while not overly affecting the programming for the normal case. For. example, in a pump controller if the water level has gone below the minimum level and the pump is on and hence pumping in more water, then the water level should rise above the minimum level within a specified time. If not, there is a fault in the system and it should be shut down and an alarm raised. Such a situation can be handled by normal case code that determines when the level has risen above the minimum, plus a timeout case handling the situation when the specified time to reach the minimum has passed. In this paper we introduce a timeout mechanism, give it a formal definition in terms of more basic real-time commands, develop a refinement law for introducing a timeout clause to implement a specification, and give an example of using the law to introduce a timeout. The framework used is a machine-independent real-time programming language, which makes use of a deadline command to represent timing constraints in a machine-independent fashion. This allows a more abstract approach to handling timeouts.