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PubMedDate not supplied

Turning the tide on medical errors in intensive care units: a human factors approach.

Errors occur in all nursing settings. The current healthcare climate tends to focus on individuals as the cause of errors rather than addressing issues that may be inherently wrong with the healthcare system that predisposes the individual to make errors. Human factors engineering (HFE), which is focused on removing human factors as much as possible from errors, has the potential to greatly impact medical errors in intensive care units. Applied in other high-risk industries, HFE has been critical in understanding and preventing errors at a systems level. Knowledge concerning the role systems play in errors and improvements to medical systems using HFE is intended to empower nurses to be advocates for systems change, resulting in a safer work environment and a safer healthcare delivery system.

Critical Care↗
PubMed1999

Measurements of radon concentration and the role of earth tides in a gypsum mine in Walferdange, Luxembourg.

Measurements of the 222Rn and 220Rn concentration in air, the atmospheric pressure, and the air sample temperature were carried out in an abandoned gypsum mine in Walferdange, Luxembourg. The 222Rn concentration shows a negative correlation with the atmospheric pressure and a tentative positive correlation with gravity variations. The results suggest a porous flow of radon bearing gas across the rock-air interface, which is induced by tidal stresses.

Air↗
PubMed1978

The tides of rural physicians: the ebb and flow, or why physicians move out of and into small communities.

To determine the characteristics of physicians who move into and out of rural areas, as well as their reasons for establishing or leaving such practices, we sent questionnaires to 67 physicians who began practice in selected rural counties in upstate New York and 88 physicians who left practices in roughly the same area. From the 52 physicians (77.6 per cent) who responded to the former survey we found that 1) good professional support is mandatory for maintaining a satisfying small community practice, 2) a predisposition to small community living is essential for physicians to be recruited for rural practice, and 3) there are substantial differences with respect to demographic characteristics among persons who share similar reasons for practicing medicine in this region. For the 68 physicians (72.0) per cent ) who responded to the latter survey, the reasons for leaving could be grouped in the following categories: economic, social, and professional logistic. Although all of these factors contribute to the decision to leave, physician geographical mobility seems to stem chiefly from an unsatisfactory professional situation. These findings suggest several strategies for improving the situations in which rural physicians practice, and thus altering the massive imbalance in physician:patient ratios in urban and rural areas.

Attitude of Health Personnel↗
PubMed2005

The rising tide of fisheries instruments and the struggle to keep afloat.

Since agreement was reached in 1982 on the UN Convention on the Law of the Sea, and particularly since the conclusion of the 1992 UN Conference on Environment and Development, the rate of development of global instruments impacting on fisheries has escalated considerably and is apparently continuing to do so. A flood of global and regional instruments relevant to fisheries has been generated, including, for example, the 1973 Convention on International Trade in Endangered Species of Wild Fauna and Flora which pre-dates the UN Convention, the 1992 Convention on Biological Diversity, 1992 Agenda 21: Programme of Action for Sustainable Development, the 1993 FAO Agreement to Promote Compliance with International Conservation and Management Measures by Fishing Vessels on the High Seas, the 1995 UN Agreement for the Implementation of the Provisions of the United Nations Convention on the Law of the Sea of 10 December 1982 relating to the Conservation and Management of Straddling Fish Stocks and Highly Migratory Fish Stocks, the 1995 FAO Code of Conduct for Responsible Fisheries and its four international plans of action and strategy, and the 2001 FAO Reykjavik Declaration on Responsible Fisheries in the Marine Ecosystem reflecting the growing international interest in ecosystem approaches to fisheries. Most recent has been the 2002 World Summit on Sustainable Development's Plan of Implementation. These instruments have been motivated by real problems associated with environmental degradation and living resource depletion, in several cases specifically in connection with fisheries. They have attempted to address these problems, and each instrument is recognized as being a positive contribution towards the sustainable use of resources and ecosystems. However, taken collectively they form a large, often confusing and potentially overwhelming set of recommendations and requirements that is putting many fishery management agencies under severe pressure as they seek to implement them. This paper provides a brief overview of the range of recent instruments and their implications for sustainable fisheries management, considers the progress being made in implementing them, identifies general problems being encountered and how they might be ameliorated in the future. A key problem is a lack of political will, or political ability, to address effectively the problems facing fisheries and marine ecosystems. One consequence of this is that the agencies charged with fisheries management are not provided with adequate technical and financial capacity to implement the instruments in most, if not all, countries. The problem is especially acute in developing countries where they are strained by the full effects of "instrument implementation fatigue".

Animals↗
PubMed2006

Rhodovulum marinum sp. nov., a novel phototrophic purple non-sulfur alphaproteobacterium from marine tides of Visakhapatnam, India.

A yellowish-brown bacterium was isolated from enrichment cultures inoculated with seawater samples from the eastern coast of India (Visakhapatnam) under photoheterotrophic conditions. Enrichment and isolation in a medium containing 2 % NaCl (w/v) yielded strain JA128(T), which has ovoid to rod-shaped cells, also forms chains and is non-motile. Phylogenetic analysis on the basis of 16S rRNA gene sequences showed that strain JA128(T) clusters with the Alphaproteobacteria and the sequence similarity with its closest relatives, Rhodovulum iodosum and Rhodovulum sulfidophilum, was 95 %. Strain JA128(T) contained vesicular intracytoplasmic membranes, bacteriochlorophyll a and carotenoids of the spheroidene series. Strain JA128(T) was mesophilic, slightly acidophilic, slightly halophilic and grew photoheterotrophically with a number of organic compounds as carbon source and electron donor. It was unable to grow photoautotrophically, chemoautotrophically or by fermentative modes. It did not utilize sulfide, thiosulfate or hydrogen as electron donors. Thiamine was required as a growth factor. Based on the 16S rRNA gene sequence analysis, morphological and physiological characteristics, strain JA128(T) was significantly different from other species of the genus Rhodovulum and was recognized as a novel species for which the name Rhodovulum marinum sp. nov. is proposed. The type strain is JA128(T) (=ATCC BAA 1215(T)=CCUG 52183(T)=JCM 13300(T)).

Carotenoids↗
PubMed1987

Chlorophyll-Protein Complexes from the Red-Tide Dinoflagellate, Gonyaulax polyedra Stein : Isolation, Characterization, and the Effect of Growth Irradiance on Chlorophyll Distribution.

A comparision of high (330 microeinsteins per meter squared per second) and low (80 microeinsteins per meter squared per second) light grown Gonyaulax polyedra indicated a change in the distribution of chlorophyll a, chlorophyll c(2), and peridinin among detergent-soluble chlorophyll-protein complexes. Thylakoid fractions were prepared by sonication and centrifugation. Chlorophyll-protein complexes were solubilized from the membranes with sodium dodecyl sulfate and resolved by Deriphat electrophoresis. Low light cells yielded five distinct chlorophyll-protein complexes (I to V), while only four (I' to IV') were evident in preparations of high light cells. Both high molecular weight complexes I and I' were dominated by chlorophyll a absorption and associated with minor amounts of chlorophyll c. Both complexes II and II' were chlorophyll a-chlorophyll c(2)-protein complexes devoid of peridinin and unique to dinoflagellates. The chlorophyll a:c(2) molar ratio of both complexes was 1:3, indicating significant chlorophyll c enrichment over thylakoid membrane chlorophyll a:c ratios of 1.8 to 2:1. Low light complex III differed from all other high or low light complexes in that it possessed peridinin and had a chlorophyll a:c(2) ratio of 1:1. Low light complexes IV and V and high light complexes III' and IV' were spectrally similar, had high chlorophyll a:c(2) ratios (4:1), and were associated with peridinin. The effects of growth irradiance on the composition of chlorophyll-protein complexes in Gonyaulax polyedra differed from those described for other chlorophyll c-containing plant species.

Journal Article↗
PubMedDate not supplied

Updated review of the coronary artery bypass grafting option in octogenarians: good tidings.

This review of the literature is presented in an attempt to keep pace with the constantly changing statistics in postsurgical outcomes, which reflect the considerable strides in technology and technical skills that have been made during the past decade in cardiovascular surgery. Although there is still much to be done in terms of improving surgical techniques and managing emergency cases, the reported results of coronary artery bypass grafting in octogenarians are similar to or even better than those obtained with medical or angioplastic approaches, and the life expectancy and quality of life are similar to or better than those of age-matched controls.

Aged↗
PubMed2004

Chloroplast phosphoglycerate kinase from Euglena gracilis: endosymbiotic gene replacement going against the tide.

Two chloroplast phosphoglycerate kinase isoforms from the photosynthetic flagellate Euglena gracilis were purified to homogeneity, partially sequenced, and subsequently cDNAs encoding phosphoglycerate kinase isoenzymes from both the chloroplast and cytosol of E. gracilis were cloned and sequenced. Chloroplast phosphoglycerate kinase, a monomeric enzyme, was encoded as a polyprotein precursor of at least four mature subunits that were separated by conserved tetrapeptides. In a Neighbor-Net analysis of sequence similarity with homologues from numerous prokaryotes and eukaryotes, cytosolic phosphoglycerate kinase of E. gracilis showed the highest similarity to cytosolic and glycosomal homologues from the Kinetoplastida. The chloroplast isoenzyme of E. gracilis did not show a close relationship to sequences from other photosynthetic organisms but was most closely related to cytosolic homologues from animals and fungi.

Amino Acid Sequence↗
PubMed1999

Stemming the tide: reducing cardiovascular disease and renal failure in Australian Aborigines.

An epidemic of cardiovascular disease (CVD) and end stage renal disease (ESRD) has developed among Aborigines in the Northern Territory; CVD deaths increased over the 1980s (tripling among women!), and are now more than five times those of non-Aboriginal people, while ESRD rates are increasing more than 20-fold and are doubling every three to four years. Dialysis costs (>$75,000 per person/year) pose a crisis for health care budgets, but premature mortality is the greater human catastrophe. Health services are not meeting the challenge of timely diagnosis, prevention and containment. We screened 90% of adults (20+ years) in one community, with CVD mortality among the highest in Australia, and ESRD rates increased 60-fold. Seventy-five per cent of persons were smokers. Central obesity was common, but BMIs only modestly increased by Caucasian standards, 23% had hypertension (>140/90), 29% had diabetes or impaired glucose tolerance (IGT) (peaking at 65% of persons aged 40-49 years), high triglyceride and insulin levels were common, and 55% had albuminuria (albumin/creatinine ratio (ACR), >3.4 gm/moL). Progressive albuminuria predicted renal failure. ACR was correlated with age, BMI, blood pressure, lipid, glucose and insulin levels, heavy drinking and past and current skin infections, and, inversely with birth weight. ACR correlated strongly with a composite CV risk score, and in a two to five year follow-up, microalbuminuria (ACR 3.4-33) and overt albuminuria (ACR 34+) have both predicted increased rate of premature death from natural causes of lower ACRs. Thus albuminuria marks CV risk/disease. This implies that renal and CV disease share common risk factors, and should respond to the same interventions, and that this response might be monitored through ACR levels. Robust public health programmes could reduce all these reversible risk factors, lowering disease rates over the intermediate term, however, few such programmes are in place. Modification of disease in persons already afflicted is a parallel responsibility. To this end, in November 1995, we introduced a treatment programme with Coversyl (perindopril, Servier) for all persons in the study community with hypertension (>140/90), for all diabetics with ACR 3.4+ and for all nondiabetic, non-hypertensive persons with progressive overt albuminuria (ACR 34+). One-quarter of all adults, or 224 persons have enrolled; 162 have reached one year of treatment and 100 have passed two years. Compliance is reasonable and enthusiasm high. Average SBP has fallen 12 mmHg (24 mmHg in hypertensive persons), while average ACR and estimated glomerular filtration rate (GFR) have stabilised. This contrasts favourably with the pretreatment course (average 2.7 years) in the same persons, when SBP had increased by 3 mmHg, ACR had increased by 15% and GFR had decreased by 3.5 mL/min each year. Cautious estimates suggest a >50% fall in ESRD, and a reduction in all-cause and CV deaths, even at this early stage, although more extended observation is needed. These data predict a dramatic and rapid fall in morbidity, premature deaths and health care costs if these basic principles of medical care are extended to all Aboriginal people. A national, concerted, multi-disciplinary effort to implement a coherent, effective strategy to this end is of great urgency.

Adult↗