Tall Man Research Articles

Human Factors Perspectives on a Systemic Approach to Ensuring a Safer Medication Delivery Process

The current, prevailing approach to addressing medication delivery safety issues has been to apply solutions at the point of failure with direct, local remediation. These include computerized physician order entry to address transcription and prescribing problems, tall man lettering for label clarity and smart pump systems to address programming use errors. We discuss the lack of a systemic, holistic approach to addressing medication delivery issues that has led to fragmented solutions that do not address the problem as intended and introduce new, unintended patient safety issues. We use recent case studies in addition to our own experimental data from human factors investigations to show how a comprehensive human factors approach can be applied to address systemic error in medication delivery. Only by identifying how (1) subsystems interconnect, (2) information flows, (3) care providers communicate and (4) users are impacted will healthcare organizations and system vendors be able to fully address error in medication delivery. Much of what is required from organizations is to transcend the organizational boundaries of medicine, pharmacy and nursing to produce a delivery system that ensures an integrated approach that addresses all stakeholders' needs.

Australian Legal Geography and the Search for Postcolonial Space in Chloe Hooper’S The Tall Man: Death and Life on Palm Island

A review of Chloe Hooper's non-fiction novel 'The Tall Man' Death and Life on Palm Island' is presented. The book recounts the death in custody of Cameron Doomadgee on Queensland's Palm Island in 2004. The novel suggests the possibility for a space of Australian postcoloniality. In addition, it is an original work of critical legal geography that analyses the tensions between Australia's north and south and outlines the laws and state policies that create racial conflict.

Improving Patient Safety by Improving Medication Communication

Any time that information about a patient's medication is communicated, there is a potential for error that occurs because of misinterpretation of abbreviations, acronyms, and dose designations. In the following discussion, corrective approaches for reducing the use of error-prone terms will be reviewed. Terms on the "Do Not Use" list are identified and the rationale for using "Tall Man" letters is addressed.

In Search of a Golden Bird upon a Bough of Memory

In Search of a Golden Bird upon a Bough of Memory Mel Livatino (bio) I once had a teacher of literature who, most of the semester, put me in mind of a frightened angel. Years later, remembering his spare body and reflective presence, I thought of Yeats’s golden bird upon a golden bough. I wasn’t alone in such aviary comparisons. Nearly fifty years after being his student, the noted psychologist Mihaly Csikszentmihalyi said this teacher reminded him of a giant crane or a great blue heron. Though I could not know it at the time, this contemplative birdlike man would be the most extraordinary teacher I ever had. The circumstances for such an encounter were highly improbable. Nothing about the school suggested such a teacher. The newly opened, densely urban campus of the University of Illinois at Chicago, known locally as Chicago Circle, hadn’t even been a four-year school until a few days earlier but was a two-year campus located on a narrow strip of concrete jutting out seven-eighths of a mile into Lake Michigan. Navy Pier, it was called then, after decades of use in commercial shipping; later it was a hastily built campus for the U.S. Navy during the Second World War. To its commuter students from 1946 through 1964, it was simply the Pier: a seemingly unending tunnel of battleship-gray classrooms that looked more like a bleak factory than a college campus. In February 1965 the campus shifted from Navy Pier to a nearly mile-square plot of urban-renewal land that had been forcibly wrenched from its largely Italian-American residents. Their homes and stores were demolished, and a handful of university buildings was soon erected. The buildings were identical pods: two stories of pebble-filled concrete with narrow vertical slits for windows. The classrooms were identical: thirty-two black wrought-iron chair-desks bolted to the floor in four rows. To many people these buildings resembled the nearby Cook County Jail, not a college. That semester the new campus was a chaos of mud, debris, and construction. Ornery orange machines were moving, [End Page 223] hauling, lifting, erecting all day every day. The roar of their exhaust pipes was the cacophony of our spheres. It was hardly the place to encounter an angel, a crane, a heron, or Yeats’s golden bird. On a cold morning in late February I was sitting in a second-floor classroom of one of these interchangeable pods when a tall thin man wearing a navy-blue overcoat, gray fedora, brownish suit, white shirt, and necktie came into the room. He put his satchel on the desk, pulled out a syllabus for English 256, American literature from 1865 to the present, and announced he was James Stronks. He was forty-four years old then, and I was twenty-four. I was struck by this man’s simple, spare elegance. His brow was high and narrow; his sandy hair, thinning; his eyes, blue, direct, and keen; his body, tall, lean, erect, and angular. He seemed stripped to the bone—reserved, formal, professional—not like an IBM salesman, but like a monk dressed in a suit. What I most noticed that first day, however, was his great interiority. It was as if he had taken only as much body as necessary to house being and knowing. Yet on that first day, and for some time to come, I did not think of Stronks as a great teacher. I was used to a different kind of excellence, teaching that was more present and rational. Stronks seemed too hesitant, too distant, too interior to be a great teacher. I had come from five and a half years (1959–1964) as a part-time student at Wright Junior College, one of Chicago’s City Colleges—and had one full-time semester on the Urbana campus of the University of Illinois. In both places I had been taught by superb teachers. At Wright Sid Berman paced up and down the aisles of our classroom in a bow tie and rolled-up sleeves, peppering us with one penetrating question after another about the texts for that semester: Ortega y...

The Vision to Make Tough Decisions

Even I heard exasperation in my voice. can be fired. I know they can! I said to my colleague Jon, also a long-time public school teacher. He stood with his back to wall--trapped--as I waved paper I clutched in my fist. His eyes filled with look of a man who knew he was dealing with a woman on edge. I've negotiated teacher contracts, I fumed. There are always processes for getting rid of teachers. Who would want bad teachers gone more than good teachers? They not only hurt our children, they hurt us. Before he could answer, I smoothed out wrinkled paper and showed him press release that had prompted my hysteria on that particular day. was from an organization called Center for Union Facts (unionfacts.com) and headline screamed, Ten Worst Union-Protected Teachers Contest Winners Announced. The center claimed that teachers who came to school drunk, molested their students, and waved firearms around in public places could not be fired because of power of evil unions. Unions don't protect teachers. They protect processes, I continued. there are processes for firing teachers. Principals just don't have spine for it, so they blame unions! I could see terror in Jon's eyes as he searched for something--anything--to defuse bomb growing closer and closer to detonation. Then he smiled knowingly. course you're right, Bobby, he said calmly. in fact, I know a principal who fires teachers. Would you like to meet him? An unexplained calm came over me. Yes. Yes, I would, I told him as I gathered myself together and tried to return to my happy place. And so it was that I drove several hours to a school in a medium-sized city to meet a principal with a I knew minute I walked in building. Not because I possess some mystical powers of observation. is just so obvious. The entrance hallway made it clear that this school was a place for children, a place where they belong. A place that celebrates them. Low bulletin boards were filled with children's Real Not coloring pages or hand-traced turkeys that so often pass as student work. And not spelling tests with 100% scrawled across top. No, there was beautiful children's work, each piece as individual as child who produced it. I lingered in hall studying each masterpiece. But that was not why I had made long trip on this late autumn day, I reminded myself. I had come to meet a principal with a So I tore myself away from hallway gallery and swung open office door. Once inside, I was promptly greeted by a friendly secretary. I'm here to see I reported--stopping just short of adding, the principal with a spine. From his office, I heard laughter and easy conversation. A few moments later, two teachers emerged talking about big plans of one kind or another. They were followed closely by David, a tall man with a big smile and welcoming demeanor. As we shook hands, he asked me if I'd like a tour of his school. I really wanted to find out more about his alleged firing of teachers, but children's work had intrigued me. So, I followed him into hallway. As we walked, I marveled at learning environment he had created. Walking from classroom to classroom, teachers' individuality and wide variety of teaching methods and philosophies was evident. When I commented on diversity, David explained, Our teachers have to be diverse because our children are. If they all are taught in same way, too many of our children would fall through cracks. Of course, I can't teach way they do, he added, laughing. It just wouldn't work for me. But that doesn't matter. What matters is that children learn. …

Estrogen and Fracture Risk in Men

Estrogen and Fracture Risk in Men

The diagnosis of art: Lowry's Cripples

Lawrence Stephen Lowry (1887-1976) is best known for his naive-style ‘matchstick’ people in the industrial north of England. In the later stages of his career, he became increasingly fascinated by misfits, down and outs, and cripples. Perhaps the attraction stemmed from his depression after the death in 1939 of his mother, to whom he was very close, or it may have arisen in the aftermath of World War II. His job as a rent collector with the Pall Mall Property Company in Manchester, until his retirement in 1952, allowed him to wander through the streets and record ‘his people’.1 Lowry was also interested in crowds. ‘Accidents interest me—I have a very queer mind you know. What fascinates me is the people they attract. The patterns those people form, and the atmosphere of tension when something has happened... Where there's a quarrel there's always a crowd... It's a great draw. A quarrel or a body.’ In The Fever Van (1935) he shows a large crowd drawn by the sight of an ambulance arriving to collect a patient, probably a child with diphtheria or scarlet fever, from a small terraced house.2 However, despite his interest in the scene, Lowry avoided excessive sentimentality and detached himself both emotionally and physically. This is also true of The Cripples (1949), a social commentary on the able-bodied beholding the disabled, painted in a distinctive mono-chrome, with tinges of red, ochre, and pale blue (Figure 1). Figure 1 The Cripples (1949); oil on canvas, 76.3 cm×101.8 cm; The Lowry, Salford Quays. In colour online Attracted to the painting as voyeurs, we are tempted to essay fanciful diagnoses of the problems that afflict some of the ‘cripples’ that Lowry assembled in this composite painting, derived from sketches made at different times. At the bottom right of the picture we see a man with no legs (an above-knee amputation on the right and a likely hindquarter amputation on the left) riding on a home-made cart. He is probably a war amputee and was well known in Manchester, where he used to sell small items on the corner of Deansgate and St Mary's Gate. Immediately above him in the middle background is a man in a grey coat and red scarf whose gait suggests that he may have a disorder such as cerebellar ataxia or Huntingdon's chorea. To his right is a very tall man with retrognathia, perhaps due to Marfan's syndrome. In the middle foreground we see a man with crutches, who may have had a stroke—he has an extended, perhaps spastic, left leg with a possible equinus deformity and may have a contralateral facial palsy. Just behind him is a woman with hunched shoulders or a short neck; she looks as if she is wearing a permanent coat-hanger and has facial asymmetry, characteristics of Klippel-Feil syndrome, in which torticollis is also common. At the bottom left is another man with crutches, this time because of a left above-knee amputation, also probably a war victim. Above him is a man with a left-sided hook prosthesis, presumably another war amputee. Talking to him is a man with a well-rounded gibbus, for which many possible causes can be suggested—tuberculosis, severe osteoarthritis, Forestier's disease (diffuse idiopathic skeletal hyperostosis), Scheuermann's disease (adolescent kyphosis) or ankylosing spondylitis. In the middle ground a man in a bowler hat with varus knees walks away from the viewer, complemented by a lady to his right, facing the viewer, with valgus knees. The underlying pathology is likely to be osteoarthritis. Of course, the point of Lowry's painting is not what the cripples are suffering from, but their very existence and the way in which the healthy on-lookers, mostly children, gaze at them with curiosity. Lowry once said, ‘I feel more strongly about these people than I ever did about the industrial scene. They are real people, sad people. I'm attracted to sadness and there are some very sad things. I feel like them.’ And look at the man in the focal centre of the painting, walking his dog. It has been suggested that this is Lowry himself, who may have suffered from Asperger's syndrome.3,4 Here he is depicted lost in thought, an emotional cripple, studiously not looking at all the physical cripples around him.

Meredith Sue Willis: Writing Her Own Dispatch

FEATURED AUTHOR—MEREDITH SUE WILLIS Meredith Sue Willis: Writing Her Own Dispatch Phyllis Wilson Moore Meredith Sue Willis—editor, teacher, community activist, wife and mother—is first and foremost a writer. She is the author of five novels for adults, two collections of short stories, three children's books, a young adult science fiction novel, essays, three books on writing and more. South Orange, New Jersey, population 16,000 plus, is her residence. It is a loved place, as is nearby New York. However, Shinnston, West Virginia, population less than 2,500, is the place she calls home and the place she returns to in person as well as in her imagination. Located 35 miles below the Mason Dixon line and an equal distance from Pittsburgh, Pennsylvania, and Sago, West Virginia, it is a bustling town straddling the West Fork River. A town where folks still plant gardens out back and a nearby electricity power station generates plumes of smoke, its tall gray towers as much a part of the environment as the river or surrounding hills. The town has changed since Willis's birth on May 31, 1946. Shinnston High School, her beloved alma mater, is no more. School consolidation resulted in the new Lincoln High School, where she has served as a consultant in creative writing. Blazing Pencils: a Guide to Writing Fiction and Essays (Teachers and Writers Collaborative, 1990) incorporates Lincoln students' examples of how to write from life's experiences. Shinnston High School played a significant role in Willis's life. An honor student, Willis completed two years of French and Latin, three years of higher level math, attended journalism camp at West Virginia University, published a story in a national publication, The Student Writer, and earned the Bausch & Lomb Science Award. She was sophomore Homecoming Princess, and the class of 1964 voted her Most Likely to Succeed and Best Leader. It might surprise classmates to learn she, too, experienced angst and was not all that comfortable trying to fit in. 10 Reared with her younger sister, Christine, in a modesthome on East Avenue, she was keenly aware of the town's religious, ethnic and socioeconomic mix and polyglot of languages. The town's early residents were of English/Welsh/Scotch-Irish parentage or German farmers and cattle ranchers, with a few Irish railroad workers and descendants of slaves in the lot. Shinnston experienced an influx of European immigrants from early 1900 to 1930. The new arrivals reacted to derogatory nicknames by retaliating with their own version of an ethnic-epithet, perhaps unique to Shinnston, and called their antagonists "Snuffies." It is likely this name came from Snuffy Smith, a do-less moonshine-making mountain man in a syndicated comic strip that is still in print. The Shinnston Snuffies and the immigrants labored together in the oil fields, zinc plants, coal mines and glass industries of the county while their children developed friendships and romances. It was a town of problems and promises. "My Father's Stories: An Essay," introduces Willis's short story collection, In the Mountains of America (Mercury House, 1994) and illustrates the point: "To my father, Shinnston, West Virginia, represented grand new vistas. This was the great world to him in a way city people can hardly imagine. Shinnston had folks from Syria and Spain and Yugoslavia. Shinnston had a mansion on a hill built by an Italian immigrant and a dark little shop in town where an elderly Jew repaired shoes. My father says the first day he was in Shinnston he met Dave Hardesty, who told him: "We have a real tall man here in town named Short, and we have a little short man named Long. There's a black man named White and a white man named Black.' A town of wonder: everything was possible." Her father, Glenn Willis, earned an undergraduate degree from nearby Fairmont State College (now a university) and a Master of Arts from West Virginia University by working in the mines between semesters. He managed a Shinnston Dairy King during the summer with Meredith Sue as his helper. According to Meredith Sue, "he was my teacher and my boss and my dad." He was the...

Central Venous Access in Obese Patients: A Potential Complication

To the Editor: Because peripheral IV access may be limited in obese patients (1), cannulation of a central vein (subclavian, internal jugular) is often recommended (2). We report a previously unrecognized complication of central line placement in an obese patient. A 54-yr-old, 160 kg, 183 cm tall (body mass index = 47.8 kg/m2) man with cerebral vasospasm was scheduled for cerebral angiography under general anesthesia. He had been admitted to the intensive care unit after an emergency craniotomy and clipping of an aneurysm after a subarachnoid hemorrhage 3 days earlier. At the time of the surgical procedure, a triple-lumen right subclavian venous catheter (Arrowgard® Blue Plus Multi-Lumen CVC, Arrow International, Inc., Reading, PA) had been percutaneously inserted without difficulty. On admission to the radiology suite propofol 100 μg · kg−1 · min−1 was infusing through the proximal lumen of the subclavian catheter and neosynephrine 200 μg · kg−1 · min−1 was infusing through the medial lumen. As is our routine, the patency of each lumen was checked before induction of general anesthesia. Blood could only be aspirated from the distal lumen. Under direct fluoroscopy using contrast medium it was noted that only the distal lumen was intravascular, and the propofol (proximal lumen) and neosynephrine (medial lumen) were extravasating into the subcutaneous tissue of the neck. A long guidewire was inserted under fluoroscopic guidance into the right atrium through the patent distal lumen. The triple-lumen catheter was removed and a double-lumen catheter (Blue FlexTip Catheter®, Arrow International) was passed over the guidewire. Fluoroscopy with dye injection confirmed that both catheter lumens were intravascular. The initial triple-lumen catheter was 16 cm long and had been inserted to the hub. The patient had an extremely large neck (>70 cm in circumference). Because of the distance between his skin and the vein, only the distal lumen was intraluminal. A chest radiograph after placement demonstrated that the catheter was intrathoracic, and because blood could be aspirated from the distal lumen its position was considered acceptable (Fig. 1). The replacement catheter was 20 cm long. The additional length was needed to allow both catheter lumens IV access (Fig. 2). A similar complication was recently reported with a much shorter 10.8 cm pulmonary artery catheter introducer in an obese patient (3).Figure 1.: A chest radiograph obtained after placement of the 16-cm triple-lumen subclavian catheter. Arrow points to the distal tip of the catheter.Figure 2.: A chest radiograph obtained after placement of the 20-cm double-lumen subclavian catheter. Arrow points to the distal tip of the catheter.Standard central venous access catheters placed in subclavian veins may not be long enough in some obese patients. Longer length catheters should be considered for these patients. When using any multilumen catheter, all lumens should be checked to confirm intravascular position after placement. In morbidly obese patients catheter position can change with movement (3), so position should be reconfirmed periodically. E. Ottestad, MD C. Schmiessing, MD John G. Brock-Utne, MD, PhD V. Kulkarni, MD D. Parris, MD J. B. Brodsky, MD Department of Anesthesia Stanford University Medical Center Stanford, CA [email protected]

Labeling of Medicines and Patient Safety: Evaluating Methods of Reducing Drug Name Confusion

We report three experiments evaluating the proposal that highlighting sections of drug names using uppercase ("tall man") lettering and/or color may reduce the confusability of similar drug names. Medication errors commonly involve drug names that look or sound alike. One potential method of reducing these errors is to highlight sections of names on labels in order to emphasize the differences between similar products. In Experiments 1 and 2, participants were timed as they decided whether similar name pairs were the same name or two different names. Experiment 3 was a recognition memory task. Results from Experiments 1 and 2 showed that highlighting sections of words using tall man lettering can make similar names easier to distinguish if participants are aware that this is the purpose of the intervention. Results from Experiment 3 suggested that tall man lettering and/or color does not make names less confusable in memory but that tall man letters may increase attention. These findings offer some support for the use of tall man letters in order to reduce errors caused by confusion between drug products with look-alike names. The use of tall man letters could be applied in a variety of visual presentations of drug names--for example, by manufacturers on packaging, labeling, and computer software, and in pharmacies on shelf labels. Additionally, this paper demonstrates two meaningful behavioral measures that can be used during product design to objectively assess confusability of packaging and labeling.

A Morning In The Museum

1. A GROUP ON THE TOP FLOOR Rauschenberg. Lichtenstein, Stella, vacuum cleaner. Scaffolding General Electric An inflated tire An Olympic swimmer The concept "A vacuum is cleaner" A balloon, a derangement of nature A primary color Don't forget The polished stone The museum makes The clean floors from How about a smear Of menstrual blood Or a sperm puddle On the formica bench Imagine Licking it A dog tongue Hungry. [End Page 24] 2. CLAES OLDENBURG: THREE SOFT SCULPTURES God bless America where we have this funny Sense of the ridiculous and "art That doesn't sit on its ass in a museum" Alphabet/ good humor (Looks like intestines) Upside down city (Stuffed muslin spray- Painted prison uniform Green, dried blood Red, and charcoal Polka dots: looks like Tortured folks hangin Upside down: or parts of em) Falling shoestring potatoes (Yellow canvas sculpture Drops from Kapok sawtooth Edge paper bag). 3. SEGAL'S DINER The shabby poetry is in the pathos The counter falling apart Is sort of sweet Like a distressed woodchuck A woodchuck sort of morning A coffee please a slice of I'm tired you'd be tired Working my kind of hours The pay I get, some life Plaster dripped over cotton And bandage gauze this guy [End Page 25] The woman behind the counter Is doughnut shape and falling Over about to bump The coffee urn. In that era kids Used to say "bunk" not bump "I bunked into it." "If he don't watch out He's gonna bunk Inta the tree." 4. MARK ROTHKO: THREE PAINTINGS Tragedy, ecstasy, doom, what the man said Painting was for, and here is a sorrow dredged From an oceanfloor, the undulant blues And purples resonant against your breastbone Like tribal drum-tones slipping through a jungle On a normal rainy day, savage and peaceful, Between two villages, or like a ship's engine Booming inaudibly while you observe The phosphorescence, the hard slaps The ocean gives to your vibrating hull, Gulls falling away as you leave the shore To enter the house of the sky. Later you'll turn your blanketed body Over and over again as the vessel travels Forward through lustrous water and moonlight. Be at peace now. The drowned tumble Endlessly in their bags, Wind blows ceaselessly Eastward above the surface, Remote from any earth where buildings stand. [End Page 26] 5. JIM DINE A) The Bathrobe Paintings Behind the dozen Or so great canvases Of the bathrobe, The human volume Afloat and aglow It is my alter ego On the museum wall Someone flits Like an insect, keeps The pot cooking, the voluminous Bathrobe washed And pressed, her thoughts to herself: It is some way To spend a life, She thinks – with her insect mind. B) Four Pastel Drawings of Tools axe like the femur shovel of a tall man shears elegant to the point clippers of pain [End Page 27] 6. LOBBY A) Cheerful Lady to Other Lady We could bring the boys I think they'd like it It's pretty weird. B) Next A boy in jeans and new Orange socks strides purposefully Through the lobby, his large And scuffed portfolio Under his arm, What do they know – What does anybody know– Walker Art Center, Minneapolis

Hypoplastic thyroid, growth hormone deficiency, corneal opacities, cataract and hyperkeratotic skin disease: a possible new ichthyosis syndrome associated with endocrinopathies

A 56 year old man presented with ichthyosis vulgaris since early childhood, clinically characterised by fine scaling of the trunk and hyperkeratotic scales on the exterior surfaces of the upper and lower extremities. The patient also showed hypothyroidism due to hypoplastic thyroid, cataract, hypercholesterinemia with concommitant arcus cornealis and biliary concrements. Renal lithiasis caused by calcio-oxalate was additionally present. Endocrinological screening revealed growth hormone deficiency in the 1.55 m tall man-(secondary) osteoporosis was observed. The clinical symptomatology indicates that this case cannot be considered as a subtype of the inherited ichthyosis group, but suggests a new syndrome as a separate nosologic entity.

Blood Ties

Grandpa's long legs once again appeared before my eyes. His long legs swaying, his arms—as thin and long as his legs—swinging, Grandpa strode into the wheat fields of my native homeland. It was a desolate and lonely image, and I can remember only what he looked like when he had become an old man: a gaunt figure striding between fields of broad beans and wheat. I see him passing time after time through the scenery, the houses, and the clan graveyards of the native place, carrying with him the scent of broad-bean flowers that were just opening. He seemed to be searching in vain for something he had lost long ago. All of this held within it a complete and profound feeling of beauty. But Grandpa walked tirelessly, as if his only goal was to remain obstinately independent, outside this sense of beauty, and to separate himself from the world. The impression of this tall old man with a stern expression and fastidiously neat beard was, without the slightest doubt, that of a guest: a lonely and unreasonable guest who didn't know where to go to return home. The area I'm describing is administratively part of Sichuan Province, but in its customs and in its heart, it belongs to Tibet. In other words, it is a mountain hamlet inhabited by Tibetans. This hamlet is my home, but it isn't Grandpa's native place. Grandpa is Chinese. I am this Chinese grandpa's Tibetan grandson. The Tibetan name Father gave me is Dorje. Before I was named, it is said that Grandpa had not yet become eccentric. People in the family knew nothing of his past. They all thought he was just naturally meek—and that he liked silence. He was so silent that at first he didn't even express an opinion on the important matter of naming his grandson. It was only when I began to learn to talk—ah, oh—and talked more every day that Grandpa also began to talk more often. "It seemed," Grandma said to Grandpa many years later, "that you were born all over again with Dorje. You talked more, and your disposition also changed." When she said this to him, I was already grown up and they were very old—not merely old but extremely old. Grandpa's eyes were so [End Page 138] clouded that they no longer seemed like eyes. For her part, Grandma became more and more childlike; even her voice sounded like a child's. It was the height of summer. Wherever I went, no matter how densely crowded it was, now I could suddenly see the light. The landscape of my native place opened up abruptly: the forests and mountains, the river valley, the hamlet shaded by a huge walnut tree. At the entrance to the village was a solid stone table. Carved on a rough stone wall was an enormous cow's head and the omnipotent three Buddhist treasures. Our family sat in the middle of the courtyard at high noon, and enjoyed the sunshine and tea. Gadflies and wild bees sang their buzzing songs amid the luxuriant flowers and grasses. One hybrid family gathered in an unusually purebred manner. I wasn't among them. The four generations were missing only me. But I saw the entire scene more clearly than the people who were placed in it. Grandma had been beautiful in her prime, but now in her old age, the skin of her face simply wrapped around the bones. Her forehead glistened like ebony. And Grandpa's lanky body seemed to be shrinking with each passing day. His head rose above the crinkled wool piled around his neck. For everyone gathered there, life was quiet, and the sour taste of barley alcohol and the sweet taste of yogurt brought a feeling of well-being to these people. In the courtyard, golden-yellow flowers were in full bloom. But I, the one far away, was making this family unhappy. This is why Grandma thought...

Drug name confusion: evaluating the effectiveness of capital (“Tall Man”) letters using eye movement data

Medication errors commonly involve confusion between drug names that look or sound alike. One possible method of reducing these errors is to print sections of the names in “Tall Man” (capital) letters, in order to emphasise differences between similar products. This paper reports an eye-tracking experiment that evaluates this strategy. Participants had their eye movements monitored while they searched for a target product amongst an array of product packs. The target pack was replaced by a similar distractor in the array. Participants made fewer errors when the appearance of the names had been altered, that is, they were less likely to incorrectly identify a distractor as the target drug. This result was reflected in the eye movement data.

Blue Ribbon Abstract Award: Applying Six Sigma Methodology for Process Improvement of Antibiotic Timing and Antibiotic Choice in the Preoperative Patient

ISSUE: The National Surgical Infection Prevention (NSIP) Project provides quality improvement tools and measures to improve surgical patient safety. Measures include antibiotic administration within 1 hour of incision and appropriate antibiotic choice. MBHS historical data revealed 37% compliance with surgical prophylactic antibiotic timing and 67% compliance with correct antibiotic selection. PROJECT: We formed an Antibiotic Timing and Antibiotic Choice in Surgery (ATACS) team utilizing Six Sigma methodology: Define, Measure, Analyze, Improve, and Control. The team's objectives were to improve antibiotic delivery from 37% to 90%, targeting administration time of 30 minutes prior to incision, and to improve prophylactic antibiotic selection compliance from 67% to 95% by June 1, 2003. The multidisciplinary team completed a cause-and-effect diagram and a Failure Mode and Effects Analysis (FMEA), and developed concise data-collection tools generating histograms, dot plots, and box plots. The team implemented a HANG & HOLD intervention and combined pre-operative order forms into one staff/physician/patient friendly Preoperative Information and Order Form. RESULTS: Antibiotic timing compliance improved 162%, from 37% (Mean=71, SD=34, N=64) to 97% (Mean=27, SD=11, n=87) (p=0.000). Compliance with correct antibiotic improved 45% from 67% (36/52) to 97% (82/84) (p=0.000). Preventing process failure was demonstrated by decreased FMEA risk scores. LESSONS LEARNED: Six Sigma methodology provided a quick study for rapid improvement. A carefully planned data-collection tool and accurate data analysis provided a basis for the team's change intervention and long-term controls. A legible pre-printed pre-operative order form guiding surgeon antibiotic choice (utilizing TALL MAN lettering) supported patient safety.

From Russia without Love: The "Fourth Wave" of Global Human Trafficking

Johanna Granville is an assistant professor of political science at Clemson University.Torgovlya Liud'mi: Sotsiokriminologicheskii Analiz, Center for the Study of Transnational Organized Crime and Corruption (TraCCC) (American University). Moscow: Akademia, 2002. 221 pp.Migrant Trafficking and Human Smuggling in Europe: A Review of the Evidence with Case Studies from Hungary, Poland, and Ukraine, International Organization for Migration (IOM). New York: United Nations Publications, 2000. 416 pp. $35.00 paperback.Disposable People: New Slavery in the Global Economy, Kevin Bales. Berkeley: University of California Press, 1999. 298 pp. $16.95 paperback.Global Human Smuggling: Comparative Perspectives, David Kyle and Rey Koslowski, ed. Baltimore: Johns Hopkins University Press, 2001. 374 pp. $18.95 paperback.War's Dirty Secret: Rape, Prostitution, and Other Crimes Against Women, Anne Llewellyn Barstow, ed. Cleveland: Pilgrim Press, 2000. 224 pp. $20.00 paperback.The roaring of the Boeing's engine matched twenty-six-year-old Lena Nakhimovskaya's barely suppressed excitement. So many months of preparation compressed into this one moment! It just proved that if you worked hard enough, you could get whatever you wanted. As the wheels finally hit the runway of Berlin's Schonefeld airport, she heard a silken feminine voice speaking rapid German. The jet airliner came to a stop, and Lena gathered up her belongings: the dog-eared hardback Istoriya Berlina too thick to fit in her purse and a long To Do list. Its first item: Ask Sergei to pay for German lessons.A few minutes later she walked beside Sergei as they entered the terminal. She had met him shortly after answering the ad for a job in Berlin as housekeeper and nanny. Friendly and outgoing when he coaxed her to sign the contract (verbovka), he had barely spoken a word during the whole journey from Samara. Strange.A tall man approached them. He wore a green T-shirt with German words on it and sleeves too tight for biceps as thick as thighs. He and Sergei conversed in low tones for about twenty minutes.Eager for action, she finally burst out, Hi. Please allow me to introduce myself. I am Lena Nakhimovskaya. Let's go tour the city now!The man looked at Sergei with a twinkle in his eye. Licking his upper lip, he ran his eyes slowly up and down her body. First take a tour of you, he said with a strong German accent.Sergei finally spoke to her, twisting her arm. I'll give the orders around here, devushka.Thunder clapped overhead as rain drops began to patter against the windows. Lena jerked away to rummage in her purse. Her voice rose hysterically. Where is my passport? Both men just stared at her with pity. You can't be serious.... her voice trailed off.The above scenario, albeit fictional, is unfortunately typical. In 1997 alone, 175,000 young women from Russia, the former Soviet Union, and Eastern and Central Europe were actually tricked and as commodities in the sex markets of the developed countries in Europe and the Americas. 1 Every year, at least 1 million women and children are taken from their homes and sold into slavery. 2 The United Nations' International Organization for Migration (IOM) estimates that as many as 4 million people worldwide are smuggled across borders each year, resulting in illicit profits amounting to $7 billion annually. 3 In addition to women from the former communist bloc, tens of thousands of other women from countries such as the Philippines, Dominican Republic, Colombia, Ghana, and Nigeria are trafficked abroad each year and forced into prostitution to pay off their debts for transportation and housing. 4 Given the extent and duration of the problem of global human trafficking and, more specifically, forced prostitution, astonishingly few people fully understand it. In Article 3 of the Protocol to Prevent, Suppress, and Punish Trafficking in Persons that supplements the United Nations Convention against Transnational Organized Crime (2000), human trafficking is defined as,the recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or use of force or other forms of coercion, abduction, fraud, deception, the abuse of power or position of vulnerability or the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. …

Memory in Canadian Courts of Law.

Abstract Thousands of people have found themselves facing criminal or civil litigation as a result of questionable memories. Sometimes these involve faulty memory of eyewitnesses to crimes. Psychological science has informed the legal system about memory and enabled productive changes in the handling of eyewitness evidence. The chances of wrongful convictions hopefully go down in the process . But sometimes the questionable memories involve allegations of massive repression of horrible brutalization. In these cases, there is enormous controversy, and downright skepticism, over whether such massive repression even occurs. Unless or until better proof becomes available for these types of claims, a reasonable argument exists for keeping these dubious claims out of the courtroom altogether. Canada has seen its share of problematic, if not downright dangerous, memories being introduced into legal cases. I had a chance to play a role in two such cases. One of them involved the mistaken identification of Thomas Sophonow, described in detail by (Yarmey, this issue). The other involved dubious allegations of repressed memories that forced teacher Michael Kliman to endure three trials before his ultimate acquittal, a case that should probably be considered when evaluating the conclusions drawn by Porter, Campbell, Birt, and Woodworth (this issue). In both of these cases, witnesses came to court to testify based on their memories, and in both cases false or highly dubious memories were accepted by Canadian jurors. For centuries now, we have had experience with people who come to court to testify, and they take the familiar solemn oath. In light of what psychological science has taught us about human memory, I recently proposed that witnesses probably ought to be taking a more realistic oath: Do you swear to tell the truth, the whole truth, or whatever it is you think you remember? (Loftus, 2002). Thomas Sophonow was accused of murdering a young waitress who worked in a donut shop in Winnipeg, Manitoba. Several eyewitnesses testified against Sophonow but there were problems with each one. For example, the photo array shown to a number of witnesses contained a picture of Sophonow, which was significantly different than the other men in the array. For one thing, Sophonow's picture was taken outdoors while the rest of the men were photographed inside. Sophonow is shown wearing a cowboy hat, unlike most of the other possible suspects. Sophonow was also the only man who was depicted in both the photo and the physical lineup, making it possible witnesses chose him because they had seen his picture before. Moreover, Sophonow was the tallest man shown to witnesses, and the killer had been described as a tall man. Despite these and other problems with the eyewitness testimony, Sophonow was convicted of murder and spent nearly four years in prison. Eventually, he was declared factually innocent. An official inquiry was established to investigate what went wrong, to determine just compensation for Mr. Sophonow, and to make recommendations about future cases. Commissioner Peter Cory was eloquent in his description of the suffering of this one man, falsely accused: What has he suffered? ...He is psychologically scarred for life. He will always suffer from the core symptoms of post-traumatic stress disorder. As well, he will always suffer from paranoia, depression and the obsessive desire to clear his name. His reputation as a murderer has affected him in every aspect of his life, from work to family relations. The community in which he lived believed him to be the murderer of a young woman, and that the crime had intimations of sexual assault. The damage to his reputation could not be greater. .... His reputation as a murder will follow him wherever he goes. There will always be someone to whisper a false innuendo. . In the mind of Thomas Sophonow, he will always believe that people are talking about him and his implication in the murder. …

Discussion: Session 4—Descending/Thoracoabdominal Aorta

Discussion: Session 4—Descending/Thoracoabdominal Aorta

Review of Light from the ashes.

PETER SUEDFELD (Ed.) Light From the Ashes Ann Arbor, MI: The University of Michigan Press, 2001, 456 pages (ISBN 0-472-06745-1, US$24.95, Softcover) Reviewed by ANDREW WINSTON How does a child of twelve experience this upheaval? asks Gerda Lederer, in Peter Suedfeld's Light From the Ashes. This upheaval is the Nazi persecution culminating in the Shoah. The contributors to this volume explore the way in which childhood experience of the Shoah affected their careers in psychology and other social sciences. The volume is the outgrowth of a 1996 symposium at the International Society for Political Psychology. Peter Suedfeld, who has studied coping in Holocaust survivors for a number of years (see, e.g., Suedfeld 1997, 2000; Suedfeld, Fell, & Krell, 1998), asked the participants to reflect on the relationship between their childhood trauma and their adult research interests. He subsequently invited other social scientists from a range of disciplines and countries to contribute to the published work. Specialists in Holocaust studies were explicitly avoided in this opportunity sample in order to focus on less obvious kinds of influence. The task proved painful for many; some potential contributors refused or withdrew. Readers will recognize such familiar names as Herbert Kelman and Ervin Staub, who are well known for their work on group conflict and violence; those from other disciplines generally have interests that overlap with political, social, or clinical psychology. In the case of Staub and Suedfeld, who have written explicitly on genocide, the influence of their experience seems obvious. However, they and the others have used these memoirs to explore the more subtle ways in which the Shoah helped to shape their emotional life, interpersonal style, values, and sense of meaning. The chapters are divided into three groups. First are six contributors, including Peter Suedfeld, who survived during the war in hiding. In contrast to the memoirs of adult concentration camp survivors such as Victor Frankl (1963), these are recollections of childhood. Mostly from assimilated middle class or professional homes, these children were forced to hide, flee, confront their own death, and confront the real death of their mothers and fathers. The use of unadorned prose increases the poignancy. Hadasa Black-Gutman tells of her experience at age five: Another family moved into our room as well. There was a tall man, his wife, and two children. They were nice. After a while the Gestapo took them away. The man came back alone. His wife and children had been killed. He became very ill, lying there for hours staring at the wall, refusing to eat. They made chicken broth for him, but he did not want any food. He died. He was put in the room at the end of the hallway where he lay covered with a sheet. I kept sneaking in, along with another little girl, to see what a dead body looked like and whether he would move again. He did not. (p. 19) Older children assume adult roles: The late Mary Engel relates how she quickly transformed herself into a courier of forged documents, an aid to the underground, and a scrounger for food. The brief narrative of her capture by the brutal Hungarian Arrow Cross is gripping, no matter how many times one has read such accounts. The urgent problem for these children was the management of their Jewish identity. Their names and histories were changed, often several times, and woe to the children who failed to remember which name was current, or to cross themselves, or to say recently learned Christian prayers. For boys, there was concealment of the body as well as the name. Circumcision must be hidden, a theme portrayed brilliantly in Agniezka Holland's 1991 film, Europa Europa. It is not surprising that themes of identity, stress, and danger appeared later in the research of these survivors. A second group of eight memoirs is provided by refugees who were able to leave Europe by 1940, some just barely in time. …

Nobel Thoughts On A Summer's Day

ALTHOUGH IT IS ONLY JULY, AT C&EN our thoughts are already turning to the Nobel Prize announcements in October. Maybe we are merely in the midst of the summer doldrums and need a diversion, or perhaps we are spurred to thinking about the Nobel Prize because of two stories in this week's issue —an appreciation of Nobel Laureate Donald J. Cram (see page 38) and a story about the Nobel Foundation's Virtual Internet Museum, also known as Nobel e-Museum (see page 42). A few words about each story. Cram, who won the Nobel Prize in Chemistry in 1987, died on June 17 at the age of 82. The outpouring of affection for this tall, imposing, friendly, and brilliant man was enormous and immediate. A number of eminent chemists called Cram their hero. Everyone at C&EN feels that our Nobel Laureates in Chemistry are global treasures and that their passing should be marked with more than ...