Position changes for residents in long-term care

The purpose of this study in long-term care facilities was to determine the factors associated with the common pressure ulcer prevention practice of turning and positioning of residents. The study showed there was a deficit in performance of two-hour turning, but not in knowledge that turning should be done. The chief reason for the aides' performance deficit was a lack of specific assignment to the task as well as a lack of time and staff. Head nurses and directors of nursing acknowledged these problems and also cited copious paperwork that prevented them from spending the necessary time to monitor compliance to facility policies on turning and positioning.     

Control of the vertical dimension in Class II correction using a cervical headgear and lower utility arch in growing patients. Part I

A retrospective cephalometric study was performed comparing three groups of 30 growing patients with Class II, Division 1 malocclusions. Group 1 was treated with a cervical headgear/lower utility arch combination (CHG/LUA), group 2 was treated with a cervical headgear alone (CHG), and the third group was untreated. The average treatment time was 1 year, 6 months. No other appliances were used during this period. Maxillary and mandibular dental and skeletal treatment responses were compared with an analysis of variance (ANOVA) and a Scheffe's test. In addition, a multiple stepwise regression was performed to determine whether pretreatment measures of facial pattern were accurate predictors of mandibular rotational response. Both treatment groups demonstrated significant reduction in maxillary protrusion. The CHG-only group showed significantly greater anterior descent of the palatal plane as compared with the untreated group. The maxillary molars showed significant distal movement in both treatment groups without any extrusion beyond that seen with normal growth. The maxillary incisor demonstrated significant retroclination in the CHG-only group. There was no statistical difference among the groups for variables commonly used for measuring mandibular rotation or protrusion. The change in vertical position of the lower molar was not significantly different among the groups. A CHG as used in this study produced maxillary orthopedic and orthodontic changes without upper molar extrusion beyond that seen with normal eruption and in the absence of an opening rotation of the mandible, even in subjects with dolicocephalic facial patterns. The LUA did not appear to influence lower molar eruption or mandibular rotational response. None of the commonly used predictors of facial pattern, such as the Y-axis, XY-axis, or MP angle, accurately predicted mandibular rotational response. Further study would be necessary to ascertain whether this was a result of their invalidation as predictors, or a result of the treatment strategy employed.     

Effects of variousMicrococcus strains on the ripening and organoleptic characteristics of Arzúa cow's-milk cheese

Ten batches of Arzúa, a soft cow's-milk cheese produced in northwest Spain, were prepared from pasteurized milk. Two (control) batches (CB) were made with a commercial starter containingLactococcus lactis subspecieslactis andcremoris. Another eight batches (MB) were made with the commercial starter plus one of eightMicrococcus spp. strains previously isolated from raw-milk Arzúa cheeses. In all MB, β-casein degradation over the 30-day ripening period was more pronounced (mean 31%) than in the CB (mean 12%). α_S1-Casein degradation was highly variable in the MB, though mean degradation over the ripening period (75%) was similar to that observed in the CB (73%). Similarly, volatile fatty acid (VFA) content was highly variable in the MB, with the mean content at 30 days (3.8 mEq per 100 g) being higher than in the CB (1.6 mEq per 100 g). Rheological characterization of the cheeses (by uniaxial compression) revealed significant differences between batches, with some samples fracturing under the compression pressure applied and others not. Sensory evaluation also revealed significant differences. “Non-milk” aromas were more frequently detected in batches made with lipolytic micrococcal strains. Betweenbatch differences in tastes and texture were also detected. Multiple correlation analysis of the data obtained at day 15 of ripening revealed statistically significant positive correlations (r>0.70) between α_S1-casein content and dry matter content, between α_S1-casein content and sensorially evaluated firmness, and between VFA content and sensorially evaluated rancidity. Statistically significant negative correlations between sensorially evaluated firmness and the ratio of α_S1-I content to α_S1-casein content were detected. The results of this study suggest a need for further studies aimed at selecting those strains which could be most suitable for the production of Arzüa cheeses; due to their effects on texture, α_S1-caseinolytic strains seem to be more appropriate than β-caseinolytic ones.     

Correlation between structure and magnetic spin state of the manganese cluster in the oxygen-evolving complex of photosystem II in the S2 state: determination by X-ray absorption spectroscopy

The structure of the manganese cluster in the S2 state with the g approximately 4 EPR signal (S2-g4 state) generated by 130 K illumination of photosystem II (PSII) membranes prepared from spinach has been investigated by X-ray absorption spectroscopy. The Mn X-ray absorption K-edge spectra of the S2-g4 state not only show a shift of the inflection point to higher energy from the S1 state but also reveal a different edge shape from that of the S2 state with the multiline signal (S2-MLS state). Extended X-ray absorption fine structure (EXAFS) studies of the Mn K-edge show that the structure of the Mn cluster in the S2-g4 state is distinctly different from those in the S2-MLS or S1 states. In the S2-g4 state, the second shell of back-scatters from the Mn absorber is found to contain two Mn-Mn distances of 2.73 and 2.85 A. We interpret this to indicate the presence of two nonequivalent di-mu-oxo-bridged Mn binuclear structures in the Mn cluster of the S2-g4 state. The third shell of the S2-g4 state at about 3.3 A also contains increased heterogeneity. By contrast, very little distance disorder was found to exist in the second shell of the S1 or S2-MLS states. A mechanism is proposed to explain these results in the context of our model for the Mn cluster and the EPR properties of the Mn complex in the S2 state.     

Characterization of the equine glycoprotein hormone alpha-subunit gene reveals divergence in the mechanism of pituitary and placental expression

The equine glycoprotein hormone alpha-subunit gene is expressed in both pituitary and placenta, unlike that of all other nonprimate mammals studied, in which expression is limited to pituitary. Previous studies of the 5'-flanking region of the equine alpha-subunit promoter have revealed unique characteristics as well as similarities with the human alpha-subunit promoter, which demonstrates a similar pattern of tissue-specific expression. We have cloned and sequenced the equine alpha-subunit gene and have used tissue culture systems and transgenic mice to characterize its expression. Unlike the human promoter, the cloned equine alpha-subunit promoter failed to direct trophoblast-specific expression in either tissue culture or transgenic mouse models, suggesting an entirely different mechanism for expression. In contrast, the equine alpha-subunit promoter was able to direct gonadotroph expression in both tissue culture and transgenic mouse models. In alphaT3-1 cells, 550 base pair (bp) was sufficient for expression. This expression involves promoter elements identified in other species as playing a role in gonadotroph expression, but mutation of these elements reveals differences in their relative contributions to promoter activity. In mice, 2800 bp of 5'-flanking sequence allowed specific expression in gonadotrophs but not in thyrotrophs or placenta. The pattern of estrogen regulation observed in transgenic mice matched neither the repression that has been observed with human and bovine alpha-subunit promoters in transgenic mice nor the stimulation in mRNA levels reported in mares, suggesting a unique mechanism that is not recapitulated in the transgenic model. Thus the equine alpha-subunit promoter uses a combination of conserved and unique features of gene regulation to direct its pattern of tissue-specific expression.     

Prenatal molecular genetic diagnosis and treatment of congenital adrenal hyperplasia due to 21-hydroxylase deficiency

Congenital adrenal hyperplasia due to 21-hydroxylase deficiency (21-OH), in its severe forms, produces virilization of the external genitalia of the affected female fetus. Early treatment with dexamethasone of the pregnant mother at risk of a fetus with 21-OH deficiency avoids the masculinization of the affected female fetus. We present a pregnant mother, where the prenatal diagnosis was established by DNA analysis of a chorionic villous sample obtained in the 9th week of gestation. Molecular analysis showed the female fetus to be affected of 21-OH deficiency. Maternal treatment with dexamethasone started on the 6th week of gestation has prevented the virilization of the affected baby. No significant side effects have been encountered. Prenatal diagnosis and treatment for 21-OH deficiency is effective and safe, as is described in the literature. This is the first case in Spain where both prenatal molecular diagnosis and treatment for 21-OH deficiency have been reported.