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Objectives: There has been very limited research linking staff perceptions of hospital patient safety culture with rates of adverse clinical events. This exploratory study examined relationships between the Agency for Healthcare Research and Quality's (AHRQ) Hospital Survey of Patient Safety Culture and rates of in-hospital complications and adverse events as measured by the AHRQ Patient Safety Indicators (PSIs). The general hypothesis was that hospitals with a more positive patient safety culture would have lower PSI rates., Methods: We performed multiple regressions to examine the relationships between 15 patient safety culture variables and a composite measure of adverse clinical events based on 8 risk-adjusted PSIs from 179 hospitals, controlling for hospital bed size and ownership. All patient safety culture data were collected in 2005 and 2006 (except 1 late 2004 hospital), and all PSI data were collected in 2005., Results: Nearly all of the relationships tested were in the expected direction (negative), and 7 (47%) of the 15 relationships were statistically significant. All significant relationships were of moderate size, with standardized regression coefficients ranging from -0.15 to -0.41, indicating that hospitals with a more positive patient safety culture scores had lower rates of in-hospital complications or adverse events as measured by PSIs., Conclusions: Our findings support the idea that a more positive patient safety culture is associated with fewer adverse events in hospitals. Further research is needed to determine the generalizability of these results to larger sets of hospitals and to examine the causal relationship between patient safety culture and clinical patient outcomes.

A disease outbreak of high morbidity and high mortality in bison (Bison bison) was investigated. Clinical signs included lameness, swollen joints, respiratory distress, and lethargy. Fifty-three of 194 animals died. Cows between 5 and 10 years of age were the most affected group, in which 40 of 88 animals died. Necropsies were performed on several animals. There were abscesses in the lung and liver, as well as fibrinosuppurative pleuritis, polyarthritis, and disseminated microabscesses in various organs. No significant bacteria were isolated by routine aerobic cultures of lung and liver from 2 representative cases. However, Mycoplasma cultures were positive. Polymerase chain reaction tests on the isolated bacteria were positive for Mycoplasma bovis. Histologically, the abscesses were characterized by areas of necrosis with variable mineralization rimmed by granulomatous inflammation and fibrous tissue. No new animals had been introduced into the herd, but a cattle herd was present adjacent to the affected bison herd. Two restriction fragment length polymorphism techniques were used to compare the bison isolate and another bison isolate from an outbreak in North Dakota with a field isolate of M. bovis from cattle and with a laboratory control strain of M. bovis; the isolates and control strain were found to be similar. The isolates and the control were sequenced and compared with sequences in GenBank. Bison isolates were more than 99% homologous to M. bovis sequences in GenBank. It was concluded that M. bovis in bison can cause disseminated infection with a high morbidity and mortality and that bison isolates are similar to bovine M. bovis isolates.

Background: Classically, models of DNA-transcription factor binding sites (TFBSs) have been based on relatively few known instances and have treated them as sites of fixed length using position weight matrices (PWMs). Various extensions to this model have been proposed, most of which take account of dependencies between the bases in the binding sites. However, some transcription factors are known to exhibit some flexibility and bind to DNA in more than one possible physical configuration. In some cases this variation is known to affect the function of binding sites. With the increasing volume of ChIP-seq data available it is now possible to investigate models that incorporate this flexibility. Previous work on variable length models has been constrained by: a focus on specific zinc finger proteins in yeast using restrictive models; a reliance on hand-crafted models for just one transcription factor at a time; and a lack of evaluation on realistically sized data sets., Results: We re-analysed binding sites from the TRANSFAC database and found motivating examples where our new variable length model provides a better fit. We analysed several ChIP-seq data sets with a novel motif search algorithm and compared the results to one of the best standard PWM finders and a recently developed alternative method for finding motifs of variable structure. All the methods performed comparably in held-out cross validation tests. Known motifs of variable structure were recovered for p53, Stat5a and Stat5b. In addition our method recovered a novel generalised version of an existing PWM for Sp1 that allows for variable length binding. This motif improved classification performance., Conclusions: We have presented a new gapped PWM model for variable length DNA binding sites that is not too restrictive nor over-parameterised. Our comparison with existing tools shows that on average it does not have better predictive accuracy than existing methods. However, it does provide more interpretable models of motifs of variable structure that are suitable for follow-up structural studies. To our knowledge, we are the first to apply variable length motif models to eukaryotic ChIP-seq data sets and consequently the first to show their value in this domain. The results include a novel motif for the ubiquitous transcription factor Sp1.

Participants were 664 relatively low achieving children who were recruited into a longitudinal study when in first grade. Measures of peer academic reputation (PAR), peer acceptance, teacher-rated academic engagement and achievement, and reading and math achievement were obtained in Year 2, when the majority of students were in second grade, and 1 year later. Measures of academic self concept were obtained in Year 1 and in Year 3. As young as second grade, children's perceptions of classmates' academic competence are distinct from their perceptions of peers' other social and behavioral characteristics. SEM analyses found that Year 2 PAR predicted Year 3 teacher-rated academic engagement and reading (but not math) achievement test scores, above the effects of prior scores on these outcomes and other covariates. Furthermore, the effect of PAR on academic engagement and achievement was partially mediated by the effect of PAR on children's academic self concept. Implications of these findings for educational practice and future research are discussed.

Background: We undertook a population genetics analysis of the tsetse fly Glossina palpalis gambiensis, a major vector of sleeping sickness in West Africa, using microsatellite and mitochondrial DNA markers. Our aims were to estimate effective population size and the degree of isolation between coastal sites on the mainland of Guinea and Loos Islands. The sampling locations encompassed Dubréka, the area with the highest Human African Trypanosomosis (HAT) prevalence in West Africa, mangrove and savannah sites on the mainland, and two islands, Fotoba and Kassa, within the Loos archipelago. These data are discussed with respect to the feasibility and sustainability of control strategies in those sites currently experiencing, or at risk of, sleeping sickness., Principal Findings: We found very low migration rates between sites except between those sampled around the Dubréka area that seems to contain a widely dispersed and panmictic population. In the Kassa island samples, various effective population size estimates all converged on surprisingly small values (10

Microtubules are one of the three primary constituents of the eukaryotic cytoskeleton and are constructed from the protein tubulin. FtsZ is a close structural homologue of tubulin within prokaryotes, and plays an important structural role during cell division. This article compares what is known about the structures that these two homologues are able to form in vivo and in vitro and examines the evidence that the water in the immediate vicinity of the structures, particularly in microtubules, may play an important role in their formation and stability. The article then examines evidence that this hydration layer might help our understanding of how the structures formed by tubulin and FtsZ are stabilised by associated proteins and selected cations. The article then considers recent studies of the charge distribution and dipole moments of tubulin and extends this work to include the electrostatic characteristics of FtsZ. There is then an examination of the ways in which the electrostatic similarities and differences between the two proteins might be related to the similarities and differences in the filamentary structures that they form.

Mycoplasma bovis was identified by a specific lesion, conventional bacterial culture, immunohistochemistry, and polymerase chain reaction in 2 feedlot bison found dead with severe, chronic, caseonecrotic pneumonia; polyarthritis; and laryngitis. On microscopic examination, pulmonary lesions were characterized by prominent, well-defined areas of caseous necrosis and bronchiectasis. Immunohistochemical analysis of lung exhibited staining in bronchiolar epithelium and in random areas of caseous necrosis. On gross examination, the laryngeal lesion observed in 1 animal was typical of changes seen in cases of calf diphtheria. Nasal swabs taken from 6 clinically ill bison from the same feedlot revealed 1 animal shedding M. bovis by the nasal route. No other pathogens were recovered from the pulmonary or laryngeal lesions; however, Mannheimia haemolytica was cultured from the nasal swabs of 2 clinically ill bison, although not from the animal found to be shedding M. bovis. Several other affected bison had swollen joints and exhibited lameness and a reluctance to move. Changes observed in dead and clinically ill bison from this feedlot are similar to what has been described in the literature as chronic pneumonia and polyarthritis syndrome in feedlot cattle caused by M. bovis. Based on the severity of the lesions, and the number of dead and affected animals, bison in a feedlot setting appear to exhibit sensitivity to infection with M. bovis.

The dramatic cell shape changes during cytokinesis require the interplay between microtubules and the actomyosin contractile ring, and addition of membrane to the plasma membrane. Numerous membrane-trafficking components localize to the central spindle during cytokinesis, but it is still unclear how this machinery is targeted there and how membrane trafficking is coordinated with cleavage furrow ingression. Here we use an arf6 null mutant to show that the endosomal GTPase ARF6 is required for cytokinesis in Drosophila spermatocytes. ARF6 is enriched on recycling endosomes at the central spindle, but it is required neither for central spindle nor actomyosin contractile ring assembly, nor for targeting of recycling endosomes to the central spindle. However, in arf6 mutants the cleavage furrow regresses because of a failure in rapid membrane addition to the plasma membrane. We propose that ARF6 promotes rapid recycling of endosomal membrane stores during cytokinesis, which is critical for rapid cleavage furrow ingression.

This article integrates theory from the cognitive tradition in negotiation with theory on culture and examines cultural influences on cognitive representations of conflict. The authors predicted that although there may be universal (etic) dimensions of conflict construals, there also may be culture-specific (emic) representations of conflict in the United States and Japan. Results of multidimensional scaling analyses of U.S. and Japanese conflict episodes supported this view. Japanese and Americans construed conflicts through a compromise versus win frame (R. L. Pinkley, 1990), providing evidence of a universal dimension of conflict construal. As the authors predicted, Japanese perceived conflicts to be more compromise-focused, as compared with Americans. There were also unique dimensions of construal among Americans and Japanese (infringements to self and giri violations, respectively), suggesting that identical conflict episodes are perceived differently across cultures.

Ninety pharyngeal tonsils were collected from 2-year-old American bison (Bison bison) bulls and sampled for members of the Pasteurellaceae family. Particular attention was paid to seasonal incidence and antimicrobial resistance in serotypes and biovariants. Multiple strains of Pasteurella haemolytica (39%), P. trehalosi (68%), P. multocida (34%) and Haemophilus somnus (13%) were cultured from 86 out of the 90 (96%) tonsil samples. Pasteurella trehalosi was the most common and evenly distributed of the organisms recovered. Pasteurella haemolytica was found in fewer numbers than P. trehalosi, but showed an increase in number of isolates recovered with each sampling period. Pasteurella multocida, both A and D capsular types, was recovered from all sampling periods. No serotype pattern was observed in any of the animal groups sampled. One hundred twenty-seven of 147 (86%) of the isolates were resistant to at least 1 antibiotic, 95/147 (65%) to at least 2 different antibiotics, and 16/147 (11%) to at least 3 antibiotics. The most common resistance pattern observed was to neomycin and spectinomycin (73/147) (49%).

Dialysis dose has been established as a determinant of morbidity and mortality in chronic hemodialysis patients. To identify remediable barriers to the delivery of adequate hemodialysis, we examined factors that affected adherence to prescribed dialysis dose. End-Stage Renal Disease (ESRD) Network 4 facilities that fell into the lowest quintile in measures of dialysis adequacy were studied. At the time of this study, Network 4 was composed of 178 dialysis facilities in Delaware and Pennsylvania. Those 29 facilities had an average delivered urea reduction ratio (URR) of <0.67 and/or 71% of patients with a URR of 0.65. (The mean URR value of Network 4 was 0. 699 with a compliance ratio of 80%.) Dialysis treatment sheets were reviewed for all patients in the 29 facilities for all treatments during a calendar week. Predialysis and postdialysis blood urea nitrogen (BUN) values from 1 treatment during this week were used to calculate URR and Kt/V. A total of 1,339 patients with a mean age of 61.9 +/- 15.1 years and a mean duration of ESRD of 3.4 +/- 3.3 years were dialyzed in the 29 units. Mean prescribed duration of dialysis (T) was 219 +/- 26 min. with a mean blood flow rate (BFR) of 393 +/- 62 mL/min. Concordance between the prescribed and delivered T (-5 min), BFR (-50 mL/min), and hemodialyzer were assessed, by patient, for each treatment (Tx). Characteristics of a delivered Kt/V < 1.2 were duration <4 hours, BFR < 350 mL/min, patient weight > 100 kg, and delivered BFR 50 mL/min less than prescribed BFR. Multivariate analysis of the relationship between delivered dose of dialysis and patients and treatment characteristics identified black race, male gender, and younger age as demographic factors associated with low delivered dose. Potential remediable barriers identified by this analysis included reduced treatment time (>10%) and use of catheters for angioaccess. These data suggest components of the dialysis process that might be targeted in future quality improvement projects to improve the adequacy of dialysis delivery., (Copyright 2000 by the National Kidney Foundation, Inc.)

Delivery of an inadequate dose of hemodialysis is associated with a significant increase in the relative risk of both hospitalization and death. We hypothesized that noncompliance with the dialysis prescription, defined as failure to achieve the prescribed blood flow, failure to dialyze for the prescribed duration, or failure to use the prescribed dialyzer, was a significant factor in patients not achieving a urea reduction ratio (URR) of > or =0.65. We identified the 29 dialysis facilities in ESRD Network 4 that had the lowest average URR and/or lowest percent of patients with a URR > or =0.65 based on quarterly data reports. Each facility was surveyed by review of all dialysis treatment sheets from a single week by network staff to evaluate for noncompliance with the dialysis prescription. Facility-specific data were reported back to each facility. Each facility was required to develop a facility-specific quality improvement plan after receiving intensive education on the quality improvement process. After 9 months the facilities were resurveyed. Although the compliance with the dialysis prescription decreased from 54.0% to 53.6% (P =.026), the delivered URR increased from 0.679 +/- 0.072 to 0.688 +/- 0.070 (P =.026) with an increase in the percentage of patients with a URR > or = 0.65 from 69.7% to 75% (P =.0096). Kt/V increased from 1.37 +/- 0.26 to 1.41 +/- 0.27 (P =. 0001). Analysis of the process changes instituted by the individual facilities showed an increase in the prescribed dose of dialysis. Thus, although the process goal of improved compliance with the dialysis prescription was not achieved, the outcome goal of an increased delivered dose of dialysis was met through an alternative process change of an augmented dialysis prescription., (Copyright 2000 by the National Kidney Foundation, Inc.)

Malignant catarrhal fever (MCF) was diagnosed by clinical signs and lesions in five out of six white-tailed deer (Odocoileus virginianus) in a North American zoo. The clinical signs and histopathological lesions in these deer were typical of MCF. Antibody to an epitope conserved among the MCF viruses was detected in the sera collected from the deer. PCR failed to amplify viral sequences from DNA extracted from peripheral blood leukocytes (PBL) and/or spleens of the deer with primers specific for ovine herpesvirus 2 (OHV-2) or specific for alcelaphine herpesvirus 1 (AHV-1). By using degenerate primers targeting a conserved region of a herpesviral DNA polymerase gene, a DNA fragment was amplified from the PBL or spleens of all six deer and sequenced. Alignment of the sequences demonstrated that the virus in the deer belongs to the Gammaherpesvirinae subfamily, exhibiting 82% identity to OHV-2, 71% to AHV-1, and 60% to a newly identified bovine lymphotropic herpesvirus. This virus, which causes classical MCF in white-tailed deer, is a newly recognized agent belonging to the MCF group of gammaherpesviruses. It is the third reported pathogenic MCF virus, genetically distinct but closely related to OHV-2 and AHV-1. The reservoir for the virus has not been identified.

An adult mink from a farm experiencing 100% mortality in affected animals was submitted for diagnostic examination. Clinical history included signs of respiratory disease, oculonasal discharge, and thickening of footpads. Canine distemper virus and Pneumocystis carinii were identified in lung tissue, suggesting immunosuppresion and secondary infection due to morbillivirus disease.

Three Haemophilus somnus isolates (2a, 3a, and 27b) and one H. somnus-like (13b) isolate from tonsils of commercially reared American bison were compared with 2 known H. somnus isolates from cattle, namely, 2336, shown to cause respiratory disease, and 129Pt, from the prepuce of an asymptomatic bull. All H. somnus isolates, but not the H. somnus-like isolate, required CO2 for growth. Biochemical utilization profiles were identical for bison and bovine H. somnus isolates with the exception of alpha-fucosidase production by isolate 3a. Isolate 27a varied from 2a, 2336 and 129Pt by hemolysis of bovine erythrocytes. Isolate 13b hemolyzed sheep but not bovine or bison erythrocytes and varied from other isolates in biochemical utilization tests. Outer membrane protein profiles of 2a, 3a and 27a were almost identical with those of bovine isolate 2336 and similar to that of 129Pt, but quite different from that of 13b. Western blots of bison isolates were similar to that of the virulent bovine 2336 isolate, including detection of high molecular mass antigens above 100 kDa and the 76 kDa antigens associated with bovine IgG2 Fc binding characteristic of virulent strains, as well as antigens of approximately 78, 60 and 40 kDa. Producers and veterinarians should be aware that H. somnus may be carried by bison and may have potential for causing diseases in bison similar to those described in cattle and sheep.

As commercial producers of American bison (Bison bison) become more numerous, concerns relative to bison health management increase. Since loss due to respiratory disease associated with Pasteurella and related Pasteurellaceae is a major concern for cattle producers, a study was conducted to determine what types of Pasteurellaceae are carried by bison to evaluate the potential of pneumonic pasteurellosis in bison herds where management practices are comparable to those used for cattle. Tonsillar biopsies, collected in May (n = 29) and August (n = 25) 1997 from 24- to 30-month-old bison bulls, at the time of slaughter were cultured for Pasteurellaceae. Pasteurella spp. were isolated from all the samples collected in May. These included isolates identified as P. haemolytica, trehalosi, testudinis, and multocida subsp. multocida a and multocida b. Actinobacillus spp. and Haemophilus somnus were also isolated from some samples. Pasteurella spp., haemolytica, trehalosi, and multocida subsp. multocida a, multocida b and septica, plus 2 nonspeciated indole-positive biotypes, U2 and U16, were isolated from the second group of tonsil samples. Most of these organisms, including P. haemolytica, P. multocida subsp., and H. somnus are associated with disease in domestic livestock and should be regarded as potential pathogens for bison, particularly in animals which become stressed by management practices commonly used with cattle such as herding, crowding, and shipping.

Of 15 athymic nude mice that received subcutaneous implants of a rat osteosarcoma cell line, two groups of four subsequently received either a short (group 1) or a more prolonged (group 2) course of subcutaneous injections of the dermonecrotic toxin (DNT) of Pasteurella multocida type D. The remaining seven mice (controls) received no DNT. Both groups of DNT-treated mice lost body weight as compared with controls. Tumour weight, expressed as a percentage of body weight, increased in the four group 1 mice. Tumours in this group 1 were consistently larger than those in appropriate controls, indicating that this percentage was not simply a function of decreased body weight. The immunohistochemical labelling of proliferating cell nuclear antigen (PCNA) and morphometric analysis of intratumoral necrosis suggested that the DNT had a mitogenic effect and contributed to the neoplastic growth. The presence of foci of neoplastic osteoblasts in the lungs of some DNT-treated mice suggested that the enhanced tumour growth led to an increased incidence of metastasis.

1. Traditional remedies are an unusual, but recognised cause of lead poisoning. Only two cases have previously been reported in this country. 2. We report a series of five cases of lead poisoning due to traditional remedies in the West Midlands. All developed typical clinical features. 3. Blood lead and zinc protoporphyrin (ZPP) concentrations were elevated 2-10 times the upper limit of normal. The remedies contained up to 60% lead by weight. One also contained traces of mercury, another arsenic, and a third aluminium and tin. 4. Confirmation of the medicines as the cause of the poisoning was made in one patient by measurement of lead isotopic ratios. 5. The present morbidity from traditional remedies may be far greater than is realised, and will continue until such time as the supply of harmful preparations can be effectively limited. There needs to be increased awareness of their dangers amongst doctors and the communities at risk. This will best be achieved by appropriately targeted education.

In this study, male and female university students in the United States were exposed to mesomorphic or nonmesomorphic stimuli as reflected by photographs of either male body builders and non-body builders or female body builders and non-body builders. Then they were asked to attribute various personality traits and sex-role behaviors to them. Subjects, irrespective of their sex, perceived male and female body builders as possessing more traditionally masculine and less traditionally feminine personality characteristics than male and female non-body builders. Also, male and female body builders were seen as possessing less socially desirable traits than non-body builders. As predicted, female body builders were perceived generally as being more likely to engage in traditionally masculine sex-role behaviors in their dating and marriage relationships than female non-body builders. Contrary to expectation, however, male body builders were not perceived as more likely to engage in higher levels of masculine sex-role behaviors than male non-body builders.

Red cell volume was measured in 259 infants admitted to a high-risk newborn unit. Red cell volume was measured using 50Cr tagging which subsequently was activated to 51Cr for counting. Total blood volume was calculated using the corrected whole body hematocrit. A low red cell volume was frequently associated with a maternal history of vaginal spotting, with placenta previa or placenta abruptio, with nonelective cesarean section, and with deliveries associated with cord compression. Asphyxiated infants without a history suggestive of blood loos often had a low red cell volume. An early central hematocrit below 45% correlated with a low red cell volume, but a normal or high hematocrit was often associated with low red cell measurements. The total blood volume depended largely on whether the tagging was done long enough after the blood loss for plasma volume equilibration to have occurred. Very low red cell volume values were associated with a high mortality rate, but birth weight played a dominant role in survival, even at low red cell volume levels.

Two patients are described who were found to have a destructive lesion of the myenteric plexus. In one the upper small intestine was involved and the clinical picture was of recurrent pseudo-obstruction; in the other the lesion was in the distal colon and resulted in intractable constipation. The lesion cannot be demonstrated by conventional histological techniques, being seen only in silver preparations cut parallel to the bowel wall, and may have been overlooked in the past. The aetiology is unknown.