Patient education for discharge after coronary bypass surgery in the 1990s: are patients adequately prepared?

Short hospitalizations for patients undergoing coronary artery bypass grafting (CABG) require continuous nursing evaluation of patients' discharge education. Six institutions collaborated in surveying 300 postoperative patients with CABG to identify learning priorities and patients' perceptions of the effectiveness of discharge education. Data analysis from the self-administered questionnaire demonstrated consistent patient priorities across institutions. Differences in teaching methods and content did not affect perceived preparedness or importance scores. Regional experience demonstrates that variable teaching efforts meet patients' priorities and provide high overall patient preparedness for discharge. Patients with the shortest hospitalizations had higher preparedness scores.     

Electron microscopy of second phases in manganese-zinc ferrite crystals

The surface and bulk microstructure of Mn-Zn ferrite single crystals oxidized at 0.7% _{o 2} have been investigated using SEM and TEM methods, assisted by energy- dispersive X-ray micro analysis. In samples heat-treated at 1000° C, haematite formed as an irregular surface layer and as laths which grew throughout the bulk, parallel with the {1 1 1 } planes (where F = ferrite). The haematite laths were related epitaxially to the ferrite host through the relationships (0001)_H | {1 1 1 }_F (where H = haematite) and . However, it was found that the latter parallelism was not exact because the haematite and ferrite lattices were rotated by 1.1 ± 0.2° about the axis perpendicular to the interface between them (i.e. [0001]H, <1 1 1 >_F). The sites for the nucleation of haematite second phase were also observed in highly oxidized ferrite. The formation of small planar defects (< O.1 m in length) in the ferrite, lying parallel to {1 10} planes, is interpreted as the combination of a local shear with the ordering of cation vacancies resulting from the oxidation. Small volumes of other second phases were also recognized, by virtue of both compositional and microstructural differences from the host ferrite.     

Root growth and phosphorus and potassium uptake by two corn genotypes in the field

In a field study P and K uptake by two corn (Zea mays L.) genotypes which differed in root growth was investigated. The effect of differences in root growth on P and K uptake was assessed using a mechanistic-mathematical model which describes nutrient uptake by growing plant roots in soil. Nitrogen was applied at 0 and 227 kg ha^–1 to Pioneer 3732 and B73xMo17 corn grown on Raub silt loam (fine-silty, mixed, mesic Aquic Argiudoll) and at 227 kg N ha^–1 to these two genotypes on Chalmers silt loam (finesilty, mixed, mesic, Typic Haplaquoll). Root growth and P and K uptake by the two corn genotypes was measured 31, 47, 75 and 91 d after planting on the Raub and 31, 47, 61 and 75 d after planting on the Chalmers soil.Root growth and P and K uptake by B73xMo17 was greater than that of Pioneer 3732 on N-fertilized Raub soil. On Chalmers soil the difference in root growth between the two genotypes resulted in an increase in K but not P uptake. The higher soil P level of the Chalmers appears to have offset possible differences in P uptake due to root size. There were no differences between the two genotypes in either the percentage of roots with root hairs, or the density or length of root hairs. Phosphorus and K uptake calculated with the simulation models for both corn genotypes on both soils over each of three growth periods agreed with observed P (Y = 0.68X + 1.71; r = 0.944^**) and K (Y = 0.88X + 15.52; r = 0.928^**) uptake. Differences in P and K uptake between B73xMo17 and Pioneer 3732 resulted primarily from the difference in root growth in the topsoil. A high correlation was found between root surface area and P (r = 0.893^**) and K (r = 0.928^**) uptake by both corn genotypes on both the soils.Journal paper No. 10,316 Purdue Univ. Agric. Exp. Stn., W. Lafayette, In 47906. Contribution from the Dep. of Agron. This paper was supported in part by a grant from the Tennessee Valley Authority.     

Intraoperative tumor detection: relative performance of single-element, dual-element, and imaging probes with various collimators

Accurate tumor staging depends on finding all tumor sites, and curative surgery requires the removal of ail cancerous tissue from those sites. One technique for locating tumors is to inject patients before surgery with a radiotracer that is preferentially taken up by cancerous tissue. Then, an intraoperative gamma-sensitive probe is used to locate the tumors. Small (<1-cm diameter) tumors, often undetectable by external imaging and by the standard surgical inspection with sight and touch, can be found with probes, Simple calculations and measurements with radioactive tumor models show that small tumors should be detected by single-element probes, but often such probes fail to detect these small tumors in practice. This discrepancy is often caused by the use of a uniform background to predict probe performance, Real backgrounds are nonuniform and can decrease probe performance dramatically. Dual-element, coincidence, or imaging probes may solve the background problem. The authors devised a method to predict probe performance in a realistic background which includes variations in normal organ uptakes. They predict the relative performance of both existing probes and those in the design stage so that optimal detector and collimator configurations can be determined. The procedure includes a Monte-Carlo-calculated point-response function, a numerical torso phantom, and measured biodistributions of a monoclonal antibody. The Hotelling Trace Value, a measure of tumor-detection performance, is computed from the probe responses in simulated studies.     

Reduced brain serotonin transporter availability in major depression as measured by [123I]-2 beta-carbomethoxy-3 beta-(4-iodophenyl)tropane and single photon emission computed tomography

BACKGROUND: Prior research has suggested reductions in the density of serotonin transporter (SERT) binding sites in blood platelets and post-mortem brain tissue of depressed patients. We sought to determine whether patients with unipolar major depression have diminished SERT availability as assessed by both brainstem [123I] beta-CIT SPECT and platelet [3H]paroxetine binding. METHODS: Drug-free depressed and healthy subjects were injected with 211 +/- 22 MBq [123I] beta-CIT and imaged 24 +/- 2 h later under equilibrium conditions. A ratio of specific to nonspecific brain uptake (V3" = (brainstem-occipital)/occipital), a measure proportional to the binding potential (Bmax/Kd), was used for all comparisons. RESULTS: Results showed a statistically significant reduction in brainstem V3" values in depressed as compared to healthy subjects (3.1 +/- .9 vs. 3.8 +/- .8, p = .02). Platelet [3H]paroxetine binding was not altered (Bmax = 2389 +/- 484 vs. 2415 +/- 538 fmol/mg protein, p = .91) and was not significantly correlated with brainstem [123I] beta-CIT binding (r = -0.14, p = .48). CONCLUSIONS: These data are the first to suggest reductions in the density of brain SERT binding sites in living depressed patients. These findings provide further support for a preeminent role for alterations in serotonergic neurons in the pathophysiology of depression.     

Domain flexibility in retroviral proteases: structural implications for drug resistant mutations

Rigid body rotation of five domains and movements within their interfacial joints provide a rational context for understanding why HIV protease mutations that arise in drug resistant strains are often spatially removed from the drug or substrate binding sites. Domain motions associated with substrate binding in the retroviral HIV-1 and SIV proteases are identified and characterized. These motions are in addition to closure of the flaps and result from rotations of approximately 6-7 degrees at primarily hydrophobic interfaces. A crystal structure of unliganded SIV protease (incorporating the point mutation Ser 4 His to stabilize the protease against autolysis) was determined to 2.0 A resolution in a new space group, P3221. The structure is in the most "open" conformation of any retroviral protease so far examined, with six residues of the flaps disordered. Comparison of this and unliganded HIV structures, with their respective liganded structures by difference distance matrixes identifies five domains of the protease dimer that move as rigid bodies against one another: one terminal domain encompassing the N- and C-terminal beta sheet of the dimer, two core domains containing the catalytic aspartic acids, and two flap domains. The two core domains rotate toward each other on substrate binding, reshaping the binding pocket. We therefore show that, for enzymes, mutations at interdomain interfaces that favor the unliganded form of the target active site will increase the off-rate of the inhibitor, allowing the substrate greater access for catalysis. This offers a mechanism of resistance to competitive inhibitors, especially when the forward enzymatic reaction rate exceeds the rate of substrate dissociation.     

NK cells can recognize different forms of class I MHC

NK recognition and lysis of targets are mediated by activation receptor(s) whose effects may be over-ridden by inhibitory receptors recognizing class I MHC on the target. Incubation of normal lymphoblasts with a peptide that can bind to their class I MHC renders them sensitive to lysis by syngeneic NK cells. By binding to class I MHC, the peptide alters or masks the target structure recognized by an inhibitory NK receptor(s). This target structure is most likely an "empty" dimer of class I heavy chain and beta2m as opposed to a "full" class I trimer formed by binding of specific peptide that is recognized by CTL.     

Prediction of indications for valve replacement among asymptomatic or minimally symptomatic patients with chronic aortic regurgitation and normal left ventricular performance

BACKGROUND: Optimal criteria for valve replacement are unclear in asymptomatic/minimally symptomatic patients with aortic regurgitation (AR) and normal left ventricular (LV) performance at rest. Moreover, previous studies have not assessed the prognostic capacity of load-adjusted LV performance ("contractility") variables, which may be fundamentally related to clinical state. Therefore, 18 years ago, we set out to test prospectively the hypothesis that objective noninvasive measures of LV size and performance and, specifically, of load-adjusted variables, assessed at rest and during exercise (ex), could predict the development of currently accepted indications for operation for AR. METHODS AND RESULTS: Clinical variables and measures of LV size, performance, and end-systolic wall stress (ESS) were assessed annually in 104 patients by radionuclide cineangiography at rest and maximal ex and by echocardiography at rest; ESS was derived during ex. During an average 7.3-year follow-up among patients who had not been operated on, 39 of 104 patients either died suddenly (n = 4) or developed operable symptoms only (n = 22) or subnormal LV performance with or without symptoms (n = 13) (progression rate=6.2%/y). By multivariate Cox model analysis, change (delta) in LV ejection fraction (EF) from rest to ex, normalized for deltaESS from rest to ex (deltaLVEF-deltaESS index), was the strongest predictor of progression to any end point or to sudden cardiac death alone. Unadjusted deltaLVEF was almost as efficient. Symptom status modified prediction on the basis of the deltaLVEF-deltaESS index. The population tercile at highest risk by deltaLVEF-deltaESS progressed to end points at a rate of 13.3%/y, and the lowest-risk tercile progressed at 1.8%/y. CONCLUSIONS: Currently accepted symptom and LV performance indications for valve replacement, as well as sudden cardiac death, can be predicted in asymptomatic/minimally symptomatic patients with AR by load-adjusted deltaLVEF-deltaESS index, which includes data obtained during exercise.     

Functional knockout of the transient outward current, long-QT syndrome, and cardiac remodeling in mice expressing a dominant-negative Kv4 alpha subunit

Amino acid changes S180A (S-->A at site 180), H197Y, Y277F, T285A, and A308S are known to shift the maximum wavelength of absorption (lambda max) of red and green visual pigments toward blue, essentially in an additive fashion. To test the generality of this "five-sites" rule, we have determined the partial amino acid sequences of red and green pigments from five mammalian orders (Artiodactyla, Carnivora, Lagomorpha, Perissodactyla, and Rodentia). The result suggests that cat (Felis catus), dog (Canis familiaris), and goat (Capra hircus) pigments all with AHYTA at the five critical sites have lambda max values of approximately 530 nm, whereas rat (Rattus norvegicus) pigment with AYYTS has a lambda max value of approximately 510 nm, which is accurately predicted by the five-sites rule. However, the observed lambda max values of the orthologous pigments of European rabbit (Oryctolagus cuniculus), white-tailed deer (Odocoileus virginianus), gray squirrel (Sciurus carolinensis), and guinea pig (Cavia procellus) are consistently more than 10 nm higher than the predicted values, suggesting the existence of additional molecular mechanisms for red and green color vision. The inferred amino acid sequences of ancestral organisms suggest that the extant mammalian red and green pigments appear to have evolved from a single ancestral green-red hybrid pigment by directed amino acid substitutions.     

Organizational Commitment: Clarifying the Concept and Simplifying the Existing Construct Typology

This paper examines popular concepts and "types" of organizational commitment in light of the definition of commitment and common factors that pertain to all commitments. It argues that a commitment is best conceptualized as a single, fundamental construct that may vary according to differences in focus, terms, and time-specific evaluation. Analysis of affective commitment measures indicates that certain measures contain more than one set of terms and make assumptions about evaluation that add constraints to the basic meaning of commitment. Recommendations include the argument that commitment measures address one set of terms and avoid evaluative phraseology.