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Learning is the only sure way to achieve ongoing performance improvement. Budgeting and learning are fundamentally orthogonal processes. Budgeting stabilizes, which is a good thing in itself, and promotes economy, but it discourages understanding of variation. Learning requires perturbation and measurement. Given the processes through which service accomplishment and operational excellence are realized, it is unlikely that budgeting, as generally practiced in government, can promote continuous improvement in enterprise performance.

Spirometry is a simple test and considered the gold standard in lung function. An obstructive ventilatory defect is a disproportionate reduction of maximal airflow from the lung in relation to the maximal volume that can be displaced from the lung. It implies airway narrowing and is defined by a reduced FEV1/FVC ratio below the 5th percentile of the predicted value (lower limit of normal, LLN). A restrictive disorder may be suspected when vital capacity (FVC) is reduced and FEV1/FVC is normal. It is definitely proven, however, only by a decrease in TLC below the 5th percentile of predicted value (LLN). The measurement of TLC by body plethysmography is necessary to confirm or exclude a restrictive defect or hyperinflation of the lung when FVC is below the LLN. 2012 a task force of the ERS published new reference values based on 74,187 records from healthy non-smoking males and females from 26 countries. The new reference equations for the 3-95 age range are now available that include appropriate age-dependent mean values and lower limits of normal (LLN). This presentation aims at providing the reader with recommendations dealing with standardization and interpretation of spirometry.

Nasal airflow resistance in brachycephalic dogs is significantly elevated compared to normal dogs. LaserAssisted TurbinEctomy (LATE)-surgery as well as xylometazolin were shown to reduce pathologically increased intranasal airway resistance in brachycephalic dogs by approximately 50 %. Impulse oscillometry provides a reliable and sensitive method to examine intranasal stenoses in the canine nose. Acoustic rhinometry allows assessment of changes in cross sectional area and volume of the canine nasal cavity.

The structure of our aging population has significantly changed in the last three decades as have also the anthropometric data. Therefore, the question arises as to whether or not the largely accepted reference values for ventilatory lung function, which were suggested by the European Community for Coal and Steel (EGKS), may still be used today, since these values were obtained in the 1960s from subjects in a limited age range. For the elderly, the measured values are deduced by extrapolation beyond the range of reference equations which had been obtained in a different population. Therefore decisions concerning elderly and smaller subjects concerning remuneration due to impaired lung function after industrial exposure on the basis of EGKS values are questionable.We have examined lung function using pneumotachography for recording static lung volumes and flow-volume curves in 176 asymptomatic non-smoking males, aged 20 to 90 years, and correlated the results to the reference values of the EGKS, SAPALDIA and LuftiBus.The age dependence of respiratory parameters (VC, FVC, FEV (1), FEV (1) %FVC, PEF, MEF (75,50,25)) for the healthy subjects can be described with a linear function (y = - m x age + n). The forced expiratory volume in one second, FEV (1), is calculated by FEV (1) = - 0.046 x age + 6.11; r = 0.88. Mean FEV1 for younger subjects was found to be 108 +/- 9.9 % of the EGKS reference values, 105 +/- 13.7 % in the middle-aged group and 97.3 +/- 12.4 % in the older subjects. All measured parameters concerning lung function can be described as linear functions of age which are steeper than those described by the EGKS reference values. The steeper slope in age dependency was also seen in other investigated parameters. The correlation of lung function parameters to height largely follows the EGKS predictions.Measured lung function values of healthy younger and elderly subjects showed a close correlation to the extrapolated reference values of the EGKS. Our results relating to normal lung function justify an extrapolation of the reference equations beyond the common ranges of age while applying the same limitations as described for subjects in the middle-age range. Our results permit an extrapolation of EGKS values beyond the range of the reference values and can be used for the classification of impaired lung function in older subjects. The alternatively discussed reference equations of the SALPADIA Study, of NHANES and partially of the LuftiBus Study are higher, but do not cover all the necessary parameters and/or age ranges. A multicentric study for contemporary reference values should be performed in order to solve the problems concerning valid reference values.

Estudiantes universitarios estadounidenses de español están expuestos a la imagen mental de asociaciones para diferenciar los usos de los verbos 'ser' y 'estar'. Los usos de estos verbos presentar desafíos especiales para angloparlantes para quienes el verbo "ser" se usa generalmente para tanto 'ser' como 'estar'. Este estudio demuestra que los estudiantes con una breve exposición a las imágenes visuales asociadas con los usos de "ser" y "estar" muestran una mejora en su habilidad para distinguir el uso correcto de cada verbo sobre los estudiantes sin dicha exposición. Los resultados del estudio apuntan el valor de incluso una breve exposición a imágenes mentales y visuales asociaciones para aumentar la capacidad de aprendizaje de los estudiantes para los puntos especialmente difíciles de gramática en un segundo idioma. El estudio puede ser replicado y aplicado a otros dificultades gramaticales en el aprendizaje del español y otras segundas lenguas.

Anterior rhinomanometry (aR) is the standard method for measurement of nasal resistance, but it has some drawbacks because it requires full co-operation of the patient and the results are disturbed by forced ventilation due to stenosis. The patient must generate flow by active ventilation. Resistance results from the flow/pressure ratio. Forced oscillation technique (IOS) does not affect spontaneous breathing. Flow/pressure ratio is generated externally by a loudspeaker. IOS measures not only resistance but also reactance. Whereas former methods used only a single frequency IOS is capable of applying and analysing frequencies between 0 and 100 Hz. The range from 5 to 35 Hz is useful for diagnostic issues. We compared IOS with aR in nasal provocation tests with histamine and checked the sensitivity of resistance (R) and reactance (X) at different frequencies.20 patients (13 m, 7 f) underwent nasal challenge test using increasing doses of histamine (max. 3.2 mg). Resistance (aR, IOS) and reactance (IOS) were measured parallel. To compare the two methods, we calculated the dose of histamine which is required to double nasal resistance.1. IOS demonstrates the increase of R at all frequencies. 2. The highest increase of R is measured at a frequency of 5 Hz (5 Hz: NaCl 0.41 +/- 0.25; Hist. 1.26 +/- 0.57; 35 Hz: NaCl 0.36 +/- 0.172; Hist. 0.60 +/- 0.1 kPa/l/s, p0.001). 3. The critical dose is significantly lower in IOS than in aR (2.29 +/- 2.59 vs. 1.06 +/- 1.16 mg/ml, p0.02). 4. Basal values of R do not differ significantly between aR and IOS (0.37 +/- 0.12 vs. 0.41 +/- 0.25 kPa/l/s, p0.001).We conclude from our results that IOS is at least equivalent to aR in measuring nasal resistance. R at 5 Hz is the most important parameter in IOS. IOS is less dependent on the cooperation of the patient. In case of stenosis it does not require forced ventilation to achieve the required flow-pressure ratio.

Diurnal profiles of impulse oscillometry during 24 hours in 3 hour intervals in sitting and lateral lying position have been studied in 20 healthy female and male probands 10-67 years of age. Approximating the profiles by a sine-cosine-function the amplitude of resistance was found up to 3, that of reactance up to 1 hPa/l/s in single cases, preferably for end-expiratory values and for the resistance-flow- and the resistance-volume-gradients, more pronounced in lying than in sitting position. The daytime reaching maxima of resistance and minima of reactance is different in single individuals. Single persons with obviously high vitality or sensibility showed very high amplitudes reproducible within IOS measuring limits of 0.2 hPa/l/s after 6 months.

The technical adaptation of the Impulse-Oscillometry (IOS) to different conditions of measurement allows a wide range of applications so that even questions of peripheral user groups using lung function tests can be answered. Thus, the variable connection of the IOS head via fold hose opens the field of bedside measurements and additional applications in pediatrics, intensive care and veterinary medicine. Rhinomanometric examinations are possible with little expenditure and high practicability using nasal tips.

To assess diurnal profiles of impulse-oscillometry (IOS) changes of IOS-parameters between different body positions have been studied using a special set IOS-Bedside for individual home care. IOS has been applied in lateral lying and in sitting position in 20 healthy female and male probands, aged 10-67, during 24 hours in intervals of 3 hours. In each test during normal breathing for approximately 30 sec about 130 spectral and structural analyses have been performed at an impulse distance of 0.2 sec. The global means of resistance at 5 Hz (R5) in lying position are in men about 0.6 and in women about 0.3 hPa/l/s higher than in sitting position, those of reactance in men and women are only about 0.2 hPa/l/s lower. There is a distinct diurnal periodicity of the differences. The maxima of them may occur at different hours of the day in single probands; but at the average mean the maxima are found at the end of night. The differences of oscillation parameters between lying and sitting position are bigger at end-expiration than at end-inspiration. The resistance-flow-gradients, representing the component of turbulent flow, are enlarged in lying position especially at night.

Increased use of gases in retinal/vitreous surgery requires a good clinical estimate of intraocular gases. This is needed, if a supplement of gas is intended, its disappearance to be predicted (e.g. to 10% to permit travelling by plane) or the amount to be calculated to cover a break. Clinical estimation of gas in the pupil is limited by its size. Accuracy of pupil measurements will be tested and compared with experimental results obtained by estimating the level of gas meniscus at the retina.Ten cadaver eyes (5 phakic, 4 aphakic, 1 pseudophakic) were fixed in a plastic mold, vitrectomized and injected with multiple randomized volumes of air. Two observers measured the level of meniscus in disc diameters above or below the superior margin of disc and then anteriorly in the pupil in millimeters from the superior limbus. Measurements were converted to milliliters through tables constructed on mathematical models of the phakic and aphakic eye.Observations at the retina and in the pupil were equally accurate for intermediate gas volumes, for which the meniscus fell within the pupil (P = 0.372). Measurements at the retina proved less vulnerable to error induced by misalignment of the observer's eye. Above the pupil observations at the retina were still reliable for small bubbles up to 4 dd above the disc (error5% in the aphakic,10% in the phakic eye). Below the pupil observations at the retina yielded a result increasing less than the injected volume because of refraction at the anterior segment gas interface (error10% of the ocular volume).Observations of the level of gas meniscus at retina with indirect ophthalmoscopy is an accurate method for estimating intraocular gas volumes. It extends the range of measurement significantly beyond the pupil. Tables based on a mathematical model convert disc diameters to milliliters.

Against the background of the working hypothesis of the 1-parametric Siregnost FD 5 forced oscillation technique-phase angle psi may be invariant in a clinical reference population-the hypothetical straight Ros-P line is in good agreement with the crowd of extremely nonlinear Rre-P-lines only within narrow limits. Neglecting phase angle measurements it might be useful to insert a known linear resistor into the airway to determine the pertaining Rre-P relation. In spite of selective tuning to the oscillation frequency of 10 Hz there is full sensitivity to stationary flow; alinear stationary flow characteristics of resistors can be readily determined by forced oscillation. There is a marked improvement in the P-psi/Rre-phi-evaluating system with respect both to the symmetry of phase angle and unequivocality of pressure when the reference phase angle alpha is shifted from 81 degrees to 0 degrees. Using digital data acquisition and processing, a flexible evaluation technique with monitor-oriented test management, automatical calculation of secondary values and multidimensional presentation of results on a graphical display is provided, which has proved its worth in experimental and clinical-physiological studies.

A report is given of laser-trabeculoplasty in 62 eyes of 53 patients. Results suggest that approximately 25% of eyes were not improved. In the 75% which were improved, the majority needed to carry on with treatment, but approximately 11% of the total were able to stop all treatment.

In three groups of healthy subjects and patients with pulmonary fibrosis or pulmonary emphysema, the secondary periodical oscillatory phenomena observed under conditions of normal breathing and a slow VC manoeuvre on the Siregnost FD 5 were broken down into a volume- and a flow-synchronous component, as also a third component with no correlation with either volume or flow, and which can be observed in the primary parameters Ros and psi, as also the secondary parameters Rre and phi. While both fibrotic patients and healthy subjects revealed a volume-inverse phase behaviour, patients with pulmonary emphysema revealed a volume-proportional phase behaviour. This difference in volume dependence is explained by the difference in elastic recoil in patients with fibrosis as compared with those suffering from emphysema, and the associated different influence on the filling of the lungs with air and blood.