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Background The Surgical Safety Checklist (SSC) improves patient safety and outcomes; however, barriers to effective use include the perceived negative impact on operating room (OR) efficiency. The purpose of this study was to determine the effect of SSC implementation on OR efficiency. Methods All operations at our large multispecialty tertiary care hospital were reviewed for 1-year pre- and 1-year post-SSC implementation. OR efficiency included operating room time, operation time, first starts on time, same-day cancellations, and OR disposable cost. Results A total of 35,570 operations were reviewed: 17,204 pre-SSC and 18,366 post-SSC. There was no difference between groups for operating room time (P = .93), operation time (P = .66), first starts on time (P = .15), and same-day cancellations (P = .57). The mean OR disposable cost was significantly lower ($70/operation) for the post-SSC group (P Conclusions The implementation of an SSC does not negatively impact OR efficiency and should not be considered a barrier to effective use. Our data suggest that SSC use can reduce overall cost per surgical procedure.

Intact phycobilisomes from a wild-type red Chondrus crispus and its vegetatively derived green mutant were isolated by centrifugation through a discontinuous sucrose density gradient. Pigment composition was subsequently characterized by spectrophotometry. Vegetative thalli of the two strains grown together for six months in the laboratory resulted in different pigment profiles. Two pigmented phycobilisome bands appeared in the sucrose gradient of the wild-type alga, a purple coloured one, and a pink one, whereas only a single blue band appeared in the gradient of the green mutant. Spectrophotometric and fluorescence analyses identified the phycobiliprotein composition of the purple band as the typical phycoerythrin-phycocyanin-allophycocyanin complement in the wild-type, but there was no detectable phycoerythrin present in the blue band of the green mutant. Sodium dodecyl sulphate, preparative polyacrylamide gel electrophoresis analysis confirmed the presence of allophycocyanin subunits in all extracts, but firm evidence of an R-phycoerythrin linker polypeptide in the blue band was missing. These results highlight the ability of C. crispus to adapt to a phycoerythrin deficiency by adjusting light harvesting pigment ratios.

Purpose In 2007, the Scott & White/Texas A&M HSC College of Medicine began requiring all internal medicine residents to attend quarterly patient panel conferences, during which former Scott & White patients speak frankly about their inpatient and outpatient experiences. The main purpose of this mixed-methods pilot study was to determine whether residents’ competency education could be enhanced via the conferences. Method Of the 54 internal medicine residents in the residency program, 31, 39, and 41 participated in three patient panel conferences, respectively, between December 2007 and August 2008. Each resident completed an assessment that included a reflection on his or her own practice and the identification of competency issues highlighted by patients’ oral narratives. Content analyses of responses to open-ended questions were performed. Consensus on themes was reached. Descriptive statistics were run on quantitative data. Results Six themes were identified: improve communication with patients/families, improve patient care, improve professional behaviors, empathize with patients/families, display sensitivity to patients’/families’ needs/concerns, and recognize system issues. When asked if the conference highlighted competency problems, residents answered “agree” or “strongly agree” as follows: 82% for professionalism, 82.9% for systems-based practice, 85.2% for interpersonal and communication skills, and 84.4% for patient care. The majority were able to provide examples of competency issues. Conclusions The patient panel conference experience was a powerful mechanism for enhancing competency education. The conferences were an effective means of presenting real-life examples of systems issues in the context of a hospital system.

Objectives Prompt and successful cardiopulmonary resuscitation during a sudden cardiac arrest can be hindered by multiple variables, ie, ineffective communication, stress, lack of training, and an unfamiliar environment, such as a new hospital facility. The main objective of the study was to use high-fidelity simulations to orient Code Blue Teams (CBTs) to critical events in a new hospital facility. A secondary objective was to elucidate factors that may have contributed to responses by debriefing teams. Methods Mock Code Blue exercises using high-fidelity simulation were implemented in real workplace settings to orient CBTs to critical events. We measured arrival time of first responder, crash cart to code site, first six CBT responders, first chest compression, and first electrical shock. After each mock code, participants were debriefed to assess any barriers to effective response and decision making. Results Twelve mock codes were conducted at different locations of the new facility. Sixty-nine percent of the participants reported that the training was beneficial. The median time of arrival of the first responders was 42 seconds and the first CBT member was 66 seconds. The median time to initiation of chest compressions was 80 seconds, crash cart arrival was 68 seconds, and first electrical shock was 341 seconds. An additional outcome of the study was the identification of facility and systems issues that had the potential to impact patient safety. Conclusions Clinical simulation can be effectively used to orient CBTs and identify critical safety issues in a newly constructed healthcare facility.

Compliance with the Accreditation Council for Graduate Medical Education resident duty hours rules has created unique educational and patient-care challenges for the general medicine inpatient teaching (GMIT) teams at Texas A&M/Scott & White Memorial Hospital, including multiple patient hand-offs, multiple resident absences during teaching time, and loss of continuity of care for individual patients, all of which may have compromised patient safety. The Texas A&M/Scott & White Memorial Hospital internal medicine residency program initially complied with the duty hours rules by having residents take call every fourth night, followed by a six-hour post-call day. This system proved to be inefficient because it significantly disrupted patient care and resident education. Residents reported that this call system frequently caused them to approach the 80-hour limit and that they had difficulty leaving post-call because of unfulfilled responsibilities. They also reported sleep interruption and inadequate time to prepare for and attend educational conferences.After determining the peak admission times at the hospital, program leaders designed a call system during which the primary call team takes admissions from 12:00 pm to 8:00 pm each day, then leaves by 10:00 pm and returns after 10 hours for a full post-call day. After-hours admissions are managed by hospitalists. The solution did require hiring additional hospitalists for night-call coverage. The new structure has greatly improved the residents' experience on the GMIT teams. The entire team works together on call and post-call. Rounds and inpatient teaching continue normally on post-call days. Residents attend clinics and conferences post-call. Hand-offs are reduced greatly, and residents report that they are better rested. Residents also state that the new call system significantly enhances their education, patient care, and personal life.

It has been claimed that the sole H(2)O(2)-scavenging system in the cyanobacterium Synechococcus sp. PCC 7942 is a cytosolic catalase-peroxidase. We have measured in vivo activity of a light-dependent peroxidase in Synechococcus sp. PCC 7942 and UTEX 625. The addition of small amounts of H(2)O(2) (2.5 microM) to illuminated cells caused photochemical quenching (qP) of chlorophyll fluorescence that was relieved as the H(2)O(2) was consumed. The qP was maximal at about 50 microM H(2)O(2) with a Michaelis constant of about 7 microM. The H(2)O(2)-dependent qP strongly indicates that photoreduction can be involved in H(2)O(2) decomposition. Catalase-peroxidase activity was found to be almost completely inhibited by 10 microM NH(2)OH with no inhibition of the H(2)O(2)-dependent qP, which actually increased, presumably due to the light-dependent reaction now being the only route for H(2)O(2)-decomposition. When (18)O-labeled H(2)O(2) was presented to cells in the light there was an evolution of (16)O(2), indicative of H(2)(16)O oxidation by PS 2 and formation of photoreductant. In the dark (18)O(2) was evolved from added H(2)(18)O(2) as expected for decomposition by the catalase-peroxidase. This evolution was completely blocked by NH(2)OH, whereas the light-dependent evolution of (16)O(2) during H(2)(18)O(2) decomposition was unaffected.

Reciprocal crosses between male and female gametes of Ascophyllum nodosum (L.) LeJolis and Fucus vesiculosus L. were made from plants collected at Tor Bay, Nova Scotia. Crosses within each species were viable and resulted in normal zygote development. Hybrids occurred in low frequency in the cultures (ca. 1–5%) and developed either an initial rhizoid or underwent one or two internal divisions. Hybrid zygotes did not develop further. More developing embryos were observed in crosses when F. vesiculosus provided the eggs, and these zygotes developed longer rhizoids. Maximum development was to three or four cells, which occurred in ca. 10 days. By 5 weeks, all zygotes had disintegrated. Nuclear diameter was the same in both species (6 μm) although almost twice as much nuclear DNA was present in A. nodosum than in F. vesiculosus. Nuclei in hybrids were larger than in the parental species. Key words: Ascophyllum nodosum, Fucus vesiculosus, Fucales, hybridization, Phaeophyta.

Phylogenetic relationships of the fungal symbiont of two brown algae were evaluated in the context of host diversity using ribosomal large subunit (nuLSU) sequences. Phylogenetic analysis indicates that Mycophycias ascophylli (phycobionts Ascophyllum nodosum, Pelvetia canaliculata) is misclassified in Verrucariales (Eurotiomycetes). There was no evidence for speciation of M. ascophylli within its two hosts, nor evidence for geographic differentiation between the eastern and western Atlantic Ocean and the White Sea (Arctic Ocean). The placement of M. ascophylli in Capnodiales (Dothideomycetes) will require a reclassification of this species, and calls into question the current classification of the other species of Mycophycias, M. apophlaea. © 2011 by Walter de Gruyter Berlin Boston.

The Association of Professors of Medicine (APM) is the national organization of departments of internal medicine at the US medicalschools and numerous affiliated teaching hospitals as represented by chairs and appointed leaders. As the official sponsor of TheAmerican Journal of Medicine, the association invites authors to publish commentaries on issues concerning academic internalmedicine.For the latest information about departments of internal medicine, please visit APM’s website at www.im.org/APM.

Coded Imager and Polarimeter for High Energy Radiation (CIPHER) is a hard X- and soft gamma- ray spectroscopic and polarimetric coded mask telescope based on an array of Cadmium telluride microspectrometers. The position sensitive detector (PSD) will be arranged in 4 modules of 32X32 crystals, each of 2x2mm2 cross-section and 10 mm thickness giving a total active area of about 160 cm2, operating over a wide energy range (10 keV to 1 MeV). Each PSD module is obtained by aligning 32 linear arrays of micro-detectors each also containing the integrated analog front end electronics on a thin ceramic layer. The CIPHER instrument will be proposed for a balloon experiment, both in order to assess the performance of such an instrumental concept for a small/medium size satellite (or an external ISS-alpha payload) survey mission and to perform an innovative high energy polarisation measurement. Herein we describe the CIPHER position sensitive spectrometer design, together with current development on CdTe detectors array and on a low noise and low power consumption ASICfor the analog front end electronics. Furthermore we present the expected performance in terms of image and spectral quality (spatial and energy resolution) and polarimetric capabilities for such a detector.

It has been claimed that the sole H(2)O(2)-scavenging system in the cyanobacterium Synechococcus sp. PCC 7942 is a cytosolic catalase-peroxidase. We have measured in vivo activity of a light-dependent peroxidase in Synechococcus sp. PCC 7942 and UTEX 625. The addition of small amounts of H(2)O(2) (2.5 microM) to illuminated cells caused photochemical quenching (qP) of chlorophyll fluorescence that was relieved as the H(2)O(2) was consumed. The qP was maximal at about 50 microM H(2)O(2) with a Michaelis constant of about 7 microM. The H(2)O(2)-dependent qP strongly indicates that photoreduction can be involved in H(2)O(2) decomposition. Catalase-peroxidase activity was found to be almost completely inhibited by 10 microM NH(2)OH with no inhibition of the H(2)O(2)-dependent qP, which actually increased, presumably due to the light-dependent reaction now being the only route for H(2)O(2)-decomposition. When (18)O-labeled H(2)O(2) was presented to cells in the light there was an evolution of (16)O(2), indicative of H(2)(16)O oxidation by PS 2 and formation of photoreductant. In the dark (18)O(2) was evolved from added H(2)(18)O(2) as expected for decomposition by the catalase-peroxidase. This evolution was completely blocked by NH(2)OH, whereas the light-dependent evolution of (16)O(2) during H(2)(18)O(2) decomposition was unaffected.