A recent study suggests that as many as 20% of “would-be” emergency department patients in California leave the hospital before seeing a doctor. According to the study author Dr. Renee Y. Hsia, an assistant professor in the department of emergency medicine at the University of California, San Francisco: “This is concerning to us as both providers and consumers because these are patients who decided they need care, and we’re not able to provide service to them.”

Hsia’s findings will appear in the Annals of Emergency Medicine. According to the U.S. Centers for Disease Control and Prevention, in 2007 hospital emergency departments saw 117 million visits, and from that number, 18% were seen in less than 15 minutes. California represents 12% of the U.S. population, and statewide there has been an alarming trend of patients who leave an emergency department without being seen.

The authors utilized data collected by the State of California’s Office of Statewide Health Planning and Development (OSHPD).  Emergency departments located in lower income communities had more patients leaving the hospital before being seen. Not for profit hospitals averaged 2.5%, and the figure doubled at county-owned facilities. Teaching hospitals had twice as high of a rate as non-teaching hospitals, and trauma centers had a 3.9% rate compared with the rate of non-trauma centers (at 2.5%).

Hsia continued: “What’s important to combat here is the myth that the people who leave an ER aren’t that sick to begin with. That’s certainly not true. Most people go to the ER only because they have to. Nobody really wants to go. So it’s a sad thing when they make that decision to go, and they need care, and they can’t get it.”

Dr. Marshall Morgan, chief of emergency medicine at the Ronald Reagan UCLA Medical Center in Los Angeles, also added: “I think it’s a big mistake for people to assume that the people who are leaving the ERs are people who don’t have serious problems. In fact, it’s been shown in other research that among the people who are leaving a certain percentage were seriously ill, as witnessed by their having to come back and be admitted within a few days. . . . So we’re not just talking about the people with sniffles and soar throats and sprained ankles. And this is a very big number. And whether it’s because of a general increase in overall volume at ERs across the state due to the general economic issues the country faces today, or for some other reason, it’s certainly a very big problem.”

Effective March 15, 2011, changes to the Americans with Disabilities Act (ADA) will expand the role of “service animals” in health care.

Service animals are individually trained to perform tasks for people with disabilities such as guiding the blind, alerting the hearing impaired, pulling wheelchairs, and alerting and protecting a person who is having a seizure. Service animals are working animals, not pets.

Now, the ADA will recognize that individuals with psychiatric, intellectual, and mental disabilities may require a service animal.  These changes both define and distinguish service animals in this context from comfort or companion animals. 

The new definition reads: “Service animal means any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability.  Other species of animals, whether wild or domestic, trained or untrained, are not service animals for the purposes of this definition.  The work or tasks performed by a service animal must be directly related to the handler’s disability.  Examples of work or tasks include, but are not limited to, assisting individuals who are blind or have low vision with navigation and other tasks, alerting individuals who are deaf or hard of hearing to the presence of people or sounds, providing non-violent protection or rescue work, pulling a wheelchair, assisting an individual during a seizure, alerting individuals to the presence of allergens, retrieving items such as medicine or the telephone, providing physical support and assistance with balance and stability to individuals with mobility disabilities, and helping persons with psychiatric and neurological disabilities by preventing or interrupting impulsive or destructive behaviors.  The crime deterrent effects of an animal’s presence and the provision of emotional support, well-being, comfort, or companionship do not constitute work or tasks for the purposes of this definition.”

In fact, if a sight-impaired individual is allergic to dogs, he or she may use a miniature horse (provided the miniature horse is house broken). As violators of ADA requirements may face money damages and penalties, following are some useful tips.

• Businesses may inquire if an animal is in fact a service animal (including the specific tasks the animal can perform), but they cannot require any special identification for the animal, or inquire about the disability.

• The service animal can go wherever the customer can go.

• Businesses cannot charge an additional fee for people with accompanying service animals, nor can they be treated unfairly.

• The only instances when a person with  a disability can be asked to remove his/her service animal from a location include: (1) the animal is out of control; or (2) the animal poses a direct threat to the health and safety of others.

The Centers for Disease Control and Prevention (CDC) recommends that individuals minimize contact with animal saliva, dander, urine, and feces. The CDC also suggests that nonhuman primates and reptiles should be avoided if possible as service animals.

Questions should be directed to ADA specialists at the U.S. Department of Justice in Washington, D.C.

An “advance health care directive,” also known as a living will or advance directive, provides a legal mechanism for individuals to specify what actions should be taken for their health in the event that they are no longer able to make such decisions due to illness or incapacity.

These instructions can prevent the need for anyone to “guess” what to do. By appointing a person or persons in this capacity, individuals can let their physician, family and/or friends know their health care preferences, including the types of special treatment they may want at the end of life, their desire for diagnostic testing, surgical procedures, cardiopulmonary resuscitation, and/or organ donation.

While many people go so far as to name a medical surrogate, too often they fail to provide adequate information about their health care preferences. A recent publication in the Annals of Internal Medicine concludes that the failure to provide these specific instructions to a medical surrogate in advance may lead to years of emotional distress.

In identifying several stressors that accompany the role of medical surrogate, the authors reviewed 40 studies. First on the list of stressors, according to the study, was being unsure of a patient’s preferences.  According to the authors: “We found that patients might also be encouraged to document their treatment preferences as a way of reducing the burden on their surrogates.” The nonprofit Engage with Grace has a LIST of some questions that may assist in this process, before the medical surrogate must make uninformed decisions.

Other stressors included uncertainty with a prognosis, discomfort with the hospital environment, poor communications with the health care professionals, insufficient time, disagreements with the medical staff, and feelings of uncertainty or guilt.

In conclusion, the study notes: “Making treatment decisions has a negative emotional effect on at least one third of surrogates, which is often substantial and typically lasts months (or sometimes years). Future research should evaluate ways to reduce this burden, including methods to identify which treatment options are consistent with the patient’s preferences”

Not only is Mississippi the hardest state to spell, it may also be the fattest. According to a recent article on CNN.com, Mississippi is the most obese state in the United States with an adult obesity rate of 33%. The state also has the highest rate of overweight and obese children in the U.S.

Paul Lacoste, a former professional football player, has launched his crusade to make Mississippi slim down. ”It’s time for Mississippi to get in shape and show the world we can beat obesity,” said Lacoste.

Lacoste is leading a 12-week fitness program for all of Mississippi while trying to avoid partisan politics. To learn more about Lacoste’s program, visit HERE.  The entire CNN.com article can also be viewed HERE.

Next time the person with whom you are conversing appears to lose interest, be careful. The ability to follow his or her gaze direction may keep you safe as it is an important way to detect predators, to recognize important social events nearby, and to anticipate what may happen next.  Understanding attention and inattention is a critical component to understanding the mind.

In a recent article published in PLoS ONE, Friederike Range and Zsofi Viranyi at the University of Vienna explains that animals often follow the gaze of other animals not just into the distance, but also around barriers. The researches found this uncommon cognitively advanced task in animals like the wolves, for example. Hand-raised wolves avoided an obstacle in order to check where another animate object (like a person) was looking, an indication that gaze following past barriers is not an advanced skill limited to primates.

The researchers contend that this information may shed light on the evolutionary origins of gaze following, offering new theories about the selective process as it affects attention coordination. The entire article can be viewed HERE.

A recent study has concluded that speaking more than one language can bolster the brain, serving as a “mental gymnasium” of sorts. The same study found that bilingual speakers often outperform monolinguals (people who speak only one language) in certain mental acumen evaluations, such as eliminating irrelevant information from a conversation and focusing on matters of importance. These same skills make bilinguals better at prioritizing tasks as well as multitasking.

“We would probably refer to most of these cognitive advantages as multi-tasking,” said Judith Kroll, Director of the Center for Language Science at Penn State University. “Bilinguals seem to be better at this type of perspective taking. The received wisdom was that bilingualism created confusion, especially in children,” Kroll told attendees at the annual meeting of the American Association for the Advancement of Science in Washington, D.C. “The belief was that people who could speak two or more languages had difficulty using either. The bottom line is that bilingualism is good for you.”

Researchers trace the source of these enhanced multi-tasking skills to the way bilinguals mentally negotiate between the languages, a skill that Kroll refers to as mental juggling. Bilinguals often slip in and out of both languages, carefully choosing the word or phrase from one language that best articulates their thoughts. At the same time, however, fluent bilinguals rarely slip into another language by accident when they converse with someone who understands only one language.

Kroll continued: “The important thing that we have found is that both languages are open for bilinguals; in other words, there are alternatives available in both languages. Even though language choices may be on the tip of their tongue, bilinguals rarely make a wrong choice.”

Kroll noted that these enhanced skills of bilinguals do not necessarily make them more intelligent or event better learners. “Bilinguals simply acquire specific types of expertise that help them attend to critical tasks and ignore irrelevant information.” Kroll compared the process of language selection to a form of mental exercise. “The bilingual is somehow able to negotiate between the competition of the languages. The speculation is that these cognitive skills come from this juggling of languages.”

The letters “Hg” stand for mercury, also known as quicksilver or hydrargyrum, a chemical element identified with the  symbol “Hg” (a Latin and Greek hybrid: hydrargyrum, from “hydr-” meaning watery or runny and “argyros” meaning silver). The atomic number for mercury is 80.

An extremely toxic chemical, Mercury was historically a  medicinal panacea, used for centuries to cure a simple scrape on the knee all the way up to syphilis.

Medicinal uses for Mercury trace back as far as 1500 BC. In ancient China and Tibet, it was believed that mercury could prolong life, heal fractures, and maintain generally good health. The ancient Greeks used mercury in ointments; the ancient Egyptians and the Romans used  the compound in cosmetics, although this led to deformations in the face.

Mercury was prescribed in either a pill or liquid form throughout the 19th century to treat various conditions, including constipation, depression, and toothaches, as well as to assist in child-bearing. In the beginning of the 20th century, doctors prescribed mercury to children on an annual basis as both laxative and dewormer. Mercury was also used in teething powders for infants.

The photo at the right shows the side effects when one physician treated his patient’s cold with “calomel,” a Mercury-based potion thought to make patients salivate and flush the body of “bad humors.” The toxic nature of mercury was simply unknown at the time.

Typically, mercury can be inhaled and absorbed through the skin, and exposure overall is very dangerous. Some side effects from Mercury exposure include tremors, chest pain, dyspnea, cough, violent muscular spasms, loss of memory, psychotic reactions, hallucinations, and suicidal tendencies.

Today, Mercury is still used in thermometers, barometers, manometers sphygmomanometers, float valves, some electrical switches, and other scientific apparati, although concerns about the element’s toxicity have led to the phasing out of many such devices. To replace Hg, alcohol-filled, digital, or thermistor-based instruments have found favor in clinical settings.

In a recent study published in the Academy of Management Journal, researchers followed a group of bus drivers for two weeks. They selected this group because bus drivers generally must engage in frequent, and hopefully courteous, interactions with people.

The study examined what transpired when the drivers engaged in “fake smiling,” also known as “surface acting.” This was compared with “deep acting,” described as authentic smiles through positive thinking.

The researchers concluded that when the bus drivers forced a smile, their moods deteriorated, and they tended to withdraw from work.  The attempt to suppress those negative thoughts, apparently, may create the persistence of these memories.

On the other hand, when the bus drivers tried to display smiles associated with pleasant thoughts and memories, their overall moods improved, and their productivity increased. Overall, the study concluded that hiding displeasure with an inauthentic smile may actually worsen your mood.

Good morning!

And so my day begins, just like any other day.