Dynamics of Dynamics within a Single Data Acquisition Session: Variation in Neocortical Alpha Oscillations in Human MEG

Background Behavioral paradigms applied during human recordings in electro- and magneto- encephalography (EEG and MEG) typically require 1–2 hours of data collection. Over this time scale, the natural fluctuations in brain state or rapid learning effects could impact measured signals, but are seldom analyzed. Methods and Findings We investigated within-session dynamics of neocortical alpha (7–14 Hz) rhythms and their allocation with cued-attention using MEG recorded from primary somatosensory neocortex (SI) in humans. We found that there were significant and systematic changes across a single ~1 hour recording session in several dimensions, including increased alpha power, increased differentiation in attention-induced alpha allocation, increased distinction in immediate time-locked post-cue evoked responses in SI to different visual cues, and enhanced power in the immediate cue-locked alpha band frequency response. Further, comparison of two commonly used baseline methods showed that conclusions on the evolution of alpha dynamics across a session were dependent on the normalization method used. Conclusions These findings are important not only as they relate to studies of oscillations in SI, they also provide a robust example of the type of dynamic changes in brain measures within a single session that are overlooked in most human brain imaging/recording studies.National Institutes of Health (U.S.) (P41RR14075)National Institutes of Health (U.S.) (K25MH072941)National Institutes of Health (U.S.) (K01AT003459)National Institutes of Health (U.S.) (1RO1-NS045130-01)National Institutes of Health (U.S.) (T32GM007484)National Science Foundation (U.S.) (0316933)Osher Lifelong Learning Institute

Nurse prescribing of medicines in Western European and Anglo-Saxon countries: a systematic review of the literature

<p>Abstract</p> <p>Background</p> <p>A growing number of countries are introducing some form of nurse prescribing. However, international reviews concerning nurse prescribing are scarce and lack a systematic and theoretical approach. The aim of this review was twofold: firstly, to gain insight into the scientific and professional literature describing the extent to and the ways in which nurse prescribing has been realised or is being introduced in Western European and Anglo-Saxon countries; secondly, to identify possible mechanisms underlying the introduction and organisation of nurse prescribing on the basis of Abbott's theory on the division of professional labor.</p> <p>Methods</p> <p>A comprehensive search of six literature databases and seven websites was performed without any limitation as to date of publication, language or country. Additionally, experts in the field of nurse prescribing were consulted. A three stage inclusion process, consisting of initial sifting, more detailed selection and checking full-text publications, was performed independently by pairs of reviewers. Data were synthesized using narrative and tabular methods.</p> <p>Results</p> <p>One hundred and twenty-four publications met the inclusion criteria. So far, seven Western European and Anglo-Saxon countries have implemented nurse prescribing of medicines, viz., Australia, Canada, Ireland, New Zealand, Sweden, the UK and the USA. The Netherlands and Spain are in the process of introducing nurse prescribing. A diversity of external and internal forces has led to the introduction of nurse prescribing internationally. The legal, educational and organizational conditions under which nurses prescribe medicines vary considerably between countries; from situations where nurses prescribe independently to situations in which prescribing by nurses is only allowed under strict conditions and supervision of physicians.</p> <p>Conclusions</p> <p>Differences between countries are reflected in the jurisdictional settlements between the nursing and medical professions concerning prescribing. In some countries, nurses share (full) jurisdiction with the medical profession, whereas in other countries nurses prescribe in a subordinate position. In most countries the jurisdiction over prescribing remains predominantly with the medical profession. There seems to be a mechanism linking the jurisdictional settlements between professions with the forces that led to the introduction of nurse prescribing. Forces focussing on efficiency appear to lead to more extensive prescribing rights.</p

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Signals of environmental health risks in 2013

Alleen digitaal beschikbaarHet ministerie van Infrastructuur en Milieu (IenM) wil vroegtijdig en gestructureerd zicht hebben op milieugezondheidsrisico's om tijdig te kunnen handelen. Het komt hiermee tegemoet aan een behoefte van de samenleving om te weten welke milieugezondheidsrisico's er spelen en wat de overheid hieraan doet. Met het oog hierop inventariseert het RIVM jaarlijks welke nieuwe milieugezondheidsrisico's vanuit de wetenschap naar voren komen. Dit rapport beschrijft de signalen die in 2013 door experts van het RIVM in interviews zijn genoemd. Het gaat bij milieugezondheidsrisico's om zaken die samenhangen met drinkwater, bodem, lucht, nanotechnologie, geluid, chemische stoffen, het binnenmilieu en elektromagnetische velden. Voorbeelden die in 2013 zijn genoemd: de winning van schaliegas, meststoffen van megastallen, lood in de bodem, geluid van windturbines, effecten van fijn stof, geneesmiddelen in water en klimaatverandering.The Dutch Ministry of Infrastructure and the Environment wants an early and structured view on recent environmental health risks in order to act in time. It is a response to a need of society to know which environmental health risks are at play and what the government is doing about it. To this end, RIVM makes an annual inventory of environmental health risks identified by science. The present report describes the signals mentioned in interviews with experts from RIVM in 2013. The environmental health risks relate to (drinking) water, soil, air, nanotechnology, noise, chemicals, the indoor environment and electromagnetic fields. Examples in 2013 at issue: the extraction of shale gas, fertilizers from mega stables, lead in soil, noise from wind turbines, effects of particulate matter, pharmaceuticals in water and climate change.Ministerie van I&

New insights in scientific signaling of environmental health risks

Het ministerie van Infrastructuur en Milieu (IenM) wil nieuwe milieugezondheidsrisico's vroegtijdig en gestructureerd signaleren om tijdig te kunnen handelen. In 2011 is daarom aan verschillende maatschappelijke groepen (nongouvernementele organisaties, bedrijfsleven en wetenschap) gevraagd welke nieuwe milieugezondheidsrisico's zij belangrijk vinden om in de peiling te houden. Het RIVM heeft in 2012 en 2013 het wetenschappelijke perspectief voor zijn rekening genomen, door een jaar lang te volgen welke signalen uit de wetenschap naar voren komen. Daarnaast geeft het een nieuw overzicht van signalen, waarbij aandacht is voor de nieuwe vorm van signalering, de zogeheten horizonverkenning. Het blijkt dat er veel activiteiten zijn om mogelijke nieuwe milieugezondheidsrisico's te signaleren. De afstemming en uitwisseling van kennis tussen wetenschap, maatschappij en beleid blijft echter een verbeterpunt. Op structurele basis worden risico's gesignaleerd op het gebied van (drink)water, luchtverontreiniging, nanotechnologie, straling en elektromagnetische velden. Dit geldt echter niet voor bodem, geluid en binnenmilieu. Om de samenwerking te stimuleren adviseert het RIVM een multidisciplinair platform op te richten. Dit platform kan signalen verzamelen en het eventuele risico ervan beoordelen. Uit de inventarisatie van de wetenschappelijke signalering blijkt dat gesprekken met experts sneller en completere informatie leveren dan wanneer het RIVM zelf literatuurattenderingen bijhoudt. Het RIVM heeft verder een onderscheid gemaakt tussen twee signaleringsvormen. De eerste, meest voorkomende vorm is reactieve signalering, waarbij nieuwe inzichten over bekende stoffen en bronnen worden gesignaleerd. Dit zijn risico's die nu al zichtbaar zijn, zoals antibiotica in drinkwater. De tweede manier van signaleren is een meer verkennende blik in de toekomst: horizonverkenning. Het betreft nieuwe ontwikkelingen waarvan de effecten nog onbekend zijn, bijvoorbeeld technologische ontwikkelingen zoals de inzet van nieuwe energiebronnen en duurzame bouw. Om tijdig te kunnen handelen is het wenselijk dat dit structureler gebeurt.The Dutch ministry of Infrastructure and the Environment wants new environmental health risks to be identified early and more structured in order to act timely. Therefore. in 2011 various social groups (non-governmental, commercial and scientific organizations) were asked what new environmental health risks they deem important to keep an eye on. The RIVM has taken responsibility for the scientific perspective in 2012 and 2013. This sequel study specifies the way in which signaling could be done best in more depth, and gives an updated overview of signals. It appears that many activities take place to signal emerging environmental health risks. The consultation and exchange of knowledge between science, commerce and society remains a point for improvement. (Drinking) water, air pollution, nanotechnology, radiation and electromagnetic fields are watched on a structural basis. This does not apply for soil, noise and indoor environment. To stimulate the cooperation, the RIVM advises to establish a platform with participants from various fields of expertise (multi-disciplinary). This platform can collect signals and judge them on possible risks. For the RIVM research, signals from scientific sources were registered for a period of one year (2012). Meetings with experts produce faster and more complete information than when we have to keep up with literature ourselves. The RIVM made an overview of two types of signaling. The first and most common one is 'reactive', in which new insights on known substances and sources are pointed out. These are risks that are currently visible, for example antibiotics in drinking water. The second type of signaling is more focused on the future, 'horizon scanning'; New developments of which the effects are yet unknown, for example technological developments like the use of new energy sources and sustainable construction. This type of signaling is much less common. However, more attention for early signaling and developments is desirable, enabling timely action.Ministerie van I&