Retrenchment: layoff procedures in a nonprofit organization

One of the most unsettling experiences that human resources and other managers must face is a large-scale employee layoff. Authors Robert Fuller, national director of personnel, Cassandra Jordan, assistant director of personnel, and Robert Anderson, employment and training manager--all at the Legal Services Corporation--show how careful management planning, extensive staff involvement, and well-planned counseling and outplacement services helped employees of Legal Services Corporation wheather such a layoff. As the first step, the planning committee (personnel director, equal employment opportunity director, and general counsel) recommended that the corporation conduct staff education about layoffs for all employees, that a representative employee task force be established to develop specific details of the layoff plan, and that the corporation hire an experienced person to help staff members implement the plan. Members of the task force, who were elected by staff members (except for one additional member who was selected to ensure proper representation of minority groups and women), made specific recommendations on the way to determine seniority and bumping rights. The task force also dealt with such issues as method of notification, an appeals procedure, reemployment rights, the counseling and outplacement services. The task force also considered the issue of "willingness to leave".

Electromyographic gait analysis before and after operative treatment for hemiplegic equinus and equinovarus deformity

Gait electromyograms were obtained before and after tendon transfer, lengthening, or release in twenty-seven hemiplegic patients with equinus or equinovarus deformities. Abnormal patterns of muscle activity almost always were present preoperatively in the gastrocnemius, soleus, tibialis posterior, flexor hallucis longus, flexor digitorum longus, peroneus brevis, and tibialis anterior muscles in these patients. The surgical procedures to correct the foot deformities altered the gross patterns of activity of most of the muscles operated on by very little. Of particular importance to the surgeon was the finding that the pattern of activity of the muscles whose tendon was transferred, lengthened, or released was not altered after operation. This finding makes the preoperative gait electromyogram a useful means of determining the appropriate surgical plan, since it is an indication of the type of muscle activity to expect postoperatively.

Specific conductance using forced airflow oscillation in mechanically ventilated human subjects

A method is described to measure specific airway conductance in mechanically ventilated patients. Airflow resistance (R) was measured continuously using the forced airflow oscillation method and plotted against volume during slow deflation of the lungs. The previously reported hyperbolic configuration of the resistance-volume curve was confirmed, but a nonlinear conductance-volume relationship was found that could be explained by a constant resistance (A) in series with the volume-dependent resistance of the lower airways. A computer-aided analysis of the resistance-volume curve determined the parameters of the hyperbola that best fitted the data and from this the volume-dependent conductance, Glaw = 1/(R - A), was calculated. This method consistently provided a very good fit to the data and resulted in a linear lower airway conductance-volume relationship in anesthetized and in awake subjects. The slope of this linear relationship (Glaw) was therefore independent of volume, and specific lower airway conductance was used as an index of bronchomotor tone. In awake subjects given bronchoconstrictor and bronchodilator aerosols, good correlation was shown between changes in specific conductance measured by this technique and by the standard plethysmographic method.

Rapid improvement in abnormal pulmonary epithelial permeability after stopping cigarettes

A new, non-invasive method of measuring pulmonary epithelial damage in man was compared with traditional tests of small-airway function. Pulmonary epithelial permeability was expressed as the half-time clearance from the lung into blood of (99m)Tc-diethylene triaminepenta-acetic acid ((99m)Tc-DTPA) deposited predominantly in the alveoli from an inhaled aerosol.Recovery from abnormal pulmonary permeability was recorded after stopping smoking for 21 days in a group of young symptomless cigarette smokers. Before stopping smoking there was a significant correlation between half-time lung clearance of (99m)Tc-DTPA and carboxyhaemoglobin concentration (r=0.69; p <0.05). There was no correlation between carboxyhaemoglobin value and closing volume, the only other abnormal test of airway function. Twenty-four hours after stopping smoking the mean half-time lung clearance of (99m)Tc-DTPA had increased significantly (p <0.001) from a baseline of 15.8 min (SEM 1.3 min) to 25.5 min (SEM 2.5 min). The mean half-time clearance continued to increase to a maximum of 35.5 min (SEM 3.1 min) at seven days, but was significantly less than the reported half-time clearance for non-smokers (59 min, SEM

Alcohol induced discoordination is not reversed by naloxone

It has previously been reported that prior administration of naloxone may prevent the decrement in performance produced by alcohol. To be clinical value, however, naloxone must be shown to reverse rather than prevent this decrement. This study examined the effect of naloxone given after consumption of alcohol. A double blind balanced crossover protocol was used to examine the effect of either 1.2 mg or 10 mg naloxone on the sensory-motor impairment produced by blood alcohol concentrations maintained between 75 and 85 mg/100 ml. This alcohol concentration significantly impaired two measures of sensory-motor performance, but there was no evidence that either dose of naloxone could reverse this decrement. We tested our subjects for a chlorpropamide alcohol flush but none gave a positive response. These results indicate that naloxone (1.2 mg or 10 mg) does not reverse the sensory-motor impairment produced by alcohol intoxication in subjects who do not exhibit a chlorpropamide alcohol flush. Nearly all the subjects exhibited somnolence after receiving alcohol and naloxone (1.2 mg or 10 mg) but not after receiving alcohol and saline.

Respiratory depression following diazepam: reversal with high-dose naloxone

The authors compared the effects of naloxone and saline solution on the respiratory changes following diazepam in a double-blind crossover trial in six subjects. Following baseline measurements of respiration, each subject was given diazepam, 15 mg, intravenously. Sixty and ninety-five minutes later each subject received either two doses of naloxone, 15 mg, intravenously, or two doses of the equivalent volume of saline solution. Forty-five minutes after diazepam administration the slopes of the curves of the ventilatory responses to rebreathing carbon dioxide (VE/PETCO2) were depressed to 53 per cent of control (P < 0.05). Following the two doses of naloxone, the slopes of VE/PETCO2 recovered, until, 120 minutes after the second dose of naloxone, slopes had returned to control values. After saline solution, however, slopes remained depressed at 68 per cent of control (P < 0.05). A similar recovery following naloxone was observed in the PETCO2 intercept of the VE/PETCO2 response curve and in the slope of the mouth-occlusion-pressure response curve to rebreathing carbon dioxide. End-tidal carbon dioxide during quiet breathing and during inspiratory resistive-loaded breathing (80 cm H2O/l/s) showed small increases after diazepam, which were not significantly reduced by naloxone. The results of this study show that diazepam produces respiratory depression, and that this may be relieved by large doses of naloxone.

Respiratory effects of analgesia after cholecystectomy: comparison of continuous and intermittent papaveretum

Two methods of administering papaveretum for relieving postoperative pain were compared in two groups of patients who had undergone cholecystectomy. In one group a loading dose of papaveretum was administered by continuous intravenous infusion (1 mg/min) until the patient could breathe deeply without undue pain. Eight times this loading dose was given as a continuous intravenous infusion over the subsequent 48 hours. This regimen was compared with a conventional intermittent intramuscular dose (0.25 mg/kg at four hourly intervals as necessary) in a second group of patients. The intravenous regimen relieved pain better than the intramuscular regimen, which may have reflected the larger dose of papaveretum given to the intravenous group, but it was accompanied by a greater degree of respiratory depression and potentially life-threatening changes in respiratory pattern. These findings suggest that the fear which often accounts for inadequate postoperative pain relief-that larger dose of analgesics will cause respiratory complications-is well founded.

Clinical experience with auditory brainstem response audiometry in pediatric assessment

We discuss our experience with evaluation of 167 children by auditory brainstem response audiometry in 1978. We summarize experience with referral sources, medication for sedation, and interpretation of test outcome. Medication for sedation was required for 136 children. Concommitant central nervous system involvement rendered auditory brainstem response ambiquous in some children; however, the technique still provide useful information about status of peripheral auditory sensitivity obtainable in no other way. Finally, agreement among auditory brainstem response, behavioral, and impedance audiometry predictions was usually quite good.

Normal audiometric findings

We argue that the scope of basic audiometric assessment must be broadened to include speech audiometric measures sensitive to central auditory dysfunction. Findings in twenty cases of retrocochlear disorder illustrate the fact that conventional criteria of audiometric normalcy are inadequate.

A comparison of the respiratory effects of meptazinol, pentazocine and morphine

The respiratory effects of a new strong analgesic, meptazinol, were compared with a placebo and with equianalgesic doses of morphine and pentazocine in a double-blind crossover trial in seven healthy volunteers. No significant change in the ventilatory response to rebreathing carbon dioxide was observed after meptazinol 100 mg/70 kg or placebo. However, both morphine 10 mg/70 kg and pentazocine 60 mg/70 kg depresesd the slope of the ventilatory response (-30.0% and -31.6% respectively, P less than 0.02, averaged over the first 3.5-h period). End-tidal carbon dioxide tension (PE'CO2) while breathing room air increased significantly following all three drugs. However, the increase in PE'CO2 after meptazinol (0.22 kPa averaged over 3.5 h) was significantly less than that following morphine (0.40 kPa, P less than 0.05) and pentazocine (0.59 kPa, P less than 0.01). While breathing room air with a resistive inspiratory load of 8 kPa litre-1 s, PE'CO2 again increased significantly (P less than 0.05) following all three drugs. The increase in PE'CO2 after meptazinol was then the same as that after morphine (0.51 kPa averaged over 3.5 h). The increase following pentazocine (0.80 kPa) was significantly greater than that after both morphine and meptazinol (P less than 0.02).

Measurement of the relative contributions of rib cage and abdomen/diaphragm to tidal breathing in man

A simple mathematical model of the chest wall was constructed so that during tidal breathing the relative volume contributions of the rib cage and abdomen/diaphragm could be measured in man, using four mercury-in-rubber strain gauges around the trunk. From the dimensions of the trunk and the change in circumference determined by the four gauges, the separate contributions of rib cage and abdomen/diaphragm could be determined using a purpose-built analog computer. The system was evaluated in 13 laboratory personnel, and in 13 other subjects before and after anaesthesia. There was a linear relationship between tidal volumes computed and measured at the mouth, over the residual volume to (FRC + 1 litre) range, with an error of +/- 8%. The relative contribution of rib cage to tidal breathing showed a large scatter from 5 to 42% with a non-significant tendency to decrease with age.

Bacillus cereus endogenous panophthalmitis

A case of severe suppurative endogenous panophthalmitis caused by Bacillus cereus resulted from intravenously administered medications. This is the first, to our knowledge, well-documented case of endogenous endophthalmitis associated with this organism. It is recommended that if on Gram's stain of the anterior chamber fluid, Gram-positive rods are seen, chloramphenicol should be administered in addition to penicillin because of the possibility of B cereus infection.

Pastoral care and chronic disaster victims: the Buffalo Creek experience

A concern for the demands of the Law and for the message of the forgiveness of sins does not characterize the way most modern, progressive, clinically educated pastors tend to view or practice their ministry with troubled persons. But if our pastoral care is to become more fully responsive and responsible to our theological heritage, and more profoundly related in a Christian way to the persons we serve, it will be necessary to recover the centrality of the doctrine of Law and Gospel in pastoral care and counseling. This article attempts to show why and how it might be done.

This article focuses on the threefold nature of chronic disaster trauma in the Buffalo Creek context and the pastoral care response to it. The introduction sketches the events of the disaster and the living conditions of the past years. Attention is then centered on unresolved grief, disaster trauma, and loss of community. Case material is used to portray features of these various forms of disaster hurt and to show the interrelatedness of psychic, social, and religious issues. The paper then portrays the pastoral care response to disaster victims. The style of ministry is described, and the assumptions of the ministry are listed. Conclusions are then made on the basis of the experience of the past two years. These conclusions emphasize the need for a comprehensive pastoral care effort which is attentive to social issues in disaster as well as intrapsychic ones and is sensitive to the cultural and religious setting.

A proteolytic pseudomonad from skin lesions of rainbow trout (Salmo gairdnerii). II. Some properties of the proteinase

An extracellular proteinase from a pseudomonad pathogenic to rainbow trout was purified 33-fold by ammonium sulfate fractionation, DEAE-cellulose column chromatography, and Sephadex G 75 gel filtration. The purified enzyme was active over a wide pH range, from pH 5.0 to 10.0. Heating at 98 °C for 1 h did not completely inactivate the enzyme. Its observed temperature optimum was 45 °C. Michaelis–Menten constants were found to be 0.625% for casein and 0.263% for rainbow trout muscle albumin. Activation energies calculated for these substrates were 8.1 kcal and 11.4 kcal per mole, respectively. The involvement of bivalent cations and free sulfhydryl groups in the enzymatic activity was demonstrated by the inhibition caused by metal-complexing agents and p-chloromercuribenzoate, respectively.