Performance of Number-Between g-Type Statistical Control Charts for Monitoring Adverse Events

Alternate Shewhart-type statistical control charts, called g and h charts, have been developed for monitoring the number of cases between hospital-acquired infections and other adverse events, such as heart surgery complications, catheter-related infections, surgical site infections, contaminated needle sticks, medication errors and other care induced concerns. This article investigates the statistical properties of these new charts and illustrates several design considerations that significantly can improve their operating characteristics and sensitivity, including the use of with-in limit rules, a new in-control rule, redefined Bernoulli trials, and probability-based limits. These new charts are based on inverse sampling from geometric and negative binomial distributions, are simple for practitioners to use, and in some cases exhibit significantly greater detection power over conventional binomial-based approaches, particularly for infrequent events and low defect rates.     

Susceptibility of clinical isolates of campylobacter pylori to 24 antimicrobial and anti-ulcer agents

Forty-nine isolates of Campylobacter pylori were tested for their susceptibility to twenty antibiotics and four anti-ulcer agents by an agar dilution technique. Penicillin and amoxycillin were the most active drugs (MIC₉₀, 0.06 /ml); erythromycin, cefazolin, minocycline, ciprofloxacin, ofloxacin and gentamicin were sligthtly less active (MIC₉₀, 1 g/ml). Moderate activity was found for doxycyclin, rifampin, nitrofurantoin, norfloxacin, pefloxacin, enoxacin, paromomycin, metronidazole and tinidazole. All strains were resistant to trimethoprim (MIC > 512 g/ml). Nalidixic acid (MIC₉₀, > 256 g/ml) and colistin (MIC₉₀, > 64 gg/m1) had little to no activity. Of four anti-ulcer drugs, only bismuth subcitrate showed activity (MIC₉₀, 64 g./ml).Strains resistant to all 4-quinolones were found in patients who had previously received ofloxacin as part of a clinical trial aimed at eradication of C. pylori. These isolates remained susceptible to amoxycillin, tetracyclines and to other classes of antibiotics.Corresponding author.     

Ultraviolet and volatility loss of herbicides

Herbicide 2,4-D formulated as a urea-type polymer was readily destroyed by long-wave uv (356-nm) irradiation, whereas conventional 2,4-D was more resistant. The opposite relationship was noted for polymeric and conventional formulations of dicamba. Polymerized 2,4-D was more resistant to thermal degradation (60°C) than non-polymerized formulations. Ultraviolet degradation of polymerized 2,4-D was eliminated by the incorporation of RYLEX-H and UVINUL D-50, industrial uv absorbers. Exposure of polymeric dicamba to 60°C heat, followed by trapping of the volatile component, indicated that 21 percent was lost by thermal degradation and 46.6 percent by volatilization. Comparable values for non-polymerized dicamba were 37.9 and 60.1 percent.     

Belgian collaborative study of the in-vitro susceptibility of the Bacteroides fragilis group

The antimicrobial susceptibility of clinical isolates of the Bacteroides fragilis group obtained from nine large Belgian university and community hospitals was studied. Of the -lactam antibiotics tested, none were active against 100% of the isolates. Piperacillin was active against 93% of the strains at a breakpoint of 64 lag/ml. The percentage of isolates inhibited at 16 g/ml (and 32 g/ml) for the 7-alpha-methoxy antibiotics was: cefoxitin 84 [94]; latamoxef 87 [93]; and cefotetan 64 [79]. B. fragilis tended to be more susceptible to all -lactams than the other members of the group.Among the non -lactam antibiotics, the resistance rate for minocycline, doxycycline, clindamycin and erythromycin (at a breakpoint of 4 g/ml) were l%, 4%, 14% and 34%, respectively. Like the -lactams, clindamycin was less active against non B. fragilis species of the group.Chloramphenicol, metronidazole and tinidazole were still active against 100% of the isolates at their breakpoint values (8 lag/ml).     

Psychosocial stressors associated with Mexican migrant farmworkers in the midwest United States

Although estimates suggest that there are upwards of 5 million migrant farmworkers in the United States, scant research has explored the stressors associated with their lifestyle. Contrary to previous work, the present study directly explored migrant farmworkers' own perceptions of what is difficult in their lives. The purposes of the present study were to qualitatively explore, from a phenomenological standpoint, the stressors associated with living as a migrant farmworker in the Midwest United States; and to determine the stressors that were most strongly related to symptoms of anxiety and depression. The findings indicated that 18 stressors were commonly experienced by the migrant farmworkers and that the farmworkers experienced overall elevated levels of anxiety and depression. A number of stressors that were not previously reported in the literature were identified. The stressors of rigid work demands and poor housing conditions were significantly associated with higher levels of anxiety and low family income/living in poverty and rigid work demands were significantly associated with depression. Implications of findings and prevention strategies are discussed.     

Dimensionen der Zufriedenheit im Alter

Zusammenfassung In einer Interview-Studie von 480 Betagten in städtischen Verhältnissen wurden neben anderen Fragen auch solche zur Zufriedenheit gestellt. Eine Faktoranalyse der Antworten erlaubt die Unterscheidung eines Faktors Depressivität von einem Faktor Zufriedenheit mit Sozial-kontakten und einer gesundheitlichen Dimension.

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Dimensions of satisfaction among old people

Summary In an interview study of 480 aged persons, questions on satisfaction with several aspects of life were included. A factor analysis allows to distinguish a factor relating to depressivity from a factor satisfaction with social contacts and a health-related dimension.

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Dimensions de la satisfaction des personnes âgées

Résumé Das une enquête d'un échantillon de 480 personnes âgées, des questions concernant leur satisfaction ont été inclues dans l'interview. Une analyse factorielle permet de distinguer un facteur associé à la dépressivité d'un facteur satisfaction avec les contactes sociaux et d'une dimension santé.

     

Mineralstaubgehalt des Lungengewebes und der Lymphknoten bei Eierschalenverkalkungen

Zusammenfassung Der exogene und endogene Mineralgehalt der Lungen und der regionären Lymphknoten von 3 verstorbenen Arbeitern mit Silikose, Eierschalenverkalkungen und Lungensteinen wurde mit Hilfe des Formamidverfahrens isoliert und chemisch sowie mineralogisch untersucht. Die in reifer Form als Hydroxylapatit vorliegenden Verkalkungen werden als Makrolithen oder Eierschalen in den mediastinalen und broncho-pulmonalen Lymphknoten und als Mikrolithen in den Lymphgewebsanteilen der Lunge gebildet. Es besteht eine ausgeprägte Abhängigkeit zwischen der Quarzmenge pro 100 g Trockengewebe und dem Ausma\ der Verkalkungen bzw. der Steinchen-Bildung. Der Transport von Quarz zu den regionären Lymphknoten war au\erordentlich rege, während die Aluminium-, Eisen-, Titan- und Magnesium-Werte im Lungenstaub höher lagen. Der Kohleanteil des Staubes war relativ gering, besonders im Schwielengewebe und in den Lymphknoten.Die Pathogenese dieser eigenartigen, endemisch auftretenden Komplikation der Silikose wird in Verbindung mit möglichen endokrinen Störungen (Hypothyreoidismus) und calciphylaktischen Reaktionen infolge erhöhter Dihydrotachysterolempfindlichkeit und Inhalation von Spurenelementen mit dem Staub (Schwermetalle) erörtert.

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Mineral dust content of the lung tissue and lymph nodes in egg-shell calcification

Summary The exogenous and endogenous mineral content of the lungs and regional lymph nodes of 3 workers who died of silicosis with egg-shell calcification was isolated by formamide decomposition and subjected to chemical and mineralogical analysis. Macroliths or egg-shells are formed in the mediastinal and pulmonary lymph nodes, and microliths in the lymphatic tissue of the lung. All fully developed calcifications consist of hydroxylapatite. There is a distinct correlation between the amount of quartz per 100 g of dry tissue and the degree of calcification or concrement formation. The transportation of quartz to the regionary lymph nodes was extraordinarily intensive, whereas the amounts of aluminium, iron, titanium, and magnesium were found to be greater in the lung dust. The carbon percentage of the dust was relatively low, especially in the callous regions and in the lymph nodes.The discussion deals with the possibility that the pathogenesis of this strange endemic complication of silicosis may be connected either with endocrine disturbances (hypothyroidism in regions were goitre is endemic) with spontaneous rise in serum calcium or calciphylactic reactions resulting from increased sensitivity to dihydrotachysterol and inhalation of trace elements (iron and heavy metals) in the dust.

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Mit Mitteln der Bergbau-Berufsgenossenschaft (Bochum) und des Landes Nordrhein-Westfalen durchgefÜhrte Forschungsarbeit.     

DDT Residues in samples of human milk,and in mothers' and cord blood serum,in a continental town in Croatia (Yugoslavia)*

Summary Concentrations of p,p'-DDE, p,p-DDD, and p,p-DDT were determined in 34 samples of human milk obtained 3–5 days after delivery and in 37 samples obtained at later times of lactation (up to 55 weeks). All samples contained p,p-DDE, but only several contained p,p-DDD and p,p-DDT. The concentrations of p,p-DDE were 31 g/l in the beginning of lactation and 53 g/l at later time intervals. The concentration ranges in both groups overlap almost completely and the difference in the mean values is not significant.Serum samples from 35 mothers and cord blood were also analyzed. All samples contained p,p-DDE, the concentrations being 18 g/l and 6.8 g/l in the mothers' and cord blood serum, respectively. Serum samples of 24 nonpregnant women contained the same amount of p,p-DDE (20 pg/1) as mothers' sera.All samples were collected in a continental town of Croatia (Yugoslavia) between 1977 and 1979. The concentrations of DDT residues were determined by gas chromatography, and two methods for extraction from milk were used and compared.This work was supported in part by the Environmental Protection Agency (USA) and the World Health Organization (Geneva)     

Investigations on neurotoxicity of chemical substances at the workplace

Summary A cross-sectional study was performed in order to investigate the influence of chronic lead-exposure on the peripheral nervous system. We examined 148 male workers of a storage battery manufacturing plant, who had been exposed to lead metal and inorganic lead compounds for 1 to 28 years (mean 11 years). Fifteen workers with non-occupational risks of peripheral neuropathy (former diseases, alcohol abuse, medication) were excluded from the study. The investigation program comprised: case history, physical examination, analyses of blood- and urine-samples and determination of maximal motor, mixed and sensory conduction velocity (NCV) of the ulnar and median nerve of the right forearm. Objectively no worker showed any signs of health effects related to lead exposure. The Biological Monitoring included the determination of (1) Blood-lead level (Pb-B), (2) Free erythrocyte porphyrins (FEP), (3) -Aminolevulinic acid dehydratase (ALA-D) and (4) -Aminolevulinic acid in urine (ALA-U). Further time-weighted-average (TWA)-values of Pb-B were calculated on the basis of several determinations over the period 1975–1981. The following actual (TWA) median values resulted: Pb-B 53 g/dl (54 g/dl), ALA-U 5.6 mg/l (8.4 mg/l), FEP 2.0 mg/l (2.0 mg/l). The Biologischer Arbeitsstoff Toleranz Wert (BAT) of 70 g//dl for Pb-B was exceeded in 15 workers (11%), and of 15 mg/l for ALA-U in 30 cases (23%). In comparison with age-matched controls, the lead workers showed a mild slowing of NCV with mean values between 0.8 and 2.0 m/s. Multiple stepwise regression analyses revealed statistically significant correlations between the four NCV and age as well as Pb-B. There were better correlations by using TWA than actual data of Pb-B. Consideration of the results of the regression analyses, together with an evaluation of the individual neurophysiological status as a function of internal lead exposure, a dose-effect-relationship was found only in the case of Pb-B exceeding 70 g/dl. From our study it is concluded that chronic lead exposure resulting in blood-lead levels of below 70 g/dl is no occupational risk causing a functionally significant slowing of nerve conduction velocities.With Grants from the Deutsche Forschungsgemeinschaft, Bonn (Project no. Va 23/19-1)     

Isomer-specific analysis and toxic evaluation of polychlorinated biphenyls in striped dolphins affected by an epizootic in the western Mediterranean sea

Isomer-specific concentrations of polychlorinated biphenyls (PCBs) including planar, mono- and di-ortho congeners and concentrations of DDT were determined in striped dolphins affected by a morbillivirus epizootic in the western Mediterranean in 1990. Extremely high concentrations of PCBs ranging from 94 to 670 g/g (wet wt) were detected in the blubber. Similarly, DDT concentrations were high, between 22 and 230 g/g (wet wt). The concentrations of three non-ortho coplanar PCBs were 43 (3,3,4,4-T₄CB), 6.8 (3,3,4,4,5-P₅CB), and 7.8 (3,3,4,4,5,5-H₆CB) ng/g (wet wt), respectively, the highest residue levels reported to date. The estimated 2,3,7,8-TCDD toxic equivalents of non-, mono- and di-ortho PCB congeners in striped dolphins were several times higher than those observed for other marine mammals and humans. Mono-ortho congeners contributed greater 2,3,7,8-TCDD toxic equivalents than non-ortho members. The higher ratio of 3,3,4,4,5,5-H₆CB/3,3,4,4,5-P₅CB (IUPAC 169/126) suggested a strong induction of mixed function oxidase enzymes and highlighted the possibility of using this ratio as an index for risk assessment of PCB contamination in marine mammals. Elevated concentrations of PCBs may have played a role in the immune depression in striped dolphins, ultimately leading to the development of morbillivirus disease.     

Percutaneous absorption of N,N-dimethylformamide in humans

Summary Skin penetration fo N,N-dimethylformamide (DMF) liquid or vapour was studied in volunteers. Exposure to liquid DMF was performed in two ways: in a dipping experiment, one hand was dipped up to the wrist in DMF for 2–20 min, while in a patch experiment, 2 mmol DMF was applied to the skin and allowed to be absorbed completely. The period of exposure to DMF vapour (50 mg · m^–3) was 4 h. The DMF metabolites N-hydroxymethyl-N-methylformamide (MF), N-hydroxymethylformamide (F), and N-acetyl-S-(N-methylcarbamoyl)cysteine (AMCC) were monitored in the urine. Liquid DMF was absorbed through the skin at a rate of 9.4 mg · cm^–2 · h^–1. Percutaneous absorption of DMF vapour depended strongly on ambient temperature and humidity and accounted for 13%–36% of totally excreted MF. The results suggest that skin absorption of liquid DMF is likely to contribute to occupational exposure substantially more than penetration of DMF vapour. The yield of metabolites after transdermal DMF absorption was only half of that seen after pulmonary absorption. Elimination of MF and F but not that of AMCC was delayed, which supports the contention that AMCC should be used instead of MF as the most suitable biomarker of DMF in cases where percutaneous intake can occur.     

Managing for health: why health care?

Health and health care are increasingly big business. The challenge is to apply our knowledge and skills to meet people's needs, if not their demands as efficiently, effectively and beneficially as possible. Value for money is the slogan. For those who deliver the goods as required, the converse, money for value should equally apply, and not only in a market driven system. This paper offers a very personal view of these issues in the light of recent UK policy developments.     

Congener-specific data on polychlorinated biphenyls in tissues of common porpoise from Puck Bay,Baltic Sea

Individual congeners of polychlorinated biphenyls (PCBs), including the highly toxic non-ortho coplanar 3,3,4,4-tetrachlorobiphenyl (IUPAC No. 77), 3,3,4,4,5-pentachlorobiphenyl (IUPAC No. 126), and 3,3,4,4,5,5-hexachlorobiphenyl (IUPAC No. 169), and their mono- and di-ortho analogs, have been identified and quantified in the blubber, liver, and muscles of three female common porpoise Phocoena phocoena collected from the Puck Bay (inner Gulf of Gdask, Poland) in 1989–1990, to elucidate actual concentrations and toxic potential. The total 2,3,7,8-tetrachlorodibenzo-p-dioxin toxic equivalent for 13 coplanar PCBs in blubber was 1,500±470 pg/g wet wt. 2,3,4,4,5-Pentachlorobiphenyl (IUPAC No. 118) was the most contributing individual and occupied between 57 and 67% in total toxic equivalent of coplanar PCBs in blubber, while 2,2,4,4,5,5-hexachlorobiphenyl (IUPAC No. 153), 2,3,3,4,4-pentachlorobiphenyl (IUPAC No. 105) and 2,2,3,4,4,5-hexachlorobiphenyl (IUPAC No. 138) comprised between 9.5–14, 7.6–11.5, and 7.2–11.0%, respectively (totally 82–95%), and 2,3,3,4,4,5-hexachlorobiphenyl (IUPAC No. 156) was absent. A potentially most toxic non-ortho PCB members such as 3,3,4,4,5-pentachlorobiphenyl, 3,3,4,4,5,5-hexachlorobiphenyl and 3,3,4,4-tetrachlorobiphenyl were only minor contributors, altogether occupying between 1.0 and 14.5% in total TEQ of coplanar PCBs. Concentrations of total PCBs in lipids of the blubber ranged from 26 to 47 g/g and were comparable or lower than reported earlier for common porpoises from the Baltic Sea, North Sea, and North Atlantic by other authors.     

The need for “psychological parents” by children in residential treatment

The literature on the socialization of children is reviewed. It is concluded that a major factor contributing to conduct problems in children is the lack of effective child caring at home. The special adult-child relationship which differentiates biological from psychological parenting is described. Implications for the residential treatment of children are discussed.     

An evolutionary perspective of sex-typed toy preferences: pink,blue, and the brain

Large sex differences in children's toy preferences are attributed to gender group identification and social learning. The proposal outlined in this paper is that contemporary conceptual categories of masculine or feminine toys are also influenced by evolved perceptual categories of male-preferred and female-preferred objects. Research on children exposed prenatally to atypical levels of androgens and research on typically developing infants suggest sex-dimorphic preferences exist for object features, such as movement or color/form. The evolution and neurobiology of mammalian visual processing—and recent findings on sex-dimorphic toy preferences in nonhuman primates—suggest further that an innate bias for processing object movement or color/form may contribute to behaviors with differential adaptive significance for males and females. In this way, preferences for objects such as toys may indicate a biological preparedness for a masculine or feminine gender role—one that develops more fully as early perceptual preferences are coupled with object experiences imposed by contemporary gender socialization.     

Chronic toxicity and bioaccumulation of 2,5,2′,5′- and 3,4,3′,4′-tetrachlorobiphenyl and Aroclor® 1242 in the amphipodHyalella azteca

The addition of 100 (g/L of Aroclor^® 1242 (A1242) or 2,5,2,5-tetrachlorobiphenyl (TeCB) during 10 week chronic toxicity tests withHyalella azteca resulted in complete mortality. There were no effects on survival, growth, or reproduction after addition of 30 g/L. Toxic effects were observed at tissue levels of between 30 and 180 g/g on a wet weight basis, and tissue levels appear to be a better indicator of toxicity than levels in water. No toxic effects were observed after additions of up to 2,700 g/L of the coplanar congener 3,4,3,4-TeCB.H. azteca has the ability to avoid accumulating in excess of 140 g/g 3,4,3,4-TeCB. The amount taken up was proportional to the amount added in water up to 100 g/L, but was constant at higher additions, possibly accounting for its relatively low toxicity. The low toxicity of the coplanar congener, as compared to the non-coplanar 2,5,2,5-TeCB, is in direct contrast to the high toxicity of coplanar PCB congeners to mammals and may be associated with slower rates of aromatic hydrocarbon metabolism in amphipods. Polychlorinated biphenyl levels measured in amphipods from Lake Ontario are approximately 100-fold below levels associated with toxicity inH. azteca, but are above levels which, through biomagnification up the food chain, lead to salmonid residues in excess of 2 g/g, a tolerance limit for human consumption.     

The effect of polychlorobiphenyls (Aroclor 1242) on bicarbonate-C14 uptake byEuglena gracilis

Summary Aroclor 1242 is inhibitory to long-term batch growth ofE uglena gracilis at 10 ppm. Exposure to PCB's, subsequent to an initial drop of 50% in the first 30 minutes, does not appear to inhibit photosynthesis on a per cell basis over the time span of four hours. Consequently our experimental findings suggest that inhibition of population growth does not lie directly in the photosynthetic pathway despite the initial inhibition by Aroclor 1242 onEuglena gracilis in light. Dark absorption of bicarbonate appears to decrease with increased PCB exposure. This decrease may be causally related to the population growth inhibition observed.     

Determinants of household health expenditure on western institutional health care

We try to identify determinants of illness reporting, provider choice and resulting expenditure with different econometric models using data from a representative household panel survey of 800 households in Nouna health district, Burkina Faso, during 2000–2001. The factors being an adult, married, illness occurred in rainy season and severe illness significantly increased the magnitude of health expenditure. Compared to malaria, individuals spent more on other infectious diseases, injury and the other disease category. In contrast, people were less likely to spend on chronic illness. An individual who belonged to a household headed by a female, a literate household head and with a higher household expenditure had a significantly positive association with the magnitude of expenditure. Findings from this study can be used for policy implication to improve health system performance in Burkina Faso through enhancing health care utilization.     

Hard hats vs. soft hearts: The conflict between principles and reality in child and adolescent care and treatment programs

Much of child care in volves quick reactions based on one's automatic pilot derived from how we were parented. This paper is about two seemingly universal automatic pilot systems—the hard hats and the soft hearts. Hard hats are behavior management and modification oriented, while soft hearts are psychodynamically and counselling oriented. Typically, the hard hats tend to have the upper hand due to the nature of our culture, and they therefore have the effect of preventing the contributions of the soft hearts from being realized. That all too frequently sets up a dominant culture and a resentful minority situation. To correct this imbalance, a value orientation from the top which emphasizes mutual respect and utilization is suggested.Grateful acknowledgement is made to Ray Peterson for his helpful suggestions in the preparation of this paper.     

Assessment of exposure to lead of the general population in the French community through biological monitoring

Summary The aim of the council directive of 29 March 1977 of the European Community (1) is the screening for non-work-related lead exposure levels in the general populations of European (member) countries. In France, such testing was carried out in eight metropolitan areas (having more than 500000 inhabitants), another eight critical areas surrounding industrial emission sources and one area (Vosges) having a high level of lead contamination in the water. In view of the reference values (maximum 35 g/ dl in an individual blood sample) adopted by the directive, the situation is most serious in the area where the exposure is due to the lead contamination in the water. Individuals here run a seven times greater risk of exceeding the 35 g/dl blood-lead limit relative to urban populations where the lead comes mostly from vehicle emissions into the atmosphere (i.e. 9.3% of the blood-lead values of the Vosgian sample exceed 35 pg/dl; 3.5% for the industrial complexes which deal with lead and 1.4% for the urban zone). While these vehicle exhausts are the subject of much current concern, in perspective, the problem of lead pipe contaminated drinking water appears to be of far greater importance.