Towards an understanding of the information dynamics of the handover process in aged care settings: A prerequisite for the safe and effective use of ICT

Background Poor clinical handover has been associated with inaccurate clinical assessment and diagnosis, delays in diagnosis and test ordering, medication errors and decreased patient satisfaction in the acute care setting. Research on the handover process in the residential aged care sector is very limited. Purpose The aims of this study were to: (i) Develop an in-depth understanding of the handover process in aged care by mapping all the key activities and their information dynamics, (ii) Identify gaps in information exchange in the handover process and analyze implications for resident safety, (iii) Develop practical recommendations on how information communication technology (ICT) can improve the process and resident safety. Methods The study was undertaken at a large metropolitan facility in NSW with more than 300 residents and a staff including 55 registered nurses (RNs) and 146 assistants in nursing (AINs). A total of 3 focus groups, 12 interviews and 3 observation sessions were conducted over a period from July to October 2010. Process mapping was undertaken by translating the qualitative data via a five-category code book that was developed prior to the analysis. Results Three major sub-processes were identified and mapped. The three major stages are Handover process (HOP) I “Information gathering by RN”, HOP II “Preparation of preliminary handover sheet” and HOP III “Execution of handover meeting”. Inefficient processes were identified in relation to the handover including duplication of information, utilization of multiple communication modes and information sources, and lack of standardization. Conclusion By providing a robust process model of handover this study has made two critical contributions to research in aged care: (i) a means to identify important, possibly suboptimal practices; and (ii) valuable evidence to plan and improve ICT implementation in residential aged care. The mapping of this process enabled analysis of gaps in information flow and potential impacts on resident safety. In addition it offers the basis for further studies into a process that, despite its importance for securing resident safety and continuity of care, lacks research.

Studies on induction of delta-aminolevulinic acid synthetase in mouse liver

Administration of 3,5-diethoxy carbonyl-1,4-dihydrocollidine (DDC) to mice resulted in a striking increase in the level of δ-aminolevulinic acid (ALA) synthetase in liver. Although the enzyme activity was primarily localized in mitochondria and postmicrosomal supernatant fluid, a significant level of activity was also detected in purified nuclei. The time course of induction showed a close parallelism between the bound and free enzyme activities with the former always accounting for a higher percentage of the total activity as compared to the latter. Studies with cycloheximide indicated a half-life of around 3 hr for both the bound and free ALA synthetase. Actinomycin D and hemin prevented enzyme induction when administered along with DDC, but when administered 12 hr after DDC treatment Actinomycin D did not lead to a decay of either the bound or free enzyme activity and hemin inhibited the bound enzyme activity but not the free enzyme level. The molecular sizes of the mitochondrial and cytosolic ALA synthetase(s) were found to be similar on sephadex columns.

Finnish-French Fundamental Cultural Antagonisms in Organising

Seeking to challenge the belief that within-West cultural differences should be seen as insignificant in organisations, this paper seeks to demonstrate how two given Western European ‘organising cultures’ (i.e. Finnish culture and French culture, as they are expressed in the process of organising) can contrast, if not conflict, with each other. Further, it aims to help the reader realise what kinds of fundamental ‘cultural antagonisms’ these contrasting organising behaviours may come from, to help her/him understand ‘the other culture’ better, and thus allow for a first step towards an improvement of Finnish-French intercultural interactions in organisational contexts. After shortly introducing what should be understood here as ‘cultural antagonisms’, the paper addresses four fundamental Finnish-French antagonisms, regarding the vision of the organisation (‘functionalist vs. personalist’), the relative importance of ‘consensus vs. dissensus’, the typical trade-off between reliability and flexibility, and the striking differences in communication, respectively. These four fundamental antagonisms are found to be closely interrelated and integrated, serving as explanation, justification and legitimisation for each other. That does not mean, however, that differences, however striking they may be, should merely be a threat to co-operation: some implications introduced at the end of the paper suggest that, provided people are aware of them, cultural antagonisms can also be seen as opportunities for a more fruitful work interaction.

Stability of spatially developing boundary layers in pressure gradients

A new formulation of the stability of boundary-layer flows in pressure gradients is presented, taking into account the spatial development of the flow and utilizing a special coordinate transformation. The formulation assumes that disturbance wavelength and eigenfunction vary downstream no more rapidly than the boundary-layer thickness, and includes all terms nominally of order R(-1) in the boundary-layer Reynolds number R. In Blasius flow, the present approach is consistent with that of Bertolotti et al. (1992) to O(R(-1)) but simpler (i.e. has fewer terms), and may best be seen as providing a parametric differential equation which can be solved without having to march in space. The computed neutral boundaries depend strongly on distance from the surface, but the one corresponding to the inner maximum of the streamwise velocity perturbation happens to be close to the parallel flow (Orr-Sommerfeld) boundary. For this quantity, solutions for the Falkner-Skan flows show the effects of spatial growth to be striking only in the presence of strong adverse pressure gradients. As a rational analysis to O(R(-1)) demands inclusion of higher-order corrections on the mean flow, an illustrative calculation of one such correction, due to the displacement effect of the boundary layer, is made, and shown to have a significant destabilizing influence on the stability boundary in strong adverse pressure gradients. The effect of non-parallelism on the growth of relatively high frequencies can be significant at low Reynolds numbers, but is marginal in other cases. As an extension of the present approach, a method of dealing with non-similar flows is also presented and illustrated. However, inherent in the transformation underlying the present approach is a lower-order non-parallel theory, which is obtained by dropping all terms of nominal order R(-1) except those required for obtaining the lowest-order solution in the critical and wall layers. It is shown that a reduced Orr-Sommerfeld equation (in transformed coordinates) already contains the major effects of non-parallelism.

HCN channels enhance spike phase coherence and regulate the phase of spikes and LFPs in the theta-frequency range

What are the implications for the existence of subthreshold ion channels, their localization profiles, and plasticity on local field potentials (LFPs)? Here, we assessed the role of hyperpolarization-activated cyclic-nucleotide-gated (HCN) channels in altering hippocampal theta-frequency LFPs and the associated spike phase. We presented spatiotemporally randomized, balanced theta-modulated excitatory and inhibitory inputs to somatically aligned, morphologically realistic pyramidal neuron models spread across a cylindrical neuropil. We computed LFPs from seven electrode sites and found that the insertion of an experimentally constrained HCN-conductance gradient into these neurons introduced a location- dependent lead in the LFP phase without significantly altering its amplitude. Further, neurons fired action potentials at a specific theta phase of the LFP, and the insertion of HCN channels introduced large lags in this spike phase and a striking enhancement in neuronal spike-phase coherence. Importantly, graded changes in either HCN conductance or its half-maximal activation voltage resulted in graded changes in LFP and spike phases. Our conclusions on the impact of HCN channels on LFPs and spike phase were invariant to changes in neuropil size, to morphological heterogeneity, to excitatory or inhibitory synaptic scaling, and to shifts in the onset phase of inhibitory inputs. Finally, we selectively abolished the inductive lead in the impedance phase introduced by HCN channels without altering neuronal excitability and found that this inductive phase lead contributed significantly to changes in LFP and spike phase. Our results uncover specific roles for HCN channels and their plasticity in phase-coding schemas and in the formation and dynamic reconfiguration of neuronal cell assemblies.

Effects of temperature on the biology of the northern shrimp, Pandalus borealis, in the Gulf of Maine

Length-frequency data collected from inshore and offshore locations in the Gulf of Maine in 1966-1968 indicated that ovigerous female northern shrimp (Pandalus borealis) first appeared offshore in August and September and migrated inshore in the fall and winter. Once eggs hatched, surviving females returned offshore. Juveniles and males migrated offshore during their first two years of life. Sex transition occurred in both inshore and oll'shore waters, but most males changed sex offshore during their third and fourth years. Most shrimp changed sex and matured as females for the first time in their fourth year. Smaller females and females exposed to colder bottom temperatures spawned first. The incidence of egg parasitism peaked in January and was higher for shrimp exposed to warmer bottom temperatures. Accelerated growth at higher temperatures appeared to result in earlier or more rapid sex transition. Males and non-ovigerous females were observed to make diurnal vertical migrations, but were not found in near- surface waters where the temperature exceeded 6°C. Ovigerous females fed more heavily on benthic molluscs in inshore waters in the winter, presumably because the egg masses they were carrying prevented them from migrating vertically at night. Northern shrimp were more abundant in the southwestern region of the Gulf of Maine where bottom temperatures remain low throughout the year. Bottom trawl catch rates were highest in Jeffreys Basin where bottom temperatures were lower than at any other sampling location. Catch rates throughout the study area were inversely related to bottom temperature and reached a maximum at 3°C. An increase of 40% in fecundity between 1973 and 1979 was associated with a decline of 2-3°C in April-July offshore bottom temperatures. Furthermore, a decrease in mean fecundity per 25 mm female between 1965 and 1970 was linearly related to reduced landings between 1969 and 1974. It is hypothesized that temperature-induced changes in fecundity and, possibly, in the extent of egg mortality due to parasitism, may provide a mechanism which could partially account for changes in the size of the Gulf of Maine northern shrimp population during the last thirty years. (PDF file contains 28 pages.)

The History of Oyster Farming in Australia

Aboriginal Australians consumed oysters before settlement by Europeans as shown by the large number of kitchen middens along Australia's coast. Flat oysters, Ostrea angasi, were consumed in southeastern Australia, whereas both flat and Sydney rock oysters, Saccostrea glomerata, are found in kitchen middens in southern New South Wales (NSW), but only Sydney rock oysters are found in northern NSW and southern Queensland. Oyster fisheries began with the exploitation of dredge beds, for the use of oyster shell for lime production and oyster meat for consumption. These natural oyster beds were nealy all exhausted by the late 1800's, and they have not recovered. Oyster farming, one of the oldest aquaculture industries in Australia, began as the oyster fisheries declined in the late 1800's. Early attempts at farming flat oysters in Tasmania, Victoria, and South Australia, which started in the 1880's, were abandoned in the 1890's. However, a thriving Sydney rock oyster industry developed from primitive beginnings in NSW in the 1870's. Sydney rock oysters are farmed in NSW, southern Queensland, and at Albany, Western Australia (WA). Pacific oysters, Crassostrea gigas, are produced in Tasmania, South Australia, and Port Stephens, NSW. FLant oysters currently are farmed only in NSW, and there is also some small-scale harvesting of tropical species, the coarl rock or milky oyster, S. cucullata, and th black-lip oyster, Striostrea mytiloides, in northern Queensland. Despite intra- and interstate rivalries, oyster farmers are gradually realizing that they are all part of one industry, and this is reflected by the establishment of the national Australian Shellfish Quality Assuarance Program and the transfer of farming technology between states. Australia's oyster harvests have remained relatively stable since Sydney rock oyster production peaked in the mid 1970's at 13 million dozen. By the end of the 1990's this had stabilized at around 8 million dozen, and Pacific oyster production reached a total of 6.5 million dozen from Tasmania, South Australia, and Port Stephens, a total of 14.5 million dozen oysters for the whole country. This small increase in production during a time of substantial human population growth shows a smaller per capita consumption and a declining use of oysters as a "side-dish."

Seasonal and interannual variation in juvenile salmonids and associated fish assemblage in open waters of the lower Columbia River estuary

The transition between freshwater and marine environments is associated with high mortality for juvenile anadromous salmonids, yet little is known about this critical period in many large rivers. To address this deficiency, we investigated the estuarine ecology of juvenile salmonids and their associated fish assemblage in open-water habitats of the lower Columbia River estuary during spring of 2007–10. For coho (Oncorhynchus kisutch), sockeye (O. nerka), chum (O. keta), and yearling (age 1.0) Chinook (O. tshawytscha) salmon, and steelhead (O. mykiss), we observed a consistent seasonal pattern characterized by extremely low abundances in mid-April, maximum abundances in May, and near absence by late June. Subyearling (age 0.0) Chinook salmon were most abundant in late June. Although we observed interannual variation in the presence, abundance, and size of juvenile salmonids, no single year was exceptional across all species-and-age classes. We estimated that >90% of juvenile Chinook and coho salmon and steelhead were of hatchery origin, a rate higher than previously reported. In contrast to juvenile salmonids, the abundance and composition of the greater estuarine fish assemblage, of which juvenile salmon were minor members, were extremely variable and likely responding to dynamic physical conditions in the estuary. Comparisons with studies conducted 3 decades earlier suggest striking changes in the estuarine fish assemblage—changes that have unknown but potentially important consequences for juvenile salmon in the Columbia River estuary.

Aspects of the biology of the Lake Tanganyika sardine, Limnothrissa miodon (Boulenger), in Lake Kariba

Juveniles of limnothrissa miodon (Boulenger) were introduced into the man-made Lake Kariba in 1967-1968. Thirty months of night-fishing for this species from Sinazongwe, near the centre of the Kariba North bank, from 1971 to 1974 are described. Biological studies were carried out on samples of the catch during most of these months. Limnological studies were carried out over a period of four months in 1973. Limnothrissa is breeding successfully and its number have greatly increased. It has reached an equilibrium level of population size at a lower density than that of Lake Tanganyika sardines, but nevertheless is an important factor in the ecology of Lake Kariba. The growth rate, size at maturity and maximum size are all less than those of Lake Tanganyika Limnothrissa. A marked disruption in the orderly progression of length frequency modes occurs in September, for which the present body of evidence cannot supply an explanation.

Selective hydrogenation of citral with transition metal complexes in supercritical carbon dioxide

The activity and selectivity of the transition metal complexes formed from Ru, Rh, Pd and Ni with triphenylphosphine (TPP) have been investigated for hydrogenation of citral in supercritical carbon dioxide (scCO(2)). High activities are obtained with Ru/TPP and Pd/TPP catalysts, and the overall activity is in the order of Pd approximate to Ru > Rh > Ni. The Ru/TPP complex is highly selective to the formation of unsaturated alcohols of geraniol and nerol. In contrast, the Pd/TPP catalyst is more selective to partially saturated aldehydes of citronellal. Furthermore, the influence of several parameters such as CO2 and H-2 pressures, N-2 pressure and reaction time has been discussed. CO2 pressure has a significant impact on the product distribution, and the selectivity for geraniol and nerol can be enhanced from 27% to 75% with increasing CO2 pressure from 6 to 16 MPa, while the selectivity for citronellol decreases from 70% to 20%. Striking changes in the conversion and product distribution in scCO(2) could be interpreted with variations in the phase behavior and the molecular interaction between CO2 and the substrate in the gas phase and in the liquid phase.

Occupational lead neurotoxicity: Improvement in behavioural effects after reduction of exposure.

To evaluate critical exposure levels and the reversibility of lead neurotoxicity a group of lead exposed foundry workers and an unexposed reference population were followed up for three years. During this period, tests designed to monitor neurobehavioural function and lead dose were administered. Evaluations of 160 workers during the first year showed dose dependent decrements in mood, visual/motor performance, memory, and verbal concept formation. Subsequently, an improvement in the hygienic conditions at the plant resulted in striking reductions in blood lead concentrations over the following two years. Attendant improvement in indices of tension (20% reduction), anger (18%), depression (26%), fatigue (27%), and confusion (13%) was observed. Performance on neurobehavioural testing generally correlated best with integrated dose estimates derived from blood lead concentrations measured periodically over the study period; zinc protoporphyrin levels were less well correlated with function. This investigation confirms the importance of compliance with workplace standards designed to lower exposures to ensure that individual blood lead concentrations remain below 50 micrograms/dl.

We could make a meal out of nothing: contested explanations of inequalities in health

This paper reports on the qualitative findings from a comparative study of public health and lifestyles in South East England and Northern France, regions with similar geographic and economic characteristics. Data from health surveys showed that both countries had an increasing BMI with age, particularly in Northern France. This was despite the finding that the percentage eating fresh fruit and vegetable at least five days a week in Northern France increased with age (from well over 50% to over 90%) compared to around 50% to around 75% in South East England. Qualitative data on health inequalities and how they could be addressed were gathered by focus groups sampling from five tiers using the Townsend Index for comparability (14 in England with 106 participants overall; 13 in France with 143 participants). Both had about two thirds women participants, with a preponderance of middle aged and older people. There was a striking difference in the salience of diet between the two countries; in the French data it was raised only 14 times, whereas in England there were 165 occurrences, and these were often distinguished by their use of narrative. Older respondents contrasted the pressures on families today and the expense of fresh fruit and vegetables with their own childhood or childrearing, when cheap meals could be created using skills which have now been lost. These data therefore provide further evidence that providing food is a moral activity.

Global latitudinal variations in marine copepod diversity and environmental factors

Latitudinal gradients in diversity are among the most striking features in ecology. For terrestrial species, climate (i.e. temperature and precipitation) is believed to exert a strong influence on the geographical distributions of diversity through its effects on energy availability. Here, we provide the first global description of geographical variation in the diversity of marine copepods, a key trophic link between phytoplankton and fish, in relation to environmental variables. We found a polar-tropical difference in copepod diversity in the Northern Hemisphere where diversity peaked at subtropical latitudes. In the Southern Hemisphere, diversity showed a tropical plateau into the temperate regions. This asymmetry around the Equator may be explained by climatic conditions, in particular the influence of the Inter-Tropical Convergence Zone, prevailing mainly in the northern tropical region. Ocean temperature was the most important explanatory factor among all environmental variables tested, accounting for 54 per cent of the variation in diversity. Given the strong positive correlation between diversity and temperature, local copepod diversity, especially in extra-tropical regions, is likely to increase with climate change as their large-scale distributions respond to climate warming.

GTP Cyclohydrolase I Gene Transfer Augments Intracellular Tetrahydrobiopterin in Human Endothelial Cells: Effects on Nitric Oxide Synthase Activity and Dimerisation.

Objectives: Tetrahydrobiopterin (BH4) is an essential cofactor for endothelial nitric oxide synthase (eNOS) activity. BH4 levels are regulated by de novo biosynthesis; the rate-limiting enzyme is GTP cyclohydrolase I (GTPCH). BH4 activates and promotes homodimerisation of purified eNOS protein, but the intracellular mechanisms underlying BH4-mediated eNOS regulation in endothelial cells remain less clear. We aimed to investigate the role of BH4 levels in intracellular eNOS regulation, by targeting the BH4 synthetic pathway as a novel strategy to modulate intracellular BH4 levels. Methods: We constructed a recombinant adenovirus, AdGCH, encoding human GTPCH. We infected human endothelial cells with AdGCH, investigated the changes in intracellular biopterin levels, and determined the effects on eNOS enzymatic activity, protein levels and dimerisation. Results: GTPCH gene transfer in EAhy926 endothelial cells increased BH4 >10-fold compared with controls (cells alone or control adenovirus infection), and greatly enhanced NO production in a dose-dependent, eNOS-specific manner. We found that eNOS was principally monomeric in control cells, whereas GTPCH gene transfer resulted in a striking increase in eNOS homodimerisation. Furthermore, the total amounts of both native eNOS protein and a recombinant eNOS–GFP fusion protein were significantly increased following GTPCH gene transfer. Conclusions: These findings suggest that GTPCH gene transfer is a valid approach to increase BH4 levels in human endothelial cells, and provide new evidence for the relative importance of different mechanisms underlying BH4-mediated eNOS regulation in intact human endothelial cells. Additionally, these observations suggest that GTPCH may be a rational target to augment endothelial BH4 and normalise eNOS activity in endothelial dysfunction states.

Comment on "correlated noise in a logistic growth model"

We argue the results published by Bao-Quan Ai et al [Phys. Rev E 67, 022903 (2003)] on "correlated noise in a logistic growth model " are not correct. Their conclusion that for larger values of the correlation parameter, lambda, the cell population is peaked at x=0, which denotes the high extinction rate is also incorrect. We find the reverse behaviour corresponding to their results, that increasing lambda, promotes the stable growth of tumour cells. In particular, their results for steady-state probability, as a function of cell number, at different correlation strengths, presented in figures 1 and 2 show different behaviour than one would expect from the simple mathematical expression for the steady-state probability. Additionally, their interpretation at small values of cell number that the steady state probability increases as they increase the correlation parameter is also questionable. Another striking feature in their figures (1 and 3) is that for the same values of the parameter lambda and alpha, their simulation produces two different curves both qualitatively and quantitatively.