Impact of patient handover structure on neonatal perioperative safety.

OBJECTIVE: To compare the incidence, severity, preventability, and contributing factors of non-routine events-deviations from optimal care based on the clinical situation-associated with team-based, nurse-to-nurse, and mixed handovers in a large cohort of surgical neonates. STUDY DESIGN: A prospective observational study and one-time cross-sectional provider survey were conducted at one urban academic children's hospital. 130 non-cardiac surgical cases in 109 neonates who received pre- and post-operative NICU care. RESULTS: The incidence of clinician-reported NREs was high (101/130 cases, 78%) but did not differ significantly across acuity-tailored neonatal handover practices. National Surgical Quality Improvement-Pediatric occurrences of major morbidity were significantly higher (p < 0.001) in direct team handovers than indirect nursing or mixed handovers. CONCLUSIONS: NREs occur at a high rate and are of variable severity in neonatal perioperative care. NRE rates and contributory factors were homogenous across handover types. Surveyed clinicians recommend structured handovers for all patients at every transfer point regardless of acuity.

Evolution of flowering decisions in a stochastic, density-dependent environment.

Demography is central to both ecology and evolution, and characterizing the feedback between ecology and evolution is critical for understanding organisms' life histories and how these might evolve through time. Here, we show how, by combining a range of theoretical approaches with the statistical analysis of individually structured databases, accurate prediction of life history decisions is possible in natural density-regulated populations undergoing large fluctuations in demographic rates from year to year. Our predictions are remarkably accurate and statistically well defined. In addition, we show that the predicted trait values are evolutionarily and convergence stable and that protected polymorphisms are possible.

Evaluation of postural stability in workers exposed to lead at a secondary lead smelter.

Postural sway testing was carried out on a group of 145 workers exposed to lead in a secondary lead smelter and 84 workers not exposed to lead in a hinge manufacturing plant. All workers were measured for blood lead levels (BLL) and erythrocyte zinc protoporphyrin (ZPP) concentrations at the time of testing and both a total cumulative and a time-weighted average BLL value was constructed for the lead exposed workers. The lead exposed workers mean BLL at the time of testing was 38.9 microg/dl and the non-exposed workers mean was 2.3 microg/dl. ZPP levels averaged 55.2 microg/dl for exposed workers and 18.9 microg/dl for non-exposed workers. Total cumulative BLL averaged 83476 microg/dl days for the exposed workers, with a mean time-weighted average BLL of 35.1 microg/dl. Six tests of postural stability, four two leg conditions and two single leg conditions were administered to all subjects using a force platform to produce measurements of sway for comparison purposes. The two leg conditions also manipulated the visual and proprioceptive systems. A statistically significant association was observed for sway measurements and the current BLL for all workers, but not with the current BLL of only the lead exposed workers. No statistically significant associations were present with the cumulative measures of long-term exposure. Of the six tests of sway, only the single leg conditions showed significant exposure effects. The results suggest effects of lead exposure among those with average BLL near 40.0 microg/dl, but only in the most challenging one leg conditions.

Are aluminium potroom workers at increased risk of neurological disorders?

OBJECTIVE: To determine whether long term potroom workers in an aluminium smelter are at increased risk of neurological disorders. METHODS: Cross sectional study of 63 current and former aluminium potroom workers first employed before 1970 and with at least 10 years of service. A group of 37 cast house and carbon plant workers with similar durations of employment and starting dates in the same smelter were used as controls. The prevalence of neurological symptoms was ascertained by questionnaire. Objective tests of tremor in both upper and lower limbs, postural stability, reaction time, and vocabulary were conducted. All subjects were examined by a neurologist. RESULTS: No significant differences in age, race, or education were found between the two groups. Although the potroom group had higher prevalences for all but one of the neurological symptoms, only three odds ratios (ORs) were significantly increased; for incoordination (OR 10.6), difficulty buttoning (OR 6.2), and depression (OR 6.2). Tests of arm or hand and leg tremor in both the visible and non-visible frequencies did not show any significant differences between the two groups. Testing of postural stability showed no definitive pattern of neurologically meaningful differences between the groups. There were no significant differences between the two groups in reaction time, vocabulary score, or clinical neurological assessment. CONCLUSIONS: The objective measures of neurological function provided little support for the finding of increased neurological symptom prevalences in the potroom workers, although increased symptoms may be an indicator of early, subtle neurological changes. The results provide no firm basis for concluding that neurological effects among long term potroom workers are related to the working environment, in particular aluminium exposure, in potrooms. These findings should be treated with caution due to the low participation of former workers and the possibility of information bias in the potroom group.

Management of multiple-antibody-mediated hyperthyroidism in children with Down's syndrome.

During a period of 7 years at our institution, four girls and one boy with Down's syndrome, ages 9 to 16 years, were examined and treated for hyperthyroidism. Two patients had Graves' disease and they responded to propylthiouracil (PTU) with a predictable clinical course resulting in remission within 4 years. The remaining three patients included in this report had hyperthyroid profiles similar to those of the two with Graves' disease except for their antibody panels. These patients, in addition to the elevated thyroid-stimulating immunoglobulin (TSI) level observed in Graves' disease, also had significantly elevated antimicrosomal antibody (AMA) and antithyroglobulin antibody (ATGA) at the time of diagnosis. Elevated TSI level was again present in two patients who had a recurrence of hyperthyroidism after PTU therapy was discontinued. Treatment of these three patients was best done with the continuation of PTU therapy at a lower dose and the addition of thyroxine as soon as mild hypothyroidism developed. Treatment with PTU and thyroxine was continued until the TSI level was no longer elevated. Levels of AMA and ATGA remained elevated long after the TSI level became normal. All three patients eventually had hypothyroidism and continue to require thyroxine replacement.

Psychosocial correlates of harassment, threats and fear of violence in the workplace.

OBJECTIVES: The purpose of this study was to investigate work climate factors and structural job aspects as predictors of workplace violence, with particular attention to the relative influence of both sets of factors. METHODS: Telephone survey data collected by a large midwestern insurance company were analyzed. Interviewers asked 598 full-time workers about their work climate, structural job aspects, and subject and workplace demographics, all of which were used as predictor variables in regression analyses. The participants were also asked about incidents of threats, harassment, physical attacks, and fear of becoming a victim of workplace violence, all of which were used as outcome measures. RESULTS: Separate logistic regressions were carried out for each of the outcome measures. The study identified a variety of factors which appear to place workers at risk of nonfatal occupational violence. Work climate variables, such as co-worker support and work group harmony, were predictive of threats, harassment, and fear of becoming a victim of violence. Structural aspects of the job, such as work schedule, were also significant in predicting threats and fear of becoming a victim of violence, but they were not predictive of harassment. CONCLUSIONS: This is the first study which suggests that both work climate and structural aspects of work may be important in promoting workplace violence. This finding suggests that intervention strategies should consider organizational and climate issues in addition to basic security measures.

The quality of regulated family day care homes and compliance with minimum standards.

A random sample of regulated family day care homes in Texas was examined for compliance with minimum standards. Each was rated on 27 quality aspects that were factor analyzed. Four major factors were identified: environment, caregiver comportment, childcare, and outside relations. Overall, quality and noncompliance were significantly and consistently related. The impact of several specific relationships between quality and noncompliance are discussed from a regulatory point of view, especially with regard to training.

Attribution difficulty and memory for attribution-relevant information.

This research compared the processing and retrieval of attribution-relevant information when the attributional inference is easy or difficult to make. Subjects attributed behavioral events to the person or to the situation, based on several items of context information. Each context sentence implied either the person or the entity as causal agent. When the attributional inference was difficult to make (an equal number of context sentences implied actor and entity as the causal agent), subjects recalled more of the behavioral events, recalled more context sentences, and were less confident in their attributions than when the attributional inference was easy to make (most context sentences implied the same causal agent). Subjects also recalled context information that was implicationally incongruent with the majority of the other context sentences with a higher probability than when that same information was implicationally congruent.

What do police officers really want from the mental health system?

A sample of 309 police officers in Cincinnati and Hamilton County, Ohio, were interviewed about their contacts with mentally ill individuals and about their need for various kinds of information and assistance from the mental health system. During a one-month period, almost 60 percent of the officers had responded to at least one call involving a presumably mentally ill person, and 42 percent had responded to more than one such call. Twenty-two percent had dealt with a presumably mentally ill person who was also mentally retarded. Police officers indicated that they most needed access to information about an individual's past history of violence or suicide attempts, and quick on-site assistance by mental health professionals in assessing suicidal or hostile mentally ill persons.

What do psychiatric emergency patients really want and how do they feel about what they get?

Psychiatric emergency patients range along a continuum from persons who present to the service with specific requests for help, to individuals who are brought to the service in handcuffs against their will for reasons they do not understand. In addition, studies suggest that psychiatric emergency patients' wishes and expectations often fall outside the traditional framework of psychiatric assessment, are not straightforward or concrete or are not accurately perceived by the clinicians who see them. How these factors impact on patient satisfaction with the treatment they have received is not well-understood, because the manner in which specific patient variables and treatments might relate to patient satisfaction among the psychiatric emergency service population has not been systematically studied. In contrast, psychiatric inpatients and outpatients usually express positive attitudes about their mental health care, although this finding may be skewed by a lack of real anonymity. Chronic patients tend to express less satisfaction with their treatment programs than do others, and patient satisfaction in some studies has been related to patient demographics, diagnoses, treatment histories and patients' global rating of treatment outcome.

Twenty-four-hour variations in rat blood and brain levels of the aromatic and branched-chain amino acids: chronic effects of dietary protein content.

Groups of young adult, male rats were given free access for 12 weeks to a single diet containing either 12%, 24%, or 40% protein (dry weight). At the end of this time, six rats from each diet group were killed every four hours throughout a single 24-hour period, and blood samples and brains were obtained for quantitation of several of the large neutral amino acids (LNAAs). The blood level of each LNAA varied significantly as a function of time of day (tending to be lower during the day than at night) and as a function of dietary protein content (typically rising as protein intake increased). Except for tyrosine and valine, the serum concentration ratio of each LNAA to the sum of the other LNAA (previously reported to be a good predictor of the competitive uptake of each LNAA into brain) and the brain level of each LNAA showed unremarkable variations with time of day and dietary protein content. In contrast, the serum ratios and brain levels of tyrosine and valine did show notable variations at night as a function of dietary protein intake. Together, the results show that within a chronic physiologic range of protein intakes, the serum ratios and brain levels of several large neutral amino acids, particularly tryptophan, bear no relationship to dietary protein level. Though good correlations between these parameters and protein intake were obtained for valine and tyrosine, their physiologic/metabolic significance, if any, is unknown. In general, the data do not support the broad, unvalidated use of serum LNAA ratios in chronic settings as predictors of brain LNAA levels.

Effects of aspartame ingestion on the carbohydrate-induced rise in tryptophan hydroxylation rate in rat brain.

Effects of aspartame (aspartyl-phenylalanine-methylester) on increases in brain-tryptophan level and hydroxylation rate following a high-carbohydrate, protein-free meal were tested. After an overnight fast, rats consumed a protein-free meal containing one of several levels of aspartame. Blood and brain amino acid levels and the in vivo rate of tryptophan hydroxylation in brain were estimated at intervals thereafter. Ingestion of the meal alone increased brain-tryptophan level and hydroxylation rate. Aspartame did not modify these effects, except at doses of 530 mg/kg body weight or more. Results suggest a threshold dose of aspartame can be identified for the rat in single-meal studies above which suppression of carbohydrate-induced increases in brain-tryptophan level and serotonin synthesis occurs. This dose, however, is large and, when corrected for species differences in metabolic rate, is unlikely to be ingested by a human subject as a single load.

Reading about homosexuality.

A study was conducted to access the importance of reading about experiences on homosexuality for adolescents and post-adolescents. Although no conclusive evidence could be found to link their reading experience to later experiences as a means of instigating change or providing role models, the author suggests that reading materials can be influential.

Absence of chronic effects of dietary protein content on brain tryptophan concentrations in rats.

Groups of young, adult, male rats were given free access for 2 wk to a diet containing 12, 24 or 40% protein (dry weight). During this period, all animals grew considerably; those consuming the 12% protein diet grew less rapidly than those ingesting the higher percent protein diets. At the end of 2 wk, six rats from each diet group were killed every 4 h throughout a 24-h period, and blood samples and whole brains were obtained for analysis. Serum tryptophan levels were lowest in animals consuming the 12% protein diet, intermediate in rats consuming the 24% protein diet and highest in rats consuming the 40% protein diet (at all times studied). Brain tryptophan levels, however, did not differ significantly as a function of dietary protein content. The ratio in serum of the concentration of tryptophan to the sum of the concentrations of its competitors for brain uptake also was not significantly influenced by dietary protein level. Levels of 5-hydroxyindoles in brain showed significant diurnal variations but no evidence of a significant effect of dietary protein content. Since the ratio of serum tryptophan to its competitors and the levels in brain of tryptophan and 5-hydroxyindoles did not vary as a function of dietary protein intake, the results do not support the view that these variables serve as signals to the brain for regulating long-term dietary protein intake.