In the aftermath of medical error : Caring for patients, family, and the healthcare workers involved

Medical errors, in particular those resulting in harm, pose a serious situation for patients ("first victims") and the healthcare workers involved ("second victims") and can have long-lasting and distressing consequences. To prevent a second traumatization, appropriate and empathic interaction with all persons involved is essential besides error analysis. Patients share a nearly universal, broad preference for a complete disclosure of incidents, regardless of age, gender, or education. This includes the personal, timely and unambiguous disclosure of the adverse event, information relating to the event, its causes and consequences, and an apology and sincere expression of regret. While the majority of healthcare professionals generally support and honest and open disclosure of adverse events, they also face various barriers which impede the disclosure (e.g., fear of legal consequences). Despite its essential importance, disclosure of adverse events in practice occurs in ways that are rarely acceptable to patients and their families. The staff involved often experiences acute distress and an intense emotional response to the event, which may become chronic and increase the risk of depression, burnout and post-traumatic stress disorders. Communication with peers is vital for people to be able to cope constructively and protectively with harmful errors. Survey studies among healthcare workers show, however, that they often do not receive sufficient individual and institutional support. Healthcare organizations should prepare for medical errors and harmful events and implement a communication plan and a support system that covers the requirements and different needs of patients and the staff involved.

Addresses on homely and religious subjects, delivered before the children of the Hebrew Orphan Asylum

by Hermann Baar

Time pressure, social work stressors and blood pressure in a team of seven IT-workers during one week of intense work

Background. In the field of information technology (IT) time pressure is common. Working with tight deadlines together on the same task increases the risk of social stressors referring to tensions and conflicts at work. Purpose. This field study tested both the association of time pressure and social stressors with blood pressure during work. Method. Seven employees – staff of a small IT enterprise – participated in repeated ambulatory blood pressure measurements over the course of one week. Time pressure and social stressors at work were assessed by questionnaire at the beginning of the study. Results. Multilevel regression analyses of 138 samples revealed higher levels of time pressure to be related to marginally significant increases in mean arterial blood pressure at noon and in the afternoon. In addition, higher levels of social stressors at work were significantly associated to elevated mean arterial pressure in the afternoon. Conclusion. Findings support the view that threats to the social self play an important role in occupational health.

Scarring Effects of Early Unemployment among Young Workers with Vocational Credentials in Switzerland

Background Using a unique, longitudinal survey that follows school-to-work transitions of pupils who participated in PISA 2000, this paper investigates adverse consequences, so-called scarring effects, of early unemployment among young adults who acquired vocational credentials in Switzerland. Methods As social, individual and contextual factors influence both early unemployment and later employment outcomes, taking into account endogeneity is of utmost importance when investigating scarring effects. In this regard we make use of nearest-neighbour propensity score matching and set up statistical control groups. Results Our results suggest that young adults who hold vocational credentials are more likely to be neither in employment nor in education, and to earn less and be more dissatisfied with their career progress later in work life than they would be, had they not experienced early unemployment. Conclusions We conclude that unemployment scarring also affects young adults with vocational credentials in a liberal labour market setting that otherwise allows for smooth school-to-work transitions. This finding runs counter to expectations that standardised vocational degrees, a liberal and flexible labour market structure, and predominantly short unemployment spells protect young skilled workers from scarring in case they happen to experience early career instability.

Genome and transcriptome sequencing identifies breeding targets in the orphan crop tef (Eragrostis tef)

Background: Tef (Eragrostis tef), an indigenous cereal critical to food security in the Horn of Africa, is rich in minerals and protein, resistant to many biotic and abiotic stresses and safe for diabetics as well as sufferers of immune reactions to wheat gluten. We present the genome of tef, the first species in the grass subfamily Chloridoideae and the first allotetraploid assembled de novo. We sequenced the tef genome for marker-assisted breeding, to shed light on the molecular mechanisms conferring tef's desirable nutritional and agronomic properties, and to make its genome publicly available as a community resource. Results: The draft genome contains 672 Mbp representing 87% of the genome size estimated from flow cytometry. We also sequenced two transcriptomes, one from a normalized RNA library and another from unnormalized RNASeq data. The normalized RNA library revealed around 38000 transcripts that were then annotated by the SwissProt group. The CoGe comparative genomics platform was used to compare the tef genome to other genomes, notably sorghum. Scaffolds comprising approximately half of the genome size were ordered by syntenic alignment to sorghum producing tef pseudo-chromosomes, which were sorted into A and B genomes as well as compared to the genetic map of tef. The draft genome was used to identify novel SSR markers, investigate target genes for abiotic stress resistance studies, and understand the evolution of the prolamin family of proteins that are responsible for the immune response to gluten. Conclusions: It is highly plausible that breeding targets previously identified in other cereal crops will also be valuable breeding targets in tef. The draft genome and transcriptome will be of great use for identifying these targets for genetic improvement of this orphan crop that is vital for feeding 50 million people in the Horn of Africa.

Application of TILLING for Orphan Crop Improvement

People in developing countries mostly depend for their diet on special staple crops, so called orphan crops. These crops play a key role in food security since they are grown by many resource-poor farmers and consumed locally. Despite their huge importance in the economy and livelihood of the developing world, orphan crops have received little attention in terms of scientific improvement. Although conventional breeding is widely implemented to improve crop plants, alternative methods such as marker-assisted breeding and reverse genetics approaches have proved to be efficient in developing crop cultivars. In this review, we present detailed description of a non-transgenic and reverse genetics technique called TILLING (Targeting Induced Local Lesion IN Genomes). The method was originally optimized in the model plant Arabidposis thaliana and subsequently applied to crops such as maize, wheat, and rice. We also present detailed procedures for several TILLING strategies and discuss their benefits and drawbacks. The application of the technique for orphan crop improvement is also discussed based on several TILLING platforms currently carried-out on these understudied crops of the world.

The granulocyte orphan receptor CEACAM4 is able to trigger phagocytosis of bacteria.

Human granulocytes express several glycoproteins of the CEACAM family. One family member, CEACAM3, operates as a single-chain phagocytic receptor, initiating the detection, internalization, and destruction of a limited set of gram-negative bacteria. In contrast, the function of CEACAM4, a closely related protein, is completely unknown. This is mainly a result of a lack of a specific ligand for CEACAM4. By generating chimeric proteins containing the extracellular bacteria-binding domain of CEACAM3 and the transmembrane and cytoplasmic part of CEACAM4 (CEACAM3/4) we demonstrate that this chimeric receptor can trigger efficient phagocytosis of attached particles. Uptake of CEACAM3/4-bound bacteria requires the intact ITAM of CEACAM4, and this motif is phosphorylated by Src family PTKs upon receptor clustering. Furthermore, SH2 domains derived from Src PTKs, PI3K, and the adapter molecule Nck are recruited and associate directly with the phosphorylated CEACAM4 ITAM. Deletion of this sequence motif or inhibition of Src PTKs blocks CEACAM4-mediated uptake. Together, our results suggest that this orphan receptor of the CEACAM family has phagocytic function and prompt efforts to identify CEACAM4 ligands.

Effectiveness of Personal Protective Equipment for Healthcare Workers Caring for Patients with Filovirus Disease: A Rapid Review.

BACKGROUND A rapid review, guided by a protocol, was conducted to inform development of the World Health Organization's guideline on personal protective equipment in the context of the ongoing (2013-present) Western African filovirus disease outbreak, with a focus on health care workers directly caring for patients with Ebola or Marburg virus diseases. METHODS Electronic databases and grey literature sources were searched. Eligibility criteria initially included comparative studies on Ebola and Marburg virus diseases reported in English or French, but criteria were expanded to studies on other viral hemorrhagic fevers and non-comparative designs due to the paucity of studies. After title and abstract screening (two people to exclude), full-text reports of potentially relevant articles were assessed in duplicate. Fifty-seven percent of extraction information was verified. The Grading of Recommendations Assessment, Development and Evaluation framework was used to inform the quality of evidence assessments. RESULTS Thirty non-comparative studies (8 related to Ebola virus disease) were located, and 27 provided data on viral transmission. Reporting of personal protective equipment components and infection prevention and control protocols was generally poor. CONCLUSIONS Insufficient evidence exists to draw conclusions regarding the comparative effectiveness of various types of personal protective equipment. Additional research is urgently needed to determine optimal PPE for health care workers caring for patients with filovirus.

Dus grose success lied "Unser neue Heim" : sung by Joseph Shoengold in Isidore Solotorefsky's "Yesoimem fin der Welt" (Orphan's of the world) ; played at Liberty Theatre East New York

music by Peretz Sandler. Words by Isidor Lilien

A MORTALITY STUDY OF BUTYL-CHLOROBUTYL RUBBER WORKERS

Worker populations are potentially exposed to multiple chemical substances simultaneously during the performance of routine tasks. The acute health effects from exposure to toxic concentrations of these substances are usually well-described. However, very little is known about the long-term health effects of chronic low dose exposure to all except a few chemical substances. A mortality study was performed on a population of workers employed at a butyl rubber manufacturing plant in Baton Rouge, Louisiana for the period 1943-1978, with special emphasis on potential exposure to methyl chloride.^ The study population was enumerated using company records. The mortality experience among the population was evaluated by comparing the number of observed deaths (total and cause-specific) to the expected number of deaths, based on the U.S. general age, race, sex specific rates. An internal comparison population was assembled to address the issue of lack of comparability when the U.S. rates are used to calculate expected deaths in an employed population.^ There were 18% fewer total observed deaths compared to the expected when the U.S. death rates were used to obtain the expected. Deaths from specific causes were also less than expected except when numbers of observed and expected deaths were small. Similar results were obtained when the population was characterized by intensity and duration of potential exposure to methyl chloride. When the internal comparison population was utilized to evaluate overall mortality of the study population, the relative risk was about 1.2.^ The study results were discussed and conclusions drawn in light of certain limitations of the methodology and study population size. ^