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Purpose: We tested "the Galker test", a speech reception in noise test developed for primary care for Danish preschool children, to explore if the children's ability to hear and understand speech was associated with gender, age, middle ear status, and the level of background noise., Methods: The Galker test is a 35-item audio-visual, computerized word discrimination test in background noise. Included were 370 normally developed children attending day care center. The children were examined with the Galker test, tympanometry, audiometry, and the Reynell test of verbal comprehension. Parents and daycare teachers completed questionnaires on the children's ability to hear and understand speech. As most of the variables were not assessed using interval scales, non-parametric statistics (Goodman-Kruskal's gamma) were used for analyzing associations with the Galker test score. For comparisons, analysis of variance (ANOVA) was used. Interrelations were adjusted for using a non-parametric graphic model., Results: In unadjusted analyses, the Galker test was associated with gender, age group, language development (Reynell revised scale), audiometry, and tympanometry. The Galker score was also associated with the parents' and day care teachers' reports on the children's vocabulary, sentence construction, and pronunciation. Type B tympanograms were associated with a mean hearing 5-6dB below that of than type A, C1, or C2. In the graphic analysis, Galker scores were closely and significantly related to Reynell test scores (Gamma (G)=0.35), the children's age group (G=0.33), and the day care teachers' assessment of the children's vocabulary (G=0.26)., Conclusions: The Galker test of speech reception in noise appears promising as an easy and quick tool for evaluating preschool children's understanding of spoken words in noise, and it correlated well with the day care teachers' reports and less with the parents' reports., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Purpose: This study evaluates initial validity and reliability of the "Galker test of speech reception in noise" developed for Danish preschool children suspected to have problems with hearing or understanding speech against strict psychometric standards and assesses acceptance by the children., Methods: The Galker test is an audio-visual, computerised, word discrimination test in background noise, originally comprised of 50 word pairs. Three hundred and eighty eight children attending ordinary day care centres and aged 3-5 years were included. With multiple regression and the Rasch item response model it was examined whether the total score of the Galker test validly reflected item responses across subgroups defined by sex, age, bilingualism, tympanometry, audiometry and verbal comprehension., Results: A total of 370 children (95%) accepted testing and 339 (87%) completed all 50 items. The analysis showed that 35 items fitted the Rasch model. Reliability was 0.75 before and after exclusion of the 15 non-fitting items. In the stepwise linear regression model age group of children could explain 20% of the variation in Galker-35-score, sex 1%, second language at home 4%, tympanometry in best ear 2%, and parental education another 2%. Other variable did not reach significance., Conclusion: The Galker-35 was well accepted by children down to the age of 3 years and results indicate that the scale represents construct valid and reliable measurement., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: Curriculum reforms in medical schools require cultural and conceptual changes from the faculty., Aims and Methods: We assessed attitudes towards curriculum reforms in different academic, economic, and social environments among 776 teachers from 2 Western European medical schools (Belgium and Denmark) and 7 medical schools in 3 countries in post-communist transition (Croatia, Slovenia, Bosnia and Herzegovina). The survey included a 5-point Likert-type scale on attitudes towards reforms in general and towards reforms of medical curriculum (10 items each)., Results: Teaching staff from medical schools in Bosnia and Herzegovina had a more positive attitude towards reforms of medical curriculum (mean score 36.8 out of maximum 50 [95% CI 36.1 to 37.3]) than those from medical schools in Croatia or Slovenia (30.7 [29.8 to 31.6]) or Western Europe (27.7 [27.1 to 28.3]) (P < 0.001, ANOVA). Significant predictors of positive attitudes towards medical curriculum reform in post-communist transition countries, but not in Western European schools, was younger age, as well as female gender in Bosnia and Herzegovina., Conclusions: Factors influencing faculty attitudes may not be easy to identify and may be specific for different settings. Their identification and management is necessary for producing sustainable curriculum reform.

Objectives: To perform internal and external evaluations of all 5 medical schools in Bosnia and Herzegovina against international standards., Methods: We carried out a 2-stage survey study using the same 5-point Likert scale for internal and external evaluations of 5 medical schools in Bosnia and Herzegovina (Banja Luka, Foca/East Sarajevo, Mostar, Sarajevo and Tuzla). Participants consisted of managerial staff, teaching staff and students of medical schools, and external expert assessors. Main outcome measures included scores on internal and external evaluation forms for 10 items concerning aspects of school curriculum and functioning: 'School mission and objectives'; 'Curriculum'; 'Management'; 'Staff'; 'Students'; 'Facilities and technology'; 'Financial issues'; 'International relationships'; 'Internal quality assurance', and 'Development plans'., Results: During internal assessment, schools consistently either overrated their overall functioning (Foca/East Sarajevo, Mostar and Tuzla) or markedly overrated or underrated their performance on individual items on the survey (Banja Luka and Sarajevo). Scores for internal assessment differed from those for external assessment. These differences were not consistent, except for the sections 'School mission and objectives', 'Curriculum' and 'Development plans', which were consistently overrated in the internal assessments. External assessments was more positive than internal assessments on 'Students' and 'Facilities and technology' in 3 of 5 schools., Conclusions: This assessment exercise in 5 medical schools showed that constructive and structured evaluation of medical education is possible, even in complex and unfavourable conditions. Medical schools in Bosnia and Herzegovina have successfully formed a national consortium for formal collaboration in curriculum development and reform.

Background: As more and more information technology (IT) resources become available both for support of campus- based medical education and for Web-based learning, it becomes increasingly interesting to map the information technology resources available to medical students and the attitudes students have towards their use., Objective: To determine how extensively and effectively information handling skills are being taught in the medical curriculum, the study investigated Internet and computer availability and usage, and attitudes towards information technology among first-year medical students in Aarhus, Denmark, during a five-year period., Methods: In the period from 1998 to 2002, students beginning the first semester of medical school were given courses on effective use of IT in their studies. As a part of the tutorials, the students were asked to complete a web-based questionnaire which included questions related to IT readiness and attitudes towards using IT in studies., Results: A total of 1159 students (78%) responded. Overall, 71.7% of the respondents indicating they had access to a computer at home, a number that did not change significantly during the study period. Over time, the power of students' computers and the use of e-mail and Internet did increase significantly. By fall 2002, approximately 90% of students used e-mail regularly, 80 % used the Internet regularly, and 60 % had access to the Internet from home. Significantly more males than females had access to a computer at home, and males had a more positive attitude towards the use of computers in their medical studies. A fairly constant number of students (3-7 %) stated that they would prefer not to have to use computers in their studies., Conclusions: Taken together with our experience from classroom teaching, these results indicate optional teaching of basic information technology still needs to be integrated into medical studies, and that this need does not seem likely to disappear in the near future.

Static web pages may be easy to setup using text processors or user-friendly web editing software. However, some basic knowledge of the implementation (HTML) is usually needed for final editing and maintenance. As a result many static web pages are left without appropriate updating. With a database driven, dynamic approach web contents may change through user interaction, the pages are usually easier to maintain, and design elements are separated from contents. Database driven solutions (or content management systems) for larger organizations may be purchased at many different levels of complexity. For smaller systems, such as separate courses or projects, they may, however, be developed locally. The present study compares four alternative technologies for database driven web pages. Each technology offers advantages and disadvantages and many issues need to be considered when selecting platform. The present study demonstrates that database driven web pages may be effectively deployed using free Open Source software. Details may be found at www.intermed.dk/datadriven.

Background: The Wireless Application Protocol technology implemented in newer mobile phones has built-in facilities for handling much of the information processing needed in clinical work., Objectives: To test a practical approach we ported a relational database of the Danish pharmaceutical catalogue to Wireless Application Protocol using open source freeware at all steps., Methods: We used Apache 1.3 web software on a Linux server. Data containing the Danish pharmaceutical catalogue were imported from an ASCII file into a MySQL 3.22.32 database using a Practical Extraction and Report Language script for easy update of the database. Data were distributed in 35 interrelated tables. Each pharmaceutical brand name was given its own card with links to general information about the drug, active substances, contraindications etc. Access was available through 1) browsing therapeutic groups and 2) searching for a brand name. The database interface was programmed in the server-side scripting language PHP3., Results: A free, open source Wireless Application Protocol gateway to a pharmaceutical catalogue was established to allow dial-in access independent of commercial Wireless Application Protocol service providers. The application was tested on the Nokia 7110 and Ericsson R320s cellular phones., Conclusions: We have demonstrated that Wireless Application Protocol-based access to a dynamic clinical database can be established using open source freeware. The project opens perspectives for a further integration of Wireless Application Protocol phone functions in clinical information processing: Global System for Mobile communication telephony for bilateral communication, asynchronous unilateral communication via e-mail and Short Message Service, built-in calculator, calendar, personal organizer, phone number catalogue and Dictaphone function via answering machine technology. An independent Wireless Application Protocol gateway may be placed within hospital firewalls, which may be an advantage with respect to security. However, if Wireless Application Protocol phones are to become effective tools for physicians, special attention must be paid to the limitations of the devices. Input tools of Wireless Application Protocol phones should be improved, for instance by increased use of speech control.

The use MEDLINE and related resources of literature information has increased significantly with the increased availability and speed of the Internet. However, literature information is presented in many different ways via the Internet and search facilities and web addresses are frequently changed. Many physicians and medical researchers find it difficult to keep track of what is available and many lack skills in effective searching. The present paper presents an overview of the MEDLINE database and related databases available from the National Library of Medicine and searchable through PubMed and Internet Greatfull Med. We discuss strategies for searching MEDLINE and the coverage of MEDLINE related to that of related databases from the NLM and other sources.

The availability of full text medical journal articles is rapidly increasing with the increased availability of the Internet. The potentials of the new technology present researchers, publishers, and librarians with new problems and challenges. Some resources are made available free of charge, whereas others are distributed as parts of large licences negotiated between publishers and consortia of research libraries. How can researchers maintain an overview of the constantly changing resources? How can libraries cope with tasks rapidly redefined by the technology? And how can publishers survive when production and distribution of literature information, including the handling of peer reviewing, might just as well be performed by the researchers themselves or their organisations? The present paper presents some of the resources available and discusses both national and international projects and activities that deal with these questions.

Continuing evolution of computer-based multimedia technologies has produced QuickTime, a multiplatform digital media standard that is supported by stand-alone commercial programs and World Wide Web browsers. While its core functions might be most commonly employed for production and delivery of conventional video programs (e.g., lecture videos), additional QuickTime VR "virtual reality" features can be used to produce photorealistic, interactive "non-linear movies" of anatomical structures ranging in size from microscopic through gross anatomic. But what is really included in QuickTime VR and how can it be easily used to produce novel and innovative visualizations for education and research? This tutorial introduces the QuickTime multimedia environment, its QuickTime VR extensions, basic linear and non-linear digital video technologies, image acquisition, and other specialized QuickTime VR production methods. Four separate practical applications are presented for light and electron microscopy, dissectable preserved specimens, and explorable functional anatomy in magnetic resonance cinegrams.

Objective: We studied the socioeconomic background of children with juvenile chronic arthritis (JCA) diagnosed during the years 1988-91 in Denmark. The working hypothesis is that JCA may be triggered by one or several different infectious agents and that the amount of exposure to infectious agents in infancy and childhood affects the risk of JCA., Methods: In this case-control study, we investigated socioeconomic variables prior to disease onset from national registers, primarily the Fertility Database of Statistics Denmark, in a national cohort of all 220 known cases of JCA fulfilling the EULAR criteria incident during the years 1988-91, identified from national and local diagnosis registers. There were 4 controls per case, matched for sex, age, and county of residence. Socioeconomic variables as risk factors were quantified by odds ratios, which are equivalent to relative risks of contracting JCA if exposed to a risk factor., Results: Three socioeconomic variables were significantly and mutually independently associated with the risk of developing JCA during the following year. An only child had a risk of JCA 1.6 times that of a child with siblings. Children whose parents had a high income had a relative risk of 1.9. Children living in an urban flat had a risk 2.7 times that of children living on a farm. We found no space-time clustering of cases and no cyclical variations of incidence rates., Conclusion: The absence of clustering and of seasonal variation does not support a theory of triggering by infection. The hitherto unreported effects of the socioeconomic variables on the risk of JCA are of the same order of magnitude as reported for certain HLA alleles. Our findings do not lend full support to either of the 2 mechanisms, that growing up under either hygienic or unhygienic conditions increases the risk of JCA, and lack an obvious biological explanation.

Aims: To provide a 3-D description and basic morphometric data along the course of subcapsular proximal tubules., Methods: Proximal convoluted (PCT) and straight (PST) tubules were analyzed in series of up to one thousand 4-micron sections of perfusion-fixed rat renal cortex. Nine proximal tubules were traced through the sections by computer-assisted 3-D reconstruction. Selected sections were reembedded and resectioned for ultrastructural morphometry., Results: Subcapsular PCTs (n = 3) had a total length of 12.0 +/- 0.2 mm (SEM), formed tight clusters and contacted the renal surface from 5 to 10 times. In contrast, mid-cortical tubules (total PT length 11.6 +/- 0.1 mm) and in particular deep cortical tubules (total PT length 12.1 +/- 0.9 mm) extended laterally and intermingled considerably with neighboring tubules. Epithelial height gradually decreased from around 11 microns in the PCT to 7.5 microns in the end of the PST. Brush-border height was around 4 microns in the first PT segment (S1), 2.3 microns in the second segment (S2) and 4.5 microns in the end of the proximal tubule. Tubular wall volume, excluding microvilli, decreased from around 1,450 micron3/microns tubule length in early PCT to 825 micron3/microns in terminal PST., Conclusions: The results provide, at precisely defined nephron levels, quantitative ultrastructural data relevant to transport physiology.

The ultrastructure of intercalated cells in the rat renal cortex was investigated after 7 days of treatment with the mineralocorticoid inhibitor spironolactone. In untreated and treated animals, two subgroups of IC cells (A-IC and B-IC) could be recognized by electron microscopy, but a substantial fraction of IC cells that corresponded to neither A nor B forms, so-called NonA-NonB, was also found. After spironolactone treatment, qualitative and morphometric analyses showed a decrease in volume density of mitochondria, in cell cross-sectional area, and in boundary length of basolateral membranes in A-IC cells. Among the NonA-NonB-IC cells, some revealed especially abundant mitochondria. Although the frequency of NonA-NonB-IC cells did not change significantly, these mitochondria-rich cells appeared with increased frequency after spironolactone treatment. The ultrastructural changes in A-IC cells might reflect a direct effect of spironolactone on the A-IC cells. However, it is also conceivable that the changes are secondary to functional alterations induced in neighboring segment-specific cells by the experimental conditions.

The effects of bafilomycin, an inhibitor of the vacuolar-type (V-type) proton pump, on nephron ultrastructure and acidification were analyzed in isolated perfused kidneys from rats with acute metabolic acidosis. Acidic intracellular compartments were labelled with the weak base DAMP, that was subsequently visualized immunocytochemically. The distribution of the proton pump was studied by immunocytochemistry. Bafilomycin inhibited urinary acidification and caused pronounced ultrastructural changes in proximal tubule cells and B-type intercalated cells (B-IC cells). Immunoreactivity for DAMP showed that bafilomycin also inhibits intracellular acidification. The distribution of the proton pump was essentially unchanged by bafilomycin in A-IC cells. In B-IC cells, immunoreactivity accumulated over studded membrane material in the apical cytoplasm. The results indicate that the V-type proton pump is important both for intracellular and for urinary acidification.

The aim of the study was to estimate the incidence of Kawasaki's disease and to describe the clinical manifestations and the prognosis of the disease in children in Denmark during the period 1981-1990. In a register of all hospital admissions in Denmark, 99 patients were registered as having Kawasaki's disease. Of those, 89 patients fulfilled the clinical diagnostic criteria. The mean incidence of the ten year period was 1.0 per 100,000 children per year. The incidence of the disease decreased in the age group from zero to seven years after which it was rarely observed. Typical laboratory findings were hypersedimentation, leucocytosis and thrombocytosis. Eight children had cardiomegaly and three had electrocardiographic changes. Echocardiography was performed in 66 patients showing coronary artery aneurysms in nine patients (14%) (six boys and three girls). No further cardiac complications were found.

Background: Functional investigations of the tubulo-glomerular feedback mechanism have indicated the existence of a contact between the distal nephron and the macula densa region. The structural justification of such a contact is investigated., Experimental Design: Tubule-tubule and tubule-arteriole contacts were investigated in distal nephrons from normal rat kidneys. Computer-assisted three-dimensional reconstructions of distal nephrons were made from serial sections of renal cortical tissue and selected sections were examined by electron microscopy., Results: In 14 of 15 reconstructed nephrons, the distal convoluted tubule or the connecting tubule approached the macula densa region. A wall-to-wall contact between two tubules corresponding to a three-dimensional distance below 28 microns between the axes of the two tubules was found in only five of the reconstructed tubules. The distal nephron contacts to afferent and efferent arterioles of the same nephron were also examined. The efferent arteriole revealed no consistent contacts but the afferent arteriole contacted the distal convoluted tubule/connecting tubules consistently in all 10 of the superficial nephrons and in 3 of 5 midcortical nephrons. Electron microscopy confirmed a close contact between the distal tubule and the afferent arteriole in superficial nephrons and small nerves were often found at or near the site of contact, but the morphology at the site of contact was not unique. The arteriole contacts were made with late distal convoluted tubules, connecting tubules, or cortical collecting ducts., Conclusions: In conclusion, the present study shows that tubule-tubule contacts are inconsistent between the macula densa region and the distal nephron but that the tubule-afferent arteriole contact is consistent and close in superficial nephrons. This morphology is compatible with the existence of a feedback mechanism between the superficial distal nephron and the afferent arteriole, apart from the one located at the juxtaglomerular apparatus.

Forty patients (age range 60-79 yr) undergoing transurethral surgery were allocated randomly to receive 0.5% plain bupivacaine 4 ml at the L2-3 (n = 20) or L4-5 (n = 20) space. The solution was injected over 30 s with the patient in the sitting position. The patient was kept sitting for 2 min, then placed supine and, 5 min later, placed in the lithotomy position. No significant differences were found in onset time, extent and duration of analgesia or duration of motor block.

The structural responses of cells in the distal convoluted, connecting, and collecting tubule to acute acid/base changes were investigated by electron microscopy. Acute metabolic acidosis was induced by administration of ammonium chloride, and acute metabolic alkalosis by potassium or sodium bicarbonate. Morphometric analyses were performed on micrographs of randomly selected distal nephron cells. No structural responses were found in distal convoluted tubule cells, connecting tubule cells, or principal cells but prominent changes were observed in intercalated cells (I cells). Thus, the surface density of the luminal membrane in I cells was significantly higher in acidotic animals and lower in KHCO3 alkalotic animals than in controls. On the contrary, the surface density of the membrane that bounds apical vesicles was higher in KHCO3 alkalotic and lower in acidotic animals than in controls. These results suggest that the luminal membrane is internalized during alkalosis and that the membrane that bounds apical vesicles is transferred to the luminal membrane during acidosis. Since a proton translocating ATPase may be present in the luminal membrane the observations are consistent with the possibility that cortical I cells participate in the maintenance of acid/base homeostasis.

A method is described for ultrastructural analysis of renal tubules after precise identification of tubule segments by computerized 3-D reconstruction at the light microscope level. Semithin serial sections were cut of entire nephrons and 3-D coordinate information was obtained by digitization of tubule cross sections in the semithin sections. With the aid of the computer the tubule axis was traced from one section to the other. Precise lengths and positions of the tubules in three dimensions were calculated and stereoscopic images generated. The method was used to analyze the 3-D structure of developing human nephrons, and the ultrastructural development of the proximal tubule. Ultrastructural segmentation of the proximal tubule was demonstrated in the human fetal nephron in developmental stage IV.

Distal nephron segments in the rat renal cortex contain distal convoluted tubule cells (DCT cells), connecting tubule cells (CNT cells), intercalated cells (I cells), and principal cells (P cells). The present study was carried out to expand present knowledge on the ultrastructure of these cells. The cells were sampled from superficial cortex and analyzed by electron microscopy. Several morphometric parameters were determined and statistical comparison between cell types was performed. Significant structural differences between the cell types were demonstrated. DCT cells showed the highest volume density of mitochondria whereas the amplification of basolateral membranes was higher in CNT cells than in I and P cells. The surface density of the membrane that bounds intermediate vesicles in the apical cytoplasm was twofold higher in I cells than in the other cell types. The morphological differentiation found in the present study adds to available evidence indicating a functional differentiation between the cell types and provides a reference for structure-function correlations in these cells.

The effect of employing different interspaces for lumbar puncture during spinal anaesthesia was evaluated in 40 patients receiving 4 ml of 0.5% plain bupivacaine at level L2/L3 or L4/L5. No differences were observed in onset, spread or duration of analgesia. Furthermore, we found that only 80% of the patients, independently of the interspace used, had a cephalad spread to T8 and conclude that spinal anaesthesia using plain bupivacaine is not ideal for supraumbilical surgery.

Lithium treatment is known to cause tubule dilation in distal nephron segments both in rat and in man. However, due to the heterogeneous cell composition of the distal nephron and the cellular changes following lithium treatment, it has been difficult to identify the structurally changed segments. In this study we have therefore applied computer-assisted reconstruction of cortical distal nephron segments. Tubule dilation was demonstrated in connecting and initial collecting tubules and in the first part of cortical collecting ducts (CCD) whereas it was absent from distal straight and distal convoluted tubules. Principal cells (P cells) in the CCD showed swelling of the cytoplasm, accumulation of actin-like microfilaments, and abnormal arrangements of basolateral membranes. Connecting tubule cells (CNT cells) showed similar but less pronounced changes. Intercalated cells (I cells) showed an accumulation of vesicles in the apical cytoplasm and a reduced luminal surface area. Lesions in P and CNT cells may, at least in part, explain the diabetes insipidus and sodium loss found during lithium treatment. Proton secretion in I cells is probably mediated by an ATPase present in the luminal membrane. The reduction in area of this membrane may explain why lithium-treated animals have a lowered ability to excrete an acid load.

The ultrastructure of superficial distal nephron segments was analyzed after precise localization of tubule cross sections using computer-assisted three-dimensional reconstructions. Five systems of tubules, each with three interconnected distal tubules, were reconstructed and the lengths of the post macula densa segment of the distal straight tubule (DST), the distal convoluted tubule (DCT), the connecting tubule (CNT), and the initial collecting tubule (ICT) were determined. Each cortical collecting duct (CCD) was in continuity with only one tubule in contact with the renal capsule. In three of the five reconstructions, the two nonsubcapsular tubules fused and had a common connection to the subcapsular tubule. The length, between the macula densa (MD) and the confluence, of subcapsular tubules (2.68 +/- 0.15 mm) significantly exceeded the length of tubules not in contact with the renal capsule (2.05 +/- 0.10 mm). This difference was mainly due to a longer ICT in subcapsular tubules. Subcapsular tubules always contacted the renal capsule in the early DCT and often again in the ICT. Cells in the early DCT showed more microvilli on the luminal surface and more infoldings of basolateral membranes than cells in the late DCT. The ultrastructure of intercalated cells (I cells) varied within a range of different manifestations and the ultrastructural variation of I cells was similar in all the analyzed tubule segments. Connecting tubule cells and principal cells were similar in ultrastructure in all tubule segments and cortical levels analyzed.