Personnel flux and workplace anxiety: Personal and interpersonal consequences of understaffing in UK ultrasound departments.

INTRODUCTION: By 2013, the UK government's Migration Advisory Committee had determined sonography to be a formal shortage speciality, and understaffing remains a key concern for research in the domain. This paper, emergent of a qualitative study funded by Health Education North West, explores unit managers' perspectives on the present state of UK ultrasound. The focus herein falls upon the personal and interpersonal consequences of this circumstance for individuals working in specific understaffed departments. METHODS: A thematic analysis informed by a Straussian model of Grounded Theory was utilised; N = 20 extended accounts provided by ultrasound department leads in public (n = 18) and private (n = 2) units were collected and analysed accordingly. RESULTS: The global themes addressed herein describe (a) how both inter-departmental movement of senior sonographers and early retirement, within a nationally understaffed picture, impacts upon local knowledge economies, and (b) how such staffing instabilities can undermine the day-to-day confidence of managerial staff and practicing sonographers alike. CONCLUSIONS: It is personnel flux, rather than simple short-staffing, that is reported to cause the greatest social-psychological problems for both managers and sonographers. The issues raised herein require further examination from the perspective of sonographers themselves, in order to corroborate the views of the managers interviewed.

The fate of a thiazolidinedione antidiabetic agent in rat and dog.

1. The fate of [14C]BRL 49653C, a novel thiazolidinedione antidiabetic agent, has been studied following oral administration to the rat and dog. 2. Clearance was almost exclusively by metabolism, with only small amounts of unchanged BRL 49653 being excreted by either species. 3. Phase I metabolism resulted in ring hydroxylation, N-demethylation and oxidative removal of the pyridinylamino function to yield a phenoxyacetic acid derivative. 4. Sulphation of phase I metabolites occurred in both species, but glucuronidation was only observed in the rat. 5. The parent compound was the major circulating component in both species at early times, but at later times sulphate conjugates of phase 1 metabolites were predominant.

The disposition of clavulanic acid in man.

Following oral administration of potassium 14C-clavulanate to four human subjects, at least 73% of the radioactive dose was absorbed. The mean absolute bioavailability was 64%. Absorption was rapid with peak plasma concentrations of radioactivity and clavulanic acid (2-6 micrograms/ml) occurring between 45 min and three hours after dosing. Values for the volume of distribution at steady-state and terminal half-life of clavulanic acid in the plasma were 12.01 and 0.8 h respectively. Following intravenous administration of clavulanic acid to the same subjects, the clearance, and volume of distribution at steady-state were 0.21 l/min, and 12.01, respectively. Clavulanic acid was the major radioactive component present in 0-24 h urine following oral dosing (23% of the dose). The two major metabolites were 2,5-dihydro-4-(2-hydroxyethyl)-5-oxo-1H-pyrrole-3-carboxylic acid (15% of the dose) and 1-amino-4-hydroxybutan-2-one (8.8% of the dose). Clavulanic acid and 1-amino-4-hydroxybutan-2-one were the major components in plasma following oral administration (52 and 21% of plasma radioactivity respectively at two hours after dosing). The major route of excretion of radioactivity following oral administration was via the urine (73% of the dose). Most of this radioactivity was excreted in the first 24 h after dosing (68% of the dose). The renal clearance of clavulanic acid was 0.1 l/min. Elimination of radioactivity also occurred via the expired air (17% of the dose) and the faeces (8% of the dose).

Absorption, metabolism and excretion studies on clavulanic acid in the rat and dog.

At least one third of an oral dose of sodium [G-14C]clavulanate was absorbed by rat and dog. Excretion of radioactivity was rapid in both species. In addition to urinary and faecal excretion of radioactivity, appreciable elimination of 14CO2 occurred, particularly in the rat. This was produced in part by the action of the gut microflora. In the rat, only a small proportion of the radioactive dose was secreted in the bile. The major metabolite in urine was identified as 1-amino-4-hydroxybutan-2-one. Clavulanic acid was also a major component in urine.

Adolescent contraception.

PIP: Both the medical profession and the general public are becoming more and more aware of the need for adolescent contraception and the devastating consequences of the lack of such care. It is the responsibility of family planning providers and educators to offer this type of service tailored to adolescents and their unique needs. The service must include counseling, education, provision of contraceptives, and followup medical care. To better understand adolescent contraception, it is necessary to understand adolescent sexuality, the teenage pregnancy problem, the risks of teenage pregnancy, and the unique aspects of the contraceptive methods available to teenagers. Each of these areas is reviewed. The most important developmental task of adolescence relates to sexual maturation. The child's body undergoes complex changes necessary for adult function, and the sex drive is awakened. The teenager is faced with the task of developing a sexual identity and personal values about sexual behavior. The 2 important tasks in sexual counseling of the adolescent are helping them to decide whether or not they are ready for sexual intimacy and encouraging them to assume responsibility for their sexual behavior. The consequences of adolescent sexual activity are the rise in teenage sexually transmitted diseases and the rise in teenage pregnancies. Medically, the hazards of an adolescent pregnancy include: an overall increase in incidence of infant mortality 2-3 times that of the normal population; twice as many growth retarded infants born to teen mothers; maternal mortality 60% higher than normal; a low incidence of prenatal care early in pregnancy; and 27% of pregnancies terminated by abortion. Equally important are nonmedical consequences for the teenage parent. In general, the consequences of teen parenthood are more severe for the young mother than for the young father. Teen mothers have a suicide rate 10 times that of the general population. In discussing contraception, attention is directed to all available contraceptive methods (abstinence, sex without intercourse, natural family planning, withdrawal, condoms and vaginal spermicidal agents, diaphragm, IUDs, and abortion), but emphasis is on oral contraceptives (OCs). The popularity of OCs among adolescents is due primarily to 2 factors: the agents are highly effective and their use is not associated directly with the act of coitus. For the physician, there are 2 concerns associated with the use of these exogenous steroids in the not fully mature patient: administration might cause premature closure of the epiphyses and inhibition of full stature development; and the steroids might cause permanent hypothalamic-pituitary dysfunction. Both concerns are relatively unwarranted. The OC might be an excellent choice for the adolescent without medical contraindication, who has established regular menses, and who has intercourse on a regular or fairly frequent basis.^ieng

The metabolic disposition of [14C]pivhydrazine, [14C]mebanazine, and [14C]benzylhydrazine in the rat.

The hydrazine drugs, [14C]pivhydrazine and [14C]mebanazine and the related compound [14C]benzylhydrazine were readily absorbed from the rat gut and the radioactivity was excreted mainly in urine. The major urinary metabolite of pivhydrazine and benzylhydrazine was [14C]hippuric acid, whereas mebanazine was shown to be excreted largely unchanged. Biliary excretion (21 and 24%, respectively) of radioactive material was observed after administration of [14C]pivhydrazine and [14C]mebanazine to bile duct-cannulated rats but only small amounts (approximately 3%) were excreted in bile after [14C]benzylhydrazine administration. The major biliary metabolites of pivhydrazine and mebanazine are acid-labile conjugates, possibly N-glucuronides. In vitro studies with rat liver homogenate suggest that benzylhyrazine may be an intermediate in the metabolism of pivhydrazine. The distribution of radioactivity in the rat 7 days after the administration of [14C]pivhydrazine and [14C]pivhydrazine and [14C]mebanazine is described.

Metabolism of hydrazines and hydrazides by the intestinal microflora.

Intestinal microorganisms are able to effect the metabolic reductive fission of hydrazines but not hydrazides during incubation in vitro.