Risk factors for 30-day readmission following hypoglycemia-related emergency room and inpatient admissions.

OBJECTIVE: Hypoglycemia is a serious complication of diabetes treatment. This retrospective observational study characterized hypoglycemia-related hospital emergency room (ER) and inpatient (in-pt) admissions and identified risk factors for 30-day all-cause and hypoglycemia-related readmission. RESEARCH DESIGN AND METHODS: 4476 hypoglycemia-related ER and in-pt encounters with discharge dates from 1/1/2009 to 3/31/2014 were identified in a large, multicenter electronic health record database. Outcomes were 30-day all-cause ER/hospital readmission and hypoglycemia-related readmission. Multivariable logistic regression methods identified risk factors for both outcomes. RESULTS: 1095 (24.5%) encounters had ER/hospital all-cause readmission within 30 days and 158 (14.4%) of these were hypoglycemia-related. Predictors of all-cause 30-day readmission included recent exposure to a hospital/nursing home (NH)/skilled nursing facility (SNF; OR 1.985, p<0.001); age 25-34 and 35-44 (OR 2.334 and 1.996, respectively, compared with age 65-74, both p<0.001); and African-American (AA) race versus all other race categories (OR 1.427, p=0.011). Other factors positively associated with readmission include chronic obstructive pulmonary disease, cerebrovascular disease, cardiac dysrhythmias, congestive heart disease, hypertension, and mood disorders. Predictors of readmissions attributable to hypoglycemia included recent exposure to a hospital/NH/SNF (OR 2.299, p<0.001), AA race (OR 1.722, p=0.002), age 35-44 (OR 3.484, compared with age 65-74, p<0.001), hypertension (OR 1.891, p=0.019), and delirium/dementia and other cognitive disorders (OR 1.794, p=0.038). Obesity was protective against 30-day hypoglycemia-related readmission (OR 0.505, p=0.017). CONCLUSIONS: Factors associated with 30-day all-cause and hypoglycemia-related readmission among patients with diabetic hypoglycemia include recent exposure to hospital/SNF/NH, adults <45 years, AAs, and several cardiovascular and respiratory-related comorbid conditions.

Value and face validity of objective structured assessment of technical skills (OSATS) for work based assessment of surgical skills in obstetrics and gynaecology.

BACKGROUND: Changes in UK Junior Doctor working patterns, reduced training hours and increased patient expectations have resulted in less exposure of Juniors to surgical procedures. Validated methods of assessment are therefore required to assure the surgical competency of future Consultants. Objective Structured Assessment of Technical Skills (OSATS) forms are one possible tool. AIMS: To investigate trainee and trainer perceptions of the value and validity of OSATS in the operating theatre. METHOD: OSATS forms and feedback questionnaires. RESULTS: 38 trainees and 16 trainers provided feedback on the OSATS forms used during 60 procedures, returning 119 questionnaires in total. Value : 85% of trainee and 76% of trainer responses agreed/strongly agreed that OSATS would improve trainees' surgical skills. Face validity: 80% of trainee and 76% of trainer responses agreed/strongly agreed with OSATS ability to assess surgical skills. APPLICATION: 76% of trainee and trainer responses agreed/strongly agreed that OSATS should become part of the annual assessment process for trainees. CONCLUSIONS: Trainees and trainers perceive OSATS to be a valuable and valid tool for the objective assessment of surgical skills in the work place. More research is required to assess their criterion-related, content, construct and predictive validity as well as their reliability in the workplace.

Operation rescue: domestic terrorism or legitimate civil rights protest?

KIE: Nathanson, a prominent participant in the abortion debate in the United States, describes the mission and methods of Operation Rescue. An activist anti-abortion organization whose members protest against legalized abortion by staging peaceful, nonviolent sit-ins at abortion clinics, Operation Rescue's tactics affect pregnant women, abortion facilities, law enforcement agencies, pro-choice advocates, and bystanders. Nathanson discusses the moral features unique to Operation Rescue, as well as counterarguments against the legitimacy of its activities, in an attempt to determine whether the organization's actions are a legitimate form of civil disobedience.^ieng

Respiratory muscle weakness in Charcot-Marie-Tooth disease. A field study.

A field study on respiratory muscle function and basic pulmonary mechanics was conducted at an international convention of 200 individuals with Charcot-Marie-Tooth disease. Forty patients with respiratory symptoms were evaluated; 15 had significant respiratory muscle dysfunction and 25 were normal. The results suggest that proximal upper limb involvement in individuals with Charcot-Marie-Tooth disease is a simple but significant predictor of respiratory muscle dysfunction.

Of mulattos, mischlinge, and Minsky's machines.

Hegel once remarked that "what experience and history teach us is that people and governments never have learned anything from history or acted on principles deduced from it." Historically, efforts to define a human being sufficiently equipped biologically or politically to meet a set of factitious standards for inclusion in the community of mankind have invariably resulted in unspeakable injustices. The continuing exclusion of the human fetus from this community is another (and the latest) tragic example of the historical myopia of which Hegel spoke.

PIP: The search for answers to the question of how to classify, measure, and define human life has an ignoble history contaminated by political rather than moral considerations. In the US during slavery, in Nazi Germany, and in South Africa, those defined as nonwhite have been classified as nonpersons. The unspeakable social and political injustice inherent in theses chapters of history is echoed in current efforts to define the point at which a fetus becomes a human being. The 1973 US Supreme Court ruling authorizing abortion introduced the concept of viability as the criterion for human life. At the time, viability was generally considered to commence at 27 weeks; however, recent advances in neonatal intensive care technology have since reduced this to 23 weeks and, by the year 2000, viability should be in the 12-week range. This trend has led to a new standard for personhood--sufficient brain development to permit consciousness. The absurdity of this approach is demonstrated by reference to the rapidly developing artificial intelligence field. Leaders of this field assert that the difference between humans and computers is only a matter of degree; they are 2 species in the genus of information processing systems. Given the ability of supercomputers to reprogram themselves, possess artificial senses, and even produce offspring, the question of whether robots should be granted civil rights arises. To carry the consciousness standard to its logical conclusion, once technology makes it possible to extend a microcomputer cable to an 8-week fetus, that fetus should qualify for personhood. All such efforts to define a human being on the basis of its ability to meet a set of factitious standards are bound to lead to unspeakable injustices.

Partial analysis of the bands seen in circular dichroism spectra of green and blue-green algal cells and thylakoids.

A comparison was made of the circular dichroism (C.D.) spectra of Chlorella, Euglena, and Anacystis cells and thylakoids. Analyses of the spectra reveal that these C.D. bands are similar to those observed previously in whole spinach choloroplasts and subchloroplast particles. C.D. spectra of Euglena chloroplasts show bands at longer wavelengths than previously reported. From comparisons of circular dichroism spectra and fine structure, it was concluded that: (a) bands seen in circular dichroism spectra were not the result of light scattering from thylakoid membranes; and (b) bands seen in the C.D. spectra of nonmembranous systems (previously reported) could account for circular dichroism of algae. We also concluded that comparisons would have to be made with model systems in order to correct for effects of absorption flattening, concentration obscuring, and differential light scattering of membranous systems.

Vacuum aspiration for second-trimester abortion not recommended.

QUESTION: Recently I observed the use of vaccuum aspiration in an attempt to induce abortion in a woman 16 weeks' pregnant, after dialation of the cervix to 14 mm under paracervical block anesthesia. Only amniotic fluid and a segment of the umbilical cord could be aspirated. The patient was returned to bed, and an oxytocin (Pitocin) infusion was begun. She aborted 24 hours later with no complications. Why is this procedure considered inferior to amniocentesis and saline solution instillation as a technique for inducing abortion? ANSWER: Transcervical rupture of the fetal membranes for the purpose of inducing second trimester abortion is unreliable as a method and is fraught with the most serious complication of intrauterine infection (Schwartz, R.H.: Septic abortion, Philadelphia, J.B. Lippincott, 1968, p. 17). On the other hand, Roufa et al. (Clinical Obstetrics and Gynecology 14:119, 1971) report no failures of abortion and only 1 significant intrauterine infection in 229 patients aborted in the second trimester by the hypertonic, intraovular, saline solution instillation method. The cervicovaginal portion of the reproductive tract is bacteriologically a contaminated area teeming with a variety of organisms. White and Koontz (Obstetrics and Gynecology 32:402, 1968) cultured the cervices of 57 pregnant women in all trimesters of pregnancy, and a significant number of these women harbored pathogens. In general the skin is preferable to the cervicovaginal tract as a route of entry into the intraovular space.

Direct and indirect mechanisms of deaggregation by fatty acids in chlorophyll-countaining systems.

The ability of an exogenous long-chain unsaturated fatty acid (linolenic acid) to induce changes in the circular dichroism (C.D.) spectra of chlorophyllous systems of various levels of organization is demonstrated and attributed to its deaggregating influence. In the case of chlorophyll in solution (CCl(4) or CCl(4)-hexane), deaggregation is by direct action on the chromophore. Evidence is also given for an indirect mechanism when chlorophyll is attached to protein (e.g., in HP-700 complexes); in this case, deaggregation results from a conformational change in the protein. Interpretations are given for the differences in C.D. spectra of nonmembranous and membranous chlorophyll-containing systems. (The latter include "digitonin-isolated" system I particles, subchloroplast particles obtained by means of sonication, and specially prepared intact chloroplasts.)