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Normalization of deviance is a phenomenon in which individuals and teams deviate from what is known to be an acceptable performance standard until the adopted way of practice becomes normalized. In health care, this phenomenon erodes the safety culture, and it can be particularly concerning in high-risk work environments, such as the operating room (OR). The purposes of this study were to: (a) Explore the concept of normalization of deviance in the OR; (b) Identify reasons for normalization of deviance; and (c) Identify factors that protect against normalization of deviance. This focused ethnographic study included a sample of 10 perioperative nurses who were interviewed. Our findings demonstrated that normalization exists in the OR. Reasons for normalization of deviance included productivity pressures, generalized complacency, complacency related to length of experience, social pressures, and negative acculturation. Factors that protect against normalization of deviance included nurse engagement and having supportive managerial relationships. [ABSTRACT FROM AUTHOR]

Feri Farassat was one of the pioneers of the use of the Ffowcs Williams & Hawkings formulation of Lighthill's acoustic analogy as a way to extrapolate radiated waves from simulations of unsteady flows. Current computational limits mean that volume source terms are often neglected, causing inaccurate acoustical predictions when entropy fluctuations or vorticity pass across the extrapolation surface. The derivation of the Ffowcs Williams-Hawkings equation is modified to allow the equivalent surface sources to be distributed over a transition layer of finite thickness rather than being confined to a single layer, in order to reduce the effect of vorticity exiting the computational domain. [ABSTRACT FROM AUTHOR]

An editorial is presented on normalization of deviance identifying health care. Topics include normalization of deviance representing a distinct risk for health care organizations by increasing patient vulnerability to harm; and shortcuts being prone becoming the cultural norm and unhinging the safety culture within an organization by gradually tolerating lower safety standards.

The theory of Green's functions for the wave and Helmholtz equations is examined with particular attention to their use in aeroacoustics for the extrapolation of acoustic wavefields from numerical flow simulations. In a new synthesis that permits straightforward generalization of previously published results, spatial and temporal windowing functions are employed to provide equivalent-source expressions to account for both initial and boundary conditions. Detailed results describe the transformation of both source terms and Green's functions to take account of uniform subsonic mean flow, and expressions are given for free-field Green's functions, both with and without flow, in time, frequency and wavenumber domains. Aworked example illustrates the non-uniqueness of the Green's function for a simple one-dimensional bounded problem. [ABSTRACT FROM AUTHOR]

The Eurobarometer Survey of the EAPC Task Force on the Development of Palliative Care in Europe is part of a programme of work to produce comprehensive information on the provision of palliative care across Europe.Aim: To identify barriers to the development of palliative care in Western Europe.Method: A qualitative survey was undertaken amongst boards of national associations, eliciting opinions on opportunities for, and barriers to, palliative care development. By July 2006, 44/52 (85%) European countries had responded to the survey; we report here on the results from 22/25 (88%) countries in Western Europe.Analysis: Data from the Eurobarometer Survey were analysed thematically by geographical region and by the degree of development of palliative care in each country.Results: From the data contained within the Eurobarometer, we identified six significant barriers to the development of palliative care in Western Europe: (i) lack of palliative care education and training programmes; (ii) lack of awareness and recognition of palliative care; (iii) limited availability of/knowledge about opioid analgesics; (iv) limited funding; (v) lack of coordination amongst services; and (vi) uneven palliative care coverage.Conclusion: Findings from the EAPC Eurobarometer Survey suggest that barriers to the development of palliative care in Western Europe may differ substantially from each other in both their scope and context and that some may be considered to be of greater significance than others. A number of common barriers to the development of the discipline do exist and much work still remains to be done in the identified areas. This paper provides a road map of which barriers need to be addressed. [ABSTRACT FROM PUBLISHER]

Private equity firms are accused by trade unions of changing industrial relations in buyouts by demonstrating an unwillingness to recognize and work with trade unions, and by downgrading information and consultation. To explore these important policy issues, this article reports the first representative pan-European survey of managers' perceptions of the impact of private equity on industrial relations. Managers report that private equity investment does not result in changes to union recognition, membership density or changes in management attitudes to trade union membership. Furthermore, managers in firms recognizing unions after private equity buyouts do not report reductions in the terms and conditions subject to joint regulation. Under private equity ownership more firms report consultative committees, managers regard these as more influential on their decisions, and indicate increased consultation over firm performance and future plans. Comparing industrial relations changes in different social models in Europe, the results suggest private equity firms adapt to national systems and traditional national industrial relations differences persist after buyout. [ABSTRACT FROM AUTHOR]

Regulatory authorities, politicians and trade unions across Europe have recently accused private equity institutions of improving the performance of buy-outs merely by reducing employment costs with negative implications for jobs, working conditions and training investments. These claims are assessed by analysing high commitment management practices and changes in these practices in private-equity backed and non-private equity backed buy-outs in the UK and the Netherlands using a large-scale representative sample that combines both questionnaire and archival data. We find that both private equity backed buy-outs compared to non-private equity backed buy-outs, and Dutch buy-outs compared to UK buy-outs, are less likely to report introducing new high commitment management practices but do not on average reduce high commitment management practices. The findings suggest private equity backed buy-outs represent only a limited adaptation of the European social model. [ABSTRACT FROM AUTHOR]

The Antikythera Mechanism, the world's oldest known geared mechanism, became widely known through the work of Derek Price who, concluding that its dials yielded astronomical and calendrical information, called it a 'calendar computer'. Price rightly drew attention to its importance as direct evidence for a high level of mechanical accomplishment in ancient times, but his account of the instrument itself is deficient. I have developed a new reconstruction on the basis of an independent survey of the original, drawing on my knowledge of early mechanism and of the history of craft techniques, and on my experience as a practical mechanic. This reconstruction follows the observed detail far more closely than does Price's. It displays somewhat different astronomical information, according closely with the contemporary literary evidence of interest in the making of planetaria. The main features of the new reconstruction, previously described elsewhere in a series of papers, are here brought together so as to convey a better impression of the whole. A model, made to the same scale as the original, demonstrates that the reconstruction is workable. [ABSTRACT FROM AUTHOR]

Background/objectives. Osteopenia is a significant morbidity in children undergoing therapy for acute lymphoblastic leukaemia (ALL) or non-Hodgkin's lymphoma (NHL). We conducted a pilot study to assess the impact of alendronate on whole body bone mineral content (WB-BMC), lumbar spine bone mineral density (LS-BMD), biochemical measures of bone mineral metabolism, as well as gross motor function and health-related quality of life (HRQL) in children undergoing therapy for ALL or NHL. Methods. Ten children (nine boys) between the ages of 3.6 and 14.6 years, on identical maintenance chemotherapy for ALL or NHL were treated with oral alendronate once weekly, and daily calcium supplementation, for a period of six months. Outcome measures were WB-BMC and LS-BMD; biochemical measures of bone mineral metabolism including plasma osteocalcin, C-terminal telopeptide of type I collagen (CTx), serum calcium, 25-hydroxy-vitamin D (25-OHD), and parathyroid hormone (PTH); as well as assessments of motor function and HRQL. Results. A gain in Z score was observed in 7/9 evaluable patients for WB-BMC (mean increase of 0.49) and LS-BMD (0.51). Plasma osteocalcin and CTx showed a change in bone turnover favouring formation over resorption. Serum calcium and 25-OHD remained normal throughout treatment. After an initial spike, serum PTH returned to baseline values at week 4. Measures of motor function showed some improvement and there were modest gains in HRQL. Conclusions. Alendronate therapy was tolerated well. Further study in a larger sample of children with ALL or NHL is warranted, in the context of a randomized clinical trial. [ABSTRACT FROM AUTHOR]

Spiritual care is an integral part of palliative care and if asked, most members of a palliative care team would state they address spiritual issues. The majority of hospices have support from a chaplain. This study was to determine the roles of chaplains within hospices and to look at their levels of stress. A questionnaire containing both open and closed questions was sent to chaplains working within hospices in the UK. The questionnaire enquired about number of sessions, specific roles of chaplain, whether they were members of the multidisciplinary team and their sources of internal support. Stress was measured on a 10-point Likert scale and the GHQ12. One hundred and fifteen questionnaires were returned, with a 72% response rate. The majority (62%) defined their denomination as Church of England and Free Church (24%); 71% of respondents had parish commitments in addition to their hospice role. Roles were predominantly defined as spiritual care of patients and staff (95%) and bereavement support of relatives (76%) and 75% regularly attended the multidisciplinary meetings. Senior medical and nursing staff and other chaplains were perceived as providing most support. Median Likert score for stressfulness was 5, and 23% scored at or above the threshold on the GHQ12 for identifiable psychological morbidity. Clear role definition was associated with less perceived stress whereas the provision of bereavement support was associated with statistically significant increased perceived stress. The role of a chaplain within a hospice is varied and this study suggests that the provision of training and formal support is to be recommended. [ABSTRACT FROM AUTHOR]

Although millions of people die each year throughout the world, and a large proportion of these would benefit from palliative care services to provide care for dying people are underdeveloped, particularly in resource-poor regions. This article describes the development of an information resource on the World Wide Web, the International Observatory on End of Life Care (IOELC), to provide information on palliative care services in Eastern Europe and Central Asia. The article describes the development of the IOELC, the structure of the resource, and how data were collected. It concludes with a discussion of plans to evaluate the website and to expand it to include other world regions, with the aim of developing it into a global information resource for the development of palliative care services. © 2004 SAGE Publications [ABSTRACT FROM AUTHOR]

The purpose of this project was to obtain input from the families of survivors of childhood cancer regarding their needs surrounding the 'coming off treatment' (COT) period. A questionnaire was developed to record their needs, their wishes, and their satisfaction surrounding this period of time. Closer examination of the time surrounding COT was undertaken in an attempt to enhance this area of service for patients and families in our clinic setting. Establishing a structured protocol is likely to alleviate some of the anxiety that surrounds this time for families and help us to provide better continuity of care. After identifying a cohort of patients and families, the reason for the survey was explained and they were asked to complete the questionnaire before they left the clinic setting. At the completion of the study, 82% of the cohort had been approached, and 100% of this group had completed the survey (n = 41). Less than 50% of participants felt they had had a formal 'coming off treatment' review but, of that same group, 89% were satisfied with the process. Participants identified areas of importance and health care professionals who they would like involved in the COT process. After reviewing the responses to the questionnaires, the decision was made to proceed in preparing a COT protocol. Copyright © 2002 by Association of Pediatric Oncology Nurses [ABSTRACT FROM AUTHOR]

Describes contemporary and proposed approaches to the provision of psychiatric expertise outside metropolitan areas in New South Wales. Extent of the problem of unequal distribution of psychiatrists between urban and rural areas in Australia and New Zealand; Traditional models of psychiatric service delivery; Contemporary approach employed and proposed solutions to the problem of psychiatric service delivery.

The objectives of the study were to ascertain the extent to which short-term goals of therapy were achieved and to assess the discrepancy, if any, between the therapy prescribed and the therapy delivered.The weekly therapy prescribed and delivered over a two-month period was recorded. The outcome of goal setting was assessed in relation to the predicted time set for achieving the goal.All patients admitted to a rehabilitation ward in an NHS teaching hospital during the two months were studied.No patients received the full treatment prescribed. The percentage of prescribed treatment given to patients ranged from 33.3% to 66.4%. Over 95% of the goals set during the period were achieved but only 60% were achieved on time and 37% were achieved later than expected.The therapy prescribed for patients was not being delivered due to inadequate resourcing of therapy time. A 5% increase in funding to the rehabilitation ward would generate a 50% increase in the amount of formal therapy given which would be likely to shorten patients' stay in hospital. [ABSTRACT FROM PUBLISHER]

Background: Bile acids can act as signalling molecules via various receptors including the nuclear farnesoid X receptor (FXR) and pregnane X receptor (PXR), and the cell surface G-protein-coupled receptor TGR5. The signalling has been implicated in the release of peptide YY (PYY) and glucagon-like peptide 1 (GLP-1), which improves glycaemic control and energy expenditure. We investigated whether morbidly obese subjects have altered postprandial bile acid responses in comparison to normal weight subjects. Method: Blood samples were taken every 30 min from 0 to 180 min following a 400 kcal test meal. Samples were taken from 12 normal weight subjects with a body mass index (BMI) of 23.2 (2.8) kg/m2 (median [interquartile range (IQR)]) and seven obese patients with a BMI of 47.2 (7.2) kg/m2. Fractionated bile acids were measured on these samples using high-performance liquid chromatography tandem mass spectrometry. Results: The obese subjects showed a lower postprandial response in total bile acids compared with the normal weight subjects. An increase of 6.4 (5.0) and 2.6 (3.3) μmol/L (median [IQR]) in normal weight and obese subjects was observed, respectively (P = 0.02). The difference was predominantly due to the glycine-conjugated fraction (P = 0.03). There was no difference in the increase of the unconjugated or taurine-conjugated fractions. Conclusions: The decreased postprandial bile acid response in obese subjects compared with normal weight subjects may partly explain the suboptimal GLP-1 and PYY responses and could affect appetite, glycaemic control and energy expenditure. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Lymphadenopathy mimicking lymphoma associated with cryoglobulinaemia and arteritis" in the August 2006 issue.

The elevation in plasma angiotensin-converting enzyme (ACE) levels observed in patients with hyperthyroidism is unexplained. In this study three hypotheses were investigated. Results from a study using rats treated with thyroid hormones indicated that the increased ACE was not due to increased cleavages of enzyme from lung endothelia. Data from patients with specific tissue damage argue against a nonspecific release of ACE from damaged cells. Data from cultured cell experiments, however, strongly support a direct effect of thyroid hormones upon ACE synthesis and secretion. [ABSTRACT FROM AUTHOR]