Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients' safety: assessor-blind pilot comparison

BACKGROUND

There are currently no field data about the effect of implementing European Working Time Directive (EWTD)-compliant rotas in a medical setting. Surveys of doctors' subjective opinions on shift work have not provided reliable objective data with which to evaluate its efficacy.

AIM

We therefore studied the effects on patient's safety and doctors' work-sleep patterns of implementing an EWTD-compliant 48 h work week in a single-blind intervention study carried out over a 12-week period at the University Hospitals Coventry & Warwickshire NHS Trust. We hypothesized that medical error rates would be reduced following the new rota.

METHODS

Nineteen junior doctors, nine studied while working an intervention schedule of <48 h per week and 10 studied while working traditional weeks of <56 h scheduled hours in medical wards. Work hours and sleep duration were recorded daily. Rate of medical errors (per 1000 patient-days), identified using an established active surveillance methodology, were compared for the Intervention and Traditional wards. Two senior physicians blinded to rota independently rated all suspected errors.

RESULTS

Average scheduled work hours were significantly lower on the intervention schedule [43.2 (SD 7.7) (range 26.0-60.0) vs. 52.4 (11.2) (30.0-77.0) h/week; P < 0.001], and there was a non-significant trend for increased total sleep time per day [7.26 (0.36) vs. 6.75 (0.40) h; P = 0.095]. During a total of 4782 patient-days involving 481 admissions, 32.7% fewer total medical errors occurred during the intervention than during the traditional rota (27.6 vs. 41.0 per 1000 patient-days, P = 0.006), including 82.6% fewer intercepted potential adverse events (1.2 vs. 6.9 per 1000 patient-days, P = 0.002) and 31.4% fewer non-intercepted potential adverse events (16.6 vs. 24.2 per 1000 patient-days, P = 0.067). Doctors reported worse educational opportunities on the intervention rota.

CONCLUSIONS

Whilst concerns remain regarding reduced educational opportunities, our study supports the hypothesis that a 48 h work week coupled with targeted efforts to improve sleep hygiene improves patient safety.

Broadband ground-plane cloak

The possibility of cloaking an object from detection by electromagnetic waves has recently become a topic of considerable interest. The design of a cloak uses transformation optics, in which a conformal coordinate transformation is applied to Maxwell's equations to obtain a spatially distributed set of constitutive parameters that define the cloak. Here, we present an experimental realization of a cloak design that conceals a perturbation on a flat conducting plane, under which an object can be hidden. To match the complex spatial distribution of the required constitutive parameters, we constructed a metamaterial consisting of thousands of elements, the geometry of each element determined by an automated design process. The ground-plane cloak can be realized with the use of nonresonant metamaterial elements, resulting in a structure having a broad operational bandwidth (covering the range of 13 to 16 gigahertz in our experiment) and exhibiting extremely low loss. Our experimental results indicate that this type of cloak should scale well toward optical wavelengths.

The epidemiology of HIV infection in Zambia

Population surveys of health and fertility are an important source of information about demographic trends and their likely impact on the HIV/AIDS epidemic. In contrast to groups sampled at health facilities they can provide nationally and regionally representative estimates of a range of variables. Data on HIV-sero-status were collected in the 2001 Zambia Demographic and Health Survey (ZDHS) and made available in a separate data file in which HIV status was linked to a very limited set of demographic variables. We utilized this data set to examine associations between HIV prevalence, gender, age and geographical location. We applied the generalized geo-additive semi-parametric model as an alternative to the common linear model, in the context of analyzing the prevalence of HIV infection. This model enabled us to account for spatial auto-correlation, non-linear, location effects on the prevalence of HIV infection at the disaggregated provincial level (nine provinces) and assess temporal and geographical variation in the prevalence of HIV infection, while simultaneously controlling for important risk factors. Of the overall sample of 3950, 54% was female. The overall HIV-positivity rate was 565 (14.3%). The mean age at HIV diagnosis for male was 30.3 (SD=11.2) and 27.7 (SD=9.3) for female respectively. Lusaka and Copperbelt have the first and second highest prevalence of AIDS/HIV (marginal odds ratios of 3.24 and 2.88, respectively) but when the younger age of the urban population and the spatial auto-correlation was taken into account, Lusaka and Copperbelt were no longer among the areas with the highest prevalence. Non-linear effects of age at HIV diagnosis are also discussed and the importance of spatial residual effects and control of confounders on the prevalence of HIV infection. The study was conducted to assess the spatial pattern and the effect of confounding risk factors on AIDS/HIV prevalence and to develop a means of adjusting estimates of AIDS/HIV prevalence on the important risk factors. Controlling for important risk factors, such as geographical location (spatial auto-correlation), age structure of the population and gender, gave estimates of prevalence that are statistically robust. Researchers should be encouraged to use all available information in the data to account for important risk factors when reporting AIDS/HIV prevalence. Where this is not possible, correction factors should be applied, particularly where estimates of AIDS/HIV prevalence are pooled in systematic reviews. Our maps can be used for policy planning and management of AIDS/HIV in Zambia.

Effects of dietary inosinic acid on carcass characteristics, meat quality, and deposition of inosinic acid in broilers

An experiment was conducted to evaluate the effects of dietary inosinic acid (inosine 5'-monophosphate, IMP) on carcass characteristics, meat quality, and deposition of IMP in Arbor Acres broilers. A total of two hundred forty 1-d-old male Arbor Acres broilers were allocated to 4 inosinic acid treatments (0, 0.25, 0.50, and 0.75% dietary IMP supplementation). Birds were slaughtered at 42 d old. Dietary IMP did not significantly affect the carcass characteristics of broilers. No significant difference among treatments was observed in muscle pH within 1 h or at 24 h postmortem (PM), or in the decrease of muscle pH within 24 h PM. Inosinic acid had no marked effect on the color of breast muscle or Hunter L* and a* values of thigh muscle. Hunter b* values in thigh muscle were lower (P < 0.05) in the 0.75% IMP supplementation group than in the control group. Both breast and thigh muscle of birds fed with 0.25% IMP diet resulted in a lower (P < 0.05) shear force value compared with those fed with the other diets. All of the test groups had greater (P < 0.05) deposition of IMP in breast and thigh muscle than that of the control group with the exception of the 0.75% IMP supplementation group for thigh muscle. Greater (P < 0.05) corrected IMP value in breast muscle was detected for the test groups compared with the control group. These results suggest that extraneous IMP addition may contribute to the improvement of growth, meat quality, and deposition of IMP in broilers.

Effects of perinatal hypothyroidism on rat behavior and its relation with apoptosis of hippocampus neurons

Thyroid hormone is an important factor for proper development of the mammalian brain. Perinatal hypothyroidism leads to long-term behavior and neuromotor competence alterations in humans and animals. Our study aimed to investigate the effects of perinatal hypothyroidism on behavior changes of rat pups and its relation with the apoptosis of hippocampus neurons. Behavior tests were taken to evaluate the effects caused by perinatal hypothyroidism. TUNEL staining was used to analyze the apoptosis of neurons on CA3 region of hippocampus. The study suggested that perinatal hypothyroidism affects behavior development, as well as leading to the decrease in spatial learning and memory capability. This condition can be improved with hormone substitute treatment. Furthermore, the changes of learning and memory capability are closely related to the increasing number of apoptotic neurons in the hippocampus.

Effect of manganese supplementation and source on carcass traits, meat quality, and lipid oxidation in broilers1

An experiment was conducted using a total of 336 one-day-old, Arbor Acres commercial male broilers to investigate the effect of dietary Mn supplementation on carcass traits, meat quality, lipid oxidation, relative enzyme activities in abdominal fat and meat, and Mn-containing superoxide dismutase (MnSOD) mRNA level in meat. Broilers were randomly allotted by BW to 1 of 8 replicate cages (6 chicks per cage) for each of 7 treatments in a completely randomized design involving a 2 x 3 factorial + 1 arrangement of treatments. Dietary treatments included the corn-soybean meal-based diet (control) and the basal diet supplemented with 100 or 200 mg of Mn/kg as MnSO(4) x H(2)O, Mn AA A with a chelation strength of 26.3 formation quotient (8.34% Mn), or Mn AA B with a chelation strength of 45.3 formation quotient (6.48% Mn). Birds fed supplemental Mn had lower (P < 0.10) percentages of abdominal fat, lipoprotein lipase (LPL), and malate dehydrogenase activities and greater (P < 0.07) hormone-sensitive lipase activities in abdominal fat than birds fed a control diet. Birds fed supplemental Mn from Mn AA A or Mn AA B had lower (P < 0.05) LPL activities in abdominal fat than those fed supplemental MnSO(4) x H(2)O. Birds fed supplemental Mn had lower (P < 0.03) malondialdehyde content in leg muscle and greater (P < 0.02) MnSOD activities and MnSOD mRNA level in breast or leg muscle than those fed the control diet. Birds fed supplemental Mn from Mn AA A had a greater (P < 0.02) MnSOD mRNA level in leg muscle than those fed supplemental MnSO(4) x H(2)O. Results from this study indicated that organic Mn was more available than inorganic Mn for decreasing LPL activity in abdominal fat of broilers, and dietary Mn might reduce abdominal adipose deposition by decreasing LPL and malate dehydrogenase activities or increasing hormone-sensitive lipase activity in abdominal adipose tissue. The results also indicated that dietary Mn upregulated muscle MnSOD gene expression pretranslationally in association with increased MnSOD activity, which might explain the decrease of malondialdehyde content in leg muscle.

Endovascular Thermal Coagulation Using the Double-Helix GDC

An experimental study was undertaken to explore the possibility of treating this subset of aneurysms with thermal coagulation.

Endovascular endosaccular thermal coagulation of experimental aneurysms was successfully performed using a radiofrequency electrical current applied to a novel device, the double-helix GDC. Theoretically this technique could be utilized in selected patients to occlude large and giant intracranial aneurysms.

[Identification of a novel human MAST4 gene, a new member of the microtubule associated serine-threonine kinase family]

Human protein kinases make up a large superfamily of homologous proteins, which are related by virtue of their kinase domains (also known as catalytic domains). Here we report the cloning and characterization of a novel human MAST4 (microtubule associated serine/threonine kinase family member 4) gene, which locates on human chromosome 5q13. The MAST4 cDNA is 7587 base pairs in length and encodes a putative protein of 2435 amino acids which contains a serine/threonine kinase domain and a PDZ domain. MAST4 protein has 64%, 63%, 59% and 39% identical aminoacid residues with MAST1, MAST2, MAST3 and MASTL respectively. RT-PCR analysis revealed relatively high expression level of MAST4 in most normal human tissues, with an exception of in testis, small intestine, colon and peripheral blood leukocyte.

Effects of a dried Bacillus subtilis culture on egg quality

The effects of a dried Bacillus subtilis culture on the egg qualities of layers were studied. Nine hundred and sixty 25-wk-old Lohmann Brown layers were randomly divided into 5 groups with 192 layers in each group. Layers in group 1 were fed a control diet. The remaining groups received the control diet that contained either 20 mg of zinc bacitracin/kg and 4 mg of colistin sulfate/kg or 500, 1,000, or 1,500 mg of B. subtilis culture/ kg, respectively. The results showed improvements in egg production, feed consumption, and feed conversion (P < 0.05) of layers when 500 mg of B. subtilis culture/kg was added to the diets. The results also showed some special improvements in this group, including increases in eggshell thickness, yolk color, and Haugh unit, and decreases in yolk cholesterol concentration (P < 0.05). However, excessive doses of B. subtilis culture did not improve the performance of layers.

Implications for prediction and hazard assessment from the 2004 Parkfield earthquake

Obtaining high-quality measurements close to a large earthquake is not easy: one has to be in the right place at the right time with the right instruments. Such a convergence happened, for the first time, when the 28 September 2004 Parkfield, California, earthquake occurred on the San Andreas fault in the middle of a dense network of instruments designed to record it. The resulting data reveal aspects of the earthquake process never before seen. Here we show what these data, when combined with data from earlier Parkfield earthquakes, tell us about earthquake physics and earthquake prediction. The 2004 Parkfield earthquake, with its lack of obvious precursors, demonstrates that reliable short-term earthquake prediction still is not achievable. To reduce the societal impact of earthquakes now, we should focus on developing the next generation of models that can provide better predictions of the strength and location of damaging ground shaking.

Characterization of two novel KRAB-domain-containing zinc finger genes, ZNF460 and ZNF461, on human chromosome 19q13.1-->q13.4

This study reports the cloning and characterization of two novel human zinc finger protein cDNAs (ZNF460 and ZNF461) from a fetal brain cDNA library. The ZNF460 cDNA is 3,135 bp in length encoding a 562-amino-acid polypeptide and the ZNF461 cDNA is 2,548 bp encoding a 563-amino-acid protein. Both of the proteins contain a KRAB A+B box and eleven C2H2 type zinc finger motifs. ZNF461 shows high similarity with the rat GIOT-1 gene (GIOT1). The ZNF460 gene mapped to 19q13.4 with 3 exons, and ZNF461 mapped to 19q13.1 with 6 exons. Both of the two genes are ubiquitously expressed in normal human tissues and the abundance of the ZNF460 mRNA is relatively low.

Molecular cloning and characterization of a novel human gene (ANP32E alias LANPL) from human fetal brain

Leucine-rich acidic nuclear protein (LANP) is a member of the leucine-rich repeats (LRRs) superfamily. Here we report on a human homologue of LANP, encoded by the gene ANP32E (alias LANPL). The gene was cloned and identified during large-scale sequencing analysis of a human fetal brain cDNA library. The human protein shared 70% amino acid identity with rat LANP. According to bioinformatics analysis, ANP32E is located on chromosome 1q22. RT-PCR analysis indicates that ANP32E was expressed in human peripheral blood leukocytes, colon, small intestine, prostate, thymus, spleen, skeletal muscle, liver and kidney.

[Surgical treatment for small cell lung cancer]

BACKGROUND

To summarize the experience of surgery for small cell lung cancer ( SCLC) and to evaluate the role of surgery in treatment of SCLC.

METHODS

A retrospective study undertaken in 145 patients with SCLC who had undergone pulmonary resection( Lobectomy 69, pneumonectomy 68, sleeve lobectomy 7 and segmentectomy 1) combined with chemo/radio( IVP, VP/Co60 ) therapy according to the new international stag ing system ( 1997 System) .

RESULTS

The 1-, 3-, 5-year overall survival rate was 73. 1% ( 106/ 145) , 24. 8% ( 36/145) and 16. 6% ( 24/145) respectively . The 1-, 3-, 5-year survival rate was 100. 0%, 80. 0% and 50. 0% for p-stage IA, 84. 6%, 30. 8% and 23. 1% for p-stage IB, 91. 7%, 83. 3% and 66. 7% for p-stage IIA. Twenty-three patients were the long term survivals. In addition, no difference of survival rate between the patients who selected surgery or chemo/radio therapy as first treatment.

CONCLUSIONS

These results suggest that operation should be considered as an important treatment choice and combined with chemotherapy for the SCLC.

Control and counter-control of TGF-beta activity through FAST and Runx (CBFa) transcriptional elements in osteoblasts

FAST and Runx (CBFa) transcription factors, which are expressed during specific phases of embryogenesis and tissue patterning, bind directly to Smad proteins and integrate effects induced by various TGF-beta gene family members. The DNA binding sequences for FAST and Runx differ only minimally. The isoform Runx2 (previously termed CBFa1) is highly expressed by osteoblasts and regulates expression of the TGF-beta receptor I in these cells. Here we show that FAST-dependent transcription is endogenously restricted in osteoblasts but can be significantly enhanced by disruption of Runx2 expression. Native and synthetic Runx2 bind to both Runx and FAST binding sequences, whereas FAST-1 efficiently binds only to the FAST binding sequence. However, overexpression of FAST-1 potently suppresses TGF-beta receptor I gene expression in osteoblasts and thereby reduces TGF-beta activity independently of competing for Runx2 at the level of DNA binding. These results provide a new example of how nuclear factors associated with specific developmental states or tissue lineages may influence TGF-beta-dependent events in restricted ways.

Modeling and analysis of the structure of the thermostable catechol 2,3-dioxygenase from Bacillus Stearothermophilus

The three-dimensional structure of thermostable catechol 2,3-dioxygenase(TC230) from Bacillus Stearothermophilus has been modeled basing on the known x-ray structure of catechol 2,3-dioxygenase(metapyrocatechase) from Pseudomonas putida mt-2, using computer graphics energy minimization techniques. The rationality of the resulting model was validated by Ramachandran plot and Profile-3D. The structure-functionally important residues, such as M++ binding residues and the substrate binding residues, were identified from the model. These residues are candidates for further site-directed mutagenesis experiments. The reason that the thermostability of TC230 is greater than metapyrocatechase(MPC) has been found, which may be due to the specific structure of the TC230 in the C-end mainly.

4-hydroxynonenal induces apoptosis via caspase-3 activation and cytochrome c release

We investigated the mechanism by which 4-hydroxynonenal (HNE), a major aldehydic product of lipid peroxidation, induces apoptosis in tumor cells. Treatment of human colorectal carcinoma (RKO) cells with HNE-induced poly-ADP-ribose-polymerase (PARP) cleavage and DNA fragmentation in a dose- and time-dependent manner. The induction of PARP cleavage and DNA fragmentation paralleled caspase-2, -3, -8, and -9 activation. Pretreatment of cells with an inhibitor of caspase-3, z-DEVD-fmk, or a broad spectrum caspase inhibitor, z-VAD-fmk, abolished caspase activation and subsequent PARP cleavage. Constitutive expression of high levels of Bcl-2 protected cells from HNE-mediated apoptosis. In addition, Bcl-2 overexpression inhibited cytochrome c release from mitochondria and subsequent caspase-2, -3, and -9 activation. These findings demonstrate that HNE triggers apoptotic cell death through a mitochondrion-dependent pathway involving cytochrome c release and caspase activation. Bcl-2 overexpression protected cells from HNE-induced apoptosis through inhibition of cytochrome c release.

[Hard tissue changes in class III patients treated with maxillary protraction and rapid palatal expansion]

OBJECTIVE

To investigate the hard tissue changes of class III patients treated with maxillary protraction and rapid palatal expansion.

METHODS

Twenty-three patients were included. All patients were treated with united method. The changes of hard tissue were compared.

RESULTS

Hard tissue grew forward and downward in natural state. After the treatment, the significant increase of S-A, Pt-A, PNS-A was found in maxilla, and the increment of PNS-A, Pt-A was larger than that of S-A. Pg and Me dislocated backward. Wits increased by 4.5 mm.

CONCLUSIONS

By applying maxillary protraction and rapid palatal expansion on Class III patients in the early permanent dentition, anterior displacement and increase in post-anterior dimension of maxilla were found. Mandible always rotated and slightly backward.