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The Late Ordovician marks an epoch of substantial change during Earth’s geologic history. It documents the first mass extinction event of the Phanerozoic, which wiped out a plethora of marine genera. Though signatures of the extinction event are quite evident on the species level, there are many underlying uncertainties as to which factors drove the near destruction of Ordovician marine life. The exact causes and contributing factors of the Late Ordovician Mass Extinction (LOME) are highly debated. Previous studies propose processes such as redox shifts, volcanism, deep-water anoxia, low atmospheric oxygen, or excess CO2 as significant influencers. In this study, we utilized a multi-archive/proxy approach in reconstructing paleoenvironmental, stratigraphic, chronologic, and diagenetic signatures of halite and carbonate sequences from two localities containing the Ordovician–Silurian boundary. Our preliminary findings suggest that an abrupt, multi-pulsed glaciation was probably the main driver of the LOME. However, the exact duration, intensity, and number of cooling pulses are still up to interpretation and will require additional geochemical work to paint the entire picture. Samples were obtained from two localities of similar low paleo-latitudes. Marine halite and carbonate were obtained from the upper Ordovician Red Head Rapids Formation, Hudson Bay Basin, Canada. Another suite of halite was collected from the Ordovician/Silurian Mallowa Salt Formation, Canning Basin, Western Australia. The diagenetic integrity of Red Head Rapids halite and carbonate were assessed through strontium isotope analysis. Since the strontium isotope remains in equilibrium with seawater, we can cross-analyse the preservation potentials of both marine archives. All sample results lay within the ± 0.00006 ‰ natural variation of 87Sr/86Sr measured in modern marine counterparts, providing evidence of primary material and accurate paleo-interpretations. Trace element chemistry study was conducted on halite samples from both localities. Previous studies suggested that the spikes of Hg, Mo, and U concentrations signify the aftermath of a greenhouse event that triggered the expansion of deep-water anoxia. Furthermore, heightened volcanic activity led to significant greenhouse gas emissions and produced a period of warming. Instead, our halite Hg, Mo and U concentrations are extremely low, many below detection limits, which correspond to glacial signatures of an icehouse. Interpretation of the sedimentary cerium anomaly of the Red Head Rapids and Mallowa salts also revealed characteristics of an oxygenated marine environment, with all calculated values below the threshold, typical of anoxia. Rigorous halite fluid inclusion analysis was conducted to qualitatively distinguish between primary and secondary material based on size, shape, orientation, and multiple growth pat­terns. Microthermometry homogenization temperatures derived quantitative distinctions between primary and secondary fluid inclusions of preserved and altered material, respectively. Paleotemperatures of primary fluid inclusions exhibited oscillations that were evident of daily/seasonal variation of inter- and/or glacial times, averaging approximately 24.2°C ± 0.5°C for the latest-Ordovician–earliest-Silurian. Apart from minor fluctuations, we noticed up to four major cool­ing pulses associated with the major glaciation characterizing the latest-Ordovician–earliest-Silurian time. [ABSTRACT FROM AUTHOR]

Background: Various guidelines have highlighted the importance of patients being given information on malignant spinal cord compression (MSCC), both when diagnosed with the condition and as a tool to aid early detection. Aim: To determine patient and staff views on the provision of MSCC information to patients with a diagnosis of or considered to be at high risk of developing MSCC. Methods: Patients with MSCC admitted to a large regional cancer centre in Scotland over a 6-month period were interviewed. Staff were also surveyed using similar questions. Results: Fifty-six patients and fifty staff were recruited. Only 4% of staff reported giving any written information about MSCC to patients with a confirmed diagnosis, although 20% of patients said they received it and 77% wanted it. A total of 54% of staff reported giving prophylactic information about MSCC to patients, although the majority of the patients (86%) said they would have wanted this information. Patients generally did not access additional information about MSCC and were dependent on the limited amount provided by the health care team. Conclusion: Health professionals need to ensure that patients get the information they want, which will allow them to recognize MSCC symptoms early for improved treatment outcomes or to better adapt to a diagnosis. [ABSTRACT FROM AUTHOR]

Abstract: This paper discusses the piloting of a computerised decision aid that provides individualised information about hypertension to patients. The program is based on decision analysis, using decision trees as a way of structuring information. It incorporates the Framingham risk equation to assess a users'' risk of coronary artery disease, together with a detailed assessment of the patient''s current lifestyle and their willingness to change behaviour. Users of the program can decide how much or how little information they access. The program assesses individual''s preferences for different treatment outcomes, before providing them with guidance on what might be the best treatment option for them. The program was evaluated by 10 patients with a diagnosis of mild to moderate hypertension and 8 health care professionals. Overall, both health care professionals and patients assessed the program positively. The use of a decision aid based on decision analysis may be a useful way of providing information to patients in order to promote shared decision making. [Copyright &y& Elsevier]

ABSTRACT At a time when males abused in childhood are coming increasingly to attention of clinical services, we review the literature, describe the process and report on clinical outcomes of a slow open long-term dynamically orientated group for abused adult males. Twenty-nine men referred to the local psychotherapy service for consideration for inclusion in the group are discussed along with some of the most prevailing themes, namely identification with the aggressor, self-esteem, guilt and sexuality. Symptoms were measured using the SCL 90-R and demonstrate relatively high levels of psychological distress in this group at initial assessment. There is significant improvement in global scores, interpersonal sensitivity, depression and psychoticism in the group of 13 men who engaged in therapy for at least six months compared with those who did not. The authors conclude that symptom measurement provides evidence that group psychotherapy is a useful therapeutic approach in a group of men who might otherwise be considered unsuitable for psychotherapeutic interventions due to symptom severity and personality difficulties. [ABSTRACT FROM AUTHOR]

A response by Judith U. Cope, Audrey E. Morrison, and Joy Samuels-Reid to a letter to the editor about their article on the use of infusion-pump technology by adolescent patients in the previous issue is presented.

Provides tips for using blood transfusion devices in the United States. Risk in blood transfusion procedures to patients undergoing surgery; List of precautions in using blood and fluid warmer; Importance of removing air from the fluid pathway before continuing the infusion.

Presents information on the disposal of needles in sharps container. What can be eliminated if a sharps container is used effectively; Precautions to take when using sharps containers.

Focuses on the incorrect usage of restraint based on a condition of a confused and restless elderly female patient who was found asphyxiated. Reason why the female was asphyxiated; Precautionary measures; Declination of restraint use.

This paper discusses the development and evaluation of a computerised decision aid that provides individualised information about Benign Prostatic Hyperplasia (BPH) and Hypertension to patients. The program is based on decision analysis, using decision trees as a way of providing users with information regarding the probability of different outcomes occurring, obtaining an individual evaluation of the different outcomes, before providing guidance on what might be the 'best' option for that patient. It is intended that the program can be used as the basis for helping patients to become more involved in decisions about their medical treatment. Eight health care professionals and 19 patients (9 with BPH and 10 with Hypertension) evaluated the program. Overall it was assessed positively by both health care professionals and patients. However, before it can be integrated into health care practice, the program is to be evaluated further in a randomised trial. [ABSTRACT FROM AUTHOR]

Background: Growing technological improvements in insulin pump design have increased the use of these devices in young children. To better understand the types of infusion pump-related problems and associated adverse events in this age group, we performed a comprehensive evaluation of pump-related adverse event reports received by the U.S. Food and Drug Administration (FDA) for children ages 1-12 years., Methods: A query was conducted of FDA's Manufacturer and User Facility Device Experience database from January 1, 1996, through December 31, 2009, in children ages 1-12 years involving insulin pumps. Report narratives were individually reviewed for age, gender, and seriousness of outcomes. Device or patient problems and potential contributory factors were assessed., Results: Over the past 14 years, 1774 (7%) of all insulin pump adverse event reports were identified in children ages 1-12. Of these reports, 777 (43%) resulted in hospitalization. In hospitalized cases (n = 614), diabetic ketoacidosis and/or hyperglycemia were the predominant patient problems, and in other cases (n = 98), hypoglycemia was evident. There were 106 emergency room visits, 19 cases requiring paramedic attention, and five deaths. The majority of reports indicated that the devices were not returned to the manufacturer, and root causes were not always confirmed., Conclusions: Younger children with diabetes deserve careful consideration of the risk and benefit of insulin pump technology. Studies are needed to better understand pediatric safety issues and to identify the root cause of adverse events. Problems related to patient education, device misuse, and malfunctions were found, highlighting the need to strengthen user training for children and their caregivers., (© 2012 Diabetes Technology Society.)

Background: Various guidelines have highlighted the importance of patients being given information on malignant spinal cord compression (MSCC), both when diagnosed with the condition and as a tool to aid early detection., Aim: To determine patient and staff views on the provision of MSCC information to patients with a diagnosis of or considered to be at high risk of developing MSCC., Methods: Patients with MSCC admitted to a large regional cancer centre in Scotland over a 6-month period were interviewed. Staff were also surveyed using similar questions., Results: Fifty-six patients and fifty staff were recruited. Only 4% of staff reported giving any written information about MSCC to patients with a confirmed diagnosis, although 20% of patients said they received it and 77% wanted it. A total of 54% of staff reported gaving prophylactic information about MSCC to patients, although the majority of the patients (86%) said they would have wanted this information. Patients generally did not access additional information about MSCC and were dependent on the limited amount provided by the health-care team., Conclusion: Health professionals need to ensure that patients get the information they want, which will allow them to recognize MSCC symptoms early for improved treatment outcomes or to better adapt to a diagnosis.

Objectives: From January 1, 2005, through December 31, 2005, the Food and Drug Administration received 5 adolescent death reports associated with the use of insulin pumps, raising concerns about use of this device in this age group. To understand better the types of infusion pump-related problems in adolescents, we performed a comprehensive evaluation of insulin and patient-controlled analgesic pump-related adverse events reported for adolescents that were received by the Food and Drug Administration from 1996 to 2005., Methods: A search for medical device adverse event reports from January 1, 1996 through December 31, 2005, involving insulin pumps or patient-controlled analgesic pumps used by patients who were aged 12 to 21 years was conducted in the Food and Drug Administration's Manufacturer and User Facility Device Experience Database. Reports were reviewed for demographic characteristics, type of adverse event, and patient morbidity, and potential contributory factors were classified from narratives in the reports., Results: A total of 1674 reports were identified: 1594 for insulin pumps and 53 for patient-controlled analgesic pumps. In reports of insulin pump events, there were 13 reported deaths, 2 reports that indicated possible suicide attempts, and several additional reports indicating severe hypoglycemic or hyperglycemic events that seemed to be device-related. A total of 102 (6.4%) insulin-pump reports highlighted factors that may have contributed to the adverse event, including problems associated with compliance, education, sports-related activities, and dropping or damaging the pump. Eighty-two percent of cases involving the insulin pump resulted in hospitalization. Half of the reports involving patient-controlled analgesic pumps indicated that the patient received an excess of medication; tampering and noncompliance were evident in some cases., Conclusions: Adolescents are a special population who deserve careful consideration of risk and benefit for use of device technology. Studies need to further identify safety problems in this age group.