National Survey of Patients’ Bill of Rights Statutes

BACKGROUND Despite vigorous national debate between 1999–2001 the federal patients' bill of rights (PBOR) was not enacted. However, states have enacted legislation and the Joint Commission defined an accreditation standard to present patients with their rights. Because such initiatives can be undermined by overly complex language, we surveyed the readability of hospital PBOR documents as well as texts mandated by state law. METHODS State Web sites and codes were searched to identify PBOR statutes for general patient populations. The rights addressed were compared with the 12 themes presented in the American Hospital Association's (AHA) PBOR text of 2002. In addition, we obtained PBOR texts from a sample of hospitals in each state. Readability was evaluated using Prose, a software program which reports an average of eight readability formulas RESULTS Of 23 states with a PBOR statute for the general public, all establish a grievance policy, four protect a private right of action, and one stipulates fines for violations. These laws address an average of 7.4 of the 12 AHA themes. Nine states' statutes specify PBOR text for distribution to patients. These documents have an average readability of 15th grade (range, 11.6, New York, to 17.0, Minnesota). PBOR documents from 240 US hospitals have an average readability of 14th grade (range, 8.2 to 17.0) CONCLUSIONS While the average U.S. adult reads at an 8th grade reading level, an advanced college reading level is routinely required to read PBOR documents. Patients are not likely to learn about their rights from documents they cannot read.Pfizer Clear Health Communication Initiativ

Antagonism of Tetherin Restriction of HIV-1 Release by Vpu Involves Binding and Sequestration of the Restriction Factor in a Perinuclear Compartment

The Vpu accessory protein promotes HIV-1 release by counteracting Tetherin/BST-2, an interferon-regulated restriction factor, which retains virions at the cell-surface. Recent reports proposed β-TrCP-dependent proteasomal and/or endo-lysosomal degradation of Tetherin as potential mechanisms by which Vpu could down-regulate Tetherin cell-surface expression and antagonize this restriction. In all of these studies, Tetherin degradation did not, however, entirely account for Vpu anti-Tetherin activity. Here, we show that Vpu can promote HIV-1 release without detectably affecting Tetherin steady-state levels or turnover, suggesting that Tetherin degradation may not be necessary and/or sufficient for Vpu anti-Tetherin activity. Even though Vpu did not enhance Tetherin internalization from the plasma membrane (PM), it did significantly slow-down the overall transport of the protein towards the cell-surface. Accordingly, Vpu expression caused a specific removal of cell-surface Tetherin and a re-localization of the residual pool of Tetherin in a perinuclear compartment that co-stained with the TGN marker TGN46 and Vpu itself. This re-localization of Tetherin was also observed with a Vpu mutant unable to recruit β-TrCP, suggesting that this activity is taking place independently from β-TrCP-mediated trafficking and/or degradation processes. We also show that Vpu co-immunoprecipitates with Tetherin and that this interaction involves the transmembrane domains of the two proteins. Importantly, this association was found to be critical for reducing cell-surface Tetherin expression, re-localizing the restriction factor in the TGN and promoting HIV-1 release. Overall, our results suggest that association of Vpu to Tetherin affects the outward trafficking and/or recycling of the restriction factor from the TGN and as a result promotes its sequestration away from the PM where productive HIV-1 assembly takes place. This mechanism of antagonism that results in TGN trapping is likely to be augmented by β-TrCP-dependent degradation, underlining the need for complementary and perhaps synergistic strategies to effectively counteract the powerful restrictive effects of human Tetherin

Optical-IR echelle spectroscopy of NGC 6302

Echelle spectroscopy of [Si VI] 1.96 μm, [Mg VIII] 3.03 μm, and [Ar VI] 4.53 μm, using UKIRT+CGS4, shows the line pro les in PN NGC 6302 are singly peaked and unresolved even at R ∼ 20 000, with line widths less than 22 kms-1. A photoionized structure is evidenced by spatial and velocity stratification as a function of ionization potential. But a variety of models, with density and Te gradients, reproduce the spectrum equally well. Preliminary analysis of the 3000-10000 Å echellogram of NGC 6302, acquired at R ∼ 80 000 using VLT+UVES, confirms the stratified nebular structure, but yields intriguing results concerning the line profiles: [Ne V] 3426 Å is broader than [Ne IV] 4723 Å. These observations rule out the existence of an evacuated cavity, or hot bubble, at least on 1″ and 3 km s-1 scales. We do not confirm the broad wings in [Ne V] 3426 Å reported by Meaburn and Walsh (1980)

Unsafe clinical practices as perceived by final year baccalaureate nursing students: Q methodology

<p>Abstract</p> <p>Background</p> <p>Nursing education necessitates vigilance for clinical safety, a daunting challenge given the complex interchanges between students, patients and educators. As active learners, students offer a subjective understanding concerning safety in the practice milieu that merits further study. This study describes the viewpoints of senior undergraduate nursing students about compromised safety in the clinical learning environment.</p> <p>Methods</p> <p>Q methodology was used to systematically elicit multiple viewpoints about unsafe clinical learning from the perspective of senior students enrolled in a baccalaureate nursing program offered at multiple sites in Ontario, Canada. Across two program sites, 59 fourth year students sorted 43 theoretical statement cards, descriptive of unsafe clinical practice. Q-analysis identified similarities and differences among participant viewpoints yielding discrete and consensus perspectives.</p> <p>Results</p> <p>A total of six discrete viewpoints and two consensus perspectives were identified. The discrete viewpoints at one site were <it>Endorsement of Uncritical Knowledge Transfer, Non-student Centered Program</it> and <it>Overt Patterns of Unsatisfactory Clinical Performance.</it> In addition, a consensus perspective, labelled <it>Contravening Practices</it> was identified as responsible for compromised clinical safety at this site. At the other site, the discrete viewpoints were <it>Premature and Inappropriate Clinical Progression, Non-patient Centered Practice</it> and <it>Negating Purposeful Interactions for Experiential Learning.</it> There was consensus that <it>Eroding Conventions</it> compromised clinical safety from the perspective of students at this second site.</p> <p>Conclusions</p> <p>Senior nursing students perceive that deficits in knowledge, patient-centered practice, professional morality and authenticity threaten safety in the clinical learning environment. In an effort to eradicate compromised safety associated with learning in the clinical milieu, students and educators must embody the ontological, epistemological and praxis fundamentals of nursing.</p