Hospital doctors' workflow interruptions and activities: an observation study

BACKGROUND Interruptions of hospital doctors' workflow are a frequent stressor, eventually jeopardising quality of clinical performance. To enhance the safety of hospital doctors' work, it is necessary to analyse frequency and circumstances of workflow interruptions. AIM To quantify workflow interruptions among hospital doctors, identify frequent sources and relate sources to doctors' concurrent activities. METHODS Within a typical hospital, 32 participant observations of doctors' full work shifts were carried out. Time-motion information was collected on types of workflow interruption and doctors' activities and analysed with logit-linear analyses. RESULTS The frequency of workflow interruptions was high, especially on the intensive care unit and emergency ward. Telephones and bleepers were the most frequently recorded type of work interruption. The combined analysis of doctors' activities and concurrent workflow interruptions revealed that the likelihood of the occurrence of certain types of interruption depended on the tasks being carried out by the doctor. CONCLUSION The present method may be useful for quantifying and distinguishing sources of hospital doctors' workflow interruptions and useful in raising awareness of organisational circumstances

New HBM values for emerging substances, inventory of reference and HBM values in force, and working principles of the German Human Biomonitoring Commission

AbstractThe German Human Biomonitoring Commission (HBM Commission) derives health-related guidance values (Human Biomonitoring assessment values, HBM values) according to the procedures described in the HBM Commission’s position papers. Since the last adaption of the methodology in 2014, the HBM Commission has established a series of new HBM values, mainly on the basis of internationally agreed TDI/RfD values, or of toxicologically well- founded points of departure observed in animal studies. The derivation of these new HBM values for HBCDD, triclosan, 2-MBT, PFOA and PFOS as well as for the metabolites of glycol ethers, of Hexamoll® DINCH®, DPHP, DEHTP, NMP, NEP, and 4-MBC is specified, and the HBM values are presented together with already established HBM values for other substances. Furthermore, the HBM Commission has defined provisional reference values for 2-methoxyacetic acid and for several parabens in the urine of the German population. It has also updated provisional reference values for PCB in the blood of the German population. An overview of all available reference values is given

Aluminosis – Detection of an almost forgotten disease with HRCT

The aim of this study was to investigate whether it is possible to detect high-resolution computed tomography (HRCT) findings in aluminium powder workers, which are consistent with early stages of aluminosis. 62 male workers from 8 departments of two plants producing aluminium (Al) powder were investigated using a standardized questionnaire, physical examination, lung function analysis, biological monitoring of Al in plasma and urine, chest X-ray, HRCT and immunological tests. Chronic bronchitis was observed in 15 (24.2%) of the workers, and four workers (6.5%) reported shortness of breath during exercise. HRCT findings in 15 workers (24.2%) were characterized by ill-defined centrilobular nodular opacities. Workers with ill-defined centrilobular nodular opacities had a lower vital capacity than workers who had no such HRCT-findings (90.9 % pred. vs. 101.8 % pred., p = 0.01). Biological monitoring in plasma and urine revealed higher internal exposure to Al in affected workers (33.5 μg/l plasma to 15.4 μg/l plasma, p = 0.01) and (340.5 μg/g creat. to 135.1 μg/g creat., p = 0.007). Years of exposure and concentration of aluminum in urine and plasma appear to be the best predictors for HRCT findings. Age and decreased vital capacity show borderline significance. We conclude that aluminosis is still relevant in occupational medicine. With HRCT it is possible to detect early stages of aluminosis and biological monitoring can be used to define workers at high risk

Государственное регулирование электроэнергетики

Цель работы – разработка теоретических и практических положений, направленных на совершенствование механизмов государственного регулирования электроэнергетики в России, выявление основных тенденций и возможных путей дальнейшего развития названной сферы в российской экономике. Объектом исследования являются отношения, возникающие в процессе осуществления государственного регулирования электроэнергетической отрасли в России.Purpose - to develop theoretical and practical provisions aimed at improving the mechanisms of state regulation of electric power industry in Russia, identifying the main trends and opportunities for further development of the said spheres of the Russian economy. The object of the study are the relations arising in the implementation of state regulation of electric power industry in Russia

Формирование национальной системы РФ по пластиковым картам

The article is devoted to the formation of national system of bank cards in Russian Federation, it's structure and qualities

Исследование влияния природы растворителя, используемого при получении электродной мембраны, на работу Ni-селективного электрода при определении ионов никеля (LL) в водных средах

Исследовано влияние природы растворителей (бензиловый спирт и хлорфенол), используемых для изготовления полимерной электродной мембраны твердофазного никельселективного электрода на основе никельгексационоферратов ({Ni2[Fe(CN)6]}), иммобилизованных в полиэтилентерефталатную (ПЭТФ) матрицу для определения ионов никеля в водных средах. Установлено, что мембраны, полученные на основе бензилового спирта имеют более высокие электродные показатели по сходимости и воспроизводимости потенциалов, стабильности работы, низком дрейфе и времени отклика электрода по сравнению с мембранами на основе хлорфенола и могут быть рекомендованы к использованию в никель селективных электродах.The influence of the nature of the solvents (benzyl alcohol and chlorophenol) used to fabricate a polymer electrode membrane of a solid-phase nickel selective electrode based on nickelhexacetanoferrates ({Ni2 [Fe (CN) 6]}) immobilized in a polyethylene terephthalate (PET) matrix for the determination of nickel ions in aqueous media . It has been established that membranes obtained on the basis of benzyl alcohol have higher electrode indices for the convergence and reproducibility of potentials, stability of operation, low drift and electrode response time compared to chlorophenol-based membranes, and can be recommended for use in nickel selective electrodes

Time- and Dose-Related Effects of Di-(2-ethylhexyl) Phthalate and Its Main Metabolites on the Function of the Rat Fetal Testis in Vitro

International audienceBACKGROUND: Endocrine-disrupting effects of phthalates are understood primarily from in utero exposures within the fetal rat testis. Nevertheless, their path of action, dose-response character, and cellular target(s) within the fetal testis are not known. OBJECTIVES: In this study we investigated the effects of di-(2-ethylhexyl) phthalate (DEHP), mono-(2-ethylhexyl) phthalate (MEHP), and several of their metabolites on the development of organo-cultured testes from rat fetus. METHODS: We removed testes from 14.5-day-old rat fetuses and cultured them for 1-3 days with or without DEHP, MEHP, and the metabolites. RESULTS: DEHP (10(-5) M) produced a proandrogenic effect after 3 days of culture, whereas MEHP disrupted testis morphology and function. Leydig cells were the first affected by MEHP, with a number of them being inappropriately located within some seminiferous tubules. Additionally, we found a time- and dose-dependent reduction of testosterone. By 48 hr, gonocyte proliferation had decreased, whereas apoptosis increased. Sertoli cell number was unaffected, although some cells appeared vacuolated, and production of anti-Müllerian hormone decreased in a time- and dose-dependent manner. The derived metabolite mono-(2-ethyl-5-hydroxyhexyl) phthalate was the only one to cause deleterious effects to the rat fetal testis in vitro. CONCLUSION: We hope that this in vitro method will facilitate the study of different phthalate esters and other endocrine disruptors for direct testicular effects

Urinary metabolite concentrations of organophosphorous pesticides, bisphenol A, and phthalates among pregnant women in Rotterdam, the Netherlands: The Generation R study

Concern about potential health impacts of low level exposures to organophosphorus (OP) pesticides, bisphenol A (BPA), and phthalates among the general population is increasing. We measured levels of six dialkyl phosphate (DAP) metabolites of OP pesticides, a chlorpyrifos-specific metabolite (3,5,6-trichloro-2-pyridinol, TCPy), BPA, and fourteen phthalate metabolites in urine samples of 100 pregnant women from the Generation R study, the Netherlands. The unadjusted and creatinine-adjusted concentrations were reported, and compared to National Health and Nutrition Examination Survey and other studies. In general, these metabolites were detectable in the urine of the women from the Generation R study and compared with other groups, they had relatively high level exposures to OP pesticides and several phthalates but similar exposure to BPA. The median concentrations of total dimethyl (DM) metabolites was 264.0 nmol/g creatinine (Cr) and of total DAP was 316.0 nmol/g Cr. The median concentration of mono-ethyl phthalate (MEP) was 222.0 µg/g Cr; the median concentrations of mono-isobutyl phthalate (MiBP) and mono-n-butyl phthalate (MnBP) were above 50 µg/g Cr. The median concentrations of the three secondary metabolites of di-2-ethylhexyl phthalate (DEHP) were greater than 20 µg/g Cr. The data indicate that the Generation R study population provides a wide distribution of selected environmental exposures. Reasons for the relatively high levels and possible health effects need investigation