Solving School's Survey Request Overload.

Limited information is available on strategies for managing the large number of survey requests that reach an individual nursing school. This article addresses problems identified in managing survey requests and describes the implementation and evaluation of a solution. Identified problems included the appearance of endorsing studies of varying quality and rigor, overlap and competition between external study requests and internal studies, respondent burden, and level of anonymity and confidentiality. The solution included a school-wide policy for tracking and vetting study requests before they were distributed. Evaluation data show the number of requests received (total, by month and source, by target population), their disposition (withdrawn, approved, not approved for distribution), and quality improvement data on meeting a 30-day target turnaround time. Additional considerations are also discussed.

Soil CO2 emission in response to organic amendments, temperature, and rainfall.

Vegetated land surfaces play an important role in determining the fate of carbon in the global carbon cycle. However, our understanding of the terrestrial biosphere on a global scale is subject to considerable uncertainty, especially concerning the impacts of climatic variables on the carbon cycle. Soil is a source and also a sink of CO2 exchange and helps in carbon sequestration. Agricultural management practices influence soil water dynamics, as well as carbon cycling by changing soil CO2 emission and uptake rates. The rate of soil CO2 emission varies for different crops and different organic amendments. The major goal of this study was to assess the impacts of the type and rate of organic amendment on soil CO2 emission in a collard greens crop grown in the southeast Texas environment. Thirty-six plots were developed to grow collard greens on Prairie View A&M University's Research Farm. Three types of organic amendments (Chicken manure, Dairy manure, and Milorganite), at four levels of application (0, 168, 336, and 672 kg N/ha) were used and replicated three times. Each organic amendment type was applied to nine randomly selected plots. Three random plots were used as a control in each row. We measured daily soil CO2 emission for the first two weeks and every other day in a week during the experiment. We evaluated the effects of organic amendments and the application rates on soil CO2 emission for collard greens during two growing seasons. The results showed higher the application rates for each organic amendment, higher the CO2 emissions from the soil. The results also showed higher cumulative CO2 emissions for the soils amended with chicken manure and milorganite, but lowest for the soils amended with dairy manure. This field experiment and analyses help better understand the temporal and spatial variations of soil CO2 emission, and also help to develop best management practices to maximize carbon sequestration and to minimize soil CO2 emissions during the growth periods of collard greens under changing temperatures using different organic amendments, and application rates.

Validation of a classification system for causes of death in critical care: an assessment of inter-rater reliability.

OBJECTIVE: Trials in critical care have previously used unvalidated systems to classify cause of death. We aimed to provide initial validation of a method to classify cause of death in intensive care unit patients. DESIGN, SETTING AND PARTICIPANTS: One hundred case scenarios of patients who died in an ICU were presented online to raters, who were asked to select a proximate and an underlying cause of death for each, using the ICU Deaths Classification and Reason (ICU-DECLARE) system. We evaluated two methods of categorising proximate cause of death (designated Lists A and B) and one method of categorising underlying cause of death. Raters were ICU specialists and research coordinators from Australia, New Zealand and the United Kingdom. MAIN OUTCOME MEASURES: Inter-rater reliability, as measured by the Fleiss multirater kappa, and the median proportion of raters choosing the most likely diagnosis (defined as the most popular classification choice in each case). RESULTS: Across all raters and cases, for proximate cause of death List A, kappa was 0.54 (95% CI, 0.49-0.60), and for proximate cause of death List B, kappa was 0.58 (95% CI, 0.53-0.63). For the underlying cause of death, kappa was 0.48 (95% CI, 0.44-0.53). The median proportion of raters choosing the most likely diagnosis for proximate cause of death, List A, was 77.5% (interquartile range [IQR], 60.0%-93.8%), and the median proportion choosing the most likely diagnosis for proximate cause of death, List B, was 82.5% (IQR, 60.0%-92.5%). The median proportion choosing the most likely diagnosis for underlying cause was 65.0% (IQR, 50.0%-81.3%). Kappa and median agreement were similar between countries. ICU specialists showed higher kappa and median agreement than research coordinators. CONCLUSIONS: The ICU-DECLARE system allowed ICU doctors to classify the proximate cause of death of patients who died in the ICU with substantial reliability.

It is just a matter of application.

The Camilla Cavendish review of support worker education was clear that improving the quality of healthcare assistant (HCA) learning is central to delivering safe and effective care. Well trained staff should treat patients well, so the point of education and training must be to support HCAs to deliver effective care. But how to guarantee this?

Inhibition of defocus-induced myopia in chickens.

PURPOSE: To determine the effect of wearing a lens with a unique peripheral optical design on the development and progression of defocus-induced myopia in newly hatched chickens. METHODS: Eighty-five newly hatched chickens underwent bilateral retinoscopy and A-scan ultrasound to determine their refractive error and axial length. They were randomly divided into Control and two Test groups, in which each chicken was fitted with a goggle-lens over the right eye, with the left eye remaining untreated. The Control group wore a lens of power -10.00 diopters (D) of standard spherical optical design. The two Test lenses both had a central optical power -10.00 D, but used different peripheral myopia progression control (MPC) designs. For all groups, retinoscopy was repeated on days 3, 7, 10, and 14; ultrasound was repeated on day 14. RESULTS: On day 0 there was no statistical difference in refractive error (mean +6.92 D) or axial length (mean 8.06 mm) between Test and Control groups or treated and untreated eyes (all P 0.05). At day 14, 37 (43.5%) of 85 chickens had not experienced goggle detachment and were included in the final analyses. in this cohort there was a significant refractive difference between the treated eyes of the control group (n = 17) and those of test 1 (n = 14) and Test 2 (N = 6) groups (both P <0.01): Control -4.65 ± 2.11 D, Test 1 +4.57 ± 3.11 D, Test 2 +1.08 ± 1.24 D (mean ± SEM). There was also a significant axial length difference (both P < 0.01): Control 10.55 ± 0.36 mm, Test 1 9.99 ± 0.14 mm, Test 2 10.17 ± 0.18 mm. CONCLUSIONS: Use of these unique MPC lens designs over 14 days caused a significant reduction in the development of defocus-induced myopia in chickens; the degree of reduction appeared to be design specific.

How nursing support staff contribute to care.

It has been suggested that low nurse to patient ratios adversely affect patient outcomes. This article critically assesses evidence on the impact of nursing workforce skill mix on health outcomes and suggests that some caution should be exercised when drawing conclusions.

Infant EEG activity as a biomarker for autism: a promising approach or a false promise?

The ability to determine an infant's likelihood of developing autism via a relatively simple neurological measure would constitute an important scientific breakthrough. In their recent publication in this journal, Bosl and colleagues claim that a measure of EEG complexity can be used to detect, with very high accuracy, infants at high risk for autism (HRA). On the surface, this appears to be that very scientific breakthrough and as such the paper has received widespread media attention. But a close look at how these high accuracy rates were derived tells a very different story. This stems from a conflation between "high risk" as a population-level property and "high risk" as a property of an individual. We describe the approach of Bosl et al. and examine their results with respect to baseline prevalence rates, the inclusion of which is necessary to distinguish infants with a biological risk of autism from typically developing infants with a sibling with autism. This is an important distinction that should not be overlooked. Please see research article: http://www.biomedcentral.com/1741-7015/9/18 and correspondence article: http://www.biomedcentral.com/1741-7015/9/60.

An evaluation of the experience of integrated GP training placements in the Kent, Surrey and Sussex Deanery.

Innovative/integrated training posts (ITPs) are an increasingly established feature of vocational training for GPStRs. They aim to extend exposure to primary care in the early years of specialty training. To date, there has been little evaluation of the post and no studies investigating how ITPs are variously structured. This research of an ITP scheme operated by the Kent, Surrey and Sussex (KSS) Deanery is the first comprehensive study of ITPs across a whole deanery. The registrars on integrated placement, their GP trainers and hospital/community-based education supervisors took part in the study reported here. Participants reported integrated training to be an effective model to develop GPStRs. Early and extended exposure and orientation to primary care were seen as key benefits. The secondary placement component provided relevant specialist training applicable to primary care. ITPs provided GPStRs with relevant learning to support the requirements of the GP curriculum. Problems identified by previous research such as integration within teams were not reported as an issue in this study. Continuity issues were, however, highlighted. Reporting on the different ITP models utilised within the Deanery, we find that GPStRs with greater exposure to primary care perceive the programme as being more effective than those with less exposure.

Introducing a clinical pathway in fluid management.

Following the publication of the National Confidential Enquiry into Perioperative Death's (NCEPOD) report, Extremes of Age (NCEPOD 1999), several recommendations were made relating to the management of patients admitted via Accident and Emergency (A&E) with fractured necks of femur (NOF). An audit was carried out relating fluid management in the elderly. A multidisciplinary clinical pathway for patients with fractured NOF was produced. The audit was repeated in 2002, 2003 and 2005 to obtain data as to whether the pathway had improved the management of patients admitted with fractured NOF Comparing audit data between 2000 and 2005 there were significant reductions in the incidence of perioperative hypotension and an increase in the percentage of patients who were prescribed and received intravenous fluids (p<0.05). A protocol-based pathway produced as a result of a recommendation from NCEPOD has greatly improved the fluid management of patients admitted to a general hospital with fractures.

Making decisions for incapable adults 4: participation in research.

In the final article on the Mental Capacity Act 2005, Richard Griffith discusses the safeguards in place to protect incapable persons who may be the subject of a research study or clinical trial. District nurses and other health professionals who wish to conduct research involving people with incapacity will have a duty to apply the 2005 Act's safeguards to ensure that the research is lawful.

Theory of mind and the right cerebral hemisphere: refining the scope of impairment.

The neuropsychological and functional characterisation of mental state attribution ("theory of mind" (ToM)) has been the focus of several recent studies. The literature contains opposing views on the functional specificity of ToM and on the neuroanatomical structures most relevant to ToM. Studies with brain-lesioned patients have consistently found ToM deficits associated with unilateral right hemisphere damage (RHD). Also, functional imaging performed with non-brain-injured adults implicates several specific neural regions, many of which are located in the right hemisphere. The present study examined the separation of ToM impairment from other deficits associated with brain injury. We tested 11 patients with unilateral right hemisphere damage (RHD) and 20 normal controls (NC) on a humour rating task, an emotion rating task, a graded (first-order, second-order) ToM task with non-mentalistic control questions, and two ancillary measures: (1) Trails A and B, in order to assess overall level of impairment and set-shifting abilities associated with executive function, and (2) a homograph reading task to assess central coherence skills. Our findings indicate that RHD can result in a functionally specific deficit in attributing intentional states, particularly those involving second-order attributions. Performance on ToM questions was not reliably related to measures of cognitive impairment; however, performance on non-ToM control questions was reliably predicted by Trails A and B. We also discuss individual RHD patients' performance with attention to lesion locus. Our findings suggest that damage to the areas noted as specialised in neuroimaging studies may not affect ToM performance, and underscore the necessity of combining lesion and imaging studies in determining functional-anatomical relations.

The emergence of the social brain network: evidence from typical and atypical development.

Several research groups have identified a network of regions of the adult cortex that are activated during social perception and cognition tasks. In this paper we focus on the development of components of this social brain network during early childhood and test aspects of a particular viewpoint on human functional brain development: "interactive specialization." Specifically, we apply new data analysis techniques to a previously published data set of event-related potential (ERP) studies involving 3-, 4-, and 12-month-old infants viewing faces of different orientation and direction of eye gaze. Using source separation and localization methods, several likely generators of scalp recorded ERP are identified, and we describe how they are modulated by stimulus characteristics. We then review the results of a series of experiments concerned with perceiving and acting on eye gaze, before reporting on a new experiment involving young children with autism. Finally, we discuss predictions based on the atypical emergence of the social brain network.

Caregiving and our inner elder: insights from a spiritual master.

Dutch Priest Henri Nouwen, who died in 1996, has a large following of devoted readers. Though not formally a gerontologist, he wrote one small book Aging: the Fulfillment of Life, full of remarkable insights into the meaning of growing old. Two approaches to caring for older people have special resonance. First, a person must appropriate his or her own aging, coming to grips with one's aging self. Secondly, one must allow the old person to enter into one's own life. Incorporating these two principles into service of elders gives it a spiritual value that goes beyond merely routine contact.

When half of the population died: the epidemic of hemorrhagic fevers of 1576 in Mexico.

During the 16th century, Mexico suffered a demographic catastrophe with few parallels in world's history. In 1519, the year of the arrival of the Spaniards, the population in Mexico was estimated to be between 15 and 30 million inhabitants. Eighty-one years later, in 1600, only two million remained. Epidemics (smallpox, measles, mumps), together with war, and famine have been considered to be the main causes of this enormous population loss. However, re-evaluation of historical data suggests that approximately 60-70% of the death toll was caused by a series of epidemics of hemorrhagic fevers of unknown origin. In order to estimate the impact of the 1576 epidemic of hemorrhagic fevers on the population we analyzed the historical record and data from the 1570 and 1580 censuses of 157 districts. The results identified several remarkable aspects of this epidemic: First, overall, the population loss for these 157 districts was 51.36%. Second, there was a clear ethnic preference of the disease, the Spanish population was minimally affected whereas native population had high mortality rate. Third, the outbreak originated in the valleys of central Mexico whence it evolved as an expansive wave. Fourth, a positive correlation between altitude and mortality in central Mexico was found. Fifth, a specific climatic sequence of events was associated with the initiation and dissemination of the hemorrhagic fevers. Although the last epidemic of hemorrhagic fevers in Mexico ended in 1815, many questions remain to be answered. Perhaps the most relevant ones are whether there is a possible reemergence of the hemorrhagic fevers and how vulnerable we are to the disease.