Obstetric anesthesia services in Israel snapshot (OASIS) study: A 72 hour cross-sectional observational study of workforce supply and demand

BACKGROUND: We planned an observational study to assess obstetric anesthesia services nationwide. We aimed to assess the effect of the anesthesia workload/workforce ratio on quality and safety outcomes of obstetric anesthesia care. METHODS: Observers prospectively collected data from labor units over 72 h (Wednesday, Thursday and Friday). Independent variables were workload (WL) and workforce (WF). WL was assessed by the Obstetric Anesthesia Activity Index (OAAI), which is the estimated time in a 24-h period spent on epidurals and all cesarean deliveries. Workforce (WF) was assessed by the number of anesthesiologists dedicated to the labor ward per week. Dependent variables were the time until anesthesiologist arrival for epidural (quality measure) and the occurrence of general anesthesia for urgent Cesarean section, CS, (safety measure). This census included vaginal deliveries and unscheduled (but not elective) CS. RESULTS: Data on 575 deliveries are from 12 maternity units only, primarily because a major hospital chain chose not to participate; eight other hospitals lacked institutional review board approval. The epidural response rate was 94.4%; 321 of 340 parturients who requested epidural analgesia (EA) received it. Of the 19 women who requested EA but gave birth without it, 14 (77%) were due to late arrival of the anesthesiologist. Median waiting times for anesthesiologist arrival ranged from 5 to 28 min. The OAAI varied from 4.6 to 25.1 and WF ranged from 0 to 2 per shift. Request rates for EA in hospitals serving predominantly orthodox Jewish communities and in peripheral hospitals were similar to those of the entire sample. More than a fifth (13/62; 21%) of the unscheduled CS received general anesthesia, and of these almost a quarter (3/13; 23%) were attributed to delayed anesthesiologist arrival. CONCLUSIONS: Inadequate WF allocations may impair quality and safety outcomes in obstetric anesthesia services. OAAI is a better predictor of WL than delivery numbers alone, especially concerning WF shortage. To assess the quality and safety of anesthetic services to labor units nationally, observational data on workforce, workload, and clinical outcomes should be collected prospectively in all labor units in Israel

Acquisition of Noun Plurals among Early Sequential Russian-Hebrew Speaking Bilinguals: A Longitudinal Multiple Case Study

Abstract The focus of the present study was the trajectory of the acquisition of noun pluralization in Hebrew as a window into the development of inflectional morphology among early sequential Russian-Hebrew speaking bilinguals. Our participants were six early sequential bilingual children between 36 and 42 months of age at the beginning of the study, who acquired Russian (L1) at home and at preschool within a 'first language first approach' and whose age at the onset of their acquisition of Hebrew (L2) was about 3 years. We investigated both qualitative and quantitative features of noun pluralization in Hebrew (L2) acquisition in order to determine (1) whether early sequential bilingual children are delayed or accelerated in this domain; (2) whether they show similar or different patterns of errors in comparison to the L1 children; and (3) at what age sequential bilingual children acquire regular versus irregular noun plural forms compared with the L1 children. We relied on a multi-faceted longitudinal analysis of noun pluralization, examining both correct and incorrect production-in structured elicitations as well as in (semi-) spontaneous interactions. Comparing our data to those collected for Hebrew L1 speakers, the results for monolinguals and early sequential bilinguals show a striking similarity with respect to the development of pluralization. These findings suggest that the accelerated rate of ESBs' L2 pluralization mechanism provides evidence of the linguistic maturation hypothesis

Group G Streptococcal Bacteremia in Jerusalem

Recurrent group G Steptococcus bacteremia, associated with lymphatic disorders and possibly emm stG840.0, is described

Phosphorylation of the Drosophila melanogaster RNA–Binding Protein HOW by MAPK/ERK Enhances Its Dimerization and Activity

Drosophila melanogaster Held Out Wings (HOW) is a conserved RNA–binding protein (RBP) belonging to the STAR family, whose closest mammalian ortholog Quaking (QKI) has been implicated in embryonic development and nervous system myelination. The HOW RBP modulates a variety of developmental processes by controlling mRNA levels and the splicing profile of multiple key regulatory genes; however, mechanisms regulating its activity in tissues have yet to be elucidated. Here, we link receptor tyrosine kinase (RTK) signaling to the regulation of QKI subfamily of STAR proteins, by showing that HOW undergoes phosphorylation by MAPK/ERK. Importantly, we show that this modification facilitates HOW dimerization and potentiates its ability to bind RNA and regulate its levels. Employing an antibody that specifically recognizes phosphorylated HOW, we show that HOW is phosphorylated in embryonic muscles and heart cardioblasts in vivo, thus documenting for the first time Serine/Threonine (Ser/Thr) phosphorylation of a STAR protein in the context of an intact organism. We also identify the sallimus/D-titin (sls) gene as a novel muscle target of HOW–mediated negative regulation and further show that this regulation is phosphorylation-dependent, underscoring the physiological relevance of this modification. Importantly, we demonstrate that HOW Thr phosphorylation is reduced following muscle-specific knock down of Drosophila MAPK rolled and that, correspondingly, Sls is elevated in these muscles, similarly to the HOW RNAi effect. Taken together, our results provide a coherent mechanism of differential HOW activation; MAPK/ERK-dependent phosphorylation of HOW promotes the formation of HOW dimers and thus enhances its activity in controlling mRNA levels of key muscle-specific genes. Hence, our findings bridge between MAPK/ERK signaling and RNA regulation in developing muscles

International examiners’ participation of the Viva: a ritual or an actual indicator of research quality?

Purpose Little is known about the impact external Viva examiners coming from the international community of scholars have on the quality of PhD research. This study aims to argue that the encounter between local and international examiners (IEs) is subject to various complexities, raising doubts about whether IEs’ participation and approval of the Viva may indicate for the quality of PhD research, and, therefore, serve to promote a university’s prestige. Design/methodology/approach A qualitative analysis of interviews conducted with IEs who served as examiners in six European countries, two African countries, two South American countries and one in the Commonwealth of Australia. Findings Findings show that structural features, cultural qualities and personal contacts restrict IEs’ ability to introduce significant changes in students’ research, turning the Viva into a ritual with confined academic significance. Originality/value The findings reveal that the Viva is mostly a ritual confined by structural and cultural barriers. While rituals are considered significant due to their consolidating and socializing functions, it appears that a Viva is mostly a ceremonial event that has little impact on the quality of PhD research or on shaping the research culture of the hosting universities according to international standards. Implications are further discussed. </jats:sec

Parental Involvement in School Governance and Decision Making in Israel

A review of the memorandums set by the Israeli Ministry of Education reveals that they stress the importance of parental involvement for schools and children. A review of studies that focused on parental involvement in Israeli school governance suggests that parents’ participation is usually confined to the provision of funds, equipment, or other everyday needs. We assert that the traditional assumption—that educators are the only ones who know what is best for children—should be replaced by a more democratic approach recognizing the unique contribution of parents to the well-being of children and schools. </jats:p

The contribution of perceived fit between job demands and abilities to teachers’ commitment and job satisfaction

The current study aims at exploring the common means that may improve organizational effectiveness by focusing on two main facets of organizational qualities: teacher commitment and job satisfaction. Data were collected from 841 randomly sampled teachers employed in 118 elementary schools in Israel. A quantitative questionnaire, which included scales measuring organizational and professional commitment, extrinsic and intrinsic satisfaction and organizational and job-related characteristics, was employed. Multiple regression analyses revealed that the single variable that predicted both types of commitment (organizational and professional) and both types of satisfaction (intrinsic and extrinsic) was teachers’ perceptions of the fit between one's job demands and abilities. The second most influential predictor was principals’ interaction with the teachers. Job-related characteristics had the least impact on teacher’s professional commitment and extrinsic satisfaction. The finding, that perceived job fit predicted both commitment and job satisfaction, reinforces the importance of the assumption about the significance of best practice in recruitment and placement processes, which has long been known to be significant in determining professional conduct. Other implications of the findings are discussed, and recommendations are provided to school principals. </jats:p