The cost of running a heat wave warning system for Philadelphia were practically at the "noise" level compared to the economic benefits of saving I 17 lives in three years. S evere and sustained episodes of summer heat are associated with increased morbidity and mortality, particularly in temperate regions. The death toll in an unprepared region can be substantial. For example, during 1-14 July 1993, the eastern United States experienced a severe heat wave with high temperatures (33.9°-38.3°C) and high humidity (36%-58%) (Centers for Disease Control and Prevention 1994). During 6-14 July, the Philadelphia, Pennsylvania, Medical Examiner's Office determined that 118 deaths were heat related (either a core body temperature of 40.6°C or higher, or a body found in a hot, unventilated environment). This is certainly an un
Last summer, Philadelphia, Pennsylvania, instituted a new Hot Weather-Health Watch/Warning System (PWWS) to alert the city's residents of potentially oppressive weather situations that could negatively affect health. In addition, the system was used by the Philadelphia Department of Public Health for guidance in the implementation of mitigation procedures during dangerous weather. The system is based on a synoptic climatological procedure that identifies "oppressive" air masses historically associated with increased human mortality. Airmass occurrence can be predicted up to 48 h in advance with use of model output statistics guidance forecast data. The development and statistical basis of the system are discussed, and an analysis of the procedure's ability to forecast weather situations associated with elevated mortality counts is presented. The PWWS, through greater public awareness of excessive heat conditions, may have played an important role in reducing Philadelphia's total heat-related deaths during the summer of 1995.
Abductor, adductor, and combined reinnervation procedures have been explored with variable success rates. We describe the experience of a tertiary care center with adductor reinnervation procedures, including preoperative and postoperative videostroboscopy and electromyography (EMG) findings. A retrospective chart review was performed from 1997 to 2001 that included 9 patients. Preoperative and postoperative voice comparison was performed by 3 blinded speech pathologists. Clinical comparisons of videostroboscopy findings for vocal fold bulk, tone, position, presence of gap, and movement are elucidated. The preoperative and postoperative EMG findings are described. In all patients, preoperative EMG revealed a dense, complete denervation of the affected recurrent laryngeal nerve. No movement was noted on videostroboscopy with persistent glottic gap. Reinnervation involved a nerve-muscle pedicle or a direct neurorrhaphy of the ansa cervicalis to the recurrent laryngeal nerve. Voice improvement was noted between 60 days and 3 months after reinnervation. Four postoperative EMG studies were performed. An early postoperative EMG study at 5 months revealed activation of the lateral cricoarytenoid muscle and thyroarytenoid muscle with head-lift. Videostroboscopy showed excellent near-midline static positioning of the vocal fold. Late EMG studies, performed 12 to 16 months after reinnervation, revealed "learning" of these muscles, with new activation on "eee" phonation. We conclude that recurrent laryngeal nerve reinnervation procedures belong in the armamentarium of the laryngologist for the treatment of vocal fold paralysis. The EMG findings reported in this study suggest that ongoing reinnervation allows for activation with phonation in matured neuronal anastomoses. Overall, this procedure results in excellent patient acceptance and near-normal vocal quality.
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