Labor time spent in foodservice activities in one hospital: a 12-year profile

Labor minutes per meal equivalent and percentage of time spent in direct work, indirect work, delay time, and total time were determined in an annual study of foodservice workers in a community hospital. Twelve activity sampling studies (from 1973 through 1984) were conducted for 7 days (Monday through Sunday), usually during the second week of February. The conventional foodservice, with the cook/hot-hold method of food production and service, averaged about 10 minutes for direct work, 1 minute for indirect work, 2 minutes for delay time, and 13 total labor minutes per meal equivalent for the 12 years. The data were similar to those of the study in the 1960s, of conventional hospital foodservices, with high productivity, which averaged about 11 minutes for direct work, 1 minute for indirect work, 2 minutes for delay time, and 14 total labor minutes per meal equivalent. Data averaged from the 1973 through 1984 studies compared with the data from the 1960s study showed that transportation, cleaning, and service required the most labor time (total of 58% in this study and total of 62% in the 1960s study). Methods reported in this article may be applied in other foodservices to identify labor time spent in work and delay activities to establish productivity guidelines for a foodservice department.     

Is homozygous α-thalassaemia a lethal condition in the 1990s?

Two cases of homozygous α-thalassaemia who received active treatment in accordance with parental wishes are reported. One infant survived and the other, although successfully weaned off mechanical respiratory support, unexpectedly developed portal vein thrombosis and died. Homozygous a-thalassaemia, a condition previously considered to be universally fatal, and an indication for therapeutic abortion, is now potentially curable with advances in diagnostic technology and treatment. However, active management of these cases raises serious ethical questions and has major financial implications on the health-care system. Invasive prenatal and intensive postnatal interventions should remain experimental and cannot be recommended as routine clinical practice until the questions of long-term neurodevelopmental outcome, and the morbidity and mortality associated with bone-marrow transplantation have been fully addressed. As a result of advances in information technology, more and more parents of affected foetuses are likely to request active treatment.     

Association of erythrocyte protoporphyrin with blood lead level and iron status in the second National Health and Nutrition Examination Survey, 1976-1980

Both iron status and body burden of lead influence heme biosynthesis. Measurement of protoporphyrin IX in the circulating erythrocyte (EP) has been used to index the extent of lead exposure and iron deficiency. The association of iron status and blood lead level with the level of EP in whole blood for persons ages 6 months through 74 years in the general U.S. population has been investigated by using data obtained in the second National Health and Nutrition Examination Survey (NHANES II). Iron status was defined as a function of percentage transferrin saturation (%TS) and total iron-binding capacity (TIBC). Both low iron status (%TS less than or equal to 16.0 or TIBC greater than or equal to 450 micrograms/dl serum) and elevated blood lead levels (greater than or equal to 30 micrograms/dl) were associated with increased EP concentrations. The analysis of the proportions of persons in the U.S. population with EP levels above the 95th percentile (30 micrograms EP/dl of whole blood in the NHANES II data) support the concern that iron status has considerable influence on interpretation of EP levels recommended for use in screening programs aimed at identifying children with lead toxicity. With screening techniques based on EP only, currently used in various public health programs, a considerable number of children with blood lead levels of greater than or equal to 30 and less than or equal to 50 micrograms/dl are not referred for further diagnostic evaluation.     

Combined early treatment of congenital melanocytic naevus with carbon dioxide and NdYag lasers.

Three cases of extensive congenital melanocytic naevi were treated with a combined approach using a ultrapulse carbon dioxide laser and a Nd Yag laser within 1 year of birth. The naevi were substantially depigmented and this result has been maintained for up to 36 months following treatment. The condition, treatment and the relevant literature are discussed.     

Targeted Disruption of NF1 in Osteocytes Increases FGF23 and Osteoid With Osteomalacia‐like Bone Phenotype

Neurofibromatosis type 1 (NF1, OMIM 162200), caused by NF1 gene mutations, exhibits multi‐system abnormalities, including skeletal deformities in humans. Osteocytes play critical roles in controlling bone modeling and remodeling. However, the role of neurofibromin, the protein product of the NF1 gene, in osteocytes is largely unknown. This study investigated the role of neurofibromin in osteocytes by disrupting Nf1 under the Dmp1‐promoter. The conditional knockout (Nf1 cKO) mice displayed serum profile of a metabolic bone disorder with an osteomalacia‐like bone phenotype. Serum FGF23 levels were 4 times increased in cKO mice compared with age‐matched controls. In addition, calcium‐phosphorus metabolism was significantly altered (calcium reduced; phosphorus reduced; parathyroid hormone [PTH] increased; 1,25(OH)₂D decreased). Bone histomorphometry showed dramatically increased osteoid parameters, including osteoid volume, surface, and thickness. Dynamic bone histomorphometry revealed reduced bone formation rate and mineral apposition rate in the cKO mice. TRAP staining showed a reduced osteoclast number. Micro‐CT demonstrated thinner and porous cortical bones in the cKO mice, in which osteocyte dendrites were disorganized as assessed by electron microscopy. Interestingly, the cKO mice exhibited spontaneous fractures in long bones, as found in NF1 patients. Mechanical testing of femora revealed significantly reduced maximum force and stiffness. Immunohistochemistry showed significantly increased FGF23 protein in the cKO bones. Moreover, primary osteocytes from cKO femora showed about eightfold increase in FGF23 mRNA levels compared with control cells. The upregulation of FGF23 was specifically and significantly inhibited by PI3K inhibitor Ly294002, indicating upregulation of FGF23 through PI3K in Nf1‐deficient osteocytes. Taken together, these results indicate that Nf1 deficiency in osteocytes dramatically increases FGF23 production and causes a mineralization defect (ie, hyperosteoidosis) via the alteration of calcium‐phosphorus metabolism. This study demonstrates critical roles of neurofibromin in osteocytes for osteoid mineralization. © 2017 American Society for Bone and Mineral Research.     

The degloved hand: immediate complete restoration of skin cover with a contralateral forearm free flap

This paper describes a method of repair of a serious injury with major skin loss on both the volar and dorsal aspects of the hand and wrist using a free "forearm flap" from the opposite limb. The technique is a one-stage procedure, provides a completely variable amount of skin, the freedom to elevate the repaired hand and the opportunity to revascularise the most distal structures using the vessels incorporated in the flap.