Home About us Contact
|
Home About us Contact | ||
|
|
||
Response System (response + system)
Kinds of Response System Selected AbstractsNovel Nursing Terminologies for the Rapid Response SystemINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2 2009Elizabeth Wong CRNA PURPOSE., Nursing terminology with implications for the rapid response system (RRS) is introduced and proposed: critical incident nursing diagnosis (CIND), defined as the recognition of an acute life-threatening event that occurs as a result of disease, surgery, treatment, or medication; critical incident nursing intervention, defined as any indirect or direct care registered nurse-initiated treatment, based upon clinical judgment and knowledge that a registered nurse performs in response to a CIND; and critical incident control, defined as a response that attempts to reverse a life-threatening condition. DATA SOURCES., The current literature, research studies, meta-analyses from a variety of disciplines, and personal clinical experience serve as the data sources for this article. DATA SYNTHESIS., The current nursing diagnoses, nursing interventions, and nursing outcomes listed in the North American Nursing Diagnosis Association International Classification, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC), respectively, are inaccurate or inadequate for describing nursing care during life-threatening situations. The lack of such standardized nursing terminology creates a barrier that may impede critical communication and patient care during life-threatening situations when activating the RRS. CONCLUSIONS., The North American Nursing Diagnosis Association International Classification, NIC, and NOC are urged to refine their classifications and include CIND, critical incident nursing intervention, and critical incident control. The RRS should incorporate standardized nursing terminology to describe patient care during life-threatening situations. IMPLICATIONS FOR NURSING PRACTICE., Refining the diagnoses, interventions, and outcomes classifications will permit nursing researchers, among others, to conduct studies on the efficacy of the proposed novel nursing terminology when providing care to patients during life-threatening situations. In addition, including the proposed novel nursing terminology in the RRS offers a means of improving care in such situations. [source] Finding outlier light curves in catalogues of periodic variable starsMONTHLY NOTICES OF THE ROYAL ASTRONOMICAL SOCIETY, Issue 2 2006P. Protopapas ABSTRACT We present a methodology to discover outliers in catalogues of periodic light curves. We use a cross-correlation as the measure of ,similarity' between two individual light curves, and then classify light curves with lowest average ,similarity' as outliers. We performed the analysis on catalogues of periodic variable stars of known type from the MACHO and OGLE projects. This analysis was carried out in Fourier space and we established that our method correctly identifies light curves that do not belong to those catalogues as outliers. We show how an approximation to this method, carried out in real space, can scale to large data sets that will be available in the near future such as those anticipated from the Panoramic Survey Telescope & Rapid Response System (Pan-STARRS) and Large Synoptic Survey Telescope (LSST). [source] Multi-Input/Multi-Output Molecular Response System Based on the Dynamic Redox Behavior of 3,3,4,4-Tetraaryldihydro[5]helicene Derivatives: Reversible Formation/Destruction of Chiral Fluorophore and Modulation of Chiroptical Properties by Solvent PolarityCHEMISTRY - A EUROPEAN JOURNAL, Issue 37 2009Takanori Suzuki Prof. Abstract 3,3,4,4-Tetaaryldihydro[5]helicenes (1) and 1,1,-binaphthyl-2,2,-diylbis(diarylcarbenium)s (22+) can be reversibly interconverted upon electron transfer, which is accompanied by a vivid color change (electrochromism) as well as by the formation/cleavage of a CC bond ("dynamic redox behavior"). Because only the neutral donor 1 exhibits strong fluorescence, electrochemical input can further modify the fluorescent properties of the pair. Due to the configurational stability of the helicity in 1 and axial chirality in 22+, the redox reaction of optically pure material proceeds stereospecifically, which induces a chiroptical change such as circular dichroism (CD) as an additional output. The CD spectra of dications 22+ exhibit solvent dependency (chiro-solvatochromism), which is accompanied by solvatochromic behavior based on the ,,, interaction of the two cationic chromophores as well as coordinative interaction of the Lewis basic solvent to the Lewis acidic triarylcarbenium moieties. Thus, the present system is endowed with multi-input functionality for modifying multiple output signals. [source] A Randomized Clinical Trial to Assess the Impact on an Emergency Response System on Anxiety and Health Care Use among Older Emergency Patients after a FallACADEMIC EMERGENCY MEDICINE, Issue 4 2007Jacques S. Lee MD Abstract Objectives: Personal emergency response systems (PERSs) are reported to reduce anxiety and health care use and may assist in planning the disposition of older patients discharged from the emergency department (ED) to home. This study measured the impact of a PERS on anxiety, fear of falling, and subsequent health care use among older ED patients. Methods: This study was a randomized controlled trial comparing PERS use with standard ED discharge planning in subjects 70 years of age or older discharged home after a fall. Outcome assessors were blinded to the study objectives. Anxiety and fear of falling were measured at baseline and 30 days using the Hospital Anxiety and Depression Scale anxiety subscale (HADS-A) and modified Falls Efficacy Scale (mFES). Return to the ED, hospitalization, and length of stay were recorded after 30 and 60 days. Results: Eighty-six subjects were randomized and completed follow up (43 per group). There was no important difference in mean reduction in anxiety (mean change treatment , control, +0.35; 95% confidence interval [CI] =,1.5 to 0.76; p = 0.55) or fear of falling (mean change, +4.5; 95% CI =,6.7 to 15.7; p = 0.70). Return visits to the ED occurred in eight of 43 patients in both the control and treatment groups (risk difference, 0.0%; 95% CI =,16% to 16%). Hospitalization occurred in six of 43 in the control group versus three of 43 in the treatment group (risk difference treatment , control =,7.0%; 95% CI =,19.8% to 5.9%). Conclusions: In contrast to previous studies, there was no evidence that a PERS reduced anxiety, fear of falling, or return to the ED among older persons discharged from the ED. [source] Analysing Emergency Response SystemsJOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT, Issue 2 2008Christian Uhr We suggest a method that can be used for analysing an emergency response system. Both the literature and empirical findings indicate that response operations sometimes diverge from existing plans when adapting to an event and its consequences. The method, which aims at achieving a better understanding of emergency response management, adopts a systems perspective using various relationships that exist or develop between personnel belonging to those organizations that are part of the emergency response operation. Results of a study of such an emergency response system are presented and discussed in order to demonstrate how the method can be employed. [source] Understanding the Chain of Communication During a DisasterPERSPECTIVES IN PSYCHIATRIC CARE, Issue 1 2007Heather Shover MD TOPIC.,Every disaster begins on a local level and may, depending on size, evolve to a state of federal disaster response. Understanding California's State Disaster Plan and the importance of the chain of communication is a first step to understanding the Federal Disaster Response system. The chain of command is critical to making sure services and resources are utilized in a timely manner without duplication. PURPOSE.,This paper's intent is to define California's present emergency management system (EMS) infrastructure from local to state level and educate healthcare professionals for disaster activation. CONCLUSIONS.,It is imperative that all voluntary healthcare professionals learn the chain of command within the disaster response system. Each disaster response begins with the individual's preparedness at the local level and all disaster preparedness must incorporate training of health professionals, citizens, and families in local disaster drills. [source] Simulation-based Morbidity and Mortality Conference: New Technologies Augmenting Traditional Case-based PresentationsACADEMIC EMERGENCY MEDICINE, Issue 1 2006John Vozenilek MD Abstract The authors describe the use of a high-fidelity simulation laboratory to re-create a patient encounter for the purposes of enhancing a morbidity and mortality conference. The use of two separate technologies were enlisted: a METI high-fidelity patient simulator to re-create the case in a more lifelike fashion, and an audience response system to collect clinical impressions throughout the case presentation and survey data at the end of the presentation. The re-creation of the patient encounter with all relevant physical findings displayed in high fidelity, with relevant laboratory data, nursing notes, and imaging as it occurred in the actual case, provides a more engaging format for the resident,learner. This technological enhancement was deployed at a morbidity and mortality conference, and the authors report the impressions collected via the audience response system. Guidelines for those who wish to re-create this type of educational experience are presented in the discussion. [source] Suicide bombings: process of care of mass casualties in the developing worldDISASTERS, Issue 4 2009Masood Umer In recent times Pakistan's biggest city, Karachi, has witnessed numerous terrorist attacks. The city does not have an emergency response system and only one of the three public sector hospitals has a trauma centre. We describe the pattern of injuries and management of two terror-related mass casualty incidents involving suicide bombers in a developing nation with limited resources. The first incident occurred in May 2002 with 36 casualties, of whom 13 (36%) died immediately and 11 (30.5%) died at the primary receiving hospitals. The second incident was targeted against the local population in May 2004. The blast resulted in 104 casualties, of which 14 (13.46%) died at the site. All patients had their initial assessment and treatment based on Advanced Trauma and Life Support principles and documented on a trauma form. [source] Civil Society and the State: Turkey After the EarthquakeDISASTERS, Issue 2 2002Rita Jalali On 17 August 1999 Turkey was hit by a massive earthquake. Over 17,000 lives were lost and there was extensive damage to Turkey's heartland. This paper examines how various public and private institutions, including state and civil society institutions such as NGOs and the media responded to the needs of earthquake survivors. It documents the extensive involvement of NGOs in the relief efforts immediately after the disaster and examines the impact of such participation on state-civil society relations in the country. The data show that state response to the disaster went through several phases from a period of ineptitude to effective management. The paper credits the media and the NGOs for acting as advocates for survivors and forcing changes at the state level. The paper argues that an ideal response system, which fully addresses the needs of victims, can only be based on state-civil society relations that are both collaborative and adversarial. [source] Information Technology and Emergency Medical Care during DisastersACADEMIC EMERGENCY MEDICINE, Issue 11 2004Theodore C. Chan MD Abstract Disaster response to mass-casualty incidents represents one of the greatest challenges to a community's emergency response system. Rescuers, field medical personnel, and regional emergency departments and hospitals must often provide care to large numbers of casualties in a setting of limited resources, inadequate communication, misinformation, damaged infrastructure, and great personal risk. Emergency care providers and incident managers attempt to procure and coordinate resources and personnel, often with inaccurate data regarding the true nature of the incident, needs, and ongoing response. In this chaotic environment, new technologies in communications, the Internet, computer miniaturization, and advanced "smart devices" have the potential to vastly improve the emergency medical response to such mass-casualty incident disasters. In particular, next-generation wireless Internet and geopositioning technologies may have the greatest impact on improving communications, information management, and overall disaster response and emergency medical care. These technologies have applications in terms of enhancing mass-casualty field care, provider safety, field incident command, resource management, informatics support, and regional emergency department and hospital care of disaster victims. [source] Immunoreactivity of corticotropin-releasing hormone, adrenocorticotropic hormone and , -melanocyte-stimulating hormone in alopecia areataEXPERIMENTAL DERMATOLOGY, Issue 7 2006Hei Sung Kim Abstract:, Psychological factors are believed to play a role in the pathogenesis of alopecia areata (AA), a frequently encountered hair disorder. In our study, statistically significant elevation of psychological stress was felt by AA patients prior hair loss compared with control, which was strongly believed contributory to hair loss (t -test, P < 0.01). The corticotropin-releasing hormone (CRH) and proopiomelanocortin (POMC) mRNA have been identified in the basal layer of the epidermis and pilosebaceous units of the normal scalp. And with the recent discovery of melanocytes and dermal fibroblasts capable of corticosterone production, the presence of a local stress response system resembling the hypothalamic,pituitary,adrenal (HPA) axis has been suggested. The local stress response system is involved in regulation of the normal hair cycle, but its precise role in AA is unknown. The influence of a local HPA axis or rather, CRH,POMC axis in AA was investigated by analysing immunohistochemically the expression levels of CRH and POMC peptides, including the adrenocorticotropic hormone (ACTH) and , -melanocyte-stimulating hormone (, -MSH), in a number of AA lesions and normal scalp (as control). The epidermis and pilosebaceous units of normal scalp stained weakly with CRH, ACTH and , -MSH, whereas those from the affected sites of the AA group showed intense expression of the peptides (chi-square test, P < 0.01). The meaning of this enhanced expression and their role in the pathogenesis of AA should be further evaluated in future. [source] Validation of interactive voice response system administration of the short inflammatory bowel disease questionnaireINFLAMMATORY BOWEL DISEASES, Issue 4 2009Manuel Y. Lam BA Abstract Background: The Short Inflammatory Bowel Disease Questionnaire (SIBDQ) is a written, self-administered instrument measuring quality of life in IBD. We assessed the validity of an interactive voice response system (IVRS) as a new mode of administering the SIBDQ. Methods: An IVRS was designed using prerecorded questions to collect data via touchtone telephone. Subjects with Crohn's disease (CD) or ulcerative colitis (UC) were randomized into 2 groups with different orders of administration: written, self-administered followed by IVRS (S-I) or IVRS followed by written, self-administered (I-S). Half of the S-I group was also randomized to receive a second IVRS. Sixty-four subjects were studied: 30 in S-I, 34 in I-S. Results: The mean SIBDQ scores were not different between written and IVRS modes (P = 0.26) with r = 0.93. IVRS scores were lower in active than inactive CD (36.1 ± 9.6 versus 54.7 ± 8.6, P < 0.001) and lower in active than inactive UC (40.8 ± 9.6 versus 59.8 ± 10.0, P < 0.001). Mean scores correlated highly with disease activity indices, and were not different between first and second IVRS administrations (P = 0.85) with r = 0.92. IVRS had excellent internal consistency (Cronbach alpha = 0.90). Conclusions: IVRS administration of the SIBDQ yields results similar to written self-administration, with excellent procedural validity, test,retest reliability, and internal consistency. (Inflamm Bowel Dis 2009) [source] Adaptive synchronization of GLHS with unknown parametersINTERNATIONAL JOURNAL OF CIRCUIT THEORY AND APPLICATIONS, Issue 8 2009Yan-Wu Wang Abstract In this paper, an adaptive controller for the synchronization of two generalized Lorenz hyperchaos systems (GLHSs) is designed by using the Lyapunov method. In the synchronization schema, the parameters of the drive system are unknown and different from those of the response system. By introducing update laws for both the control coefficients and the parameters of the response system, the adaptive controller proposed in this paper is brand new compared with the former relative works. The proposed adaptive controller is feasible for any possible parameters of GLHS. Numerical simulation is carried out to verify and illustrate the analytical result. Copyright © 2008 John Wiley & Sons, Ltd. [source] Novel Nursing Terminologies for the Rapid Response SystemINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2 2009Elizabeth Wong CRNA PURPOSE., Nursing terminology with implications for the rapid response system (RRS) is introduced and proposed: critical incident nursing diagnosis (CIND), defined as the recognition of an acute life-threatening event that occurs as a result of disease, surgery, treatment, or medication; critical incident nursing intervention, defined as any indirect or direct care registered nurse-initiated treatment, based upon clinical judgment and knowledge that a registered nurse performs in response to a CIND; and critical incident control, defined as a response that attempts to reverse a life-threatening condition. DATA SOURCES., The current literature, research studies, meta-analyses from a variety of disciplines, and personal clinical experience serve as the data sources for this article. DATA SYNTHESIS., The current nursing diagnoses, nursing interventions, and nursing outcomes listed in the North American Nursing Diagnosis Association International Classification, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC), respectively, are inaccurate or inadequate for describing nursing care during life-threatening situations. The lack of such standardized nursing terminology creates a barrier that may impede critical communication and patient care during life-threatening situations when activating the RRS. CONCLUSIONS., The North American Nursing Diagnosis Association International Classification, NIC, and NOC are urged to refine their classifications and include CIND, critical incident nursing intervention, and critical incident control. The RRS should incorporate standardized nursing terminology to describe patient care during life-threatening situations. IMPLICATIONS FOR NURSING PRACTICE., Refining the diagnoses, interventions, and outcomes classifications will permit nursing researchers, among others, to conduct studies on the efficacy of the proposed novel nursing terminology when providing care to patients during life-threatening situations. In addition, including the proposed novel nursing terminology in the RRS offers a means of improving care in such situations. [source] Role of xenobiotic transporters in bacterial drug resistance and virulenceIUBMB LIFE, Issue 9 2008Kunihiko Nishino Abstract Since the discovery of antibiotic therapeutics, the battles between humans and infectious diseases have never been stopped. Humans always face the appearance of a new bacterial drug-resistant strain followed by new antibiotic development. However, as the genome sequences of infectious bacteria have been gradually determined, a completely new approach has opened. This approach can analyze the entire gene resources of bacterial drug resistance. Through analysis, it may be possible to discover the underlying mechanism of drug resistance that will appear in the future. In this review article, we will first introduce the method to analyze all the xenobiotic transporter genes by using the genomic information. Next, we will discuss the regulation of xenobiotic transporter gene expression through the two-component signal transduction system, the principal environmental sensing and response system in bacteria. Furthermore, we will also introduce the virulence roles of xenobiotic transporters, which is an ongoing research area. © 2008 IUBMB IUBMB Life, 60(9): 569,574, 2008 [source] Shared Care in Geriatric Oncology: Primary Care Providers' and Medical/Oncologist's PerspectivesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2009Cynthia Owusu MD Existing literature lends support to the benefit of shared care in the management of chronic diseases, but there are limited data on the feasibility, cost-effectiveness, or benefits of shared care in oncology. A recent conference organized by the Aging and Cancer Program of the Case Comprehensive Cancer Center sought to explore the perceptions of physicians and other allied health professionals who attended the conference about shared care in the acute management of older patients with cancer using a case history presentation and an anonymous audience response system. Analyses of the audience response indicated that shared responsibility and enhanced information exchange in addition to the current level of communication between providers involved in the acute management of older patients with cancer is desirable. Studies exploring the feasibility and benefits of a shared care model in the management of older patients with cancer are needed. [source] A literature review: factors that impact on nurses' effective use of the Medical Emergency Team (MET)JOURNAL OF CLINICAL NURSING, Issue 24 2009Lisa Jones Aims and objectives., The aim of this literature review is to identify factors, both positive and negative, that impact on nurses' effective use of the Medical Emergency Team (MET) in acute care settings. Background., Outcomes for patients are often dependent on nurses' ability to identify and respond to signs of increasing illness and initiate medical intervention. In an attempt to improve patient outcomes, many acute hospitals have implemented a rapid response system known as the Medical Emergency Team (MET) which has improved management of critically ill ward patients. Subsequent research has indicated that the MET system continues to be underused by nurses. Design., A comprehensive thematic literature review. Methods., The review was undertaken using key words and the electronic databases of Cumulative Index to Nursing and Allied Health Literature (CINAHL), OVID/MEDLINE, Blackwell Synergy, Science Direct and Informit. Fifteen primary research reports were relevant and included in the review. Results., Five major themes emerged from the analysis of the literature as the major factors effecting nurses' use of the MET system. They were: education on the MET, expertise, support by medical and nursing staff, nurses' familiarity with and advocacy for the patient and nurses' workload. Conclusions., Ongoing education on all aspects of the MET system is recommended for nursing, medical and MET staff. Bringing MET education into undergraduate programs to prepare new graduates entering the workforce to care for acutely ill patients is also strongly recommended. Further research is also needed to determine other influences on MET activation. Relevance to clinical practice., Strategies that will assist nurses to use the MET system more effectively include recruitment and retention of adequate numbers of permanent skilled staff thereby increasing familiarity with and advocacy for the patient. Junior doctors and nurses should be encouraged to attend ward MET calls to gain skills in management of acutely ill patients. [source] Towards a System-Oriented Framework for Analysing and Evaluating Emergency ResponseJOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT, Issue 1 2010Marcus Abrahamsson Information can be provided by studying and evaluating past emergencies and the response in connection to them. This information would then be useful in efforts directed at preventing, mitigating and/or preparing for future emergencies. However, the analysis and evaluation of emergency response operations is not an easy task, especially when the operation involves several cooperating actors (e.g. the fire and rescue services, the police, the emergency medical services, etc.). Here, we identify and discuss four aspects of this challenge: (1) issues related to the values governing the evaluation, (2) issues related to the complexity of the systems involved, (3) issues related to the validity of the information on which the analysis and evaluation is based and (4) issues related to the limiting conditions under which the emergency response system operated. An outline of a framework for such an analysis and evaluation, influenced by systems theory, accident investigation theories and programme evaluation theories dealing with the above aspects, is introduced, discussed and exemplified using empirical results from a case study. We conclude that the proposed framework may provide a better understanding of how an emergency response system functioned during a specific operation, and help to identify the potential events and/or circumstances that could significantly affect the performance of the emergency response system, either negatively or positively. The insights gained from using the framework may allow the actors involved in the response operation to gain a better understanding of how the emergency response system functioned as a whole, as well as how the actors performed as individual components of the system. Furthermore, the information can also be useful for actors preparing for future emergencies. [source] Analysing Emergency Response SystemsJOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT, Issue 2 2008Christian Uhr We suggest a method that can be used for analysing an emergency response system. Both the literature and empirical findings indicate that response operations sometimes diverge from existing plans when adapting to an event and its consequences. The method, which aims at achieving a better understanding of emergency response management, adopts a systems perspective using various relationships that exist or develop between personnel belonging to those organizations that are part of the emergency response operation. Results of a study of such an emergency response system are presented and discussed in order to demonstrate how the method can be employed. [source] Toll-like receptors and their role in gastrointestinal diseaseJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 6 2009Adam G Testro Abstract The innate immune response to invading pathogens is centred upon a family of non-clonal, germline-encoded pattern recognition receptors (PRRs), the Toll-like receptors (TLRs). These provide specificity for a vast range of microbial pathogens, and offer an immediate anti-microbial response system. Thirteen mammalian TLRs have been described; 10 are expressed in humans, each responsible for the recognition of distinct, invariant microbial structures originating from bacteria, viruses, fungi and protozoa. The two most thoroughly studied are TLR4 and TLR2, the PRRs for Gram-negative and Gram-positive bacterial products, respectively. TLR4 is also the major receptor recognising endogenous ligands released from damaged or dying cells. Activation of a TLR by its relevant ligand rapidly ignites a complex intracellular signaling cascade that ultimately results in upregulation of inflammatory genes and production of proinflammatory cytokines, interferons and recruitment of myeloid cells. It also stimulates expression, upon antigen presenting cells, of co-stimulatory molecules required to induce an adaptive immune response. Whilst a robust TLR response is critical for survival and defence against invading pathogens, inappropriate signaling in response to alterations in the local microflora environment can be detrimental. Such ,unhelpful TLR responses' could form the basis for a large number of gastrointestinal and liver disorders, including inflammatory bowel disease, viral hepatitis, autoimmune liver diseases and hepatic fibrosis. As our understanding of TLRs expands, the pathogenesis of a number of gastrointestinal disorders will be further elucidated, and this offers potential for specific therapies aimed directly at TLR signaling. [source] Effects of rapid response systems on clinical outcomes: Systematic review and meta-analysisJOURNAL OF HOSPITAL MEDICINE, Issue 6 2007Sumant R. Ranji MD Abstract BACKGROUND A rapid response system (RRS) consists of providers who immediately assess and treat unstable hospitalized patients. Examples include medical emergency teams and rapid response teams. Early reports of major improvements in patient outcomes led to widespread utilization of RRSs, despite the negative results of a subsequent cluster-randomized trial. PURPOSE To evaluate the effects of RRSs on clinical outcomes through a systematic literature review. DATA SOURCES MEDLINE, BIOSIS, and CINAHL searches through August 2006, review of conference proceedings and article bibliographies. STUDY SELECTION Randomized and nonrandomized controlled trials, interrupted time series, and before-after studies reporting effects of an RRS on inpatient mortality, cardiopulmonary arrests, or unscheduled ICU admissions. DATA EXTRACTION Two authors independently determined study eligibility, abstracted data, and classified study quality. DATA SYNTHESIS Thirteen studies met inclusion criteria: 1 cluster-randomized controlled trial (RCT), 1 interrupted time series, and 11 before-after studies. The RCT showed no effects on any clinical outcome. Before-after studies showed reductions in inpatient mortality (RR = 0.82, 95% CI: 0.74-0.91) and cardiac arrest (RR = 0.73, 95% CI: 0.65-0.83). However, these studies were of poor methodological quality, and control hospitals in the RCT reported reductions in mortality and cardiac arrest rates comparable to those in the before-after studies. CONCLUSIONS Published studies of RRSs have not found consistent improvement in clinical outcomes and have been of poor methodological quality. The positive results of before-after trials likely reflects secular trends and biased outcome ascertainment, as the improved outcomes they reported were of similar magnitude to those of the control group in the RCT. The effectiveness of the RRS concept remains unproven. Journal of Hospital Medicine 2007;2:422,432. © 2007 Society of Hospital Medicine. [source] Submicromolar hydrogen peroxide disrupts the ability of Fur protein to control free-iron levels in Escherichia coliMOLECULAR MICROBIOLOGY, Issue 3 2007Shery Varghese Summary In aerobic environments, mutants of Escherichia coli that lack peroxidase and catalase activities (Hpx,) accumulate submicromolar concentrations of intracellular H2O2. We observed that in defined medium these strains constitutively expressed members of the Fur regulon. Iron-import proteins, which Fur normally represses, were fully induced. H2O2 may antagonize Fur function by oxidizing the Fur:Fe2+ complex and inactivating its repressor function. This is a potential problem, as in iron-rich environments excessive iron uptake would endanger H2O2 -stressed cells by accelerating hydroxyl-radical production through the Fenton reaction. However, the OxyR H2O2 -response system restored Fur repression in iron-replete Luria,Bertani medium by upregulating the synthesis of Fur protein. Indeed, when the OxyR binding site upstream of fur was disrupted, Hpx, mutants failed to repress transporter synthesis, and they exhibited high levels of intracellular free iron. Mutagenesis and bacteriostasis resulted. These defects were eliminated by mutations or chelators that slowed iron import, confirming that dysregulation of iron uptake was the root problem. Thus, aerobic organisms must grapple with a conundrum: how to monitor iron levels in oxidizing environments that might perturb the valence of the analyte. The induction of Fur synthesis by the OxyR response comprises one evolutionary solution to that problem. [source] Understanding the Chain of Communication During a DisasterPERSPECTIVES IN PSYCHIATRIC CARE, Issue 1 2007Heather Shover MD TOPIC.,Every disaster begins on a local level and may, depending on size, evolve to a state of federal disaster response. Understanding California's State Disaster Plan and the importance of the chain of communication is a first step to understanding the Federal Disaster Response system. The chain of command is critical to making sure services and resources are utilized in a timely manner without duplication. PURPOSE.,This paper's intent is to define California's present emergency management system (EMS) infrastructure from local to state level and educate healthcare professionals for disaster activation. CONCLUSIONS.,It is imperative that all voluntary healthcare professionals learn the chain of command within the disaster response system. Each disaster response begins with the individual's preparedness at the local level and all disaster preparedness must incorporate training of health professionals, citizens, and families in local disaster drills. [source] Using behavioral and academic indicators in the classroom to screen for at-risk statusPSYCHOLOGY IN THE SCHOOLS, Issue 2 2005Laura Belsito The present study validated a brief at-risk screening instrument designed for easy use by teachers in the elementary school. School performance measures were collected for students in first to sixth grade one year following initial teacher ratings using the Screening For At-Risk Status screening instrument. Findings indicated that the instrument is best seen as measuring a single at-risk construct with items drawn from three domains: academic skills, social confidence, and social cooperation. Correlations between at-risk scores and school performance measures taken one year later demonstrated predictive validity. The screening instrument correctly identified at-risk students with 88% accuracy and not-at-risk students with 74% accuracy. There were 12% false negatives. Use of the instrument provides teachers with a quick, easy screening of students who may develop difficulties in the future. For schools, the screening can be used as the first step in a supportive response system to assist at-risk students from developing serious school difficulties and possibly failure in the longer term. © 2005 Wiley Periodicals, Inc. Psychol Schs 42: 151,158, 2005. [source] 21 CFR Part 11: electronic records.QUALITY ASSURANCE JOURNAL, Issue 2 2002An interactive voice response system. Abstract A large full-service clinical research organization in the US needed to replace their legacy interactive voice response system which did not provide 21 CFR Part 11 compliant audit trails. They chose to custom-build the new software using C++ component architecture, eXtensible Markup Language (XML), Hypertext Markup Language (HTML), and Microsoft web telephony engine. The case study described in this article illustrates that when systems developers read, study, understand, and embrace 21 CFR Part 11 before designing and validating their product, the regulations are easily met. Copyright © 2002 John Wiley & Sons, Ltd. [source] Detoxification of the explosive 2,4,6-trinitrotoluene in Arabidopsis: discovery of bifunctional O - and C -glucosyltransferasesTHE PLANT JOURNAL, Issue 6 2008Fernando Gandia-Herrero Summary Plants, as predominantly sessile organisms, have evolved complex detoxification pathways to deal with a diverse range of toxic chemicals. The elasticity of this stress response system additionally enables them to tackle relatively recently produced, novel, synthetic pollutants. One such compound is the explosive 2,4,6-trinitrotoluene (TNT). Large areas of soil and groundwater are contaminated with TNT, which is both highly toxic and recalcitrant to degradation, and persists in the environment for decades. Although TNT is phytotoxic, plants are able to tolerate low levels of the compound. To identify the genes involved in this detoxification process, we used microarray analysis and then subsequently characterized seven uridine diphosphate (UDP) glycosyltransferases (UGTs) from Arabidopsis thaliana (Arabidopsis). Six of the recombinantly expressed UGTs conjugated the TNT-transformation products 2- and 4-hydroxylaminodinitrotoulene, exhibiting individual bias for either the 2- or the 4-isomer. For both 2- and 4-hydroxylaminodinitrotoulene substrates, two monoglucose conjugate products, confirmed by HPLC-MS-MS, were observed. Further analysis indicated that these were conjugated by either an O - or C -glucosidic bond. The other major compounds in TNT metabolism, aminodinitrotoluenes, were also conjugated by the UGTs, but to a lesser extent. These conjugates were also identified in extracts and media from Arabidopsis plants grown in liquid culture containing TNT. Overexpression of two of these UGTs, 743B4 and 73C1, in Arabidopsis resulted in increases in conjugate production, and enhanced root growth in 74B4 overexpression seedlings. Our results show that UGTs play an integral role in the biochemical mechanism of TNT detoxification by plants. [source] Questioning as an instructional method: Does it affect learning from lectures?APPLIED COGNITIVE PSYCHOLOGY, Issue 6 2009Julie Campbell What can be done to improve student engagement and learning in college lectures? One approach is to ask questions that students answer during the lecture. In two lab experiments, students received a 25-slide PowerPoint lecture in educational psychology that included four inserted multiple-choice questions (questioning group) or four corresponding statements (control group). Students in the questioning group used a personal response system (PRS), in which they responded to questions using a hand-held remote control, saw a graph displaying the percentage of students voting for each answer, and heard the teacher provide an explanation for the correct answer. Students in the control group received the corresponding slide as a statement and heard the teacher provide an explanation. The questioning group outperformed the control group on a retention test in Experiment 1 (d,=,1.23) and on a transfer test in Experiment 2 (d,=,0.74), but not on other tests. The results are consistent with a generative theory of learning, and encourage the appropriate use of questioning as an instructional method. Copyright © 2008 John Wiley & Sons, Ltd. [source] 2 Incorporation of Audience Participation Technology into Resident Curriculum ReviewACADEMIC EMERGENCY MEDICINE, Issue 2008Brian Sayger We have incorporated audience participation technology (Turning Point) into our weekly curriculum review sessions. This audience response system consists of individual remote response keypads, a USB port-compatible receiver, and software which integrates into PowerPoint. Board-style questions are written into PowerPoint slides and presented by the speaker. Rather than selecting one resident to answer a question, all audience members select an answer using their keypad. The receiver registers the answers and immediately displays a graph of the audience's responses. Questions with more incorrect answers are discussed in detail while less time is spent on questions answered correctly by most of the audience. This encourages active participation for each question and eliminates the stress of a single resident giving an incorrect answer in front of a large number of peers. Audience members are engaged throughout the hour rather than concentrating only on questions assigned to them. Residents and students discover that challenging questions are answered incorrectly by a significant number of audience members. In a short time using this system, we've seen audience discussion increase dramatically. We plan to expand our use of this technology to other lectures. Speakers will administer end-of-lecture quizzes, immediately assessing how effectively their presentation achieved its learning objectives. All residents have an assigned keypad, and their percentage of correct answers is recorded during every session. This allows the program to monitor a resident's progress and to identify areas in which the resident may need more instruction. This system has potential applications for competency assessment. [source] Improving Surge Capacity for Biothreats: Experience from TaiwanACADEMIC EMERGENCY MEDICINE, Issue 11 2006Fuh-Yuan Shih MD This article discusses Taiwan's experience in managing surge needs based on recent events, including the 1999 earthquake, severe acute respiratory syndrome in 2003, airliner crashes in 1998 and 2001, and yearly typhoons and floods. Management techniques are compared and contrasted with U.S. approaches. The authors discuss Taiwan's practices of sending doctors to the scene of an event and immediately recalling off-duty hospital personnel, managing volunteers, designating specialty hospitals, and use of incident management systems. The key differences in bioevents, including the mathematical myths regarding individual versus population care, division of stockpiles, the Maginot line, and multi-jurisdictional responses, are highlighted. Several recent initiatives aimed at mitigating biothreats have begun in Taiwan, but their efficacy has not yet been tested. These include the integration of the emergency medical services and health-facility medical systems with other response systems; the use of the hospital emergency incident command system; crisis risk-communications approaches; and the use of practical, hands-on training programs. Other countries may gain valuable insights for mitigating and managing biothreats by studying Taiwan's experiences in augmenting surge capacity. [source] Molecular mechanisms of heavy metal tolerance and evolution in invertebratesINSECT SCIENCE, Issue 1 2009Thierry K. S. Janssens Abstract Following the genomics revolution, our knowledge of the molecular mechanisms underlying defenses against stress has been greatly expanded. Under strong selective pressure many animals may evolve an enhanced stress tolerance. This can be achieved by altering the structure of proteins (through mutations in the coding regions of genes) or by altering the amount of protein (through changes in transcriptional regulation). The latter type of evolution can be achieved by substitutions in the promoter of the gene of interest (cis -regulatory change) or by altering the structure or amount of transcriptional regulator proteins (trans -regulatory change). The metallothionein system is one of the best studied stress response systems in the context of heavy metals. Metallothionein expression is assumed to be regulated by metal transcription factor 1 (MTF-1); however, up to now the involvement of MTF-1 has only been proven for some vertebrates and Drosophila. Data on invertebrates such as nematodes and earthworms suggest that other mechanisms of metallothionein induction may be present. A detailed study of Cd tolerance was done for a species of soil-living springtail, Orchesella cincta. The metallothionein gene of this species is overexpressed in metal-exposed field populations. Analysis of the metallothionein promoter has demonstrated extensive polymorphisms that have a functional significance, as shown in bioreporter assays. In a study comparing 20 different populations, the frequency of a high-expresser promoter allele was positively correlated with the concentration of metals in soil, especially Cd. The springtail study shows that cis -regulatory change of genes involved in the cellular stress response may contribute to evolution of metal tolerance. [source] | ||||||||||||||||||||||||||||