Charting progress

Logbooks can be considered aggregate databases that registered nurses (RNs) have the primary responsibility of completing in most health care settings. However, RNs may be unaware of the many uses for the information contained in logbooks and the importance of these entries (Paine et al., 1988). Labor and delivery (L&D) logs provide an essential source of vital statistics birth data for the medical records staff. These data bits are used for reporting statistics, projecting trends, and planning future care for pregnant women.     

Is it possible to perform immediate cardiac assist using untrained latissimus dorsi muscle in a work-rest regimen?

The authors investigated what contractile force (CF) could be obtained from unconditioned latissimus dorsi muscle immediately after mobilization and for the 2 week vascular period of recovery. Latissimus dorsi muscle mobilization was performed on seven adult (4 experimental and 3 control) sheep leaving only the pedicle and the peripheral muscle intact. Telectronics stimulators (Myostim 7220; Teletronics Pacing Systems, Inc, Englewood, CO) were implanted. Immediately after mobilization 11-35% of the initial CF was lost. A 30 min fatigue test was performed 1 hr after mobilization (20 g/kg preload, 10 V, 10 Hz, 15 BPM, 6 impulses per burst) using a 1 min work-1 min rest regimen. Two sheep lost 2-12% of initial CF; two increased CF by 14-24%. At the end of the fatigue test, CF consisted of 74-89% of immobilized CF. Electrical stimulation training of the muscle was then initiated with the following regimen in the experimental animals only: 15 BPM, single impulses, 5 V, 10 Hz. Every day the muscle was exercised using a work-rest regimen to mimic cardiac assist, starting with 20 min on day 2, and increasing by 2 min per day until a total of 50 min was reached on day 16. All animals were retested for CF using a 42 min fatigue test on days 6, 11, and 16. On day 6, there was no fatigue evident in the experimental group during the 42 min test. CF after testing was 59-81% (mean 67%) of initial data. In the control group (animals with no electrical stimulation training protocol), CF decreased by 11% (from 64 to 53%). On day 11, there was no fatigue evident in the experimental group; CF in all animals increased by 2-8%. On day 16, there was also no fatigue evident in the experimental group; CF increased by 0-9%. An additional 20 min of continuous contraction (15 BPM) fatigue testing was performed on the muscle without rest between the tests. No fatigue was evident at the end of testing. Light microscopic analysis of latissimus dorsi muscle biopsy specimens taken on the days of testing showed no evidence of necrotic damage. Our investigations suggest that it may be possible to start muscle transformation immediately after mobilization and use the untrained latissimus dorsi muscle for cardiac assist immediately after surgery for short periods.     

Comparison of treatment utilization and outcome for Hispanics and non-Hispanic whites

Ketoprofen is a chiral non-steroidal anti-inflammatory drug (NSAID) available as a racemic (rac) mixture of S-(+)- and R-(-)-isomers. Its inhibitory effect on prostaglandin biosynthesis resides virtually in the S-form. Interestingly, R-ketoprofen does not undergo substantial metabolic inversion in humans. Though contraindicated during the last trimester of pregnancy, NSAIDs, including ketoprofen, are used as tocolytic agents in some cases. The S/R plasma concentration ratio was reported to average 2.3 in premature neonates whose mothers were given rac-ketoprofen and to be close to 1 in the maternal plasma. Thus, we investigated the placental transfer of rac-ketoprofen in vitro using Schneider's perfused human cotyledon model. Glucosed Earle solutions with and without human serum albumin (HSA) were used. Several maternal perfusates were tested with different rac-ketoprofen concentrations together with 20 mg L-1 of antipyrine as a reference substance. Ketoprofen enantiomers were assayed by a specific HPLC method with derivatization procedure. HSA concentrations in maternal perfusate influenced the placental transfer of ketoprofen enantiomers. In the absence of HSA in the maternal perfusate, the S-(+)/R-(-) concentration ratio was close to 1 in the fetal perfusate. By contrast, this ratio averaged 1.44 after addition of HSA 10 g L-1 on the maternal side. Similar results were found for dialysis experiments using an inert Spectrapor 2 membrane suggesting that the S-(+)-free concentration is superior to the R-(-)-free concentration in the presence of HSA. Direct measurements of the free concentrations by centrifugal ultrafiltration confirmed this hypothesis. Accordingly, the data observed in vivo may result, at least in part, from the stereoselective protein binding of ketoprofen.     

Resistance of Vigna unguiculata (cowpea) seeds to Callosobruchus maculatus is restricted to cotyledonary tissues

We have investigated the survival of Callosobruchus maculatus larvae when reared on resistant IT81D 1045 Vigna unguiculata seeds, whose resistance has been associated with variant forms of vicilins. Here, we present data which show that larvae of C. maculatus feeding on embryonic axis of resistant cowpea reach a mass of around 28 times higher than those feeding on cotyledonary tissues. Additionally, incorporation of 5–10% of embryonic axis flour on artificial seeds made of resistant flour restores toxicity of seeds to the bruchid. Vicilins purified from both susceptible and resistant embryonic axis had no deleterious effects either on insect development or on insect survival until a level of 4% of incorporation. In contrast, vicilins from resistant cotyledons show an LD₅₀ (50% lethal dose) and WD₅₀ (half weight dose) of 2%. Total vicilin contents of embryonic axes were around two times lower than in cotyledonary tissues, while proteolytic activities of all four proteinase classes were always higher in the former tissues. By 2D‐PAGE we visualized eight protein spots, which seem to be exclusively found on resistant cotyledons. Copyright © 2006 Society of Chemical Industry     

Neonatal bladder rupture: an unusual complication of umbilical catheterization

Bladder injury in the neonatal period is an exceedingly rare phenomenon that is usually iatrogenic. Bladder rupture as a complication of umbilical catheterization in a newborn with urinary ascites, respiratory distress and hematuria is presented and discussed.     

WFS + branch and bound = stable models

Though the semantics of nonmonotonic logic programming has been studied extensively, relatively little work has been done on operational aspects of these semantics. In this paper, we develop techniques to compute the well-founded model of a logic program. We describe a prototype implementation and show, based on experimental results, that our technique is more efficient than the standard alternating fixpoint computation. Subsequently, we develop techniques to compute the set of all stable models of a deductive database. These techniques first compute the well-founded semantics and then use an intelligent branch and bound strategy to compute the stable models. We report on our implementation, as well as on experiments that we have conducted on the efficiency of our approach     

Neutralizing antibodies from the sera of human immunodeficiency virus type 1-infected individuals bind to monomeric gp120 and oligomeric gp140

Antibodies that neutralize primary isolates of human immunodeficiency virus type 1 (HIV-1) appear during HIV-1 infection but are difficult to elicit by immunization with current vaccine products comprised of monomeric forms of HIV-1 envelope glycoprotein gp120. The limited neutralizing antibody response generated by gp120 vaccine products could be due to the absence or inaccessibility of the relevant epitopes. To determine whether neutralizing antibodies from HIV-1-infected patients bind to epitopes accessible on monomeric gp120 and/or oligomeric gp140 (ogp140), purified total immunoglobulin from the sera of two HIV-1-infected patients as well as pooled HIV immune globulin were selectively depleted of antibodies which bound to immobilized gp120 or ogp140. After passage of each immunoglobulin preparation through the respective columns, antibody titers against gp120 and ogp140 were specifically reduced at least 128-fold. The gp120- and gp140-depleted antibody fraction from each serum displayed reduced neutralization activity against three primary and two T-cell line-adapted (TCLA) HIV-1 isolates. Significant residual neutralizing activity, however, persisted in the depleted sera, indicating additional neutralizing antibody specificities. gp120- and ogp140-specific antibodies eluted from each column neutralized both primary and TCLA viruses. These data demonstrate the presence and accessibility of epitopes on both monomeric gp120 and ogp140 that are specific for antibodies that are capable of neutralizing primary isolates of HIV-1. Thus, the difficulties associated with eliciting neutralizing antibodies by using current monomeric gp120 subunit vaccines may be related less to improper protein structure and more to ineffective immunogen formulation and/or presentation.     

An evaluation of the effectiveness of competency-based code blue education

Two types of mock code programs were compared. The specific factors investigated were nurse satisfaction, comfort, and retention of knowledge and skills. A sample of 48 nurses initially participated in the mock code program, with 45 nurses participating in the 6-month follow-up evaluation. The study revealed that competency-based and group code blue programs resulted in similar levels of satisfaction, knowledge, and rate of performance of critical elements 6 months after the initial program.     

Boundary Objects and Prototypes at the Interfaces of Engineering Design

The primary hypothesis of this paper is thatinternal and external changes in design andmanufacturing organizations affect theviability of boundary objects (representations,drawings, models – virtual and physical) andrequire changes in the underlying distributedcognitive models. Internal and external factorsinclude new advances in technologies, insightsinto organizational processes, organizationalrestructuring and change of market focus. Ifthe above hypothesis is true, then there areconsequences for the methodologies of designingcomputational support systems for co-operativeengineering work. We provide evidence bydescribing three empirical studies ofengineering design we have performed in largeorganizations. We investigate how changingtechnologies disrupt the common grounds amonginterfaces and how this opens debate onthe role of boundary objects, especially in theproduct visualization and analysis arena. Wethen argue that changes in market forces andother factors leading to changes inorganizational structures often lead to erosionof common understanding of representations andprototypes, above all at the interfaces. Weconclude by making the case that everystructural and information flow change inengineering organizations is accompanied by thepotential deterioration of the common ground.This requires the synthesis of new commongrounds to accommodate the needs of newinterfaces.