Identifying avoidable switchboard delays in England's NHS hospitals: phase one of the national SWITCH project.

BACKGROUND: Inter-hospital communication frequently requires mediation via a switchboard. Identifying and eliminating switchboard inefficiencies may improve patient care. METHODS: All 175 acute hospital switchboards in England were contacted six times. Call contents and duration were recorded. No clinician calls or bleeps were connected. RESULTS: The mean delay before contacting a switchboard operative was 55±46 seconds. 115 hospitals (66%) used automated switchboards; 34 of these (30%) had infection control messages. Robot operators introduced an additional 40 second delay versus humans (mean 70.3±28 versus 29.8±23 seconds, p<0.0001). Multivariate analysis identified robot operators (HR 5.1, p<0.0001) and infection control messages (HR 2.9, p=0.003) as predictors of delays over 60 seconds. CONCLUSIONS: There are significant avoidable delays in contacting switchboard operatives across England. Quality improvement is underway.

Skin sensitization and possible groupings for 'read across' for rosin based substances.

A series of chemically modified rosin resins have been tested for their potential to cause skin sensitization using the mouse LLNA. Where direct comparative evidence is available, the results of the mouse LLNA are consistent with previously obtained data using the GPMT. Reactions with sufficient fumaric acid or maleic anhydride lead to maleopimaric acid anhydride (an acid anhydride), and give a clear response of a strong sensitizer that definitely requires classification. This sensitization is probably immunologically distinct from that claimed for oxidized rosin. Esterification will deactivate acid anhydrides formed from reacting rosin with maleic anhydride or fumaric acid. However, with maleic anhydride, there remains material capable of inducing a marginal (but classifiable under current criteria) immune response after the rosin had been maleinated and esterified. If proposed potency criteria are used these substances would not be considered 'strong sensitizers'. This response may be a function of a greater solubility in vehicle of the esterified maleinated (or fumarated) rosin over directly esterified material. Solubility limitations in the case of gum rosin directly esterified with pentaerythritol mean that it is not classifiable. Decarboxylated rosin and the glycerol ester of tall oil rosin are adequately soluble, and are not classifiable according to EU criteria. Polymers formed from rosin are also not classifiable as sensitizers. These studies confirm the value of grouping substances for 'read across' and the groupings chosen under the US EPA High Production Volume (HPV) Challenge Program. They also confirm the difficulties involved in dealing scientifically when examining the problem of skin sensitization associated with rosin related substances whilst still meeting current EU regulatory criteria.

On the skin sensitisation potential of rosin and oxidised rosin.

In the EU rosin is classified as a skin sensitiser, apparently on the basis of its oxidation to sensitising agents. Rosin (gum, tall oil or wood) is not a skin sensitiser when examined in the guinea pig maximisation test (GPMT). Oxidised rosins are sensitisers in the GPMT. Oxidised gum rosin was further tested in the mouse local lymph node assay (LLNA) and the Buehler test, but is not a sensitiser in either of these tests. Further, the outcome of the LLNA can be used to assess the potency of oxidised rosin as an inducing agent in humans, and oxidised rosin is, at most, a weak sensitiser in this test. Thus, oxidised rosin is not a potent inducing agent for skin sensitisation unless the dermal barrier is bypassed and/or there is deliberate use of Freund's Complete Adjuvant to induce greater susceptibility. The material used for human patch testing ('colophony') is in oxidised form. A re-examination of epidemiological studies suggests that patients in dermatological clinics show higher response rates than do the general population or those occupationally exposed to presumably oxidised rosin. Thus, the differences seen in susceptibility in the regulatory tests may be reflected in the human population. These results are discussed in terms of possible testing and classification strategies for dealing with existing chemicals, with particular reference to the new European Union legislation.

Observations on the accessibility of acceptor substrates to the active centre of UDP-glucuronosyltransferase in vitro.

The partition coefficients between octanol and pH 7.4 buffer for eleven substrates of UDP-glucuronosyltransferase (EC 2.4.1.17) have been determined. They range between 1.1 and 690 in the order p-aminophenol less than phenol less than (o-aminobenzoic acid = o-aminophenol = p-aminobenzoic acid) less than p-nitrophenol less than 4-methylumbelliferone less than mercaptobenzothiazole less than harmol less than phenolphthalein less than 1-naphthol. The effect of Triton X-100, used as a model membrane pertubant, on the enzyme activity of UDP-glucuronosyltransferase in rat liver homogenates towards these substrates was determined and compared with the partition coefficients. Enzyme activities towards p-aminophenol and phenol were decreased by Triton X-100, the enzyme activities towards other acceptor substrates were enhanced maximally with 0.025% (w/v) Triton. "Native" enzyme activity (except for amino containing compounds) and activation could be related to partition coefficient of the substrate. An increase in lipid solubility resulted in reduced enzyme activity in untreated homogenates and greater activation. These results suggest UDP-glucuronosyltransferase lies behind a partially lipid-impenetrable abrrier and it is suggested that this barrier is broken up by membrane perturbants to permit free access of the more lipid-soluble substrates. In addition, the formation in vitro of a glucuronide from mercaptobenzothiazole was demonstrated.

Congenital sinus of the upper lip. A case report.

A case report of a congenital midline sinus in the upper lip of a 13-year-old girl is presented. Theories proposed regarding the aetiology of this rare anomaly are discussed.

Peer Assessment Rating (PAR) index outcomes for orthodontic and orthognathic surgery patients.

The Peer Assessment Rating (PAR) index is commonly used to evaluate occlusal outcomes after orthodontic treatment. We compared the PAR outcomes of 40 consecutively treated orthodontic patients and 40 orthognathic patients to evaluate the standard of care given. A patient-centred questionnaire was used to examine patients' perceptions of the benefits of orthognathic treatment. PAR scores of orthodontic and orthognathic patients improved by a mean of 77% and 74%, respectively, after treatment indicating that excellent to good occlusal results were achieved for both groups. A high quality occlusal outcome is important for all patients as good intercuspation at the end of treatment is thought to improve stability. Most orthognathic patients reported improvements in their dental and facial appearance and thought that the treatment had been beneficial.

Sentinel node biopsy in synovial sarcoma.

AIMS: To examine the relevance of sentinel node biopsy in patients with synovial sarcoma. METHODS: Between July 2004 and February 2007 11 consecutive patients with synovial sarcoma treated in our clinic underwent sentinel node biopsy after a preoperative lymphoscintigraphy. A handheld gamma-probe was used during the procedure to identify the sentinel nodes, which were then resected and submitted for histopathologic evaluation. RESULTS: At least one sentinel node was identified in every patient. Of a total of 15 sentinels, one was positive and 14 negative. The patient with the positive sentinel underwent a regional lymph node dissection and remains disease-free 17 months later. One patient developed regional nodal metastases despite negative sentinel node biopsy and died 12 months after the procedure. No biopsy-associated complications were observed. CONCLUSIONS: Sentinel node biopsy can be successfully and safely applied to patients with synovial sarcoma. Further prospective studies are required to determine the optimal treatment approach, the false negative rate and the prognostic significance of a positive sentinel node biopsy.

Extrapolating from toxicity data to occupational exposure limits: some considerations.

This paper evaluates procedures relevant to extrapolating from toxicity data in man and animals to Occupational Exposure Limits. It examines effects at or around the "No Observed Adverse Effect Level' (NOAEL) and the magnitude of safety factors which can be applied in developing occupational exposure limits for non-stochastic effects. The relationship between incidence of stochastic effect and occupational exposure limit is also discussed.

Is working in greenhouses healthy? Evidence concerning the toxic risks that might affect greenhouse workers.

Greenhouses are essentially microcosms aimed at providing physical environments suitable for the survival and growth of plants. Crops grown intensively in greenhouses in Great Britain include cut flowers, pot plants and edible crops such as tomato, lettuce cucumber and celery. The enclosed conditions mean that greenhouse workers are more likely to be exposed to higher levels of plant material, plant pests and plant protection products than general horticulture workers. The potential for ill-health in greenhouse workers is examined with particular reference to Great Britain. The principal potential effects expected include irritancy, asthma, allergic aleveolitis and dermatitis. Although biological control agents are widely used, there were no reports of their having caused ill-health in greenhouse workers. About two people per year are found to have suffered ill-health as a consequence of greenhouse exposure to chemical pesticides in reported pesticides incidents in Great Britain.

Assessment of toxicity for major hazards: some concepts and problems.

Approaches to the assessment of the toxic effects which may arise from chemical Major Hazards are examined. The definitions of hazard and risk and the types of toxicity data required for risk analysis are investigated with particular reference to the quality of the data and models available.