Most civilian and air traffic control facilities in the United States use rapid shift schedules. These schedules have generally been chosen for social reasons. Safety concerns have been raised because the air traffic controllers (ATCs) often carry an acute sleep dept onto the night-shift where they have little active work to do as they sit in the dark at the nadir of their circadian rhythms. This paper reviews advancing and delaying rapid shiftwork schedules, ATC workload factors as they relate to error rates and safety, and potential countermeasures. Recent studies indicate that ATC performance declines on the night-shift and that ATCs may be falling asleep while on-duty. There is indirect evidence that ATC error rates are highest on the night-shift. There are only limited studies which have evaluated potential countermeasures. The operational significance of the problems associated with ATC shiftwork is not yet clear. Further study is needed
Appointments and Schedules ; Aviation* ; Circadian Rhythm ; United States

BACKGROUND: Rates of overweight and obese Australians are high and continue to rise, putting a large proportion of the population at risk of chronic illness. Examining characteristics associated with preference for a work-based weight-loss program will enable employers to better target programs to increase enrolment and benefit employees' health and fitness for work. METHODS: A cross-sectional survey was undertaken at two Australian mining sites. The survey collected information on employee demographics, health characteristics, work characteristics, stages of behavior change, and preference for workplace assistance with reaching a healthy weight. RESULTS: A total of 897 employees participated; 73.7% were male, and 68% had a body mass index in the overweight or obese range. Employees at risk of developing obesity-related chronic illnesses (based on high body mass index) were more likely to report preference for weight management assistance than lower risk employees. This indicates that, even in the absence of workplace promotion for weight management, some at risk employees want workplace assistance. Employees who were not aware of a need to change their current nutrition or physical activity behaviors were less likely to seek assistance. This indicates that practitioners need to communicate the negative effects of excess weight and promote the benefits of a healthy lifestyle to increase the likelihood of weight management. CONCLUSION: Weight management programs should provide information, motivation. and trouble-shooting assistance to meet the needs of at-risk mining employees, including those who are attempting to change and maintain behaviors to achieve a healthy weight and be suitably fit for work.
Body Mass Index ; Chronic Disease ; Cross-Sectional Studies ; Demography ; Healthy People Programs ; Humans ; Life Style ; Male ; Mining* ; Motivation ; Motor Activity ; Obesity* ; Occupational Health ; Occupational Health Services ; Overweight ; Population Characteristics

The Ministry of Education, Sports and Culture has taken increasing interest in the usefulness and importance of clinical clerkships for 5th-and 6th-year medical students. This paper is the product of a symposium at the Nagoya University School of Medicine which was convened to examine the role of clinical rotations for medical students in the United States and Japan. This paper contains: an overview of medical education and the role of medical student clinical rotations in the United States; observations on being a clinical clerk in the United States; observations on being a clinical clerk in Japan and experiences of Japanese medical students in the United States; an integrated summary of the problems of clinical rotations in the United States; and experiences of Japanese medical students in clinical rotations in the United States. Clinical clerkship for 5th-and 6th-year medical students can only be developed and implemented with careful thought, significant time, and adjustment to new systems. Nevertheless, adoption of clinical clerkship in Japan has great potential for improving the quality of medical education in Japan.

Objective: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) can cause bacterial skin infections that are common problems for Aboriginal children in New South Wales (NSW). MRSA is not notifiable in NSW and surveillance data describing incidence and prevalence are not routinely collected. The study aims to describe the epidemiology of CA-MRSA in Aboriginal children in the Hunter New England Local Health District (HNELHD). Methods: We linked data from Pathology North Laboratory Management System (AUSLAB) and the HNELHD patient administration system from 33 hospital emergency departments. Data from 2008–2014 for CA-MRSA isolates were extracted. Demographic characteristics included age, gender, Aboriginality, rurality and seasonality. Results: Of the 1222 individuals in this study, 408 (33.4%) were Aboriginal people. Aboriginal people were younger with 45.8% aged less than 10 years compared to 25.9% of non-Aboriginal people. Most isolates came from Aboriginal people who attended the regional Tamworth Hospital (193/511 isolates from 149 people). A larger proportion of Aboriginal people, compared to non-Aboriginal people, resided in outer regional (64.9% vs 37.2%) or remote/very remote areas (2.5% vs 0.5%). Most infections occurred in summer and early autumn. For Aboriginal patients, there was a downward trend through autumn, continuing through winter and spring. Discussion: Aboriginal people at HNELHD emergency departments appear to represent a greater proportion of people with skin infections with CA-MRSA than non-Aboriginal people. CA-MRSA is not notifiable in NSW; however, pathology and hospital data are available and can provide valuable indicative data to health districts for planning and policy development.

Cardiopulmonary bypass surgery is one of the most common major problems in many hospitals and the benefits of this surgery are now accepted. The majority of these patients have extensive arteriosclerotic cardiovascular disease and the surgery carries a risk. About 50% of these patients have significant surgical complications, 2-5% have complications in the central nervous system and 0.1% have hearing loss. Rare instances of unilateral hearing loss with incomplete recovery in these patients have been reported and attributed to either embolism or perfusion failure. In 1971, Arenberg et al., for the first time, reported on a 57 year old female who had a unilateral sudden hearing loss with some improvement in the early post-operative period. In 1975, Wright and Saunders reported on a 59 year old male, who had a sudden loss of hearing which did not improve. In 1981, Plasse et al,. reported seven cases, all with early post-operative hearing loss, four of whom improved some degree but none recovered completely. Shapiro et al. (1981) reported two cases of bilateral loss of hearing with no indication of improvement in hearing. Brownson et al. (1971), in a prospective study of 50 patients, found no significant changes in hearing following open heart surgery. The purpose of this paper is to present the consecutive audiological findings in a case with a sudden unilateral sensorineural hearing loss with subsequent complete recovery following an open heart surgery.
Audiometry, Pure-Tone ; Cardiopulmonary Bypass/adverse effects* ; Hearing Loss, Sensorineural/etiology* ; Human ; Male ; Middle Age

*Chemoembolization, Therapeutic ; Liver Neoplasms, Experimental/*therapy ; Microspheres ; Polyglactin 910/*therapeutic use ; Rats, Inbred ACI

The mucocele is a salivary gland pathology that results from rupture of salivary gland duct and spillage of mucin into the surrounding tissues. The term mucous extravacation is also used to describe this lesion. The rupture of the gland or duct may be due to local trauma. The most common site of mucocele is lower lip. The treatment of mucocele includes cryosurgery , intra-lesional corticosteroid injection, micro-marsupialization, marsupialization of the mucocele, conventional surgical removal of the lesion , and laser ablation. The advantages of laser ablation over other methods include less treatment time, avoidance of suturing, minimal complications and relapse. Here we report a case of mucocele on lower lip treated using diode laser.

BACKGROUND AND PURPOSE: Perioperative stroke is a significant complication of transcatheter aortic valve implantation (TAVI). This study aimed to quantify perioperative stroke as an independent risk factor for in-hospital mortality and postoperative morbidity in patients receiving TAVI. METHODS: A retrospective cohort study was conducted using the National Inpatient Sample. Patients undergoing TAVI during 2012 and 2013 were identified using diagnostic codes of International Classification of Diseases, ninth revision. Univariate and multivariate analyses were performed using patient demographics and comorbidities to identify predictors of mortality and morbidity, defined by a length of stay of >14 days and/or discharge to a place other than home. RESULTS: Data were obtained from 7,556 patients undergoing TAVI during 2012 and 2013. The incidence rates of mortality and morbidity were 4.57 and 71.12%, respectively. Perioperative stroke was an independent risk factor for mortality [odds ratio (OR)=3.182, 95% confidence interval (CI)=1.530–6.618, p=0.002], as were infection (OR=17.899, 95% CI=9.876–32.440, p<0.001) and pericardial tamponade (OR=7.272, 95% CI=2.874–18.402, p<0.001). Stroke also predicted morbidity (OR=5.223, 95% CI=2.005–13.608, p=0.001), which was also associated with age, being female, being Asian, moderate and high Van Walraven scores (VWR), and infection. CONCLUSIONS: In conclusion, perioperative stroke was found to be independently associated with in-hospital mortality and postoperative morbidity, as are age and high VWR. Our findings support the use of further preoperative, intraoperative, and postoperative management strategies during TAVI.
Asian Continental Ancestry Group ; Cardiac Tamponade ; Cohort Studies ; Comorbidity ; Demography ; Female ; Hospital Mortality* ; Humans ; Incidence ; Inpatients ; International Classification of Diseases ; Length of Stay ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Stroke* ; Transcatheter Aortic Valve Replacement*

We performed real-time 3D echocardiography in sixteen sheep to compare acute geometric changes in the mitral annulus after left anterior descending coronary artery (LAD, n=8) ligation and those after left circumflex coronary artery (LCX, n=8) ligation. The mitral regurgitation (MR) was quantified by regurgitant volume (RV) using the proximal isovelocity surface area method. The mitral annulus was reconstructed through the hinge points of the annulus traced on 9 rotational apical planes (angle increment=20 degrees). Mitral annular area (MAA) and the ratio of antero-posterior (AP) to commissure-commissure (CC) dimension of the annulus were calculated. Non-planar angle (NPA) representing non-planarity of the annulus was measured. After LCX occlusion, there were significant increases of the MAA during both early and late systole (p<0.01) with significant MR (RV: 30+/-14 mL), while there was neither a significant increase of MAA, nor a significant MR (RV: 4+/-5 mL) after LAD occlusion. AP/CC ratio (p<0.01) and NPA (p<0.01) also significantly increased after LCX occlusion during both early and late systole. The mitral annulus was significantly enlarged in the antero-posterior direction with significant decrease of non-planarity compared to LAD occlusion immediately after LCX occlusion.
Sheep ; Mitral Valve/*pathology/*ultrasonography ; Ligation ; Image Processing, Computer-Assisted ; Echocardiography, Three-Dimensional ; Coronary Vessels/*pathology/*ultrasonography ; Coronary Arteriosclerosis/pathology/ultrasonography ; Animals

The authors have decided to remove one of the authors, Serpil C. Erzurum, MD, who was cited as the 5th author on the original manuscript.