Ratings of the performances of practicing internists by hospital-based registered nurses

PURPOSE: To examine the feasibility and reliability of ratings completed by hospital-based registered nurses of the humanistic qualities, communication skills, and selected aspects of the clinical skills of practicing internists. METHOD: In 1988-1989, registered nurses who worked in the same 175 hospitals as 232 internists with admitting privileges at these hospitals rated the internists' performances. The nurses were selected from medicine floors, specialty floors, and intensive care units and/or critical care units, using lists provided by head nurses. A total of 1,877 rating questionnaires with 13 performance categories were collected (with a mean of 8.01 nurses per internist). The ratings were analyzed to determine measurement characteristics and the relationships of the nurses' demographic characteristics to the ratings. In addition, for each of ten performance categories for 152 of the internists, the average rating each internist received from nurses was compared with the average rating each internist received from peer physicians. Statistical analysis used Pearson correlations, canonical correlations, factor analyses, Student's t-tests, analysis of variance, and stepwise multiple regression. Finally, the internists themselves, including physicians who were not actually rated by the nurses, were asked to complete a brief questionnaire that included questions about their opinions of the use of nurses' ratings. RESULTS: The nurses' ratings correlated moderately strongly with the peer physicians' ratings and had a common structure. However, the nurses' ratings were lower for several humanistic qualities, including respect, integrity, and responsibility, and their ratings were higher for medical knowledge and verbal communications. Across the 13 performance categories, approximately 10-15 ratings from nurses were needed to obtain a reliable assessment of an internist's humanistic qualities and communication skills. Many internists felt that nurses' ratings should be used equally with, or at least as a lesser contribution to, ratings by peer physicians of humanistic qualities and communication skills. CONCLUSION: Nurses' ratings appear to provide a feasible and reliable method of evaluating the internists' communication skills and humanistic qualities, when used in conjunction with ratings by peer physicians.     

Determination of the relative amounts of free and complexed manganese ions in aqueous solution by nuclear magnetic resonance.

The ratio of the transverse relaxation rate to the longitudinal relaxation rate of water protons (T1/T2) at 90 MHz can be used to determine the relative amounts of free Mn2+ ions (the hexaquo ion) and chelated manganese ions when both species are present in the same aqueous solution. This technique is demonstrated for simple aqueous solutions containing known concentrations of both the free Mn2+ ion and a manganese(III) porphyrin. The accuracy of the method is found to be +/- 7.3% for the solutions considered in this report. The determinations of the relative amounts of the free Mn2+ ion and the manganese(III) porphyrin by this T1/T2 method are shown to agree well with those determined by nuclear magnetic resonance dispersion profiles. The theoretical basis of this ratio method as well as the scope and limitations in its application to aqueous solutions containing both free Mn2+ ions and chelated manganese species other than manganese(III) porphyrins are also discussed. This work demonstrates a unique use of NMR as a means for the quantitative analysis of manganese in which the effects of the metal ion on the solvent, and not the metal itself, are observed.     

Short contact time dissolution of vitrinite and inertinite concentrates

The short contact time dissolution of vitrinite and inertinite concentrates of an Australian bituminous coal was studied under isothermal conditions with tetralin as solvent. The reactivity of the two maceral types and the yields and nature of the products were determined for a range of reaction temperatures (400, 420 and 440 °C) and reaction times (2–20 min). The dissolution of vitrinite proceeded at a significantly greater rate than for inertinite and was associated with greater selectivity to soluble non-gaseous products. At very short reaction times (2 min), the vitrinite underwent solubilizing reactions to yield products of higher molecular weight and greater oxygen functionality than was the case for inertinite, for which changes in the chemical nature of the products were negligible over the range of conditions studied. At longer reaction times (5 min), the composition of the vitrinite-derived products was similar to that of the inertinite-derived products.     

Artefactual cleavage of E coli H-NS by OmpT

In the bacterium Escherichia coli, H-NS-(H1, H1a) is a heat-stable protein with a molecular mass of 15.5 kDa involved in nucleoid organisation and gene regulation linked to certain signal transduction pathways. We have shown that, following addition of preparations of everted inner membrane vesicles, heat-stable cleavage products of approximately 10 kDa of H-NS are formed in vitro from newly synthesised, radio-labelled H-NS and from purified H-NS. The 15.5 kDa protein and its cleavage products were also recovered from a minicell system. These results raised the possibility that cleavage of H-NS is physiologically significant. However, the cleavage of H-NS observed appears to occur during cell breakage and to depend on the method of protein extraction and the presence of the outer membrane protease, OmpT. Nevertheless, the results indicate that H-NS may contain at least two separate domains with cleavage occurring between these domains at a preferred OmpT site. Failure to take account of H-NS cleavage in sample preparation and analysis can lead to serious underestimation of H-NS levels.     

Coaggregation of oral lactobacilli with streptococci from the oral cavity

The ability of oral lactobacilli to coaggregate with streptococci and actinomycetes was investigated. Of the 7 species of lactobacilli studied, only two were capable of coaggregation and the coaggregation was restricted to streptococci. Lactobacillus salivarius strains (2/4) coaggregated with Streptococcus salivarius, Streptococcus gordonii, Streptococcus crista and tufted Streptococcus sanguis II strains. Lactobacillus fermentum (2/3) coaggregated with S. gordonii and S. sanguis. The coaggregation between L. salivarius and S. salivarius, S. gordonii or tufted S. sanguis II strains was mediated by a protein on the surface of the lactobacilli and was not inhibited by lactose. The coaggregation between L. fermentum and the streptococci was mediated by protein on the surface of the streptococci and was inhibited by lactose.     

Changes in the orientation of the smooth-muscle cells of the tunica media from major arteries under constant lengthwise stretching in situ

It has been shown that changes in the orientation of arterial smooth muscle cells during a constant longitudinal stretching of the artery in vivo are not similar in different sections of the stretching zone. Cells in the proximal and distal sections keep their orientation but this orientation differs from that of smooth muscle cells in the control arteries. Cells in the central part of the stretching region lose their definite orientation to settle randomly.     

High levels of interleukin-12 in the aqueous humor and vitreous of patients with uveitis

OBJECTIVE: This study aimed to investigate the role of interleukin-12 (IL-12) and interleukin-10 (IL-10) in initiation and maintenance of intraocular inflammation. DESIGN: Case series. PARTICIPANTS: Aqueous humor and vitreous levels of IL-12 and IL-10 were measured in 22 patients with uveitis undergoing cataract surgery, paracentesis of the anterior chamber, and/or vitrectomy for diagnostic reasons, and in 4 patients with cataract only. INTERVENTION: Aqueous humor and vitreous levels of IL-12 and IL-10 were measured with specific enzyme-linked immunosorbent assays. MAIN OUTCOME MEASURES: Disease activity was correlated to IL-12 levels in the aqueous humor and the vitreous of patients with uveitis. RESULTS: Cytokine levels found in the anterior chamber and the vitreous are presented in picogram/milliliter (medium; range). The highest IL-12 levels were found in patients with active uveitis (108.5 pg/ml; 72-293 pg/ml). Interleukin-12 in patients with moderate uveitis or with their disease in remission was lower (32 pg/ml; 15-94 pg/ml) than in patients with active disease (P > 0.001) but higher than in the control group (10.5 pg/ml; 9-14 pg/ml). Interleukin-10 was detectable in only 3 of 22 patients with uveitis (12 pg/ml; 9-23 pg/ml). CONCLUSION: The authors found statistically significant differences of IL-12 levels in the various patient groups (active vs. inactive vs. control). These results support the idea that these uveitis cases represent type 1 (Th1)-T lymphocyte-mediated diseases in which IL-12 plays a pivotal role in the initiation and maintenance of the intraocular inflammation. The high levels of IL-12 in the vitreous and/or aqueous humor of the patients with uveitis suggest that susceptibility or resistance to ocular autoimmunity may be connected to a genetic predisposition to an elevated Th1 response.     

Quantitative evaluation of pancreatic enhancement during dual-phase helical CT

PURPOSE: To determine the improvement in pancreatic enhancement at helical computed tomography (CT) performed with an early delay after administration of contrast material compared with that performed with a standard delay. MATERIALS AND METHODS: Dual-phase helical CT of the abdomen was performed in 120 patients with a 150-mL bolus of contrast material infused at 5 mL/sec. Early and standard delayed scanning was performed beginning at 20 seconds and 49-71 seconds, respectively. Regions of interest were measured in the head, body, and tail of the pancreas in 92 patients. The difference in enhancement between early and standard delayed scanning was calculated. RESULTS: Mean pancreatic enhancement was 82 HU +/- 3 (standard error) with an early delay, whereas enhancement on standard delay scans was 62 HU +/- 2 (P < .001). An improvement in enhancement greater than 10 HU was attained in 66 of 92 cases (72%). CONCLUSION: Pancreatic enhancement at helical CT with an early delay after contrast material administration is often significantly greater than the enhancement seen with a standard delay when a monophasic, rapidly infused bolus of contrast material is used.     

ELISA detection of IL-1 beta in human sera needs independent confirmation. False positives in hospitalized patients

Electrical field stimulation evoked a reproducible outflow of calcitonin gene-related peptide-like immunoreactivity (CGRP-LI) from the dorsal half of the rat spinal cord, an effect which was abolished by prior application of capsaicin, tetrodotoxin or removal of extracellular Ca2+. Adenosine (EC50 3.2 microM) and the selective adenosine A1 receptor agonist N6-cyclohexyladenosine (EC50 8.2 nM) inhibited evoked CGRP-LI outflow, while the selective adenosine A2 receptor agonist CGS-21680 was ineffective up to 10 microM. The action of adenosine was prevented by the adenosine A1 receptor selective antagonist 8-cyclopentyl-1,3-dipropylxanthine (30 microM), which did not affect CGRP-LI release on its own.