Nursing in the NHS: the executive nurse director

The advent of trusts within the NHS brought a new dimension to the role of nurses in management, in that each trust must appoint an executive nurse director to sit on the trust board. The function and potential function of this role is, I believe, pivotal to the development of clinical services within the NHS.     

Ensuring reliability of outcome measures in multicenter clinical trials of treatments for acute ischemic stroke. The program developed for the Trial of Org 10172 in Acute Stroke Treatment (TOAST)

BACKGROUND AND PURPOSE: Ensuring the reliability and validity of outcome measures used in clinical trials is essential to the success of the trial. The Trial of Org 10172 in Acute Stroke Treatment (TOAST) is a multicenter clinical trial that is recruiting patients with acute ischemic stroke seen at medical centers across the United States. METHODS: This paper describes an approach to train physicians to use three clinical measures: the National Institutes of Health (NIH) Stroke Scale, a supplemental motor examination, and the Glasgow Outcome Scale. The program included education, certification, remediation when needed, monitoring, and reliability assessment. The goal was to ensure that interrater assessments were as equivalent to one another as possible. RESULTS: Of the first 95 clinicians who began the certification process, 75 passed during the first evaluation. Eighteen of the other physicians were able to complete the process after remediation. The intraclass correlations of both the NIH Stroke Scale and supplemental motor examination exceeded 0.95. The kappa values for the Glasgow Outcome Scale were 0.61 and 0.62 for the first and second ratings of the videotape, respectively. CONCLUSIONS: Our experience suggests that a program that includes educational and certification processes can be performed as part of the design of a multicenter clinical trial. The method of providing educational and testing videotapes to each site so that physicians can be trained and certified is an effective, inexpensive, and practical approach for enhancing and certifying the expertise of the large number of physicians involved in a multicenter study.     

Radiation protection systems for the final focus test beam at SLAC

The Final Focus Test Beam (FFTB) is a new beam line at the Stanford Linear Accelerator Center designed to test new beam optics concepts, hardware, and techniques necessary to achieve and measure the small spot sizes required for future generations of high-energy e+e- linear colliders. The FFTB takes a 47 GeVc-1, 1 kW electron beam at the end of the Stanford Linear Accelerator Center linear accelerator and transports it to the FFTB beam dump. A radiation protection system was designed and installed for the FFTB with the primary goal that the integrated dose equivalent outside the shielding resulting from beam loss would not exceed 10 mSv y-1. This system is comprised of shielding, a beam containment system and a personnel protection system. This paper presents various aspects of radiation safety at Stanford Linear Accelerator Center that were considered in the design of the FFTB radiation protection system. Beam tests were conducted in which the performance of various beam containment devices and the shielding effectiveness were evaluated. Preliminary results from these tests are presented.     

Magnetic circular dichroism studies of exogenous ligand and substrate binding to the non-heme ferrous active site in phthalate dioxygenase

BACKGROUND: Mononuclear non-heme iron centers are found in the active sites of a variety of enzymes that require molecular oxygen for catalysis. The mononuclear non-heme iron is believed to be the active site for catalysis, and is presumed to bind and activate molecular oxygen. The mechanism of this reaction is not understood. Phthalate dioxygenase is one such enzyme. Because it also contains a second iron site, the Rieske site, it is difficult to obtain information on the structure of the active site. We therefore used magnetic circular dichroism (MCD) spectroscopy to probe the mononuclear, non-heme Fe2+ site in this biodegradative enzyme. RESULTS: The MCD spectrum of the resting enzyme shows features indicative of one six-coordinate Fe2+ site; substrate binding converts the site to two different five-coordinate species, opening up a coordination position for O2 binding. MCD spectra of the corresponding apoenzyme have been subtracted to account for temperature-independent contributions from the Rieske site. Azide binds both to the resting enzyme to produce a new six-coordinate species, showing that one of the ferrous ligands is exchangeable, and also to the enzyme-substrate complex to form a ternary species. The low azide binding constant for the substrate-enzyme species relative to the resting enzyme indicates steric interaction and close proximity between exogenous ligand and the substrate. CONCLUSIONS: We have been able to provide some detailed structural insight into exogenous ligand and substrate binding to the non-heme Fe2+ site, even in the presence of the enzyme's [2Fe-2S] Rieske center. Further mechanistic studies are now required to maximize the molecular-level detail available from these spectroscopic studies.     

Predicting outcome after listing for heart transplantation in children: comparison of Kaplan-Meier and parametric competing risk analysis. Pediatric Heart Transplant Study Group

Two methods of estimating premorbid WAIS-R intelligence were compared in matched samples of normal and AD persons. The NART and Barona 1984 demographic equations accurately predicted the IQs of the normal group and overestimated the IQs of the AD subjects. When the AD group was divided into mild and moderately impaired subgroups, the more severely demented subjects displayed lower WAIS-R IQs and NART estimated IQs, revealing that NART performance is sensitive to dementia severity. However, the NART estimated IQs for the mild and moderately impaired AD subgroups were larger than the WAIS-R IQs, suggesting that while the NART is sensitive to dementia severity, it may still provide relevant clinical information.