Comparison between videofluoroscopy and endoscopic evaluation of swallowing for the diagnosis of dysphagia in children

OBJECTIVE: To compare videofluoroscopy swallowing study (VFSS) with the fiberoptic endoscopic evaluation of swallowing (FEES) in children and to determine the accuracy of FEES in the diagnosis of specific swallowing disorders. STUDY DESIGN: Cross-sectional study. SETTING: Hospital da Crianca Santo Antonio, affiliated with Santa Casa de Misericordia Hospital Complex, Porto Alegre, RS, Brazil. SUBJECTS AND METHODS: FEES findings were compared to those of VFSS in 30 children. Kappa coefficients for interobserver agreement were calculated. Thereafter, these coefficients were evaluated in terms of agreement between FEES and VFSS. In addition, the sensitivity, specificity, positive predictive value, and negative predictive value of FEES were calculated for four swallowing parameters (posterior spillover, pharyngeal residues, laryngeal penetration, and laryngotracheal aspiration). RESULTS: Interobserver agreement rates greater than 70 percent were obtained for all FEES parameters analyzed, except for pharyngeal residues with puree consistency (agreement = 66.7%, K = 0.296, P = 0.091). Laryngeal aspiration and penetration yielded the best level of agreement (100%, K = 1) for the laryngeal aspiration of puree residues. CONCLUSION: The diagnostic agreement between FEES (both observers) and VFSS was low. Regarding the analyzed parameters, laryngeal penetration and aspiration yielded the highest interobserver agreement in terms of FEES, and also showed the highest specificity and positive predictive value when compared to VFSS. (C) 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.

Visitor profiles and environmental attributes, especially of birds, attracting visitors to Lamington National Park: Tourist attitudes and economic issues

Uses a sample of 622 day and overnight visitors to the O’ Reilly’s/Green Mountains site of Lamington National Park, Queensland, Australia, to identify their socio-economic and other pertinent characteristics and the main reasons and attributes that attract them to the site. Particular attention is given to birds and their attributes as attractions. The primary economic injection accruing locally as a result of visits is examined and the difference that the presence of birds makes to local expenditure by visitors is explored. The extent of support for and objection to the introduction of a fee for entering Lamington National Park is estimated. The many suggestions received from visitors for environmental improvements at this site are discussed. It is suggested that unless a way can be found to regulate the number of visitors to this site and obtain extra funds to finance improvements at this site, the magnitude of many of these problems will grow. This will necessitate a fresh look at the desirability or otherwise for charging entry fees to Lamington National Park.

Comparison of two cellular harvesting methods for primary human oral culture of keratinocytes

The possibility of obtaining transplantable oral epithelia opens new perspectives for oral treatments. Most of them are surgical, resulting in mucosal failures. As reconstructive material this in vitro epithelia would be also useful for other parts of the human body. Many researchers still use controversial methods; therefore it was evaluated and compared the efficiency of the enzymatic and direct explant methods to obtain oral keratinocytes. To this project oral epithelia fragments were used. This work compared: time needed for cell obtainment, best cell amount, life-span and epithelia forming cell capacity. The results showed the possibility to obtain keratinocytes from a small oral fragment and we could verify the advantages and peculiar restrictions. We concluded that under our conditions the enzymatic method showed the best results: in the cells obtaining time needed, cell amount and life-span. Both methods showed the same capacity to form in vitro epithelia.

Credibility and staff conduct make or break bank customer service quality

Service quality is assessed by customers along the dimensions of staff conduct, credibility, communication, and access to teller services. Credibility and staff conduct emerge as the highest loading first-order factors. This highlights the significance of rectifying mistakes while keeping customers informed, and employing branch staff that are responsive and civilized in their conduct. Discovery of a valid second-order factor, namely, overall customer service quality, underscores the importance of providing quality service across all its dimensions. For example, if the bank fails to rectify mistakes and keep customers informed but excels in all other dimensions, its overall customer service quality can still be rated poorly.

State Banks and Economic Development in China

State-owned banks remain dominant in China's financial sector despite over two decades of gradual financial liberalization. Their performance is typically evaluated using commercial banking criteria. The standard view is that because state banks have experienced declining profitability and capital adequacy, they have been a drain on past economic development and endanger future growth prospects. However, we argue that state banks have strong development bank characteristics and hence warrant different performance criteria. The analysis in this paper suggests that while thier commercial performance may have been poor, the overall impact of state banks on China's economic development appears to have been both positive and sustainable. Copyright © 2001 John Wiley & Sons, Ltd.

Auditor independence and fee dependence

This study investigates whether fee dependence within the audit firms' offices jeopardises auditor independence. Fee dependence is examined at both the national audit firm level as well as the local office level and in a setting where public disclosure of fees is mandatory. We focus our tests on audit fee dependence and at the same time we control for the effects of non-audit service fee dependence post the 1989 mergers. We operationalise the exercise of independent judgement in auditing by the propensity to issue qualified audit opinions. If fee dependence affects auditors' independent judgement, then auditors are less likely to qualify the accounts. The study's results show that the level of auditor fee dependence does not affect auditor propensity to issue unqualified audit opinions. The findings remain robust to a number of sensitivity tests including the analyses controlling for the effects of non-audit service fee dependence and other settings in which there is heightened pressure on auditors to confront the effects of fee dependence on exercising independent audit judgement. (C) 2002 Elsevier Science B.V. All rights reserved.

Cross-border insolvency: Adoption of CLERP 8 as an evolution of Australian insolvency law

In 1997 the United Nations adopted the UNCITRAL Model Law on Cross-Border Insolvency and recommended that member states adopt it as part of domestic legislation. In 2002 Australia, an active participant in UNCITRAL's Working Group on Insolvency Law, announced that the next phase of the Commonwealth Government's Corporate Law Economic Reform Program would be a review of cross-border insolvency law. CLERP 8 seeks feedback on the proposed enactment of the Model Law by a separate Commonwealth statute. This article places such a development within the context of Australian cross-border insolvency law as it has evolved from early English bankruptcy legislation through case law arising from the banking collapses of the late 19th century to the more recent jurisprudence produced by corporate collapses of the late 1980s to early 1990s and current high-profile insolvencies.

Transformando burocracias para financiar os mais pobres: a evolu????o do Pronaf Cr??dito Grupo B

Institui????es banc??rias tradicionalmente n??o oferecem servi??os financeiros, principalmente cr??dito produtivo, aos grupos de mais baixa renda. Considerando-se a rigidez do sistema financeiro em trabalhar com os mais pobres, o presente artigo descreve o processo de cria????o e aperfei??oamento de uma pol??tica p??blica de microcr??dito rural dentro do Programa Nacional de Fortalecimento da Agricultura Familiar (Pronaf). S??o apresentadas as motiva????es para altera????es no desenho da linha de cr??dito, assim como as mudan??as normativas, de fontes e de agentes operadores, efetuadas em cada ano-safra para tornar poss??vel superar os desafios apresentados pela burocracia do Sistema Nacional de Cr??dito Rural ??? SNCR. O texto apresenta ainda o impacto no n??mero de contrata????es resultante das diversas medidas tomadas. Finalmente, ?? feito um balan??o das principais li????es aprendidas assim como dos desafios atuais de maior qualifica????o do microcr??dito e integra????o com outras pol??ticas p??blicas.

A Política Nacional de Humanização como política que se faz no processo de trabalho em saúde

Este artigo tem como objetivo realizar um exercício analítico do modo de fazer da Política Nacional de Humanização (PNH) sobre a função apoio institucional, com base em diferentes dispositivos, diretrizes e princípios. O texto está dividido em três partes: na primeira, traz reflexões acerca da concepção de humano e humanismo que fundamenta as análises; a segunda busca ampliar o debate sobre a indissociabilidade entre atenção e gestão e o modo de fazer apoio institucional; a terceira aborda a indissociabilidade entre a produção de serviços e produção de sujeitos, e encaminha a discussão dessas três partes que se desdobram em outros planos de análise. Ressalta, em todo o texto, a aposta na inclusão dos diferentes sujeitos e na análise e gestão coletiva dos processos de trabalho como estratégia para criar desestabilizações produtivas e práticas de humanização dos serviços de Saúde.