Gastroesophageal reflux (GER) is common among patients with asthma, and it has been speculated that high GER may exacerbate asthma in some. This study was designed to determine if suppression of acid reflux in patients with asthma would improve pulmonary function. A double-blind, placebo-controlled crossover study design was used to determine the effect of GER suppression with omeprazole (20 mg twice daily) on pulmonary function among asthmatic patients with esophagitis. Four of 15 (27%) asthma patients with GER were shown to have a > or = 20% net improvement in pulmonary function (FEV1) after treatment for six weeks with omeprazole. These results indicate that some patients with asthma and GER will have improved pulmonary function when acid GER is treated with omeprazole.

Significant upper gastrointestinal disease is identifiable among most premenopausal women with IDA (18 of 19 or 95%), even when careful evaluation by a specialist in gynecology suggests a gynecological source. Upper endoscopy should be considered in the evaluation of all premenopausal women with IDA expressing digestive complaints or in those with IDA refractory to iron supplementation. Lower endoscopic examination may be reserved for those women with symptoms or signs suggestive of colorectal disorders.

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The purpose of this study is to determine if frequent reflux events from an incompetent LES or poor clearance from decreased peristalsis is the predominant abnormality in PSS patients with severe reflux esophagitis. Seven patients with both classic manometric findings of PSS and endoscopic findings of esophageal ulcerations and/or Barrett's esophagus were compared to nine patients with similar endoscopic findings but with no evidence of a connective tissue disorder. All patients underwent simultaneous intraesophageal pH monitoring and scintigraphy for a total of 40 min after a radiolabeled meal. Four of the PSS patients and all the non-PSS patients had simultaneous manometry. We found that PSS patients had significantly fewer reflux events (P less than 0.01), but the reflux events had significantly longer duration (P less than 0.01) compared to patients with similar severity of esophagitis and no connective tissue disease. We conclude that decreased smooth muscle peristalsis appears to be the primary contributor to acid exposure and esophageal injury in PSS.

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Abstract:This essay investigates the relationships among scripts, schemata, and social norms. The authors examine how social norms are triggered by particular schemata and are grounded in scripts. Just as schemata are embedded in a network, so too are social norms, and they can be primed through spreading activation. Moreover, the expectations that allow a social norm’s existence are inherently grounded in particular scripts and schemata. Using interventions that have targeted gender norms, open defecation, female genital cutting, and other collective issues as examples, the authors argue that ignoring the cognitive underpinnings of a social norm can hamper the effectiveness of behavioral interventions.

Celiac disease appears to be more common among patients with insulin-dependent diabetes mellitus than in the general U.S. population (p less than 0.001). Two of the three patients with coexistent disease in this study had subclinical or latent celiac disease.

Access to information in electronic forms is currently difficult for blind people, but electronic information, particularly hypermedia, provide great potential to overcome the difficult ies that blind people have in accessing information. The E.U. funded ACCESS Project is developing tools to facilitate user interfaces which will be adaptable to the needs of different user groups. One demonstrator developed with these tools is a hypermedia system for blind students. This paper presents the initial designs for the hypermedia system which has a non-visual interface named DAHNI (Demonstrator of the ACCESS Hypermedia Non-visual Interface). DAHNI can be used with a variety of assistive inputioutput systems for blind users. Output from the system includes synthetic and digitised speech, non-speech sounds and refreshable Braille; input to the system can be via a small or large touchtablet, joystick, and/or conventional keyboard. This paper presents an evaluation of DAHNI by seven blind and partially sighted students. Plans for further development and evaluation of the system are also discussed.