Simulation: an evolving methodology for health administration education.

Simulation provides a valuable addition to a university's teaching methods. Computer-assisted gaming is especially effective in teaching advanced business strategy and corporate policy when the nature and complexity of the simulation permit. The potential for using simulation techniques in postgraduate professional education and in managerial self-assessment appears to be significant over the next several years.

Cardiac conduction disturbance after loperamide abuse.

CONTEXT: Prescription opioid abuse is a major public health concern and an ongoing epidemic in the United States. Loperamide is a widely available and inexpensive over-the-counter antidiarrheal with peripheral mu-opioid receptor activity. Online resources discuss the use of loperamide for the amelioration of withdrawal symptoms or recreational abuse. We describe the clinical course of 5 patients abusing loperamide, 3 of whom had life-threatening cardiac arrhythmias. METHODS: In this observational case series, patients with cardiac arrhythmias or history of loperamide abuse with cardiac arrhythmias were identified; 5 patients were identified and 4 of the 5 patients were seen directly at the bedside. Clinical profile and outcome of patients is reported. RESULTS: We report 5 patients with history of loperamide abuse; 3 of the 5 patients had life-threatening cardiac arrhythmias. One of the patients experienced a second life-threatening arrhythmia after he resumed loperamide abuse. Loperamide levels were obtained in 4 of the 5 patients and were at least one order of magnitude greater than therapeutic concentrations. Discontinuation of loperamide resulted in complete resolution of cardiac conduction disturbances. CONCLUSION: This case series describes several patients with cardiac conduction abnormalities and life-threatening ventricular arrhythmias temporally related to loperamide abuse. With the recent efforts to restrict the diversion of prescription opioids, increasing abuse of loperamide as an opioid substitute may be seen. Toxicologists should be aware of these risks and we urge all clinicians to report such cases to FDA Medwatch(®).

Rhodopsin bleaching signals in essential night blindness.

1. The dark-adaptation curves of two subjects with essential night blindness revealed no evidence for functioning rod vision. Cone vision was normal.2. The photopupillomotor dark adaptation, and flash intensity response amplitude curves on one of these subjects confirmed the absence of rod function.3. However, there is the normal amount of rhodopsin in their rods with normal kinetics.4. Cone pigment kinetics are also nearly normal. After a full bleach, log threshold elevation of the foveal cones is linearly related to pigment regeneration. The constant of proportionality is about 3.0 as it is in the normal retina.5. After a full rhodopsin bleach, the contralateral pupil size recovered its full dark value along a curve which followed the regeneration of rhodopsin.6. The results in (5) are identical to those previously found on normal subjects.7. With the exception of a very small response attributed to the contribution of cones, no significant changes in pupil size were evoked by uniform ganzfeld steady backgrounds until the intensity of retinal illuminance was so high that appreciable rhodopsin was bleached. This contrast to the changes evoked by weak steady backgrounds in the normal eye.8. Therefore, rod bleaching signals are normal in such retinas but rod signals evoked by real lights are not functional. This supports Rushton's concept as to how bleaching signals influence retinal sensitivity as opposed to the view of Barlow.9. The defect in essential night blindness very probably involves the rod automatic gain control, but because of (4) the cone gain control must be normal.10. Therefore, rod and cone gain control mechanisms must be independent in these night blind retinas and, by analogy, in the normal retina as well.

Using managerial role motivation theory to predict career success.

Managerial role motivation theory has proved to be useful for understanding executive performance in a wide range of highly structured organizational environments. Consistent results of studies indicate that the theory may be useful for understanding managerial behavior and predicting performance in health care organizations.

Absence of ocular pathology after repeated exposure of unanesthetized monkeys to 9.3-GHz microwaves.

Unfettered monkeys (Macaca mulatta) have been trained to expose the face and eyes to pulsed microwave radiation at a frequency of 9.31 GHz and an average power density of 150 mW/cm2. Performance of an operant response required the monkeys to maintain the head within the field of the radiation source. Twelve monkeys were individually irradiated during 30 to 40 sessions and then were observed for a period of one year. No deleterious effects such as cataracts have been observed.