Unfavorable Disposition Research Articles

Commercial Gestational Surrogacy and Afrocentrism: A Determination of the Nigerian Disposition

This study surveys the disposition of Nigerians to commercial gestational surrogacy. It also examines the moral dilemma created by the fragmentation of motherhood into biological, gestational, and social motherhood that has created enormous conflicts over who should be considered a ‘mother’ and the concomitant parental rights and responsibilities for a child. The debates surrounding gestational surrogacy and its implications on existing reproductive rights raises most profound issues on the maternal roles which historically resided in one mother, and how this phenomenon can be situated within the African cultural milieu. While legislations exist in many countries on the permissibility or otherwise of commercial gestational surrogacy, there are no meaningful legislation specific to commercial gestational surrogacy in Nigeria. Therefore, the overall objective of this research is to determine the Nigerian disposition to commercial gestational surrogacy. To achieve this objective, a total sample size of two thousand (2000) questionnaires containing thirty items, aimed at capturing the subjectivity and phenomenology of this study, were randomly distributed amongst some selected Nigerians, and responses were collected and analyzed using simple percentages. Data collected indicates that 89.2% of the respondents were negatively disposed to commercial gestational surrogacy. Findings further show that gestational surrogacy presents challenges with some ethical and Afrocentric objections and unfavourable disposition. In conclusion, this study recognizes that gestational surrogacy has the potentials to adversely impact the value of human dignity and the family unit, and therefore a problem of public ethos. This study recommends that an authentic Afrocentric ethics should drive any legislation that might emanate from Nigeria concerning commercial gestational surrogacy, that Afrocentrism should be of paramount consideration in all gestational surrogacy engagements. Therefore, the Afrocentric import of gestational surrogacy should form a starting point of all engagements and actionable programmes in this novel emerging moral dilemma called “gestational surrogacy.”

사립학교 교원의 권리구제 효율화 방안

Education is the key responsibility to carry out the state because the achievement of education is the most important factor in determining the future of the country. Therefore, the status of teachers in charge of education should be guaranteed, and the educational activities of teachers should be protected and respected. And if the status and authority of the teacher are violated illegally, the authority must be protected and respected promptly and accurately. Under the current law, if a request for a petition is filed by the Teachers' Appeals Review Committee or if it is dissatisfied with the decision of the petition, the administrative litigation may be filed and remedied by the defendant, and the legal relationship of the private school teachers may be remedied through civil litigation. However, there are cases where the right to dispose of is not able to promptly and accurately remedy the right by neglecting the decision of appeal or filing an administrative lawsuit against the decision. Therefore, in order to secure the effectiveness of the decision of the appeal examination and to expand the right remedy, the objectivity of the appeal examination request should be expanded, the legitimacy of the disposition should be secured, the right of disposition should be prevented from abusing or being neglected, the implementation of the appeal examination decision should be enforced, and further punishment should be applied effectively. In addition, if the compensation through civil litigation becomes an issue, it will be possible to introduce a mediation system to promote rapid and economic rights relief. These teachers' rights relief is not only effective because the law and system are revised and newly introduced. Based on the importance of education, the right to dispose of the disposition should secure procedural and content legality, and in the teacher appeal examination system or litigation, it is necessary to strictly examine the disciplinary disposition or unfavorable disposition to improve the effect of legislation and system.

Technology acceptance before and after COVID-19: no-touch service from hotel robots

Aceptación de la tecnología antes y después de la pandemia del COVID-19: Servicios ofrecidos por robots en hotelesResumenPropósitoEsta investigación analiza la aceptación por parte de clientes del uso de robots en hoteles antes y después del comienzo de la pandemia del COVID-19, prestando una atención especial a si dicha pandemia ha tenido un efecto significativo sobre los niveles de aceptación de robots por parte de clientes en hoteles en China a raíz de la pandemia del COVID-19.Diseño/metodología/enfoqueLa muestra de este estudio incluye clientes de hoteles en China encuestados antes y después del brote de COVID-19, con 247 cuestionarios recogidos antes del brote y otros 601 después del mismo. Este estudio incluye una serie de hipótesis puestas a prueba adoptando un diseño de investigación de carácter pseudo-experimental.HallazgosLos resultados de este estudio apuntan a que el brote de COVID en China conllevó un incremento en la proporción de los clientes de hoteles propensos a aceptar el uso de robots en este contexto. Después de la pandemia, hubo un incremento en la percepción de la importancia de su utilidad, influencia social, actitud y valor de los robots en este contexto, mientras que descendió la percepción de la importancia de la facilidad del use de robots y antropomorfismo descendió. Como servicio sin necesidad de contacto físico, la utilidad de los robots en hoteles fue más valorada por los clientes Esto produjo una disminución en los requisitos de los usuarios en lo referente a la facilidad del uso de robots en hoteles. Además, los participantes en esta encuesta se mostraron más propensos a valorar la influencia sobre la sociedad del uso de robots.Restricciones e implicaciones del estudioLa actitud de clientes de hoteles y su aceptación del uso de robots en este contexto, así como los servicios que éstos proveen están cambiando rápidamente. No obstante, aún no se sabe con certeza hasta que punto estos cambios son meramente efímeros y motivados por una actitud pragmática hacia la crisis creada por la pandemia del COVID-19.Implicaciones prácticasEl sector de la hostelería debería intentar desarrollar un perfil de clientes nuevo en lo referente a su grado de aceptación de los robots como parte de los servicios ofrecidos. Los hoteles deberían considerar el uso de robots en los servicios ofrecidos dependiendo de las características demográficas de sus clientes (ejem. Nivel de estudios y formación).Originalidad del estudioEste estudio demuestra que las crisis de gran magnitud, como lo es la pandemia actual de COVID-19, pueden afectar las actitudes y comportamientos del consumidor en lo referente al uso de nuevas tecnologías. La pandemia del COVID-19 ha llevado a muchos clientes de hoteles a prestar una mayor atención a las ventajas de los servicios ofrecidos por robots como forma de reducir las posibilidades de contagio.

Criminal responsibility for leading to unfavorable disposal of the property

The article presents the legal framework of criminal liability for leading to an unfavorable disposition of property within the meaning of Art. 286 § 1 of the CC According to the wording of this provision, the person who, in order to gain financial gain, leads another person to an unfavorable disposition of his own or someone else's property by misleading him or exploiting a mistake or inability to properly understand the undertaken action, is subject to criminal liability.

How neuropsychiatric comorbidity, modulatory indication, demographics, and other factors impact deep brain stimulation inpatient outcomes in the United States: A population-based study of 27,956 patients

ObjectiveTo determine how neuropsychiatric comorbidity, modulatory indication, demographics, and other characteristics affect inpatient deep brain stimulation (DBS) outcomes. MethodsThis is a retrospective study of 45 months’ worth of data from the National Inpatient Sample. Patients were aged ≥ 18 years old and underwent DBS for Parkinson Disease (PD), essential tremor (ET), general dystonia and related disorders, other movement disorder (non-PD/ET), or obsessive-compulsive disorder (OCD) at a US hospital. Primary endpoints were prolonged length of stay (PLOS), high-end hospital charges (HEHCs), unfavorable disposition, and inpatient complications. Logistic models were constructed with odds ratios under 95% confidence intervals. A p-value of 0.05 determined significance. ResultsOf 214,098 records, there were 27,956 eligible patients. Average age was 63.9 ± 11.2 years, 17,769 (63.6%) were male, and 10,182 (36.4%) patients were female. Most of the cohort was White (51.1%), Medicare payer (64.3%), and treated at a large-bed size (80.7%), private non-profit (76.9%), and metro-teaching (94.0%) hospital. Neuropsychiatric comorbidity prevalence ranged from 29.9% to 47.7% depending on indication. Compared with PD, odds of complications and unfavorable disposition were significantly higher with other movement disorders and dystonia, whereas OCD conferred greater risk for HEHCs (p < 0.05). Patients with ET had favorable outcomes. Neuropsychiatric comorbidity, Black race, and Charlson Comorbidity Index > 0 were significantly associated with unfavorable outcomes (p < 0.05). ConclusionThe risk of adverse inpatient outcomes for DBS in the United States is independently correlated with non-PD/ET disorders, neuropsychiatric comorbidity, and non-White race, reflecting the heterogeneity and infancy of widespread DBS for these patients.

Associations between Features of External Ventricular Drain Management, Disposition, and Shunt Dependence

Abstract Background In the United States, nearly 25,000 patients annually undergo percutaneous ventriculostomy for the management of increased intracranial pressure with little consensus on extraventricular drain management. To characterize relationships between external ventricular drain management, permanent ventriculoperitoneal shunt placement, and hospital disposition, we hypothesized that patients requiring extended drainage would have greater association with ventriculoperitoneal shunt placement and unfavorable disposition. Methods Adult patients admitted to the Duke University Hospital Neuroscience Intensive Care Unit between 2008 and 2010 with extraventricular drains were analyzed. A total of 115 patient encounters were assessed to determine relative impact of age, sex, days of extraventricular placement, weaning attempts, cerebrospinal fluid drainage volumes, Glasgow Coma Scale, and physician’s experience on disposition at discharge and ventriculoperitoneal shunt placement. Univariate logistic regression was first used to test the effect of each variable on the outcome, followed by backward selection to determine a final multivariable logistic regression. Variables in the final model meeting p &lt; 0.05 were declared as significant factors for the outcome. Results Increased extraventricular drain duration (odds ratio [OR] = 1.17, confidence interval [CI] = 1.05–1.30, p = 0.0049) was associated with ventriculoperitoneal shunt placement, while older age (OR = 1.05, CI = 1.02–1.08, p = 0.0027) and less physician extraventricular drain management experience (OR = 4.04, CI = 1.67–9.79, p = 0.0020) were associated with unfavorable disposition. Conclusion In a small cohort, exploratory analyses demonstrate potentially modifiable factors are associated with important clinical outcomes. These findings warrant further study to refine how such factors affect patient outcomes.

Clinical outcomes of moderate to severe acute ischemic stroke in a telemedicine network

Acute ischemic strokes (AIS) with severe neurologic deficits are associated with poor short- and long-term prognosis. Thrombectomy alone or in combination with thrombolysis is used for reperfusion in patients with moderate-to-severe AIS. However, the best therapeutic approach within the setting of telemedicine networks needs to be elucidated further. The objective of this study was to analyze clinical and imaging based outcomes of moderate to severe stroke following treatment with thrombolysis, thrombectomy or a combination of both in a telemedicine network. Data of this retrospective study was abstracted from the institutional telestroke database. Patients with a National Institute of Health Stroke Scale score (NIH-SS ≥ 10) were included into the study. Primary outcome measure was the difference in NIH-SS at admission compared to discharge from the hospital. Secondary outcome measure was the discharge disposition defined as favorable (discharge to home or rehabilitation) versus unfavorable disposition (discharge to hospice/death). Furthermore, outcome was analyzed based on reperfusion status following thrombectomy using the Thrombolysis in Cerebral Infarction (TICI) scale. The NIH-SS improved in all three groups, independent of treatment subtype, with a trend towards best outcomes following thrombolysis and combined treatment therapy compared to thrombectomy alone. In addition, reperfusion rates were higher in the combination group compared to the thrombectomy only group. The number of favorable discharges was similar in all three groups. The present study stresses the benefits of tele-stroke networks in allowing to early identify and treat even patients with severe strokes and benefit from different treatment modalities.

Geriatric Trauma Screening Tool: Preinjury Functional Status Dictates Intensive Care Unit Discharge Disposition

Older adults account for an increasing percentage of trauma patients and have worse outcomes when compared with younger populations. Simple prediction tools are needed to designate risk categories among these patients. The Geriatric Trauma Screening Tool (GTST) was developed to risk stratify older adults admitted to the ICU at a Level 1 trauma center. One hundred fifty patients aged ≥ 65 years were prospectively screened for high-risk (HR) injuries, comorbidities, and prehospital function using the GTST. Patients who screened for HR were more likely to have an unfavorable disposition than non-HR patients. HR patients had significantly longer ICU and hospital length of stays when compared with non-HR patients. In addition, patients with prior functional impairment were at higher risk for an unfavorable discharge disposition than their counterparts. Implementation of the GTST predicted discharge disposition in geriatric trauma patients admitted to the ICU. Pre-injury functional status was a better predictor of discharge disposition than either the types of HR injuries or the presence of comorbidities. Risk stratification of geriatric trauma patients allows for early engagement of patients and caregivers regarding transitions of care as well as more efficient utilization of hospital resources.

Validation of a Geriatric Trauma Prognosis Calculator: A P.A.L.Li.A.T.E. Consortium Study.

The P.A.L.Li.A.T.E. (prognostic assessment of life and limitations after trauma in the elderly) consortium has previously created a prognosis calculator for mortality after geriatric injury based on age, injury severity, and transfusion requirement called the geriatric trauma outcome score (GTOS). Here, we sought to create and validate a prognosis calculator called the geriatric trauma outcome score ii (GTOS II) estimating probability of unfavorable discharge. Retrospective cohort. Four geographically diverse Level 1 trauma centers. Trauma admissions aged 65 to 102 years surviving to discharge from 2000 to 2013. None. Age, injury severity score (ISS), transfusion at 24 hours post-admission, discharge dichotomized as favorable (home/rehabilitation) or unfavorable (skilled nursing/long term acute care/hospice). Training and testing samples were created using the holdout method. A multiple logistic mixed model (GTOS II) was created to estimate the odds of unfavorable disposition then re-specified using the GTOS II as the sole predictor in a logistic mixed model using the testing sample. The final dataset was 16,114 subjects (unfavorable discharge status = 15.4%). Training (n = 8,057) and testing (n = 8,057) samples had similar demographics. The formula based on the training sample was (GTOS II = Age + [0.71 × ISS] + 8.79 [if transfused by 24 hours]). Misclassification rate and AUC were 15.63% and 0.67 for the training sample, respectively, and 15.85% and 0.67 for the testing sample. GTOS II estimates the probability of unfavorable discharge in injured elders with moderate accuracy. With the GTOS mortality calculator, it can help in goal setting conversations after geriatric injury.

The Relationship Between Frailty and the Subjective Decision to Conduct a Goals of Care Discussion With Burned Elders.

Best practices are to conduct an early discussion of goals of care (GoC) after injury in the elderly, but this intervention is inconsistently applied. We hypothesized that a frail appearance was a factor in the decision to conduct a GoC discussion after thermal injury. A retrospective review was performed of all burn survivors aged ≥ 65 years at our American Burn Association (ABA)-verified level 1 burn center between April 02, 2009, and December 30, 2014. Demographic information included age, gender, mechanism of injury, percentage TBSA burned, revised Baux score, patient/physician racial discordance, documented GoC discussion (as defined within the electronic medical record), length of stay (LOS), and disposition. One rater retrospectively assigned clinical frailty scores to patients using the Canadian Study of Health and Aging Criteria, which ranged from 1 (very fit) to 7 (severely frail). Ordinal logistic regression was performed. Demographics for the cohort of 126 subjects were (mean ± SD): age = 75.5 ± 7.7 years, %TBSA burned = 11.9% ± 7.2, revised Baux = 87.8 ± 10.2, hospital LOS (days) = 14.9 ± 13.7, Intensive Care Unit (ICU) LOS (days) = 6.2 ± 1.2, frailty score = 4.1 ± 1.1. Overall, 72% of geriatric survivors had a favorable discharge disposition. GoC discussions occurred in 25% of patients. GoC discussion (OR, 3.42; 95% CI, 1.54-7.60) and an unfavorable disposition (OR, 9.01; 95% CI, 3.91-20.78) were associated with greater predicted odds of receiving a higher ordered frailty score. Our results suggest that, even in the absence of a formal diagnosis, a frail appearance may influence a provider's decision to perform GoC discussions after severe thermal injury.

English

Rice production is limited by many biotic and abiotic factors which are aggravated when climate change induces variation in climate patterns. Predicting effects of these variations in climate parameters on rice is not straight forward because crops in growth stage are affected in a specific manner which involves tactical adjustments of cropping calendar in order to ensure optimum production. Primary data were collected from randomly sampled 112 rice farmers in the study area using structured interview schedule on their socio-economic and farm enterprise characteristics, awareness of climate change and perception of effects of climate change on rice development stages in Niger State. More than half (67.0%) and (58.0%) of the respondents had favourable disposition towards climate change effects on rice vegetative and maturity stages, respectively while 75% had unfavourable disposition on the reproductive stage. There was inverse relationship (r-value = -0.16, p-value = 0.09) between perceived effects of climate change and farmers productivity. Farmers perception of effects of climate change on rice is hinged on irregular rainfall pattern that encourages weed growth, and excess water encourages fungal diseases spread which lowers rice yield. Rice farmers therefore, are advised to plant varieties that can withstand changes in the climate. Key words: Rice farmers, rice development stages, climate change effects.

Abstract TP30: Is IV tPA Use Associated With Acute Carotid Stent Closure in Patients Presenting With Acute Ischemic Stroke With Tandem Lesions Treated With Endovascular Therapy?

Introduction: Carotid occlusions are responsible for 10-25% of large vessel acute ischemic strokes (AIS). While endovascular therapy (ET) is now standard of care for large vessel AIS, tandem lesions remain a therapeutic challenge. Outcomes of patients with tandem lesions undergoing ET with carotid revascularization remain unknown. We aimed to determine the prevalence, risk factors and outcomes of acute carotid stent closure (ACSC) in AIS patients with tandem lesions undergoing ET. Methods: Retrospective review of endovascular database of AIS patients treated in a single tertiary care center from 2010-2016. Patients with tandem lesions identified. Baseline demographics, home medications, IV tPA use, procedural characteristics and outcomes collected. Patients grouped according to carotid stent patency. Data analyzed using SPSS. Factors with p &lt; 0.20 included in multivariate model. Results: Out of 280 AIS patients undergoing ET, a total of 32 patients with tandem lesions identified. ACSC seen in 25% of patients. Baseline demographics similar in two groups. IV tPA use associated with 3 times greater risk of ACSC (12.5% vs 37.5%; p = 0.10). Number of stents (No ACSC 1.13 ± 0.33 vs ACSC 1.75 ± 1.04; p = 0.013) significant in univariate analysis. Baseline mRS, IV tPA use, Number of Stents, Post Stent Angioplasty, Residual ICA stenosis and Poor TICI recanalization grade included in the multivariate model. Number of stents (p = 0.028) and Poor TICI recanalization grade (p = 0.031) reached significance on multivariate linear regression analysis. Patients with ACSC had significantly greater hospitalization days (7.08 ± 3.73 vs 13.5 ± 6.86; p = 0.002), worse discharge mRS (2.17 ± 2.09 vs 4.5 ± 0.75; p = 0.005), worse discharge NIHSS (4.33 ± 4.53 vs 14.71 ± 4.85; p = 0.001), unfavorable disposition (16.67% vs 62.5%; p = 0.023) and worse 90 days mRS (2.0 ± 2.25 vs 4.67 ± 0.82; p = 0.01). Conclusions: ACSC seen in 25% of AIS with tandem lesions treated with ET. IV tPA use associated with 3 times greater risk of ACSC (37.5% vs 12.5%) presumably due to an inability for antiplatelet loading. Number of stents and poor TICI recanalization grade reached significance on multivariate analysis. ACSC associated with significantly worse outcomes. Larger studies are required to confirm these findings

Standardizing ICU management of pediatric traumatic brain injury is associated with improved outcomes at discharge.

OBJECT The goal of critical care in treating traumatic brain injury (TBI) is to reduce secondary brain injury by limiting cerebral ischemia and optimizing cerebral blood flow. The authors compared short-term outcomes as defined by discharge disposition and Glasgow Outcome Scale scores in children with TBI before and after the implementation of a protocol that standardized decision-making and interventions among neurosurgeons and pediatric intensivists. METHODS The authors performed a retrospective pre- and postprotocol study of 128 pediatric patients with severe TBI, as defined by Glasgow Coma Scale (GCS) scores < 8, admitted to a tertiary care center pediatric critical care unit between April 1, 2008, and May 31, 2014. The preprotocol group included 99 patients, and the postprotocol group included 29 patients. The primary outcome of interest was discharge disposition before and after protocol implementation, which took place on April 1, 2013. Ordered logistic regression was used to assess outcomes while accounting for injury severity and clinical parameters. Favorable discharge disposition included discharge home. Unfavorable discharge disposition included discharge to an inpatient facility or death. RESULTS Demographics were similar between the treatment periods, as was injury severity as assessed by GCS score (mean 5.43 preprotocol, mean 5.28 postprotocol; p = 0.67). The ordered logistic regression model demonstrated an odds ratio of 4.0 of increasingly favorable outcome in the postprotocol cohort (p = 0.007). Prior to protocol implementation, 63 patients (64%) had unfavorable discharge disposition and 36 patients (36%) had favorable discharge disposition. After protocol implementation, 9 patients (31%) had unfavorable disposition, while 20 patients (69%) had favorable disposition (p = 0.002). In the preprotocol group, 31 patients (31%) died while 6 patients (21%) died after protocol implementation (p = 0.04). CONCLUSIONS Discharge disposition and mortality rates in pediatric patients with severe TBI improved after implementation of a standardized protocol among caregivers based on best-practice guidelines.

Impact of early palliative care consultation on inpatient length of stay and discharge disposition among oncology patients.

53 Background: As palliative care develops as a medical subspecialty, studies are needed to assess its impact on patient care. Studies examining the effect of inpatient palliative care consult (PCC) on the admission length of stay (LOS) for non-ICU patients have failed to demonstrate consistent results. Also, there is a paucity of data on the effect of PCC on discharge disposition. The objective of this study is to examine the effect of early PCC on the length of stay and discharge disposition among cancer patients discharged alive. Methods: A retrospective review of oncology inpatients (pts) from January 2011 to Jan 2014 of whom 307 had PCC (PC group) and 305 pts did not have PCC (NC group). Visits less than 4 days, those ending with in-hospital deaths and those with PCC called more than 3 days into the admission were excluded. Groups were randomly matched based on All Patient Refined Diagnosis Related Group (APR DRG) Severity of Illness scores. Median LOS was compared with the Mann Whitney test. Pts coming from home without services (certified home health agency, advanced illness management, hospice, skilled nursing facility, or rehabilitation center) and discharged with services were considered favorable dispositions; any discharge without services was considered unfavorable disposition; all other dispositions considered neutral. Chi Square test was used to analyze discharge disposition. Results: The demographic profiles of 2 groups were similar in age, race, religion, marital status, insurance and living condition; females were more likely to get PCC (60 % vs 44 %, p&lt;0.001). Median (minimum, maximum) LOS for PC group was longer by 1 day: 8 (4, 76) days vs 7 (4, 251) days for NC group (p=0.003). PC group was more likely to receive a favorable discharge disposition (45 % vs 36 %); less likely to receive unfavorable discharge (13 % vs 28 %, overall p &lt; 0.001). Neutral dispositions were similar (41% vs 35 %). Conclusions: Oncology pts with PCC have 1 day longer LOS compared to those without it but are more likely to get a favorable discharge disposition. This may favorably impact readmission rates, which we hope to study in the future.

HPM-2, the Layered Precursor to Zeolite MTF

HPM-2 is a new organosilicate layered material synthesized by the fluoride route using 2-ethyl-1,3,4-trimethylimidazolium. The layers are of a new structural type (denoted mtf) and are held together by strong hydrogen bonds giving rise to a 1H magic angle spinning (MAS) nuclear magnetic resonance (NMR) at around 16 ppm and by Coulombic interactions between silanolates and the organic cations residing in the interlayer space. Upon calcination HPM-2 transforms into the pure silica MTF zeolite by topotactic condensation, a process that is essentially completed at 400 °C. Attempts to apply known methods to derive new materials (swelling, delamination, interlayer expansion) are described. In the case of the interlayer expansion reaction, a nonmicroporous dense phase is obtained, which is likely due to an unfavorable disposition of silanols in close couples within each layer. Silanol condensation between the newly incorporated silicon species occurs across the main window producing narrower (6 member ring, 6MR)...

Influence of attitude and social belief on domestication of snail production in the South Senatorial District of Delta State Nigeria

The study was designed to analyze the influence of attitude and social beliefs on domestication of snail production in the south Senatorial District of Delta State Nigeria. It was a follow-up of the introduction and technical training for commercial snail production organized by the Fadama Agricultural Development Program, Delta State Nigeria in 2010. The specific objectives were: (i) identify the sources of snail supply to major markets in the study area, (ii) assess the extent of adoption of �snailery� by the program participants, (iii) examine the attitude of the program participants to domestication of snail production; (iv) ascertain the influence of social beliefs on domestication and consumption of snail; and (v) draw a relationship between religious affiliation and domestication of snail. An interview schedule which consisted of structured and semi structured items was used for data collection. Simple random sampling was used in selecting the program participants. Snow ball sampling was used in selecting snail traders in markets where the traders were scattered within the vicinity. Data were measured by the use of four point Likert type rating scale. Data were analyzed by the use of percentage, mean and Chi square test. It was found that the major source of snail supply to the markets was through wild gathering (91.18%). A high number of the program participants (88.04%) have adopted �snailery� but only (6.17%) have offered their products for sale in the markets. The program participants showed favourable disposition to eight and unfavourable disposition to two attitude statements with a grand mean of 3.22 and 1.82 respectively. The respondents agreed that some people forbid snail meat because of religious and cultural reasons hence the large scale domestication was slow (M=2.65). This meant that religion and culture affected large scale domestication of snail production. There was a significant relationship (p < 0.05) between domestication of snail production and religious affiliation (X2=49.15). Donor agencies and social workers should take into cognizance the social environment of an innovation before the introduction in order to facilitate its adoption. Education campaign geared to appreciate the value of snail consumption and domestication should be carried out by development intervention agencies in the study area.

Effect of implementation of a paediatric neurocritical care programme on outcomes after severe traumatic brain injury: a retrospective cohort study

Outcomes after traumatic brain injury are worsened by secondary insults; modern intensive-care units address such challenges through use of best-practice pathways. Organisation of intensive-care units has an important role in pathway effectiveness. We aimed to assess the effect of a paediatric neurocritical care programme (PNCP) on outcomes for children with severe traumatic brain injury. We undertook a retrospective cohort study of 123 paediatric patients with severe traumatic brain injury (Glasgow coma scale scores ≤8, without gunshot or abusive head trauma, cardiac arrest, or Glasgow coma scale scores of 3 with fixed and dilated pupils) admitted to the paediatric intensive-care unit of the St Louis Children's Hospital (St Louis, MO, USA) between July 15, 1999, and Jan 15, 2012. The primary outcome was rate of categorised hospital discharge disposition before and after implementation of a PNCP on Sept 17, 2005. We developed an ordered probit statistical model to assess adjusted outcome as a function of initial injury severity. We assessed care-team behaviour by comparing timing of invasive neuromonitoring and scored intensity of therapies targeting intracranial hypertension. Characteristics of treated patients (aged 3-219 months) were much the same between treatment periods. Before PNCP implementation, 33 (52%) of 63 patients had unfavourable disposition at hospital discharge (death or admission to an inpatient facility) and 30 (48%) had a favourable disposition (home with or without treatment); after PNCP implementation, 20 (33%) of 60 patients had unfavourable disposition and 40 (67%) had favourable disposition (p=0·01). Seven (11%) patients died before PNCP implementation compared with two (3%) deaths after implementation. The probit model indicated that outcome improved across the spectrum of Glasgow coma scale scores after resuscitation (p=0·02); this improvement progressed with increasing injury severity. Kaplan-Meier analysis suggested that neuromonitoring was started earlier and maintained longer after implementation of the PNCP (p=0·03). Therapeutic intensity scores were increased for the first 3 days of treatment after PNCP implementation (p=0·0298 for day 1, p=0·0292 for day 2, and p=0·0471 for day 3). The probit model suggested that increasing age (p=0·03), paediatric risk of mortality III scores (p=0·0003), and injury severity scores (p=0·02) were reliably associated with increased probability of unfavourable outcomes whereas white race (p=0·01), use of intracranial pressure monitoring (p=0·001), and increasing Glasgow coma scale scores after resuscitation (p=0·04) were associated with increased probability of favourable outcomes. Outcomes for children with traumatic brain injury can be improved by altering the care system in a way that stably implements a cooperative programme of accepted best practice. St Louis Children's Hospital and the Sean Glanvill Foundations.

Outcomes associated with transdermal nicotine replacement therapy in a neurosurgery intensive care unit

The outcomes associated with transdermal nicotine replacement therapy (NRT) in a neurosurgery intensive care unit (ICU) were studied. Data from pharmacy records, neurosurgery ICU admission logs, and computerized patient charts at the University of Illinois Medical Center at Chicago from January 2001 through August 2008 were reviewed for patients older than 18 years who were admitted to the neurosurgery ICU for neurologic insults. Patients were categorized into three groups: smokers who received transdermal NRT (n = 114), smokers who did not receive transdermal NRT (n = 113), and nonsmokers (n = 113). The primary outcome of this study was unfavorable disposition at discharge from the hospital. Secondary outcomes measured included overall mortality; lengths of hospital and neurosurgery ICU stays; and rates of subarachnoid hemorrhage (SAH) rebleeding, angiographic vasospasm, intracerebral hemorrhage rebleeding, and ischemic stroke. Overall, there was no difference in unfavorable discharge disposition among the three groups (p = 0.17). However, the group who received NRT had higher admission rates of SAH, smoked more cigarettes for a longer period of time, and had longer stays in the neurosurgery ICU and hospital compared with the other groups. All patients who received NRT had prolonged hospital (p = 0.014) and neurosurgery ICU (p = 0.006) stays compared with those who did not receive NRT. There were no differences in other secondary outcomes among the groups. There was no significant difference in unfavorable discharge disposition among neurosurgery ICU patients who were smokers treated with NRT, smokers not treated with NRT, and nonsmokers not treated with NRT.

Synthesis and application of diphenylbis (3,5-dimethylpyrazol-1-yl)methane to form η 2-arene complexes of molybdenum

The neutral nitrogen-bidentate ligand, diphenylbis(3,5-dimethylpyrazol-1-yl)methane, Ph 2CPz′ 2, can readily be obtained by the reaction of Ph 2CCl 2 with excess HPz′ in a mixed-solvent system of toluene and triethylamine. It reacts with [Mo(CO) 6] in 1,2-dimethoxyethane to give the η 2-arene complex, [Mo(Ph 2CPz′ 2)(CO) 3] ( 1). This η 2-ligation appears to stabilize the coordination of Ph 2CPz′ 2 in forming [Mo(Ph 2CPz′ 2)(CO) 2(N 2C 6H 4NO 2- p)][BPh 4] ( 2) and [Mo(Ph 2CPz′ 2)(CO) 2(N 2Ph)] [BF 4] ( 3) from the reaction of 1 with the appropriate diazonium salt but the stabilization seems not strong enough when [Mo{P(OMe) 3} 3(CO) 3] is formed from the reaction of 1 with P(OMe) 3. The solid-state structures of 1 and 3 have been determined by X-ray crystallography: 1-CH 2Cl 2, monoclinic, P2 1/ n, a = 11.814(3), b = 11.7929(12), c = 19.46 0(6) Å, β = 95.605(24)°, V = 2698.2(11) Å 3, Z = 4, D calc = 1.530 g/cm 3 , R = 0.044, R w = 0.036 based on 3218 reflections with I > 2σ( I); 2 ( 3)-1/2 hexane-1/2 CH 3OH-1/2 H 2O-1 CH 2Cl 2, monoclinic, C2/ c, a = 41.766(10), b = 20.518(4), c = 16.784(3) Å, β = 101.871(18)°, V = 14076(5) Å 3, Z = 8, D calc = 1.457 g/cm 3, R = 0.064, R w = 0.059 based on 5865 reflections with I > 2σ( I). Two independent cations were found in the asymmetric unit of the crystals of 3. The average distance between the Mo and the two η 2-ligated carbon atoms is 2.574 Å in 1 and 2.581 and 2.608 Å in 3. The unfavourable disposition of the η 2-phenyl group with respect to the metal centre in 3 and the rigidity of the η 2-arene ligation excludes the possibility of any appreciable agostic CH → Mo interaction.

Guidance and Guidance Systems in Secondary Schools: The Teacher's Views

The reorientation of school guidance to involve teachers in career guidance was the premise for this study. The objectives were to assess the attitudes of secondary vocational teachers toward the importance and adequacy of school guidance systems. Some 248 teachers were sent an instrument listing 19 guidance activities. Two scales of five options were used for importance and adequacy. A 75% response rate was achieved. Overall, the teachers believe that career guidance is an important function; however, they have an unfavorable disposition toward the adequacy of school guidance systems in providing students with career guidance.