Sequential monitoring of hospital adverse events when control charts fail : the example of fall injuries in hospitals

Objective To evaluate methods for monitoring monthly aggregated hospital adverse event data that display clustering, non-linear trends and possible autocorrelation. Design Retrospective audit. Setting The Northern Hospital, Melbourne, Australia. Participants 171,059 patients admitted between January 2001 and December 2006. Measurements The analysis is illustrated with 72 months of patient fall injury data using a modified Shewhart U control chart, and charts derived from a quasi-Poisson generalised linear model (GLM) and a generalised additive mixed model (GAMM) that included an approximate upper control limit. Results The data were overdispersed and displayed a downward trend and possible autocorrelation. The downward trend was followed by a predictable period after December 2003. The GLM-estimated incidence rate ratio was 0.98 (95% CI 0.98 to 0.99) per month. The GAMM-fitted count fell from 12.67 (95% CI 10.05 to 15.97) in January 2001 to 5.23 (95% CI 3.82 to 7.15) in December 2006 (p<0.001). The corresponding values for the GLM were 11.9 and 3.94. Residual plots suggested that the GLM underestimated the rate at the beginning and end of the series and overestimated it in the middle. The data suggested a more rapid rate fall before 2004 and a steady state thereafter, a pattern reflected in the GAMM chart. The approximate upper two-sigma equivalent control limit in the GLM and GAMM charts identified 2 months that showed possible special-cause variation. Conclusion Charts based on GAMM analysis are a suitable alternative to Shewhart U control charts with these data.

Human parvovirus infections during pregnancy : Special reference to the child-care employees

Human parvovirus B19 (B19V) is known to cause anemia, hydrops fetalis, and fetal death especially during the first half of pregnancy. Women who are in occupational contact with young children are at increased risk of B19V infection. The role of the recently discovered human parvovirus, human bocavirus (HBoV), in reproduction is unknown. The aim of this research project was to establish a scientific basis for assessing the work safety of pregnant women and for issuing special maternity leave regulations during B19V epidemics in Finland. The impact of HBoV infection on the pregnant woman and her fetus was also defined. B19V DNA was found in 0.8% of the miscarriages and in 2.4% of the intrauterine fetal death (IUFD; fetal death after completed 22 gestational weeks). All control fetuses (from induced abortions) were B19V-DNA negative. The findings on hydropic B19V DNA-positive IUFDs with evidence of acute or recent maternal B19V infection are in line with those of previous Swedish studies. However, the high prevalence of B19V-related nonhydropic IUFDs noted in the Swedish studies was mostly without evidence of maternal B19V infection and was not found during the third trimester. HBoV was not associated with miscarriages or IUFDs. Almost all of the studied pregnant women were HboV-IgG positive, and thus most probably immune to HBoV. All preterm births, perinatal deaths, smallness for gestational age (SGA) and congenital anomaly were recorded among the infants of child-care employees in a nationwide register-based cohort study over a period of 14 years. Little or no differences in the results were found between the infants of the child-care employees and those of the comparison group. The annual B19V seroconversion rate was over two-fold among the child-care employees, compared to the women in the comparison group. The seropositivity of the child-care employees increased with age, and years from qualification/joining the trade union. In general, the child-care employees are not at increased risk for adverse pregnancy outcome. However, at the population level, the risk of rare events, such as adverse pregnancy outcomes attributed to infections, could not be determined. According to previous studies, seronegative women had a 5 10% excess risk of losing the fetus during the first half of their pregnancy, but thereafter the risk was very low. Therefore, an over two-fold increased risk of B19V infection among child-care employees is considerable, and should be taken into account in the assessment of the occupational safety of pregnant women, especially during the first half of their pregnancy.

Working Memory Networks for Learning Multiple Groupings of Temporarily Ordered Events: Applications to 3-D Visual Object Recognition

Working memory neural networks are characterized which encode the invariant temporal order of sequential events that may be presented at widely differing speeds, durations, and interstimulus intervals. This temporal order code is designed to enable all possible groupings of sequential events to be stably learned and remembered in real time, even as new events perturb the system. Such a competence is needed in neural architectures which self-organize learned codes for variable-rate speech perception, sensory-motor planning, or 3-D visual object recognition. Using such a working memory, a self-organizing architecture for invariant 3-D visual object recognition is described that is based on the model of Seibert and Waxman [1].

Events: Temporal and Eternal (in preparation)

This monograph develops a theory of events which provides the foundation for a plausible and coherent account of God’s relation to time, and which has independent appeal (independent, that is, of theological considerations). The book is divided into three parts. The first part involves an investigation of those fundamental aspects of time which have important implications for the nature of events, such as whether time is substantival or relational, and whether time is continuous, dense, or discrete. This part also includes a chapter on how these issues relate to different interpretations of the special theory of relativity. The second part involves a defense of the fundamentality of events, and the development of a theory of events in time. The third part considers ways in which we might plausibly conceive of events as eternal entities. This involves an investigation of different ways of characterizing divine eternity, and then an analysis of the possible relations these ways bear to the antecedently developed theory of temporal events. The thought here is that there are certain characteristics of temporal events which can be assimilated to eternity, and that by evaluating the extent to which different theories of divine eternity allow for this assimilation, we will be able to determine which of those theories is most plausible, and therefore which conception of God’s relation to time is most plausible. The basis of this evaluation will be the theory’s ability to coherently account for God’s knowledge of, and interaction with, the created temporal world. One specific issue here is how to account for God’s knowledge of the future free actions of humans (an issue that I address in 'Eternity, Knowledge, and Freedom'), but there are many other difficulties associated with God’s relation to time, such as God’s creation of contingent time, God’s knowledge of what is happening now, God’s dialogue with humans, and God’s causally interacting with the temporal world in general. A successful theory of eternal events, and, in particular, divine events, will provide a framework for dealing with these difficulties.

I have not yet sough a publisher for this work, but intend to do so in 2013, with a target publication date of 2014.

Introduction to the Special Section Value Development from Middle Childhood to Early Adulthood: New Insights from Longitudinal and Genetically Informed Research

Research into values at an early age has only started recently, although it has expanded quickly and dynamically in the past years. The purpose of this article is twofold: First, it provides an introduction to a special section that aims to help fill the gap in value development research. The special section brings together four new longitudinal and genetically informed studies of value development from the beginning of middle childhood through early adulthood. Second, this article reviews recent research from this special section and beyond, aiming to provide new directions to the field. With new methods for assessing children's values and an increased awareness of the role of values in children's and adolescents' development, the field now seems ripe for an in-depth investigation. Our review of empirical evidence shows that, as is the case with adults, children's values are organized based on compatibilities and conflicts in their underlying motivations. Values show some consistency across situations, as well as stability across time. This longitudinal stability tends to increase with age, although mean changes are also observed. These patterns of change seem to be compatible with Schwartz's (1992) theory of values (e.g., if the importance of openness to change values increases, the importance of conservation values decreases). The contributions of culture, family, peers, significant life events, and individual characteristics to values are discussed, as well as the development of values as guides for behavior.

Mesozooplankton of the Arabian Sea and the Bay of Bengal with special reference to planktonic ostracods

The Arabian Sea and the Bay of Bengal are both highly dynamic ecosystems, due to the seasonally reversing monsoon winds, but the processes affecting the mesozooplankton community remain poorly understood. These are important basins exhibiting enhanced biological production as a result of upwelling, winter cooling and other episodic events such as eddies and gyres. Zooplankters are primarily the prey for almost all fish larvae. Seasonal changes in the biogeochemical processes can strongly affect zooplankton density and distribution, which in turn, strongly affect the larval growth, and consequently, the pelagic fish recruitment. It is clear that plankton biomass and biogeochemical fluxes are not in steady state. Acoustic data on mesozooplankton abundance suggests that they also exist in the mesopelagic zone. Earlier studies were confined only to the upper 200 m and hence the structure of mesozooplankton community in the deeper layers was not well known. Copepods are the dominant mesoplankton group, and therefore the majority of the studies were focused on them. The planktonic ostracods are the second major crustacean group and at times, their swarms can outnumber all other planktonic groups. The understanding of the community structure of the ostracods is essential to establish their role in the marine food web. Mesozooplankton is responsible for the vertical flux of organic matter produced by phytoplankton and is assumed to be equivalent to new production (Eppley & Peterson, 1979). Since the fate of newly produced organic matter depends upon their consumers, the zooplankton biomass must be estimated in size fractions or taxonomic components to understand the vertical flux of organic carbon. It is thus important to update our knowledge on different groups of zooplankton on the basis of seasonal and temporal distribution. The distribution in space and time is essential for modeling the carbon cycling that structure the marine ecosystems

Geology and geochronology of the Betara region in south-southeastern Brazil: Evidence for possible Statherian (1.80-1.75 Ga) and Calymmian (1.50-1.45 Ga) extension events

The results of geological mapping, chemical analysis and radiometric dating of metabasic rocks of Betara Formation, and mapping and dating of those present in the Betara basement nucleus together with mylonitic granodiorite and syenogranite are reported here. U-Pb analysis of bulk zircon fractions from the metabasic rocks of the basement nucleus yielded a Statherian age of 1790 +/- 22 Ma, while the metabasic rocks from the upper part of the Betara Formation yielded a Calymmian age between 1500 and 1450 Ma. This age is a minimum for the deposition of the Betara Formation. The older metabasic rocks are associated with post-tectonic, possibly anorogenic syenogranite, while the younger ones are gabbro or very porphyritic ankaramite whose REE patterns are consistent with crystallization from an N-MORB parent magma. The observations and data point to the probable events associated with extensional processes of the end of Paleoproterozoic and early Mesoproterozoic. Similar registers of Statherian (1.80-1.75 Ga) and Calymmian (1.50-1.45 Ga) extensional events are recorded in other parts of the South American and African continents. The Neoproterozoic witnessed the formation and junction of the tectonic slices which formed the Apiai domain during the assemblage of western Gondwana. (C) 2010 International Association for Gondwana Research. Published by Elsevier B.V. All rights reserved.

ECLAC Notes Nº 53. Special Issue

Special Issue: 50th Anniversary of the Latin American and Caribbean Demographic Centre (CELADE) - ECLAC Population Division. A Region Where Fewer Children Are Born. Challenges and Opportunities of Moving Elsewhere. Opinion by ECLAC's Executive Secretary, José Luis Machinea. The Latin American and Caribbean Population Challenge. CELADE Celebrates Its 50th Anniversary. Highlights. A New Look at the Population Pyramid Death and Inequality. Recent titles. Calendar of Events

Die Re-Definition der Wirklichkeit durch Motto-Events

Eine aktuelle Ausprägung der Veranstaltungslandschaft sind die so genannten Motto-Events, die die Inszenierung einer Anderswelt-Konstruktion einsetzen, um emotionale und kommunikatorische Ziele zu erreichen. Dabei werden themengebundene Entwürfe räumlich und inhaltlich in die lebensweltliche Wirklichkeit transportiert und auf diese Weise eine dynamische und integrative Scheinwelt erschaffen. In dieser konstruierten Welt können schließlich Abenteuer erlebt und heroische Taten begangen werden. Durch die reziproke Beeinflussung von Inszenierung und Handlung befinden sich die Akteure außerhalb der gesellschaftlichen Norm, sie erleben innerhalb der "gated community" der Motto-Veranstaltung eine re-definierte Wirklichkeit. Aus einer Kombination von aktiven und passiven Elementen werden homogene Klischees inszeniert, die durch ihren Bekanntheitsgrad eine hohe Anschlussfähigkeit der Teilnehmer garantieren. Die vorliegende Arbeit beschäftigt sich mit den Mechanismen, die diese re-definierte Wirklichkeit in Szene setzen. Dadurch wird es möglich, in einer zusammenfassenden Betrachtung die Rezeption verschiedener Event-Modelle zu beschreiben und Handlungsempfehlungen zu geben.

Spastin in the human and mouse central nervous system with special reference to its expression in the hippocampus of mouse pilocarpine model of status epilepticus and temporal lobe epilepsy

In the present in situ hybridization and immunocytochemical studies in the mouse central nervous system (CNS), a strong expression of spastin mRNA and protein was found in Purkinje cells and dentate nucleus in the cerebellum, in hippocampal principal cells and hilar neurons, in amygdala, substantia nigra, striatum, in the motor nuclei of the cranial nerves and in different layers of the cerebral cortex except piriform and entorhinal cortices where only neurons in layer II were strongly stained. Spastin protein and mRNA were weakly expressed in most of the thalamic nuclei. In selected human brain regions such as the cerebral cortex, cerebellum, hippocampus, amygdala, substania nigra and striatum, similar results were obtained. Electron microscopy showed spastin immunopositive staining in the cytoplasma, dendrites, axon terminals and nucleus. In the mouse pilocarpine model of status epilepticus and subsequent temporal lobe epilepsy, spastin expression disappeared in hilar neurons as early as at 2h during pilocarpine induced status epilepticus, and never recovered. At 7 days and 2 months after pilocarpine induced status epilepticus, spastin expression was down-regulated in granule cells in the dentate gyrus, but induced expression was found in reactive astrocytes. The demonstration of widespread distribution of spastin in functionally different brain regions in the present study may provide neuroanatomical basis to explain why different neurological, psychological disorders and cognitive impairment occur in patients with spastin mutation. Down-regulation or loss of spastin expression in hilar neurons may be related to their degeneration and may therefore initiate epileptogenetic events, leading to temporal lobe epilepsy.

The Geology of Lost Creek Canyon with Special Reference to Igneous Activity

This investigation was undertaken primarily as a problem in geologic mapping, coupled with a study of stratigraphy, glaciation, igneous phenomena, and structure. The area is admirably suited to a study of geology and geologic events. Because it is small in extent, the area was studied in some detail during the time which was devoted to field work. The record of igneous activity of past geological ages is re­markably well exposed, since Lost Creek Canyon was carved through the roof of a stock or batholith by the glaciers of the Pleistocene epoch.

The special Sm core structure of the U7 snRNP: far-reaching significance of a small nuclear ribonucleoprotein

The polypeptide composition of the U7 small nuclear ribonucleoprotein (snRNP) involved in histone messenger RNA (mRNA) 3' end formation has recently been elucidated. In contrast to spliceosomal snRNPs, which contain a ring-shaped assembly of seven so-called Sm proteins, in the U7 snRNP the Sm proteins D1 and D2 are replaced by U7-specific Sm-like proteins, Lsm10 and Lsm11. This polypeptide composition and the unusual structure of Lsm11, which plays a role in histone RNA processing, represent new themes in the biology of Sm/Lsm proteins. Moreover this structure has important consequences for snRNP assembly that is mediated by two complexes containing the PRMT5 methyltransferase and the SMN (survival of motor neurons) protein, respectively. Finally, the ability to alter this polypeptide composition by a small mutation in U7 snRNA forms the basis for using modified U7 snRNA derivatives to alter specific pre-mRNA splicing events, thereby opening up a new way for antisense gene therapy.

The ring vaccination trial: a novel cluster randomised controlled trial design to evaluate vaccine efficacy and effectiveness during outbreaks, with special reference to Ebola

A World Health Organization expert meeting on Ebola vaccines proposed urgent safety and efficacy studies in response to the outbreak in West Africa. One approach to communicable disease control is ring vaccination of individuals at high risk of infection due to their social or geographical connection to a known case. This paper describes the protocol for a novel cluster randomised controlled trial design which uses ring vaccination.In the Ebola ça suffit ring vaccination trial, rings are randomised 1:1 to (a) immediate vaccination of eligible adults with single dose vaccination or (b) vaccination delayed by 21 days. Vaccine efficacy against disease is assessed in participants over equivalent periods from the day of randomisation. Secondary objectives include vaccine effectiveness at the level of the ring, and incidence of serious adverse events.Ring vaccination trials are adaptive, can be run until disease elimination, allow interim analysis, and can go dormant during inter-epidemic periods.

On the Dark Side of Therapies with Immunoglobulin Concentrates: The Adverse Events

Therapy by human immunoglobulin G (IgG) concentrates is a success story ongoing for decades with an ever increasing demand for this plasma product. The success of IgG concentrates on a clinical level is documented by the slowly increasing number of registered indication and the more rapid increase of the off-label uses, a topic dealt with in another contribution to this special issue of Frontiers in Immunology. A part of the success is the adverse event (AE) profile of IgG concentrates which is, even at life-long need for therapy, excellent. Transmission of pathogens in the last decade could be entirely controlled through the antecedent introduction by authorities of a regulatory network and installing quality standards by the plasma fractionation industry. The cornerstone of the regulatory network is current good manufacturing practice. Non-infectious AEs occur rarely and mainly are mild to moderate. However, in recent times, the increase in frequency of hemolytic and thrombotic AEs raised worrying questions on the possible background for these AEs. Below, we review elements of non-infectious AEs, and particularly focus on hemolysis and thrombosis. We discuss how the introduction of plasma fractionation by ion-exchange chromatography and polishing by immunoaffinity chromatographic steps might alter repertoire of specificities and influence AE profiles and efficacy of IgG concentrates.