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Rationale: Unrecognized airway infection and inflammation in young children with cystic fibrosis (CF) may lead to irreversible lung disease; therefore early detection and treatment is highly desirable., Objectives: To determine whether the lung clearance index (LCI) is a sensitive and repeatable noninvasive measure of airway infection and inflammation in newborn-screened children with CF., Methods: Forty-seven well children with CF (mean age, 1.55 yr) and 25 healthy children (mean age, 1.26 yr) underwent multiple-breath washout testing. LCI within and between-test variability was assessed. Children with CF also had surveillance bronchoalveolar lavage performed., Measurements and Main Results: The mean (SD) LCI in healthy children was 6.45 (0.49). The LCI was higher in children with CF (7.21 [0.81]; P < 0.001). The upper limit of normal for the LCI was 7.41. Fifteen (32%) children with CF had an elevated LCI. LCI measurements were repeatable and reproducible. Airway infection was present in 17 (36%) children with CF, including 7 (15%) with Pseudomonas aeruginosa. Polymicrobial growth was associated with worse inflammation. The LCI was higher in children with Pseudomonas (7.92 [1.16]) than in children without Pseudomonas (7.02 [0.56]) (P = 0.038). The LCI correlated with bronchoalveolar lavage IL-8 (R(2) = 0.20, P = 0.004) and neutrophil count (R(2) = 0.21, P = 0.001). An LCI below the upper limit of normality had a high negative predictive value (93%) in excluding Pseudomonas., Conclusions: The LCI is elevated early in CF, especially in the presence of Pseudomonas and airway inflammation. The LCI is a feasible, repeatable, and sensitive noninvasive marker of lung disease in young children with CF.

Providing continuing patient care when healthcare infrastructure has been damaged or destroyed requires careful advanced planning. Substantial numbers of patients will seek medical care during a disaster, including those injured during the acute phase of the disaster, those injured in recovery and evacuation attempts, and the chronically ill who have been displaced and do not have access to their medications. As a vital department of any healthcare facility, the Health Information Service (HIS) should have a planned response for retrieving medical records, and allocating new ones, should a disaster situation occur. Problems that may be encountered by the HIS at hospitals or healthcare facilities should be identified and responses that mitigate these problems should be discussed by staff and included in a disaster plan that can be activated in a timely manner. A disaster planning strategy for the management of medical records in health facilities is outlined in this paper.

The skills necessary to successfully perform radiological procedures in general dental practice are described and should be used as criteria when developing an effective undergraduate curriculum and as determinants of the contents of continuing education programmes. The present status of undergraduate curricula. continuing education, and postgraduate programmes as well as the recognition of the specialized nature of dento-maxillo-facial radiology, are discussed and recommendations for future developments are made.