Experiences of pursuing an intensivist career in regional and rural Australia: An interview study.

The regional and rural intensivist workforce is vital to delivering high standards of healthcare to all Australians. Currently, there is an impending workforce disaster, with higher senior medical officer vacancy rates among regional and rural intensive care units, with these units being staffed by junior doctors who are in earlier stages of their training, which in turn increases supervisory burden. There is a lack of comprehensive literature on the barriers and enablers of training, recruiting and retaining regional and rural intensivists. To address this gap, a qualitative study was conducted, involving 13 in-depth, structured interviews with full-time and part-time intensivists from eight Australian regional and rural hospitals. Content analysis of the interview data resulted in the identification of four major categories: unique practice context, need for a broad generalist skill set, perks and challenges of working in a regional/rural area and workforce implications. The study findings revealed that regional and rural intensive care practice offers positive aspects, including work satisfaction, supportive local teams and an appealing lifestyle. However, these benefits are counterbalanced by challenges such as a heavier burden of on-call work, a higher proportion of junior staff which increase supervisory burden and limited access to subspecialist services. The implications of these findings are noteworthy and can be utilised to inform government policies, hospitals, the College of Intensive Care Medicine and the Australian and New Zealand College of Anaesthetists in developing strategies to enhance the provision of intensive care services and improve workforce planning in regional and rural areas.

Modifications to rapid response team (medical emergency team) activation criteria and its impact on patient safety.

BACKGROUND: Modifications to rapid response team (RRT) activation criteria occur commonly in Australian hospitals without evidence to define their use. AIMS: To evaluate the effectiveness of RRT activation criteria modifications in preventing RRT activation and differences in adverse events associated with treatment delays caused by modifications. METHODS: A prospective chart audit of hospital patients with RRT activation criteria modifications admitted during a 12-month period in a large regional hospital in Toowoomba, Australia. The incidence of RRT activation criteria modifications, RRT activations and rates of adverse events following criteria modifications were investigated. Adverse events were defined as a delayed treatment on the ward, unplanned intensive care unit admission, cardiac arrest and unexpected death. Differences in patient outcomes among medical and surgical patients were also investigated. RESULTS: A total of 271 patients out of 4009 admitted patients had modifications to their RRT activation criteria. There was no difference in rates of RRT activation in patients with modified criteria compared with patients with unmodified criteria (P = 0.37). In patients with RRT activation criteria modifications, rates of adverse events were higher in patients who met their modified RRT criteria (93.3%) compared with those who did not meet modified RRT criteria (3.8%; P < 0.001). Additionally, in patients with modifications, rates of adverse events were higher in medical patients (27.6%; n = 50) compared with surgical patients (15.6%; n = 14; P = 0.03). CONCLUSIONS: The results strongly suggest that RRT criteria modification is associated with no difference in rates of RRT activation and with detrimental impacts on patient safety, particularly in medical patients.

The role of genetic essentialism and genetics knowledge in support for eugenics and genetically modified foods.

People are regularly exposed to discussions about the role of genes in their lives, despite often having limited understanding about how they operate. The tendency to oversimplify genetic causes, and ascribe them with undue influence is termed genetic essentialism. Two studies revealed that genetic essentialism is associated with support for eugenic policies and social attitudes based in social inequality, and less acceptance of genetically modified foods. These views about eugenics and genetically-modified foods were especially evident among people who had less knowledge about genes, potentially highlighting the value of education in genetics.

Considering cross-cultural differences in sleep duration between Japanese and Canadian university students.

Sleep is a fundamental biological process that all humans exhibit, and there is much evidence that people suffer adverse health outcomes from insufficient sleep. Despite this evidence, much research demonstrates significant heterogeneity in the amounts that people sleep across cultures. This suggests that despite serving fundamental biological functions, sleep is also subject to cultural influence. Using self-report and actigraphy data we examined sleep among European Canadian, Asian Canadian, and Japanese university students. Significant cultural differences emerged in terms of various parameters of sleep (e.g. sleep time), and beliefs about sleep (e.g. perceived relation between sleep and health). Despite sleeping significantly less than European Canadians, Japanese participants slept less efficiently, yet reported being less tired and having better health. Moreover, relative to European Canadians, Japanese participants perceived a weaker relation between sleep and physical health, and had a significantly shorter ideal amount of sleep. Asian Canadians' sleep behaviors and attitudes were largely similar to European Canadians suggesting that people acculturate to local cultural sleep norms.

Exploring people's thoughts about the causes of ethnic stereotypes.

Much research has shown that people tend to view genes in rather deterministic ways-often termed genetic essentialism. We explored how people would view the causes of ethnic stereotypes in contexts where human genetic variability was either emphasized or downplayed. In two studies with over 1600 participants we found that people viewed ethnic stereotypes to be more of a function of underlying genetics after they read an article describing how ancestry can be estimated by geographic distributions of gene frequencies than after reading an article describing how relatively homogeneous the human genome was or after reading a control essay. Moreover, people were more likely to attribute ethnic stereotypes to genes when they scored higher on a measure of genetic essentialism or when they had less knowledge about genes. Our understanding of stereotypes is a function of our understanding of genetics.

Making Sense of Genetics: The Problem of Essentialism.

"Psychological essentialism" refers to our tendency to view the natural world as emerging from the result of deep, hidden, and internal forces called "essences." People tend to believe that genes underlie a person's identity. People encounter information about genetics on a regular basis, as through media such as a New York Times piece "Infidelity Lurks in Your Genes" or a 23andMe commercial showing people acquiring new ethnic identities as the result of their genotyping. How do people make sense of new scientific findings that are inherently complex if they don't have years of specialized training and education at their disposal? Given the substantial overlap between a lay understanding of genetics and lay intuitions about essences, we argue that, when most people are thinking about genes, they are not really thinking about genes in the complex ways that good scientists are. Combating people's essentialist biases can be a formidable challenge. Although we have identified some promising results of trying to reduce people's genetic essentialist tendencies, there is still much to learn about how these essentialist biases can be countered. It is important to help people understand genetic information so they are able make well-informed decisions about their lives.

A Case Report of Preeclampsia Causing Severe Hyponatremia: Rare or Rarely Reported?

Preeclampsia presenting as severe hyponatremia is an enigma of modern obstetric practice. The hyponatremia can cause severe maternal neurological morbidity, including cerebral edema and seizures. Neonates, with serum sodium reflecting maternal levels, are also at risk. Despite this, the literature remains ambiguous about its incidence, the pathophysiology is poorly understood, and guidelines on preeclampsia (including those of the American College of Obstetricians and Gynecologists) do not discuss the issue. This case of preeclampsia associated with severe hyponatremia in a laboring woman highlights these issues.

Hepatotoxicity after paracetamol overdose in a patient with cystic fibrosis despite early acetylcysteine and utility of microRNA to predict hepatotoxicity.

CASE DETAILS: A 19-year-old girl presented to the emergency department following overdose of 10 g of paracetamol on a background history of cystic fibrosis. Paracetamol concentration was below the nomogram line, but was treated with acetylcysteine seven hours post-overdose given her symptomatology. Nineteen hours following her overdose she developed hepatotoxicity, despite early initiation of acetylcysteine. She was discharged well six days post-ingestion. On presentation, delta miRNA-122-miR483 was 20 times that of control patients, however, alanine aminotransferase was normal. DISCUSSION: Patients with cystic fibrosis are more likely to have glutathione deficiency, and greater susceptibility to liver injury. Delta miRNA may be a better detector of early liver injury than hepatic aminotransferases. Empiric treatment with acetylcysteine and serial biochemical reassessment in this setting should be considered.

Effect of Dexmedetomidine Added to Standard Care on Ventilator-Free Time in Patients With Agitated Delirium: A Randomized Clinical Trial.

IMPORTANCE: Effective therapy has not been established for patients with agitated delirium receiving mechanical ventilation. OBJECTIVE: To determine the effectiveness of dexmedetomidine when added to standard care in patients with agitated delirium receiving mechanical ventilation. DESIGN, SETTING, AND PARTICIPANTS: The Dexmedetomidine to Lessen ICU Agitation (DahLIA) study was a double-blind, placebo-controlled, parallel-group randomized clinical trial involving 74 adult patients in whom extubation was considered inappropriate because of the severity of agitation and delirium. The study was conducted at 15 intensive care units in Australia and New Zealand from May 2011 until December 2013. Patients with advanced dementia or traumatic brain injury were excluded. INTERVENTIONS: Bedside nursing staff administered dexmedetomidine (or placebo) initially at a rate of 0.5 µg/kg/h and then titrated to rates between 0 and 1.5 µg/kg/h to achieve physician-prescribed sedation goals. The study drug or placebo was continued until no longer required or up to 7 days. All other care was at the discretion of the treating physician. MAIN OUTCOMES AND MEASURES: Ventilator-free hours in the 7 days following randomization. There were 21 reported secondary outcomes that were defined a priori. RESULTS: Of the 74 randomized patients (median age, 57 years; 18 [24%] women), 2 withdrew consent later and 1 was found to have been randomized incorrectly, leaving 39 patients in the dexmedetomidine group and 32 patients in the placebo group for analysis. Dexmedetomidine increased ventilator-free hours at 7 days compared with placebo (median, 144.8 hours vs 127.5 hours, respectively; median difference between groups, 17.0 hours [95% CI, 4.0 to 33.2 hours]; P = .01). Among the 21 a priori secondary outcomes, none were significantly worse with dexmedetomidine, and several showed statistically significant benefit, including reduced time to extubation (median, 21.9 hours vs 44.3 hours with placebo; median difference between groups, 19.5 hours [95% CI, 5.3 to 31.1 hours]; P < .001) and accelerated resolution of delirium (median, 23.3 hours vs 40.0 hours; median difference between groups, 16.0 hours [95% CI, 3.0 to 28.0 hours]; P = .01). Using hierarchical Cox modeling to adjust for imbalanced baseline characteristics, allocation to dexmedetomidine was significantly associated with earlier extubation (hazard ratio, 0.47 [95% CI, 0.27-0.82]; P = .007). CONCLUSIONS AND RELEVANCE: Among patients with agitated delirium receiving mechanical ventilation in the intensive care unit, the addition of dexmedetomidine to standard care compared with standard care alone (placebo) resulted in more ventilator-free hours at 7 days. The findings support the use of dexmedetomidine in patients such as these. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01151865.

The double-edged sword of genetic accounts of criminality: causal attributions from genetic ascriptions affect legal decision making.

Much debate exists surrounding the applicability of genetic information in the courtroom, making the psychological processes underlying how people consider this information important to explore. This article addresses how people think about different kinds of causal explanations in legal decision-making contexts. Three studies involving a total of 600 Mechanical Turk and university participants found that genetic, versus environmental, explanations of criminal behavior lead people to view the applicability of various defense claims differently, perceive the perpetrator's mental state differently, and draw different causal attributions. Moreover, mediation and path analyses highlight the double-edged nature of genetic attributions-they simultaneously reduce people's perception of the perpetrator's sense of control while increasing people's tendencies to attribute the cause to internal factors and to expect the perpetrator to reoffend. These countervailing relations, in turn, predict sentencing in opposite directions, although no overall differences in sentencing or ultimate verdicts were found.

Can merely learning about obesity genes affect eating behavior?

Public discourse on genetic predispositions for obesity has flourished in recent decades. In three studies, we investigated behaviorally-relevant correlates and consequences of a perceived genetic etiology for obesity. In Study 1, beliefs about etiological explanations for obesity were assessed. Stronger endorsement of genetic etiology was predictive of a belief that obese people have no control over their weight. In Study 2, beliefs about weight and its causes were assessed following a manipulation of the perceived underlying cause. Compared with a genetic attribution, a non-genetic physiological attribution led to increased perception of control over one's weight. In Study 3, participants read a fictional media report presenting either a genetic explanation, a psychosocial explanation, or no explanation (control) for obesity. Results indicated that participants who read the genetic explanation ate significantly more on a follow-up task. Taken together, these studies demonstrate potential effects of genetic attributions for obesity.

Do scientific theories affect men's evaluations of sex crimes?

Evolutionary psychology accounts of gender differences in sexual behaviors in general and men's sexual aggression, in particular, has been criticized for legitimizing males' sexual misconduct. To empirically assess such critiques, two studies examined how men's judgments of male sex crimes (solicitation of sex from a prostitute; rape) are influenced by exposure to (a) evolutionary psychological theories and (b) social-constructivist theories. Across two studies, a consistent pattern emerged compared with a control condition (a) exposure to evolutionary psychology theories had no observable impact on male judgments of men's criminal sexual behavior, whereas (b) exposure to social-constructivist theories did affect judgments, leading men to evaluate sex crimes more harshly. Additional results (from Study 2) indicate that this effect is mediated by perceptions of male control over sexual urges. These results have implications for journalists, educators, and scientists. Aggr. Behav. 37:440-449, 2011. © 2011 Wiley-Liss, Inc.

Evidence for a sensitive period for acculturation: younger immigrants report acculturating at a faster rate.

Though recent adult immigrants often seem less acculturated to their new society than people who immigrated as children, it is not clear whether this difference is driven by duration of exposure or exposure during a sensitive developmental period. In a study aimed at disambiguating these influences, community and student samples of Hong Kong immigrants to Vancouver, Canada, completed the Vancouver Index of Acculturation, a measure that assesses respondents' identification with their mainstream and heritage cultures. A longer duration of exposure was found to be associated with greater identification with Canadian culture only at younger ages of immigration, but not at later ages of immigration. Conversely, identification with Chinese culture was unaffected by either age of immigration or length of exposure to Canadian culture. These findings provide evidence for a sensitive period for acculturation: People are better able to identify with a host culture the longer their exposure to it, but only if this exposure occurs when they are relatively young.

Information on the Internet about head injury pertaining to intensive care: less quantity and more quality is needed.

OBJECTIVE: Published data suggest that the quality of information on diseases accessible on the Internet using non-medical search engines is poor. Such data do not exist for illnesses requiring intensive care. This study investigated the accuracy of health information about head injury pertaining to intensive care on the Internet, and correlated website characteristics with the quality of their content. METHODS: A cross-sectional survey was conducted of the first 20 websites retrieved by the seven most frequently used search engines, with the information evaluated by two independent observers. Inter-observer reliability was evaluated using the kappa statistic. Website information on head injury was compared with "gold standard" guidelines from the Brain Trauma Foundation. Website characteristics were assessed, and their correlation with quality of website content was analysed. RESULTS: 58 websites were assessed. Weighted kappa for interobserver agreement on quality scores was 0.72. The median content score was 2 (interquartile range, 0-4) out of a possible maximum of 23. Logistic regression analysis suggested that medical authors, government sponsors, and being in the second 10 websites retrieved by a search engine were associated with higher website quality scores, while financial incentive and advertisement were associated with lower quality scores. CONCLUSION: This study demonstrated that information retrieved by the public on head injury from non-medical websites may be incomplete and inaccurate. It also identified website characteristics associated with poor content quality.