Do we need new personalized emergency telehealth solutions? A survey of 100 emergency department patients and a first report of the swiss limmex emergency wristwatch: an original study

Development of new personal mobile and wireless devices for healthcare has become essential due to our aging population characterized by constant rise in chronic diseases that consequently require a complex treatment and close monitoring. Personal telehealth devices allow patients to adequately receive their appropriate treatment, followup with their doctors, and report any emergency without the need of the presence of any caregivers with them thus increasing their quality of life in a cost-effective fashion. This paper includes a brief overview of personal telehealth systems, a survey of 100 consecutive ED patients aged >65 years, and introduces "Limmex" a new GSM based technology packaged in a wristwatch. Limmex can by a push of a button initiate multiple emergency call and establish mobile communication between the patient and a preselected person, institution, or a search and rescue service. To the best of our knowledge, Limmex is the first of its kind worldwide.

The Estimation of the Ecological Condition of the City Environment by Methods of Phytoindication (as Applied to the Vasileostrovsky District of St. Petersburg)

The project aimed to use results of contamination of city vegetation with heavy metals and sulphur compounds as the basis for analysing the integral response of trees and shrubs to contamination, through a complex method of phytoindication. The results were used to draw up recommendations on pollution reduction in the city and to develop the method of phytoindication as a means of monitoring environmental pollution in St. Petersburg and other large cities. Field investigations were carried out in August 1996, and 66 descriptions of green areas were made in order to estimate the functional state of plants in the Vasileostrovsky district. Investigations of the spectrum reflecting properties of plants showed considerable variation of albedo meanings of leaves under the influence of various internal and external factors. The results indicated that lime trees most closely reflect the condition of the environment. Practically all the green areas studied were in poor condition, the only exceptions being areas of ash trees, which are more resistant to environmental pollution, and one lime-tree alley in a comparatively unpolluted street. The study identified those types of trees which are more or less resistant to complex environmental pollution and Ms. Terekhina recommends that the species in the present green areas be changed to include a higher number of the more resistant species. The turbidimetric analysis of tree barks for sulphates gave an indication of the level and spatial distribution of each pollutant, and the results also confirmed other findings that electric conductivity is a significant feature in determining the extent of sulphate pollution. In testing for various metals, the lime tree showed the highest contents for all elements except magnesium, copper, zinc, cadmium and strontium, again confirming the species' vulnerability to pollution. Medium rates of concentration in the city and environs showed that city plants concentrate 3 times as many different elements and 10 times more chromium, copper and lead than do those in the suburbs. The second stage of the study was based on the concept of phytoindication, which presupposes that changes in the relation of chemical elements in regional biological circulation under the influence of technogenesis provide a criterion for predicting displacements in people's health. There are certain basic factors in this concept. The first is that all living beings are related ecologically as well as by their evolutionary origin, and that the lower an organism is on the evolutionary scale, the less adaptational reserve it has. The second is that smaller concentrations of chemical elements are needed for toxicological influence on plants than on people and so the former's reactions to geochemical factors are easier to characterise. Visual indicational features of urban plants are well defined and can form the basis of a complex "environment - public health" analysis. Specific plant reactions reflecting atmospheric pollution and other components of urbogeosystems make it possible to determine indication criteria for predicting possible disturbances in the general state of health of the population. Thirdly the results of phytoindication investigations must be taken together with information about public health in the area. It only proved possibly to analyse general indexes of public health based on statistical data from the late 1980s and early 1990s as the data of later years were greatly influenced by social factors. These data show that the rates of illness in St. Petersburg (especially for children) are higher than in Russia as a whole, for most classes of diseases, indicating that the population there is more sensitive to the ecological state of the urban environment. The Vasileostrovsky district had the second highest sick rate for adullts, while the rate of infant mortality in the first year of life was highest there. Ms. Terekhina recommends further studies to more precisely assess the effectiveness of the methods she tested, but has drawn up a proposed map of environmental hazard for the population, taking into account prevailing wind directions.

Swiss residents' speciality choices--impact of gender, personality traits, career motivation and life goals

BACKGROUND: The medical specialties chosen by doctors for their careers play an important part in the development of health-care services. This study aimed to investigate the influence of gender, personality traits, career motivation and life goal aspirations on the choice of medical specialty. METHODS: As part of a prospective cohort study of Swiss medical school graduates on career development, 522 fourth-year residents were asked in what specialty they wanted to qualify. They also assessed their career motivation and life goal aspirations. Data concerning personality traits such as sense of coherence, self-esteem, and gender role orientation were collected at the first assessment, four years earlier, in their final year of medical school. Data analyses were conducted by univariate and multivariate analyses of variance and covariance. RESULTS: In their fourth year of residency 439 (84.1%) participants had made their specialty choice. Of these, 45 (8.6%) subjects aspired to primary care, 126 (24.1%) to internal medicine, 68 (13.0%) to surgical specialties, 31 (5.9%) to gynaecology & obstetrics (G&O), 40 (7.7%) to anaesthesiology/intensive care, 44 (8.4%) to paediatrics, 25 (4.8%) to psychiatry and 60 (11.5%) to other specialties. Female residents tended to choose G&O, paediatrics, and anaesthesiology, males more often surgical specialties; the other specialties did not show gender-relevant differences of frequency distribution. Gender had the strongest significant influence on specialty choice, followed by career motivation, personality traits, and life goals. Multivariate analyses of covariance indicated that career motivation and life goals mediated the influence of personality on career choice. Personality traits were no longer significant after controlling for career motivation and life goals as covariates. The effect of gender remained significant after controlling for personality traits, career motivation and life goals. CONCLUSION: Gender had the greatest impact on specialty and career choice, but there were also two other relevant influencing factors, namely career motivation and life goals. Senior physicians mentoring junior physicians should pay special attention to these aspects. Motivational guidance throughout medical training should not only focus on the professional career but also consider the personal life goals of those being mentored.

Loss of pulp sensitivity and pain as the first symptoms of a Ewing's sarcoma in the right maxillary sinus and alveolar process: report of a case

This case report describes the diagnosis and treatment of a Ewing's sarcoma in the right maxillary sinus and alveolar bone of a 19-year-old female patient. The first clinical symptoms were a loss of sensitivity of the premolars and first molar in the right maxilla and acute pain located in the area of these teeth. Initially, the referring dentist had treated these findings as an acute apical periodontitis with root canal medication. Because swellings on the palatal and buccal aspects of the teeth occurred and could not be treated with incision and drainage, the dentist referred the patient. Cone-beam computed tomography revealed a proliferation of soft tissue in the right maxillary sinus, with a radiopaque material at the tip of the mesiobuccal root of the first molar and resorptive signs of the mesiobuccal and distobuccal roots of the first molar. The palatal cortical bone of the right alveolar process seemed to be intact. After explorative surgery with biopsies from the buccal, palatal, and sinus proliferation areas, the pathologist diagnosed the lesion as a Ewing's sarcoma. Treatment of the patient consisted of initial chemotherapy, hemimaxillectomy, and postsurgical chemoradiotherapy.

Exophytic mass of the gingiva as the first manifestation of metastatic pulmonary adenocarcinoma

BACKGROUND: Metastasis of a malignant tumor to the oral cavity is rare, but it can be the first manifestation of a primary tumor. METHODS: The clinicopathologic features of a gingival metastasis originating from lung adenocarcinoma in a female patient are described. A 57-year-old woman showed a rapidly growing, painless, exophytic mass in the left mandibular gingiva. The whole lesion was excised, and histologic and immunohistochemical analyses were performed. RESULTS: The histopathologic sections showed a proliferation of poorly differentiated spindle and pleomorphic cells. Because the differentiation between carcinoma and sarcoma of spindle cell tumors was difficult, additional immunohistochemical evaluation was performed. The intraoral healing after tumor removal was uneventful. The discrepancy between the histopathologic results and the clinical findings led to a thorough examination by the patient's physician. Finally, a biopsy of the lungs confirmed a poorly differentiated adenocarcinoma with multiple metastases, including the oral cavity. CONCLUSIONS: An exophytic lesion on the gingiva can be the first sign of metastatic adenocarcinoma to the oral mucosa. This case emphasizes that even apparently benign-looking gingival lesions in anamnestically healthy patients need to be examined histopathologically.

Psychosocial and neurocognitive performance after spontaneous nonaneurysmal subarachnoid hemorrhage related to the APOE-epsilon4 genotype: a prospective 5-year follow-up study

OBJECT: In this study, the authors prospectively evaluated long-term psychosocial and neurocognitive performance in patients suffering from nonaneurysmal, nontraumatic subarachnoid hemorrhage (SAH) and investigated the association between the APOE-epsilon4 genotype and outcome in these patients. METHODS: All patients admitted to the authors' institution between January 2001 and January 2003 with spontaneous nonaneurysmal SAH were prospectively examined (mean follow-up 59.8 months). The APOE genotype was determined in all patients by polymerase chain reaction from a blood sample. Of the 30 patients included in this study, 11 were carriers of the epsilon4 allele. RESULTS: All patients showed a good recovery and regained full independence with no persisting neurological deficits. The patients with the epsilon4 allele, however, scored significantly higher on the Beck Depression Inventory (22.1 +/- 6.3 vs 14.1 +/- 5.1). At follow-up, depression was more persistent in the group with the epsilon4 allele compared with the group that lacked the allele. This finding reached statistical significance (p < 0.05). Selective attention was impaired in all patients during the first year of follow-up, with an earlier recovery noted in the patients without the epsilon4 allele. Moreover, there was a tendency toward a linear relationship between the Beck Depression Inventory and the d2 Test of Attention. Two patients who carried the epsilon4 allele did not return to their employment even after 5 years. CONCLUSIONS: The findings in this study suggest that the APOE genotypes may be associated with the psychosocial and neurocognitive performance after spontaneous nonaneurysmal SAH, even in the absence of neurological impairment. Physicians should consider patient genotype in assessing the long-term consequences of nonaneurysmal SAH.

Pediatric cranio-facial surgery. First-year's experience with a gun applying bioabsorbable tacks

AIM: In 2001 a prototype of a gun to apply bioabsorbable tacks in cranio-facial surgery has been developed. METHODS: From May 2001 to May 2002 this device has been used in the University Hospital of Innsbruck (Austria) for different cranioplasty procedures, in 34 children, showing its reliability for cranio-facial bone fixation. The children were affected by isolated craniosynostosis or by syndromical synostosis (Apert, Crouzon) and in a case of benign tumor of the parietal skull vault. The range of age, at the time of surgery, was between 3 months and 204 months of age. Bone segments were fixed using self-reinforced polylactide plates and tacks. RESULTS: Firm fixation was obtained intra-operatively and the operative time was reduced about 25-30 minutes as compared to use of plates and screws. This device has just one limitation in its own spring force: sometimes the bone thinner than 1 mm has been broken applying the tacks. CONCLUSION: After the first-year's experience it is possible to confirm that this device reduces, in selected cases, operative time, blood loss, risk of infection and, as a result, the costs.

SUPPORTING LEARNING FOR NAVAJO STUDENTS THROUGH ETHNOMATHEMATICS

The purpose of this research was to address how culturally informed ethnomathematical methods of teaching can be utilized to support the learning of Navajo students in mathematics. The study was conducted over the course of four years on the Navajo Reservations at Tohatchi Middle School in Tohatchi New Mexico. The students involved in the study were all in 8th grade and were enrolled either in Algebra 1 or a Response to Intervention, RTI, class. The data collected came in the form of a student survey, student observation and student assessment. The teacher written survey, a math textbook word problem, and two original math textbook problems along with their rewritten version were the sources of these three studies. The first year of the study consisted of a math attitude survey and how Navajo students perceived math as a subject of interest. The students answered four questions pertaining to their thoughts about mathematics. The students’ responses were positive according to their written answers. The second year of the study involved the observation of how students worked through a math word problem as a group. This method tested how the students culturally interacted in order to solve a math problem. Their questions and reasoning to solve the problem were shared with peers and the teacher. The teacher supported the students in understanding and solving the problem by asking questions that kept the students focused on the goal of solving the problem. The students worked collaboratively and openly in order to complete the activity. During the iv study, the teacher was more able to notice the students’ deficiencies individually or as a group, therefore was able to support them in a more specific manner. The last study was conducted over a period of two different years. This study was used to determine how textbook bias in the form of its sentence structure or word choice affects the performance of students who are not culturally familiar with one or both. It was found that the students performed better and took less time on the rewritten problem than on the original problem. The data suggests that focusing on the culture, language and education of Navajo students can affect how the students learn and understand math.

Habitat fragmentation and adaptation: a reciprocal replant-transplant experiment among 15 populations of Lychnis flos-cuculi

1. Habitat fragmentation and variation in habitat quality can both affect plant performance, but their effects have rarely been studied in combination. We thus examined plant performance in response to differences in habitat quality for a species subject to habitat fragmentation, the common but declining perennial herb Lychnis flos-cuculi. 2. We reciprocally transplanted plants between 15 fen grasslands in north-east Switzerland and recorded plant performance for 4 years. 3. Variation between the 15 target sites was the most important factor and affected all measures of plant performance in all years. This demonstrates the importance of plastic responses to habitat quality for plant performance. 4. Plants from smaller populations produced fewer rosettes than plants from larger populations in the first year of the replant-transplant experiment. 5. Plant performance decreased with increasing ecological difference between grassland of origin and target grassland, indicating adaptation to ecological conditions. In contrast, plant performance was not influenced by microsatellite distance and hardly by geographic distance between grassland of origin and target grassland. 6. Plants originating from larger populations were better able to cope with larger ecological differences between transplantation site and site of origin. 7. Synthesis: In addition to the direct effects of target grasslands, both habitat fragmentation, through reduced population size, and adaptation to habitats of different quality, contributed to the performance of L. flos-cuculi. This underlines that habitat fragmentation also affects species that are still common. Moreover, it suggests that restoration projects involving L. flos-cuculi should use plant material from large populations living in habitats similar to the restoration site. Finally, our results bring into question whether plants in small habitat remnants will be able to cope with future environmental change.

Cochleovestibular Deficit as First Manifestation of Syphilis in a HIV-Infected Patient

We report the detailed documented case of a 57-year-old homosexual HIV-positive man with bilateral cochleovestibular deficits as a first symptom of syphilis infection in early stage II disease. As a morphological substrate, a strong enhancement of both inner ears and vestibulocochlear nerves were found on gadolinium-enhanced MR scans. The serological tests identified an active infection with Treponema pallidum. After a high-dose treatment with penicillin G and prednisolone, the auditory and vestibular functions and the MR morphology of the vestibulocochlear nerves and inner ears on both sides returned to normal.

Simulator Network project report: a tool for improvement of teaching materials and targeted resource usage in Skills Labs

During the last decade, medical education in the German-speaking world has been striving to become more practice-oriented. This is currently being achieved in many schools through the implementation of simulation-based instruction in Skills Labs. Simulators are thus an essential part of this type of medical training, and their acquisition and operation by a Skills Lab require a large outlay of resources. Therefore, the Practical Skills Committee of the Medical Education Society (GMA) introduced a new project, which aims to improve the flow of information between the Skills Labs and enable a transparent assessment of the simulators via an online database (the Simulator Network).

Risk factors associated with first symptomatic infection of {\it Cryptosporidium parvum\/} in an infant population in Bilbeis, Egypt

Diarrhea disease is a leading cause of morbidity and mortality, especially in children in developing countries. An estimate of the global mortality caused by diarrhea among children under five years of age was 3.3 million deaths per year. Cryptosporidium parvum was first identified in 1907, but it was not until 1970 that this organism was recognized as a cause of diarrhea in calves. Then it was as late as 1976 that the first reported case of human Cryptosporidiosis occurred. This study was conducted to ascertain the risk factors of first symptomatic infection with Cryptosporidium parvum in a cohort of infants in a rural area of Egypt. The cohort was followed from birth through the first year of life. Univariate and multivariate analyses of data demonstrated that infants greater than six months of age had a two-fold risk of infection compared with infants less than six months of age (RR = 2.17; 95% C.I. = 1.01-4.82). When stratified, male infants greater than six months of age were four times more likely to become infected than male infants less than six months of age. Among female infants, there was no difference in risk between infants greater than six months of age and infants less than six months of age. Female infants less than six months of age were twice more likely to become infected than male infants less than six months of age. The reverse occurred for infants greater than six months of age, i.e., male infants greater than six months of age had twice the risk of infection compared to females of the same age group. Further analysis of the data revealed an increased risk of Cryptosporidiosis infection in infants who were attended in childbirth by traditional childbirth attendants compared to infants who were attended by modern childbirth attendants (nurses, trained midwives, physicians) (RR = 4. 18; 95% C.I. = 1.05-36.06). The final risk factor of significance was the number of people residing in the household. Infants in households which housed more than seven persons had an almost two-fold risk of infection compared with infants in homes with fewer than seven persons. Other risk factors which suggested increased risk were lack of education among the mothers, absence of latrines and faucets in the homes, and mud used as building material for walls and floors in the homes. ^

Feedback von Schülerinnen und Schülern als Quelle des Lernprozesses im Praktikum von Lehramtsstudierenden

Rückmeldungen von Schülerinnen und Schülern zum Unterricht nehmen eine wichtige Rolle zur Verbesserung der Unterrichtsqualität ein. Während der Ausbildung von Lehrpersonen wird dieses Potenzial bisher aber selten genutzt. Der Beitrag stellt Ergebnisse aus dem Forschungsprojekt "Lernen im Praktikum" vor. Befragt wurden 150 Studierende des Lehramts für 7.-9. Klassen (Sekundarstufe 1) zur Bedeutung von Schülerrückmeldungen im Praktikum sowie 1331 Schülerinnen und Schüler aus Praktikumsklassen zum Praktikum und zum Lernprozess der Praktikantinnen und Praktikanten. Die Ergebnisse unterstützen einerseits die Relevanz systematischer Schülerrückmeldungen für das Lernen im Praktikum. Andererseits machen sie auf die Notwendigkeit aufmerksam, die Kriterien, die Schülerbeurteilungen zugrunde liegen, weiter zu erforschen.

[Nocardia cyriacigeorgici: First report of invasive human infection]

BACKGROUND Diagnostic laboratories increasingly offer bacterial identification to the species level. The 17 nocardia species known to date differ in their clinical presentation, antibiotic resistance patterns and geographic distribution. The discovery of a new species with pathogenicity for humans calls for the characterization of its clinical and epidemiological properties. PATIENTS AND METHODS Nocardia isolated from multifocal brain abscesses of an immunocompromised patient were further identified by the analysis of their cellular fatty acids and sequencing of the 16S ribosomal DNA. Quantitative antibiotic resistance testing was performed with E-tests. RESULTS The 16S ribosomal DNA analysis showed a 99 % homology to Nocardia cyriacigeorgici. This is the first report of this species as an invasive human pathogen. N. cyriacigeorgici was found susceptible for meropenem, amikacin, ceftriaxon and cotrimoxazole. The combination of surgical drainage and antibiotic treatment for 13 months was curative. CONCLUSIONS N. cyriacigeorgici has the potential to cause invasive infections at least in immunocompromised patients. Comparing clinical and in vitro characteristics with N. asteroides, the main causative agent of nocardial infections in Europe, we found no clinically relevant differences.