To Meet the Changing Demographics of the American Work Force, New Management Strategies That Are Sensitive to the Needs of a Distinctive Multi-Cultural Population Will Be Needed

After more than 30 years of affirmative action programs and a more recent emergence of politically correct thinking, the work force of many of America\u27s corporations and agencies have voluntarily (and some involuntarily) become more culturally diverse . Recently statistics from the U.S. Department of Labor indicate that more than half the American work force is made of people of color and women. Changes in the racial makeup of companies are forcing managers to realize that when people of different races and genders are added to the corporate mix, their experiences, backgrounds and differences must be considered and integrated into the company\u27s corporate culture . As minorities and people of other ethnic cultures fill the work force, problems will arise. White corporate managers, some mandated to integrate their staffs by company decree, are ill prepared and lost on how to successfully incorporate people of different cultures into their ranks. As the work force has become more and more diverse and demanding, the old mindset isn\u27t working. New methods of managing diversity are being introduced as a different philosophy of management. Some of the new methods suggested are flex-management, directly confronting problems as they occur, and training to develop sensitivity to language barriers and respect for cultural differences . Finally, the discussion explores the assessment of management\u27s methods of managing diversity and the personal viewpoints of managers and employees of the results. The future area of concern for management is developing the appropriate skills for working effectively and productively with an increasingly diverse workforce. There are five basic skills discussed that most managers and employees have agreed upon to build. However, none of the five basic skills will assist corporate managers or employees to learn to adjust to their changing work places if one vital tool is not used-TALKING- Getting out in the open for analysis and reevaluation, the varying attitudes and assumptions we have about one another that create barriers to understanding, respect and teamwork

Etiologic predictive value of a rapid immunoassay for detection of group A streptococcus antigen from throat swabs in patients presenting with a sore throat

Context: A sore throat is a common symptom mainly caused by virus but also by a variety of bacteria such as group A betahaemolytic streptococci (GAS) often resulting in unnecessary antibiotic prescribing. Combinations of symptoms and scores are not specific enough to accurately sort out aetiology. Rapid diagnostic antigen tests (RADT) have demonstrated high sensitivity and specificity in detecting presence of GAS. Objective: Establish the probability that finding of GAS in a RADT shows a true link between symptoms and GAS while considering carriers of GAS ill from a virus. Design: Cross-sectional study comparing two groups. Setting: Emergency department (ED) also managing primary health care cases in a remote rural town with 22,000 residents. Patients/Participants: 101 consecutive children aged 3-15 years attending for a sore throat as the main complaint and 147 consecutive children of the same age attending the same ED for other reasons than an infection. Main And Secondary Outcome Measures: Positive and negative Etiologic Predictive Value (EPV). Results: Positive EPV was 98% (88-100%). Negative EPV was 98% (97-99%). The positive EPV depends on setting and findings in this study and may not be transferable to other settings. It was mathematically shown that negative EPV found in this study is valid in all other reasonable settings and hence can be transferred to any other setting. Conclusions: The evaluated RADT (Alere Test Pack+Plus With OBC Strep A) is always useful to rule out GAS infection in patients with an uncomplicated sore throat. It is often, depending on setting, useful to rule in a GAS infection in these patients

Etiologic predictive value of a rapid immunoassay for detection of group A streptococcus antigen from throat swabs in patients presenting with a sore throat

Context: A sore throat is a common symptom mainly caused by virus but also by a variety of bacteria such as group A betahaemolytic streptococci (GAS) often resulting in unnecessary antibiotic prescribing. Combinations of symptoms and scores are not specific enough to accurately sort out aetiology. Rapid diagnostic antigen tests (RADT) have demonstrated high sensitivity and specificity in detecting presence of GAS. Objective: Establish the probability that finding of GAS in a RADT shows a true link between symptoms and GAS while considering carriers of GAS ill from a virus. Design: Cross-sectional study comparing two groups. Setting: Emergency department (ED) also managing primary health care cases in a remote rural town with 22,000 residents. Patients/Participants: 101 consecutive children aged 3-15 years attending for a sore throat as the main complaint and 147 consecutive children of the same age attending the same ED for other reasons than an infection. Main And Secondary Outcome Measures: Positive and negative Etiologic Predictive Value (EPV). Results: Positive EPV was 98% (88-100%). Negative EPV was 98% (97-99%). The positive EPV depends on setting and findings in this study and may not be transferable to other settings. It was mathematically shown that negative EPV found in this study is valid in all other reasonable settings and hence can be transferred to any other setting. Conclusions: The evaluated RADT (Alere Test Pack+Plus With OBC Strep A) is always useful to rule out GAS infection in patients with an uncomplicated sore throat. It is often, depending on setting, useful to rule in a GAS infection in these patients

Synergistic interactions between kainate and mGlu receptors regulate bouton Ca2+ signalling and mossy fibre LTP

It is currently unknown why glutamatergic presynaptic terminals express multiple types of glutamate receptors. We have addressed this question by studying both acute and long-term regulation of mossy fibre function in the hippocampus. We find that inhibition of both mGlu1 and mGlu5 receptors together can block the induction of mossy fibre LTP. Furthermore, mossy fibre LTP can be induced by the pharmacological activation of either mGlu1 or mGlu5 receptors, provided that kainate receptors are also stimulated. Like conventional mossy fibre LTP, chemically-induced mossy fibre LTP (chem-LTPm) depends on Ca2+ release from intracellular stores and the activation of PKA. Similar synergistic interactions between mGlu receptors and kainate receptors were observed at the level of Ca2+ signalling in individual giant mossy fibre boutons. Thus three distinct glutamate receptors interact, in both an AND and OR gate fashion, to regulate both immediate and long-term presynaptic function in the brain

I Am Getting Healthier". Perceptions of Urban Aboriginal and Torres Strait Islander People in a Chronic Disease Self-Management and Rehabilitation Program

Abstract Chronic disease is a main contributor to the disproportionately high burden of illness experienced by Aboriginal and Torres Strait Islander Australians. However, there are very few programs addressing chronic disease self-management and rehabilitation which are designed specifically for urban Aboriginal and Torres Strait Islander people. This paper aims to explore client and staff perceptions of the Work It out Program, a chronic disease rehabilitation and self-management program designed for urban Aboriginal and Torres Strait Islander people. The study used a mixed methods approach to explore the success, barriers and self-reported outcomes of the program. Quantitative data were collected through a structured survey, comprising social and demographic data. Qualitative data were collected through interviews using Most Significant Change theory. Twenty-eight participants were recruited, 6 staff and 22 clients (M = 7, F = 21) with an age range between 21 and 79 years of age (Mean = 59.00, SD = 17.63). Interviews were completed in 2013 across four Work It out locations in Southeast Queensland. Semi-structured interviews were conducted either individually or in groups of two or three, depending on the participants' preference. Thematic analysis of the data revealed six main themes; physical changes, lifestyle improvements, social and emotional well-being, perceptions about the successful features of the program, perceived barriers to the program and changes for the future. This exploratory study found that clients and staff involved in the Work It out Program perceived it as an effective self-management and rehabilitation program for urban Aboriginal and Torres Strait Islander Australians. Further evaluation with a larger sample size is warranted in order to establish further outcomes of the program. A. Nelson et al. 53

Using routine clinical and administrative data to produce a dataset of attendances at Emergency Departments following self-harm

Background: Self-harm is a significant public health concern in the UK. This is reflected in the recent addition to the English Public Health Outcomes Framework of rates of attendance at Emergency Departments (EDs) following self-harm. However there is currently no source of data to measure this outcome. Routinely available data for inpatient admissions following self-harm miss the majority of cases presenting to services. Methods: Using the Clinical Record Interactive Search system, the electronic health records (EHRs) used in four EDs were linked to Hospital Episode Statistics to create a dataset of attendances following self-harm. This dataset was compared with an audit dataset of ED attendances created by manual searching of ED records. The proportion of total cases detected by each dataset was compared. Results: There were 1932 attendances detected by the EHR dataset and 1906 by the audit. The EHR and audit datasets detected 77 and 76 of all attendances respectively and both detected 82 of individual patients. There were no differences in terms of age, sex, ethnicity or marital status between those detected and those missed using the EHR method. Both datasets revealed more than double the number of self-harm incidents than could be identified from inpatient admission records. Conclusions: It was possible to use routinely collected EHR data to create a dataset of attendances at EDs following self-harm. The dataset detected the same proportion of attendances and individuals as the audit dataset, proved more comprehensive than the use of inpatient admission records, and did not show a systematic bias in those cases it missed. © 2015 Polling et al

Improving GHB withdrawal with baclofen: study protocol for a feasibility study for a randomised controlled trial

Background: GHB (gamma-hydroxybutyrate) and its pro-drugs GBL (gamma-butyrolactone) and 1,4-butanediol (1,4-BD) are central nervous system depressants whose street names include ‘G’ and ‘liquid ecstasy’. They are used recreationally predominately for their stimulant and pro-sexual effects or for sedation to help with sleep and/or to ‘come down’ after using stimulant recreational drugs. Although overall population prevalence is low (0.1 %), in some groups such as men who have sex with men, GHB/GBL use may reach 20 %. GHB/GBL dependence may be associated with severe withdrawal with individuals presenting either acutely to emergency departments or to addiction services for support. Benzodiazepines are currently prescribed for GHB/GBL detoxification but do not prevent all complications, such as behavioural disinhibition, that may require hospitalisation or admission to a high dependency /intensive care unit. The GABAB receptor mediates most effects of GHB/GBL and the GABAB agonist, baclofen, has shown promise as an adjunct to benzodiazepines in reducing withdrawal severity when prescribed both during withdrawal and as a 2-day ‘preload’ prior to detoxification. The key aim of this feasibility study is provide information about recruitment and characteristics of the proposed outcome measure (symptom severity, complications including delirium and treatment escalation) to inform an application for a definitive randomised placebo controlled trial to determine the role of baclofen in the management of GHB/GBL withdrawal and whether starting baclofen 2 days earlier improves outcomes further. Methods/design: This is a prospective, randomised, double-blind, placebo-controlled feasibility study that will recruit participants (aged over 18 years) who are GHB/GBL- dependent and wish to undergo planned GHB/GBL detoxification or are at risk of acute withdrawal and are inpatients requiring unplanned withdrawal. We aim to recruit 88 participants: 28 unplanned inpatients and 60 planned outpatients. During detoxification we will compare baclofen 10 mg three times a day with placebo as an adjunct to the usual benzodiazepine regimen. In the planned outpatient arm, we will also compare a 2-day preload of baclofen 10 mg three times a day with placebo. Ratings of GHB/GBL withdrawal, sleep, depression, anxiety as well as GHB/GBL use will be collected. The main data analyses will be descriptive about recruitment and characterising the impact of adding baclofen to the usual benzodiazepine regimen on measures and outcomes of GHB/GBL withdrawal to provide estimates of variability and effect size. A qualitative approach will evaluate research participant and clinician acceptability and data collected to inform cost-effectiveness. Discussion: This feasibility study will inform a randomised controlled trial to establish whether adding baclofen to a benzodiazepine regimen reduces the severity and complications of GHB/GBL withdrawal

Polonium-210 poisoning: a first-hand account

Background: Polonium-210 (210Po) gained widespread notoriety after the poisoning and subsequent death of Mr Alexander Litvinenko in London, UK, in 2006. Exposure to 210Po resulted initially in a clinical course that was indistinguishable from infection or exposure to chemical toxins, such as thallium. Methods: A 43-year-old man presented to his local hospital with acute abdominal pain, diarrhoea, and vomiting, and was admitted to the hospital because of dehydration and persistent gastrointestinal symptoms. He was initially diagnosed with gastroenteritis and treated with antibiotics. Clostridium difficile toxin was subsequently detected in his stools, which is when he first raised the possibility of being poisoned and revealed his background and former identity, having been admitted under a new identity with which he had been provided on being granted asylum in the UK. Within 6 days, the patient had developed thrombocytopenia and neutropenia, which was initially thought to be drug induced. By 2 weeks, in addition to bone marrow failure, he had evidence of alopecia and mucositis. Thallium poisoning was suspected and investigated but ultimately dismissed because blood levels of thallium, although raised, were lower than toxic concentrations. The patient continued to deteriorate and within 3 weeks had developed multiple organ failure requiring ventilation, haemofiltration, and cardiac support, associated with a drop in consciousness. On the 23rd day after he first became ill, he suffered a pulseless electrical activity cardiorespiratory arrest from which he could not be resuscitated and was pronounced dead. Findings: Urine analysis using gamma-ray spectroscopy on day 22 showed a characteristic 803 keV photon emission, raising the possibility of 210Po poisoning. Results of confirmatory analysis that became available after the patient's death established the presence of 210Po at concentrations about 109-times higher than normal background levels. Post-mortem tissue analyses showed autolysis and retention of 210Po at lethal doses in several organs. On the basis of the measured amounts and tissue distribution of 210Po, it was estimated that the patient had ingested several 1000 million becquerels (a few GBq), probably as a soluble salt (eg, chloride), which delivered very high and fatal radiation doses over a period of a few days. Interpretation: Early symptoms of 210Po poisoning are indistinguishable from those of a wide range of chemical toxins. Hence, the diagnosis can be delayed and even missed without a high degree of suspicion. Although body surface scanning with a standard Geiger counter was unable to detect the radiation emitted by 210Po, an atypical clinical course prompted active consideration of poisoning with radioactive material, with the diagnosis ultimately being made with gamma-ray spectroscopy of a urine sample

Using digital social market applications to incentivise active travel: Empirical analysis of a smart city initiative

Information and communication technologies (ICTs), such as mobile communication networks, and behaviour-based approaches for citizen engagement play a key role in making future cities sustainable and tackling persistent problems in high-density urban areas. In the context of Sharing Cities, an EU-funded programme aiming to deliver smart city solutions in areas such as citizen participation and infrastructure improvements of buildings and mobility, a prominent intervention has been the deployment and monitoring of a Digital Social Market (DSM) tool in Milan (Italy). The DSM allows cities to engage with residents and encourage sustainable behaviours by offering non-monetary rewards. This paper aims to evaluate the effectiveness of the DSM approach to promote active travel (cycling and walking) by analysing the data collected through the app as well as through participant surveys. Our model results show that a broader engagement with the DSM app (number of claps to posts, number of posts made, non-monetary rewards earned by participating in non-travel events) is positively correlated with the monitored level of active travel. Lifestyles, attitudes, and social influence also explain the variability in cycling and walking. This highlights the importance of investigating these factors when replicating such initiatives on a large scale