Trial protocol: a clustered, randomised, longitudinal, type 2 translational trial of alcohol consumption and alcohol-related harm among adolescents in Australia.

BACKGROUND: This cluster randomised control trial is designed to evaluate whether the Communities That Care intervention (CTC) is effective in reducing the proportion of secondary school age adolescents who use alcohol before the Australian legal purchasing age of 18 years. Secondary outcomes are other substance use and antisocial behaviours. Long term economic benefits of reduced alcohol use by adolescents for the community will also be assessed. METHODS: Fourteen communities and 14 other non-contiguous communities will be matched on socioeconomic status (SES), location, and size. One of each pair will be randomly allocated to the intervention in three Australian states (Victoria, Queensland and Western Australia). A longitudinal survey will recruit grade 8 and 10 students (M = 15 years old, N = 3500) in 2017 and conduct follow-up surveys in 2019 and 2021 (M = 19 years old). Municipal youth populations will also be monitored for trends in alcohol-harms using hospital and police administrative data. DISCUSSION: Community-led interventions that systematically and strategically implement evidence-based programs have been shown to be effective in producing population-level behaviour change, including reduced alcohol and drug use. We expect that the study will be associated with significant effects on alcohol use amongst adolescents because interventions adopted within communities will be based on evidence-based practices and target specific problems identified from surveys conducted within each community. TRIAL REGISTRATION: The trial was retrospectively registered in September, 2017 ( ACTRN12616001276448 ), as communities were selected prior to trial registration; however, participants were recruited after registration. Findings will be disseminated in peer-review journals and community fora.

Impaired fear recognition in regular recreational cocaine users.

INTRODUCTION: The ability to read facial expressions is essential for normal human social interaction. The aim of the present study was to conduct the first investigation of facial expression recognition performance in recreational cocaine users. MATERIALS AND METHODS: Three groups, comprised of 21 cocaine naïve participants (CN), 30 occasional cocaine (OC), and 48 regular recreational cocaine (RC) users, were compared. An emotional facial expression (EFE) task consisting of a male and female face expressing six basic emotions (happiness, surprise, sadness, anger, fear, and disgust) was administered. Mean percent accuracy and latencies for correct responses across eight presentations of each basic emotion were derived. Participants were also assessed with the "Eyes task" to investigate their ability to recognize more complex emotional states and the Symptom CheckList-90-Revised to measure psychopathology. RESULTS: There were no group differences in psychopathology or "eyes task" performance, but the RC group, who otherwise had similar illicit substance use histories to the OC group, exhibited impaired fear recognition accuracy compared to the OC and CN groups. The RC group also correctly identified anger, fear, happiness, and surprise, more slowly than CN, but not OC participants. The OC group was slower than CN when correctly identifying disgust. The selective deficit in fear recognition accuracy manifested by the RC group cannot be explained by the subacute effects of cocaine, or ecstasy, because recent and less recent users of these drugs within this group were similarly impaired. Possible parallels between RC users and psychopaths with respect to impaired fear recognition, amygdala dysfunction, and etiology are discussed.

Association of retinal vessel caliber and visual field defects in glaucoma.

PURPOSE: This study evaluates the asymmetry of peripapillary retinal vessel caliber between inferior and superior hemispheres in eyes with visual field defects predominantly in one hemifield. DESIGN: Observational case series. METHODS: In a retrospective study, 64 eyes of 64 patients with primary open-angle glaucoma who had a marked difference in visual field defects between hemifields and who had no history of diabetes, trauma, or vascular occlusive disease were studied. The diameters of the superior and inferotemporal vessels were measured at the optic disk border with calipers on an enlarged image. RESULTS: In 64 eyes, the average ratio of the superior temporal artery diameter to inferotemporal artery diameter was significantly greater in the eyes with predominantly superior visual field defects as compared with those with inferior defects (1.10 +/- 0.22 vs. 0.92 +/- 0.19, respectively, P =.002, two-tailed t test). This indicates that the arteriole corresponding to the hemifield with the greater visual field defect was narrower than the arteriole in the other hemifield. This relationship was confirmed using chi(2) analysis (P =.002) comparing the proportions of eyes with ratios greater or less than normal vessel caliber ratios (normal ratio = 0.95 from data reported by Jonas and associates to the location of the dominant field defect. No statistically significant relationship was detected between retinal vein diameter and localized visual field defects, as determined by both the unpaired t test and chi(2) analysis. CONCLUSION: In eyes with primary open-angle glaucoma, this study demonstrates a strong association between decreased peripapillary arteriole diameter and visual field defects in the corresponding hemifield. This reflects either an ischemic basis for glaucomatous damage or vascular constriction when there are fewer axons to nourish.

Comparison of gas chromatography and immunoassay methods for the detection of atrazine in water and soil.

Leachate and soil samples collected from different tillage systems were analyzed for atrazine using gas chromatography (GC) and an enzyme-linked immunosorbent assay (ELISA) based on magnetic particle technology. Solid-phase extraction (SPE) was used to concentrate atrazine residues in leachate samples and soil extracts before GC analysis. Atrazine concentrations determined by GC ranged from 0.1 to 600 micrograms L-1 for water samples and from 1.0 to 700 micrograms kg-1 for soil samples. Atrazine concentrations in 92 leachate samples as determined by ELISA were well-correlated (R = 0.97) with GC levels over the entire concentration range. Soil samples (215) were prepared and analyzed by three combinations of extraction/detection methods: 1) conventional extraction for GC/detection by GC analysis; 2)conventional extraction for GC/detection by ELISA analysis; 3)extraction for ELISA using a commercially available field kit/detection by ELISA analysis. Methanol (MeOH) in water was the common extractant. Although the initial comparison of soil extracts between the two different systems (Method 1 versus Method 3) was favorable (R = 0.97), two-thirds of the samples contained levels below the lower threshold for atrazine detection by both methods and some extracts were perceived to provide unfavorable substrate conditions (> 10% MeOH). Elimination of these data points reduced the correlation value (R = 0.77). To determine possible sources of variability, the extraction and detection methods were examined separately. In a comparison of extraction methods (Method 2 versus Method 3), ELISA analysis of kit extracts underestimated (R = 0.71) atrazine levels compared to those conventionally extracted, suggesting that differences in extraction time between methods may have accounted for reduced kit efficiency. Where detection methods (Method 1 versus Method 2) were compared on specific extracts (< 10% MeOH), good agreement (R = 0.99) was achieved between ELISA and GC values, illustrating that control of extractant concentration is critical in using this assay for atrazine detection in soil.

Accreditation surveys. Coping with the worst-case scenario.

Survey scheduled? Feeling out of control? An administrator from a small Texas hospital shares her worst-case experience-five surveys in 3 months.

Assisted suicide: nurse practitioners as providers?

Changes in the law of death are being made. Nurse practitioners will be asked to help their patients commit suicide, and to help euthanize their patients. Currently most nurse practitioners have legal authority to prescribe the drugs that can potentially kill patients. NPs may be more likely than physicians to be asked for these drugs. Assisted suicide, euthanasia, and related terms are defined. The specific changes in the law of causing death are provided. Collective payment for illness care may be one reason that changes in the law are now being made. Society projects that dying people do not want to live; but that assumption is wrong. NPs in the future may choose to act at the lowest standard of behavior (the law) or they may behave in accord with a higher standard, their personal ethics. NPs should assert that their professional duty is to do good for the patient, not to help kill the patient.

Caring for corpses or killing patients?

Care of patients in a persistent vegetative state raises serious ethical questions. Often misdiagnosed, this "new disease," which is the result of advancing medical technology, raises such serious issues as the definition of death, nurses' personal ethical and religious convictions, and the ethical integrity of the nursing profession. Conscience clauses that allow nurses to refuse to cause death in non-dying patients vary widely, but few, if any, address the situation of incompetent but non-dying patients.

How to analyze nurse practitioner licensure laws.

Nurse practitioners (NPs) are capable of analyzing the regulation of their practice by state authorities. The annotated nursing statute, the medicine and pharmacy statutes, regulations from those three boards and cases noted in the annotated statutes should be read. Nurse practitioner definitions of practice can be broadly written (making relicensure in a state with similar definition easier) or specific (requiring all states to adopt similar qualifications for endorsement, as is done now with basic RN licensure). Requirements for NP credentialing by nonstate entities have advantages and problems too. State-granted monopoly of licensure is good for NP economics and bad for patient economics. Medical practice law is important to the NP. Pharmacy statutes are important even if the NP statute provides for prescribing. Revision of NP pharmacy law is becoming less necessary as more control of prescribing by guidelines is exercised on nurses and physicians alike. Rules for analysis of statutes are given.

Postoperative utilization of critical care services by cardiac surgery: a multicenter study in the Canadian healthcare system.

OBJECTIVES: To describe patterns of critical care services used after cardiac surgery and to evaluate whether variations in the process of care influence outcome. DESIGN: Multicenter, prospective study. SETTING: A convenience sample of four cardiac surgical units: three in university-affiliated (teaching) hospitals and one in a nonteaching regional referral center. PATIENTS: A "consecutive sample" of 335 patients after cardiac surgery in four hospitals. INTERVENTIONS: Data were collected regarding all cardiac surgery patients admitted to the critical care units in the four test hospitals. MEASUREMENTS AND MAIN RESULTS: The critical care unit and hospital lengths of stay and survival were followed. The Therapeutic Intervention Scoring System (TISS) was used to assess the intensive care unit (ICU) interventions used during the first 24 hrs in the ICU and for the final 24 hrs before discharge from the ICU. The severity of illness on admission was assessed using the Acute Physiology and Chronic Health Evaluation (APACHE) scoring system. For patients having similar procedures (e.g., aortocoronary bypass and nonaortocoronary bypass procedures) and with similar outcome (mortality/total hospital length of stay), we found significant differences in the pattern of ICU resource utilization among hospitals. Significant (p < .05) differences in unit length of stay were related to varying factors in different hospitals. In hospital unit A, the type of procedure and preoperative chronic health status influenced unit length of stay (aortocoronary bypass 2.8 +/- 1.7 days; nonaortocoronary bypass 8.7 +/- 8.9 days) because length of stay was different for differing procedure groups. In hospital unit B, the critical care management system and lack of step-down (intermediate care) unit availability resulted in an increased unit length of stay for aortocoronary bypass patients (5.1 +/- 4.5 days) as compared with the other units (mean ICU lengths of stay of 2.8, 2.3, and 3.0 days, respectively). Unit B kept patients for monitoring purposes and had a reduced need for critical care nursing on the day of discharge (TISS = 7.5 +/- 5.5) as compared with the other units (mean TISS scores of 27.4, 23.2, and 21.5). CONCLUSIONS: Significant differences exist among hospitals in the same healthcare system in the utilization of critical care services for cardiac surgery. In spite of these differences, for similar patient "input," the outcome (mortality and hospital lengths of stay) appeared similar. Assessments of utilization of critical care must focus on more detailed specific issues than unit length of stay, and must include factors such as availability of intermediate care areas, the unit management system, chronic health status, and the operative procedures performed, if a utilization management process is to effect improved resource use in critical care.