Retroviruses normally infect the somatic cells of their host and are transmitted horizontally, i.e., in an exogenous way. Occasionally, however, some retroviruses can also infect and integrate into the genome of germ cells, which may allow for their vertical inheritance and fixation in a given species; a process known as endogenization. Lentiviruses, a group of mammalian retroviruses that includes HIV, are known to infect primates, ruminants, horses, and cats. Unlike many other retroviruses, these viruses have not been demonstrably successful at germline infiltration. Here, we report on the discovery of endogenous lentiviral insertions in seven species of Malagasy lemurs from two different genera—Cheirogaleus and Microcebus. Combining molecular clock analyses and cross-species screening of orthologous insertions, we show that the presence of this endogenous lentivirus in six species of Microcebus is the result of one endogenization event that occurred about 4.2 million years ago. In addition, we demonstrate that this lentivirus independently infiltrated the germline of Cheirogaleus and that the two endogenization events occurred quasi-simultaneously. Using multiple proviral copies, we derive and characterize an apparently full length and intact consensus for this lentivirus. These results provide evidence that lentiviruses have repeatedly infiltrated the germline of prosimian species and that primates have been exposed to lentiviruses for a much longer time than what can be inferred based on sequence comparison of circulating lentiviruses. The study sets the stage for an unprecedented opportunity to reconstruct an ancestral primate lentivirus and thereby advance our knowledge of host–virus interactions.

We assessed the occurrence of four safety concerns among labor and delivery teams: dangerous shortcuts, missing competencies, disrespect, and performance problems. 3282 participants completed surveys. 92% of physicians (906/985), 93% of midwives (385/414), and 98% of nurses (1846/1884) observed at least one concern within the preceding year. A majority of respondents said these concerns undermined patient safety, harmed patients, or led them to seriously consider transferring or leaving their positions. Only 9% of physicians, 13% of midwives, and 13% of nurses shared their full concerns with the person involved. Organizational silence is evident within labor and delivery teams. Improvement will require multiple strategies, employed at the personal, social, and structural levels.

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Objective To explore clinician perspectives on whether they experience difficulty resolving patient-related concerns or observe problems with the performance or behavior of colleagues involved in intrapartum care. Design Qualitative descriptive study of physician, nursing, and midwifery professional association members. Participants and Setting Participants (N=1932) were drawn from the membership lists of the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN), American College of Obstetricians and Gynecologists (ACOG), American College of Nurse Midwives (ACNM), and Society for Maternal-Fetal Medicine (SMFM). Methods Email survey with multiple choice and free text responses. Descriptive statistics and inductive thematic analysis were used to characterize the data. Results Forty-seven percent of participants reported experiencing situations in which patients were put at risk due to failure of team members to listen or respond to a concern. Thirty-seven percent reported unresolved concerns regarding another clinician’s performance. The overarching theme was clinical disconnection, which included disconnections between clinicians about patient needs and plans of care and disconnections between clinicians and administration about the support required to provide safe and appropriate clinical care. Lack of responsiveness to concerns by colleagues and administration contributed to resignation and defeatism among participants who had experienced such situations. Conclusion Despite encouraging progress in developing cultures of safety in individual centers and systems, significant work is needed to improve collaboration and reverse historic normalization of both systemic disrespect and overt disruptive behaviors in intrapartum care.

Effective, patient-centered communication facilitates interception and correction of potentially harmful conditions and errors. All team members, including women, their families, physicians, midwives, nurses, and support staff, have a role in identifying the potential for harm during labor and birth. However, the results of collaborative research studies conducted by organizations that represent professionals who care for women during labor and birth indicate that health care providers may frequently witness, but may not always report, problems with safety or clinical performance. Some of these health care providers felt resigned to the continuation of such problems and fearful of retribution if they tried to address them. Speaking up to address safety and quality concerns is a dynamic social process. Every team member must feel empowered to speak up about concerns without fear of put-downs, retribution, or receiving poor-quality care. Patient safety requires mutual accountability: individuals, teams, health care facilities, and professional associations have a shared responsibility for creating and sustaining environments of mutual respect and engaging in highly reliable perinatal care. Defects in human factors, communication, and leadership have been the leading contributors to sentinel events in perinatal care for more than a decade. Organizational commitment and executive leadership are essential to creating an environment that proactively supports safety and quality. The problem is well-known; the time for action is now.

126IntensI v pflege IntensI v medIzIn · s t u dIe Silent killsStudie Stellen Sie sich vor, Sie sind eine Pflegekraft und haben neue Sicherheitsinstrumente (Safety Tools) bekommen, die Sie warnen, wann immer Ihre Patienten in Gefahr sind. Das wäre doch eine beeindruckende, lebensrettende Information, oder? Was aber, wenn Ihnen dann niemand zuhören und Ihre Warnung beachten würde? Derartige Pannen sind in Krankenhäusern an der Tagesordnung. Und manchmal hat das Stillschweigen tödliche Konsequenzen. ▀ Schlechte Kommunikation ist tödlich -insbesondere auf der Intensivstation [1, 2]. Der Zusammenbruch der Kommunikation auf Intensivstationen und in Operationssälen führt oft zu katastrophalen Schäden [3, 4, 5, 6] und sogar zum Tod [7, 8]. Diese Studie untersucht eine besonders gefährliche Art der Kommunikationsstörung: bekannte Risiken, die nicht angesprochen werden oder Tabuthemen sind. Diese Studie basiert auf einer Untersuchung aus dem Jahr 2005 durch die Ame-:: "Ich denke, dass wir fast jeden Tag mit Allergielisten konfrontiert werden. Oft ordnet der Chirurg ein Antibiotikum an, gegen das der Patient gemäß der Sicherheits-Checkliste allergisch ist. Wenn der Patient aus dem Operationssaal heraus ist, muss das Pflegepersonal den Chirurgen, den Anästhesisten und oft sogar den Apotheker anrufen, bevor jemand zu hört. Manchmal geben wir die Medikamente einfach trotzdem, aber wenn man dem Patienten wirklich zugehört hat, ist das nicht immer richtig." (Eine von 681 im Laufe dieser Studie erhaltenen Stellungnahmen)

This study examined whether children could benefit from the simultaneous use of two mnemonic strategies. In Experiment 1, 3rd and 6th graders were taught to use the rehearsal and organizational strategies of same-or different-aged peers. At both ages, Ss who used developmentally advanced techniques recalled more than those who sorted and rehearsed like younger children; moreover, use of both efficient strategies together increased recall additively. In Experiment 2,3rd graders rehearsed in any way they wished while learning taxonomically related or unrelated items. With each type of materials, 4 groups differed in whether the items were left visible, in whether Ss were asked to sort, and, if so, in whether they were instructed to sort to "help them remember" or on the basis of meaning. Those Ss instructed to sort showed higher recall and more active rehearsal, regardless of type of sort instructions or items. Thus, the use of one strategy may elicit effective use of another.

First-level supervisors have traditionally expressed frustration over their difficulty in effectively managing subordinates. This paper describes a social learning theory based on organizational development intervention focused on helping wood products plant supervisors develop better participative problem-solving skills. All the foremen in a plywood mill participated in workshops conducted over a three-month period. Measures of five key behaviors were taken immediately before the intervention began, shortly after it ended, and finally, six months later. Behavioral measures consisted of subordinates' perceptions of their supervisor. Results showed significant positive behavior change between before and after measures and the maintenance of this change for the six months thereafter. Significant improvement in productivity and labor relations indices also occurred.