High Level Of Vigilance Research Articles

Incidence of Glove Perforation During Hand Surgical Procedures

To determine the rate of glove perforation during hand surgery. We prospectively examined the rate of glove perforations among 10 fellowship-trained hand surgeons at our institution during a 6 week period. Gloves were tested for perforation using a water-fill technique at the conclusion of each surgical procedure. Surgeons recorded the presence of any glove perforations. Eleven perforations were identified in 10 gloves among 600 surgical procedures during the study period. The perforation rate per case was 1.5% (95% confidence interval, 0.78% to 2.8%). Forty percent of perforations (n= 4) occurred during fracture surgery. Other holes occurred during isolated carpal tunnel release (n= 3) or combined carpal tunnel and trigger finger release (n= 3). The perforation was noticed intraoperatively in only 2 gloves. The difference in perforation rate between single- and double-gloved procedures was not significant. There were no perforations in the inner glove of surgeons who double gloved. A total of 73% of holes (8 of 11) occurred on surgeons' index finger; 75% of these were on the dominant hand. The dominant thumb, non-dominant ring and nondominant little fingers each had a single perforation. The rate of glove perforation during hand surgery is low. Holes can occur even during soft tissue procedures of short duration. The dominant index finger appears to be at greatest risk for perforation. When they do occur, most often holes are not noticed by the operating surgeon. The baseline glove perforation rate is unknown. A high level of vigilance is required to maintain sterile technique.

Locoregional recurrence of breast cancer presenting as upper limb venous thromboembolism

Locoregional recurrence of breast cancer is a major concern for both patient and oncologist. Presentation as venous thromboembolism (VTE) carries risk of delayed diagnosis and has a poor prognosis. Here...

Immunosenescence: the Role of Aging in the Predisposition to Neuro-Infectious Complications Arising from the Treatment of Multiple Sclerosis.

This review highlights some of the important changes in the immune system that occur in the process of normal aging. Immunosenescence as a concept is directly relevant to the world of neuro-inflammation, as it may be a contributing factor to the risks associated with some of the current immunosuppressive and immunomodulatory therapies used in treating multiple sclerosis (MS) and other inflammatory disorders. Profound qualitative and quantitative changes occur in the adaptive and innate immunity compartments during aging. These changes may explain why patients of older age are at an increased risk of infections and infection-associated mortality. Immunosenescence-associated changes may be additive or synergistic with the effects produced by immunomodulatory and immunosuppressive medications. Clinicians should exercise a high level of vigilance in monitoring the risk of infections in older patients on these treatments.

A phenomenological construct of caring among spouses following acute coronary syndrome.

The aim of this study was interpret the existential construct of family caring following Acute Coronary Syndrome. Family support is known to have a positive impact on recovery and adjustment after cardiac events. Few studies provide philosophically-based, interpretative explorations of carer experience following a spouse's ischaemic event. As carer experiences, behaviours and meaning-making may impact on the quality of the support they provide to patients, further understanding could improve both patient outcomes and family experience. Fourteen spouses of people experiencing Acute Coronary Syndrome in Sydney, Australia were engaged in a single, semi-structured interview. Interviews were audio-recorded and transcribed verbatim. Data were analysed using hermeneutic interpretation within a Heideggerian phenomenological framework. Acute Coronary Syndrome disrupts lived temporality, and the projected potential for carers' being-alongside. Carers experienced an existential uncertainty that arose from difficulty in diagnosis, and situated fear as an attuned, being-towards-death. They constructed protective strategies to insulate their partner and themselves from further stress and risk, however, unclear boundaries for protection heightened carer anxiety. The existential structure of care included one of two possible Heideggerian modes: leaping-in care was a dominating mode that required a high level of carer vigilance; leaping-ahead care was a metaphorical walking alongside, as carers gave back control, freeing opportunities for the person to 'own' care. Supporting carers through the intensive phase of leaping-in care, and equipping them for informed leaping-ahead care should be a focus in both the acute and post-discharge care phases.

The Relationship between Sustained Attention and PTSD Symptoms in Chinese Earthquake Orphans

The authors examined sustained attention performance and PTSD symptoms in a sample of 281 orphans and non-orphans who experienced the Sichuan Earthquake in China. They hypothesized that the orphans had a higher possibility to risk for PTSD than non-orphans, and the former also might even tend to be more impulsive, allergic which might affect their basic cognitive skill-attention. The findings showed evidence of cognitive developmental stages, from vigilance to numbness and avoidance, in the continuous performance test (CPT) task by including pre-earthquake orphans. The post-earthquake orphans were still in a high level of vigilance and performed well in the CPT task when compared with the pre-earthquake orphans. The non-orphans with high possibility to risk for PTSD were the most concentrated and least impulsive. Given the potentially mutual relationship between sustained attention and posttraumatic stress disorder, careful consideration must be given to the treatment of traumatized children who present with PTSD symptoms. In accordance with practice guidelines, a duplex informant, duplex measure approach in the decision of educational plans for these children is strongly recommended.

Design Considerations for Genetic Linkage and Association Studies.

This chapter describes the main issues that genetic epidemiologists usually consider in the design of linkage and association studies. For linkage, we briefly consider the situation of rare highly penetrant alleles showing a disease pattern consistent with Mendelian inheritance investigated through parametric methods in large pedigrees, or with autozygosity mapping in inbred families, and we then turn our focus to the most common design, the affected sibling pair design that is of more relevance for common, complex diseases. Power and sample size calculations are provided as a function of the strength of the genetic effect being investigated. We also discuss the impact of other determinants of statistical power such as disease heterogeneity, pedigree and genotyping errors and the effect of the type and density of genetic markers. For association studies, we consider the popular case-control design for dichotomous phenotypes and we provide power and sample size calculations for one-stage and multistage designs. For candidate genes, guidelines are given on the prioritization of genetic variants, and for genome-wide association studies (GWAS) the issue of choosing an appropriate SNP array is discussed. A warning is issued regarding the danger of designing an underpowered replication study following an initial GWAS. The risk of finding spurious association due to population stratification, cryptic relatedness, and differential bias is underlined.

Assessing anti-predator decisions of foraging eastern chipmunks under varying perceived risks: the effects of physical and social environments on vigilance

Animals foraging under risk have to trade-off resource acquisition and predator avoidance. Environmental factors can modulate the level of risk and should thus influence the expression of anti-predator behaviours such as vigilance. In this study, we investigated the effects of physical and social environments on eastern chipmunks’ (Tamias striatus) vigilance, by varying the perceived risk through playback experiments of alarm calls and neutral environmental sounds, and by integrating habitat and weather characteristics, as well as neighbour density. Chipmunks showed higher levels of vigilance when foraging in more open habitats, under high wind conditions, when they heard alarm calls and when surrounded by a high neighbour density. The effects of wind intensity and neighbour density on vigilance were also stronger during the broadcast of alarm calls rather than neutral sounds. Our results emphasize how both the physical and social environments can modify risk perception and therefore risk-taking decisions of foraging individuals.

The awareness to metabolic syndrome among hospital health providers

BackgroundMetabolic syndrome (MetS) was shown to be related to a variety of diseases. High level of vigilance for the diagnosis of MetS is expected among health providers. We evaluated the level of awareness to MetS among physician and nurses working in a central hospital. Methods and resultsA specially designed anonymous questionnaire was used, including both open and multiple choice questions set to evaluate the participant's awareness to MetS. The study included 126 participants, 71% physicians and 29% nurses. Mean age was 36.2±3.8 years. Among physicians, 68.5% were residents and 45.5% were internists. 98% of the participants stated that they were familiar with the term MetS and that they treat MetS patients regularly. Most participants knew the correct number of criteria included in MetS definition and the number of criteria needed for MetS diagnosis (84% and 90%, respectively). However, only 12% were able to discriminate correctly all MetS cases from non-MetS ones. Physicians performed better than nurses (15.6% and 3.1%, respectively, P=0.003). Neither, field of practice nor seniority was found to have a significant influence on the results.The frequency of recommendation for MetS risk factor modulation in the discharge files was also analyzed. Such recommendations were scarcely given, with cardiology department being the exception (80% of discharge files from cardiology department compared with less than 20% in other departments). ConclusionThough hospital workers showed high level of awareness to the existence of MetS, they failed to differentiate correctly MetS cases from non-MetS ones.

Reversible Cerebral Vasoconstriction Syndrome Induced by Pseudoephedrine

Background: Thunderclap headache and focal neurologic deficits are major diagnostic challenges to the neurologists. Besides subarachnoid hemorrhage and stroke, reversible cerebral vasoconstriction syndrome (RCVS) should be given high priority in the differential diagnosis. Case Report: A 46-year-old woman visited our hospital with thunderclap headache and left hemiparesis. Computed tomography (CT) angiography showed multifocal narrowing of the basilar artery. Headache, resistant to conventional medication, had a waxing and waning course during hospitalization. After a review of the medication history, administration of pseudoephedrine for allergic rhinitis was noted 3 days before hospital admission. History of a prior episode of severe headache after taking the same medication was also revealed. Under suspicion of secondary RCVS related to sympathomimetics, she was treated with nimodipine, and then, the headache improved gradually. Follow-up CT angiography showed normalization of the previously narrowed cerebral vessels. Conclusion: The problem of underdiagnosis of RCVS cannot be overcome without a high level of vigilance. Thunderclap headache with normal brain parenchyma on MRI but multifocal narrowing of brain vessels highly suggests the need for scrutiny of potential triggers of RCVS. Key Words: Vasoconstriction; Thunderclap headache; Pseudoephedrine

Prevention, Recognition, and Management of Urologic Injuries During Gynecologic Surgery

The urethra, bladder, and ureters are particularly susceptible to injury during gynecologic surgery. When preventive measures fail, prompt recognition and management of injury can avoid long-term sequelae such as fistula formation and loss of renal function. Intraoperative identification should be the primary goal when an injury occurs, although this is not always possible. Postoperative injury recognition requires a high level of suspicion and vigilance. In addition to history and physical examination, appropriate radiologic studies can be useful in localizing injury and planning management strategies. Some injuries may require Foley catheter drainage or ureteral stenting alone, whereas others will require operative intervention with ureteral resection and reanastomosis or reimplantation. Prompt restoration of urinary drainage or diversion will avoid further renal compromise.

Pregnancy-associated severe sepsis.

This article examines the contemporary knowledge and uncertainties about the burden of pregnancy-associated severe sepsis (PASS), and its manifestations, management, and outcomes. There are relatively sparse data on PASS, related in part to infrequent reports and varying use of terminology and case definitions. PASS remains rare, although its incidence appears to be rapidly rising in some high-resource countries, affecting especially women with limited resources, minorities, and those with chronic illness. High level of clinician vigilance and rapid initiation of appropriate antimicrobial therapy, coupled with effective systemic support for organ dysfunction and correction of occult and overt hypoperfusion are the keys to limit adverse outcomes. However, timely diagnosis and provision of effective care remain a challenge, with reported prevalent delay in recognition and delivery of time-sensitive care interventions among maternal decedents. The mortality rate of PASS has been rising and its case fatality, although relatively low, has remained unchanged, in contrast to the outcome gains in the general population. The long-term sequelae of PASS remain unknown. The relatively limited contemporary data on PASS suggest a rising public health hazard in the obstetric population in high-resource countries, with ongoing challenges in assuring consistent provision of time-sensitive care.

Watch out or relax: conspecifics affect vigilance in wild spider monkeys (Ateles geoffroyi)

In most animal species, predation risk is considered the main factor affecting vigilance, and an individual is expected to spend less time vigilant in larger than in smaller groups. However, vigilance patterns in primates appear to differ, with no consistency in group-size effects. As individuals in highly gregarious species such as diurnal primates face frequent threats from group members, there may be increased vigilance in larger groups to monitor conspecifics rather than or in addition to predators. We tested this hypothesis in wild spider monkeys, which live in communities but fission and fuse in subgroups of variable size and membership throughout the same day. We found no overall effect of subgroup size, as traditionally measured, on vigilance. However, a possible explanation is that vigilance may be effectively shared only with individuals in close proximity, rather than with all subgroup members. We found that a larger number of neighbours (i.e., subgroup members within 5 m) was associated with a lower proportion of time individuals spent vigilant, which is similar to findings in other studies. Another social factor that may affect individuals’ vigilance is the possibility of between-community encounters. Higher levels of vigilance can be expected in areas closer to the boundary of the home range, where between-community encounters are more likely to occur compared with non-boundary areas. We found that location in terms of boundary vs. non-boundary areas had a significant effect on the time individuals spent vigilant in the expected direction. We also found that location modulated the effect of subgroup size on vigilance: only in the boundary areas did larger subgroup sizes result in less individual vigilance time. We concluded that conspecifics affect vigilance of wild spider monkeys in multiple ways.

End-Stage Liver Disease Is a Strong Predictor of Early Mortality in Cryptococcosis.

Background. Cryptococcosis in the setting of end-stage liver disease (ESLD) has been associated with high mortality. We sought to compare the outcome of cryptococcal disease in patients with ESLD to that of human immunodeficiency virus (HIV)-positive patients and to those patients without HIV or ESLD. Methods. We assembled a retrospective cohort of 232 consecutive cases of cryptococcosis in our institution, from 2002 to 2014, inclusively. We analyzed the cases for comorbidities, type of infection, and survival. Data were analyzed with t tests, Fishers Exact test, and Kaplan-Meyer analysis. Results. Twenty-five (10.8%) patients with cryptococcal infection had concomitant ESLD; of these, 5 (20%) presented with peritonitis. Most (17 of 25, 68%) did not have any other cause of immunocompromise that has been more classically associated with cryptococcosis. Patients with ESLD had a significantly higher mortality than HIV-positive patients and HIV-negative patients without ESLD (HIVNE) (80% vs 13.6% and 22.7%, respectively; P < .001). In addition, fatal outcome in ESLD patients occurred more rapidly than in HIVNE patients, with a median survival of 6 days (vs 17), despite a comparable time to diagnosis (6.2 vs 6.6 days). Conclusions. Cryptococcosis is an important morbidity in patients with ESLD. Patients with ESLD who are infected with Cryptococcus have a high and rapid mortality. This suggests that a high level of vigilance for cryptococcal infection should be kept in patients with ESLD.

A clinical analysis of 16 patients with maternal listeriosis

To summarize the clinical characteristics and outcome of maternal listeriosis so as to improve the understanding of disease and the level of diagnosis and treatment. Retrospectively, 16 cases of maternal listeriosis, who were treated at Peking Union Medical College Hospital between March 2007 and December 2014 were reviewed. Maternal listeriosis is defined when a pregnant woman presents with symptoms as listeriosis, meanwhile Listeria monocytogenes is isolated from sterile tissue or peripheral blood, or from a non-sterile site (uterus swab) or pathological evidence of chorioamnionitis. The neonatal listeriosis is diagnosed as acute listeria sepsis. The mean age of these 16 patients was (30.0 ± 3.9) years old. There were 1, 8, 7 patients with listeriosis diagnosed in the first, second and third trimester of pregnancy, respectively. All had an acute onset of illness (≤ 2 weeks), the median time from onset to presentation was 2.5 days. Clinical manifestations included fever (93.8%, 15/16), leukocytosis (78.6%, 11/14), chorioamnionitis (77.8%, 7/9), gastrointestinal symptoms (37.5%, 6/16) and fetal movement decrease (31.3%, 5/16). Listeria monocytogenes were isolated from blood (6 cases), uterus swab (6 cases), blood plus uterus swab (1 case), and neonates (3 cases). All maternal cases recovered well after the termination of pregnancy, even none of them had received empiric antibiotics sensitive to listeria. A very high proportion of adverse pregnancy outcomes occurred (15/16, 93.8%). There were 8 fetal losses. Seven neonates were complicated with listeria sepsis and treated successfully. The patients with maternal listeriosis commonly presented with acute fever and an extremely high incidence of adverse pregnancy outcomes, however empiric antibiotics can hardly cover this pathogenic bacterium. So both pregnant women and clinicians should maintain a high level of vigilance against listeriosis and pay more attention to dietetic hygiene.

Effects of context and individual predispositions on hypervigilance to pain-cues: an ERP study.

BackgroundHypervigilance to pain is the automatic prioritization of pain-related compared with other stimuli. The processing of threat information is influenced by negative contexts. Therefore, we intended to explore such context effects on hypervigilance to pain-cues, taking individual differences in self-reported vigilance to pain into consideration.MethodsIn all, 110 healthy subjects viewed task-irrelevant emotional facial expressions (anger, happy, neutral, and pain) overlaid in half of the trials with a fine grid. The instructed task was to indicate the presence/absence of this grid. A threatening context was established by applying electrical stimuli slightly below pain-threshold. Using scores of Pain Vigilance and Awareness Questionnaire, the sample was divided into high vs low pain vigilant subjects. Reaction times and event-related brain potentials were recorded.ResultsNo distinct attentional processing of pain faces (based on the event-related brain potentials) was observed as a function of high levels of self-reported vigilance to pain and contextual threat induction. High pain vigilant subjects showed generally enhanced processing of emotional and neutral faces as indicated by parameters of early (early posterior negativity) and late (late positive complex) processing stages. This enhancement was abolished when electro-stimuli were presented.ConclusionContextual threat does not enhance the attentional capture of pain-cues when they are presented concurrently with competing task demands. The study could, however, replicate a generally enhanced attentional processing of emotional cues in high pain vigilant subjects. This underpins that hypervigilance to pain is related to changes in emotional processing.

Rank-related response in foraging site selection and vigilance behaviour of a small passerine to different winter weather conditions

The foraging patterns and time spent on vigilance behaviour by Willow Tits (Poecile montanus) were studied under varying weather conditions in a subalpine forest in central Norway during the winters of 2009-2013. The birds adjusted their microhabitat use in pines and their vigilance levels in response to perceived risk of predation and starvation. At low temperatures, the dominating adults foraged mainly in the upper and most predation safe areas in pines and the subordinate juveniles in the more predator risky lower halves. When the outer canopies of pines were covered by snow, the adults tended to restrict their foraging activities to the inner parts of the lower halves of the trees and thus overlapped considerably with the juveniles. In windy weather, the age classes differed in site use, mostly because juveniles foraged more in the outer part of the branches. Juveniles were significantly More vigilant than adults under all the weather conditions, and they spent about 60% of their time seeking food whereas adults spent about 85%. It is suggested that the high level of vigilance by the subordinate juveniles is costly and may be the main cause of the higher winter mortality of juveniles compared to that of adults.

Adding the "in" to justice: a qualitative and quantitative investigation of the differential effects of justice rule adherence and violation.

Although justice scholars often assume that individuals react to injustice in a manner that is distinct from their reactions to justice, few studies have examined this assumption. Indeed, the most widely utilized measures in the literature assess only the adherence to rules of justice--not their violation. We conducted 2 studies to build and test theory about differential reactions to justice and injustice. An inductive study revealed that reactions to the adherence to justice rules reflected different constructs than reactions to the violations of justice rules. In a follow-up field study, we derived hypotheses for those patterns by drawing on the negativity bias and regulatory focus literatures. Specifically, justice rule violation was predicted to be more relevant to prevention-laden outcomes that represent a high level of vigilance and concerns about safety. Justice rule adherence was predicted to be more relevant to promotion-laden outcomes that represent concerns about becoming the ideal self. The field study supported many of those predictions while showing that a full-range justice measure (i.e., one that sampled both justice rule adherence and justice rule violation) explained more variance in outcomes than existing "truncated" justice measures.

Substantive editing as a form of plagiarism among postgraduate students in Australia

In university plagiarism policies, and in the research into plagiarism, one form of collusion remains virtually unacknowledged: substantive editing performed by editors. While almost all Australian universities allow postgraduate students to have their thesis professionally edited, substantive editing is prohibited. This article discusses the problems inherent in this arrangement, given that most students and supervisors, and some editors, are not clear on where the line is between the two. Moreover, it is evident that there are a myriad of social and economic pressures that lead to substantive editing being performed even when all three parties are aware that it is occurring. Substantive editing is a particularly insidious form of plagiarism since it has received so little attention by universities, it is seen as less serious than other forms of plagiarism, it requires high levels of vigilance to detect and there are no deterrents in place. This article argues that there are significant numbers of students engaging in this form of plagiarism. This study aims to shed light on this issue by examining the nature, motivations behind and prevalence of substantive editing, while recognising the social context and negative effects of the issue.

In Government We Distrust: Citizen Skepticism and Democracy in the United States

AbstractVirtually all accounts of political trust in the US regard declining trust over the past half-century to be troubling. We argue that these interpretations are in need of reassessment since they often are rooted in the normatively questionable assumption that higher trust is always desirable. We review traditions in democratic theory and American thought extolling the virtues of skepticism and distrust of government and discuss potential problems in common trust measures and conclusions based on them. Using data from the 2014 General Social Survey, we explore relationships between trust, commitment to being vigilant watchdogs of government, and attitudes and behaviors generally considered desirable for a healthy democracy. Our findings indicate that higher trust is not always accompanied by characteristics of good democratic citizens. In fact, it is those individuals who exhibit lower levels of trust with high levels of vigilance who are most politically engaged. Thus, healthy skepticism of government may contribute to the vitality of democracy.

The Canadian Immunization Monitoring Program, ACTive (IMPACT): Active surveillance for vaccine adverse events and vaccine-preventable diseases.

For almost 25 years the Canadian Immunization Monitoring Program, ACTive (IMPACT) has been conducting active surveillance for severe adverse events following immunization (AEFIs) and vaccine-preventable diseases in children. The network, which consists of volunteer paediatric infectious diseases investigators at 12 tertiary care paediatric hospitals, is an important component of Canada's AEFI monitoring. The network employs nurses at each of the sites to search for and report possible AEFIs to local, provincial and national public health authorities. The active nature of the surveillance ensures a high level of vigilance for severe AEFIs in children.