Perioperative nursing documentation in liver transplantation.
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Biomedical subjects
Publications and source records attributed to M Flynn.
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295 first- and fourth-year students in the College of Education at the University of Saskatchewan, Canada were asked to describe learning disabilities. When the descriptors they used were categorized, nonparticipation in the classroom formed the largest single category.
This article describes the design specification of the Vapor Phase Catalytic Ammonia Removal (VPCAR) process and the relative benefits of its utilization in a Mars Transit Vehicle application. The VPCAR process is a wastewater treatment technology that combines distillation with high-temperature catalytic oxidation of volatile impurities such as ammonia and organic compounds.
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This study addressed the recycle of carbon from inedible biomass to CO2 for utilization in crop production. Earlier work identified incineration as an attractive approach to resource recovery from solid wastes because the products are well segregated. Given the effective separation of carbon into the gaseous product stream from the incinerator in the form of CO2 we captured the gaseous stream produced during incineration of wheat inedible biomass and utilized it as the CO2 source for crop production. Injection rate was based on maintenance of CO2 concentration in the growing environment. The crop grown in the closed system was lettuce. Carbon was primarily in the form of CO2 in the incinerator product gas with less than 8% of carbon compounds appearing as CO. Nitrogen oxides and organic compounds such as toluene, xylene, and benzene were present in the product gas at lower concentrations (< 4 micromol mol-1); sulfur containing compounds were below the detection limits. Direct utilization of the gaseous product of the incinerator as the CO2 source was toxic to lettuce grown in a closed chamber. Net photosynthetic rates of the crop was suppressed more than 50% and visual injury symptoms were visible within 3 days of the introduction of the incinerator gas. Even the removal of the incinerator gas alter two days of crop exposure and replacement with pure CO2 did not eliminate the toxic effects. Both organic and inorganic components of the incinerator gas are candidates for the toxin.
Ethylene glycol-bis(beta-aminoethyl ether)-N,N,N',N'-tetraacetic acid (EGTA) was used as an intracellular Ca2+ chelator to shorten the duration of the Ca2+ transient and to determine the rate-limiting steps in relaxation of frog skeletal muscle at 10 and 20 degrees C. Incubation with the acetoxymethyl ester of EGTA (EGTA-AM) produced a linear approximately twofold increase in the rate of fall in twitch Ca2+ concentration ([Ca2+]) over 0-70 min at 10 degrees C. The rate of relaxation initially increased from 5 to 9/s over 0-13 min and then leveled, as the rate of fall in [Ca2+] continued to increase and peak force decreased. Increasing the rate of fall in [Ca2+] increased the rate of relaxation, until a rate-limiting step was reached at approximately 9/s at 10 degrees C. At 20 degrees C, incubation with EGTA-AM produced a linear approximately twofold increase in the rate of fall in twitch [Ca2+] without affecting the rate of relaxation (27/s). Ca2+ dissociated from the regulatory sites of purified troponin (Tn) at approximately 8/s at 10 degrees C and at 23/s at 20 degrees C. When the duration of the Ca2+ transient was decreased by EGTA or increased by partial inhibition of the sarcoplasmic reticulum Ca(2+)-ATPase, twitch force increased linearly with Ca2+ transient duration. Thus the duration of the Ca2+ transient is a primary determinant of twitch force and, whereas the rate of fall in [Ca2+] is rate limiting for relaxation at 10 degrees C, Ca2+ dissociation from Tn may be rate limiting at 20 degrees C.
Prevention of meningococcal disease relies in part on the prompt treatment of household and other close contacts of cases. New York State requires that all meningococcal disease cases be reported within 24 hours of diagnosis to ensure that chemoprophylaxis is given to all exposed persons. The authors used a capture-recapture method to assess completeness of reporting of meningococcal disease in 1991 by comparing persons reported to the Department of Health surveillance system with patients listed in the New York State computerized hospital discharge data set who had a discharge diagnosis of meningococcal disease. Medical records of persons identified from the discharge data set were reviewed to verify the diagnosis of meningococcal disease, and timeliness of reporting was assessed by reviewing surveillance case reports. In 1991, 110 cases of meningococcal disease were reported to the Department of Health and 197 patients were identified from hospital discharge data, of which charts were reviewed for 179 (91%). Of the charts reviewed, 116 (65%) had confirmed or probable meningococcal disease, and 57 (32%) did not have the disease. Completeness of reporting to the notifiable disease surveillance system was estimated to be 93%, and 78% were reported within 2 days of diagnosis. Errors of physicians and medical records departments contributed to the misclassification of medical records. The authors conclude that notifiable disease surveillance for meningococcal disease is relatively complete, but there is a delay in reporting some cases. Frequent errors may make invalidated hospital discharge data unsuitable for communicable disease surveillance.
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Myosin light chain kinase and peptides from the calmodulin (CaM) binding domains of myosin light chain kinase (RS-20, M-13), CaM kinase II, and the myristoylated alanine-rich protein kinase C substrate protein slowed Ca2+ dissociation from CaM's N-terminal sites from 405 +/- 75/s to 1.8-2.9/s and from CaM's C-terminal sites from 2.4 +/- 0.2/s to 0.1-0.4/s at 10 degrees C. Since Ca2+ dissociates 5-29 times faster from the N-terminal in these CaM.peptide complexes and both lobes are required for activation, Ca2+ dissociation from the N-terminal would control target protein inactivation. Ca2+ binds 70 times faster to the N-terminal (1.6 x 10(8) M-1 s-1) than the C-terminal sites (2.3 x 10(6) M-1 s-1). In a 0.6-ms half-width Ca2+ transient, Ca2+ occupied > 70% of the N-terminal but only 20% of the C-terminal sites. RS-20 produced a 9-fold and CaM kinase II a 6.3-fold increase in C-terminal Ca2+ affinity, suggesting that some target proteins may be bound to the C-terminal at resting [Ca2+]. When this is the case, Ca2+ exchange with the faster N-terminal sites may regulate CaM's activation and inactivation of these target proteins during a Ca2+ transient.
OBJECTIVE: To cross-validate the Delirium Rating Scale (DRS). DESIGN: Cross-sectional. SETTING: Geriatric medicine and geriatric psychiatry assessment units and consultation services. PARTICIPANTS: A total of 104 older patients on the above services. MEASUREMENTS: Mini-Mental State Examination (MMSE) score, Barthel Index score, DRS score, Blessed Dementia Scale score, clinical diagnoses using DSM-III-R criteria. MAIN RESULTS: The mean DRS score was highest in the delirium group. Cronbach's alpha was .90, and inter-rater reliability of total scores was .91 (intra-class correlation). Receiver Operating Characteristic curve analysis showed that the area under the curve for the DRS was significantly higher than the MMSE as a test for delirium. At its published cutpoint of 10, the sensitivity of the DRS is .82 and the specificity is 94. The value at which the sensitivity of the DRS is .90 is 8, at which specificity is .82. CONCLUSIONS: The DRS appears to a feasible instrument. In a sample with a high proportion of delirious patients, it has acceptable measurement properties when used by expert observers.
An earlier investigation indicated that the education students in this sample gave estimates of the prevalence of learning disabilities that were 4 times greater than those given by experts. In the present study, we identified the sources of information these students used to conceptualize and estimate the prevalence of these disabilities. These 140 first-year education students cited direct contact with persons identified as learning disabled as the primary individual source and personal experience as the primary type of source they used to form conceptions of learning disabilities. These findings raise questions about the effects exposure to possible stereo-types of learning disabilities and their resolution may have on the practices of educators. Faculty must present research to students so stereotypical views of pupils who have difficulty learning in school and the solutions to their problems are questioned.
The inhibition of low density lipoprotein (LDL) oxidation has been postulated as one mechanism by which antioxidants may prevent the development of atherosclerosis. Available data on the ability of beta-carotene to inhibit LDL oxidation are conflicting. We examined the role of in vivo and in vitro supplementation with beta-carotene on metal ion-dependent (cupric ions, Cu2+) and metal ion-independent (2,2'-azobis[2-amidinopropane]dihydrochloride, AAPH) oxidation of LDL as measured by the formation of conjugated dienes (absorbance at 234 nm). Sixteen subjects were supplemented with 50-100 mg of beta-carotene on alternate days for 3 weeks following a week-long loading dose of 100 mg/day. Plasma beta-carotene levels rose 5.5-fold, while LDL beta-carotene levels rose 8.5-fold. Oxidation of LDL by Cu2+ or AAPH was not significantly delayed after in vivo supplementation with beta-carotene compared with baseline. For AAPH, the lag phase (in minutes) was 75 +/- 8 at baseline and 83 +/- 14 after supplementation (P = 0.07). For Cu2+, the lag phase was 172 +/- 41 at baseline and decreased to 130 +/- 24 after supplementation (P < 0.01). Similarly, no protective effect against Cu(2+)-induced oxidation was observed when beta-carotene was added to LDL in vitro. Supplementation of plasma with beta-carotene in vitro prior to LDL isolation also did not enhance LDL's resistance to Cu(2+)- or AAPH-induced oxidation, despite a 5-fold increase in LDL beta-carotene levels over vehicle control.(ABSTRACT TRUNCATED AT 250 WORDS)
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Laparoscopic assisted vaginal hysterectomy (LAVH) performed in 109 cases has been reviewed. In this series the mean operative time was 89 minutes and mean inpatient hospitalization was 3.7 days. Throughout the review, 6 patients were considered to have major complications and each is discussed. The association of previous caesarean section and bladder damage is noted. LAVH widens the indications available for vaginal hysterectomy in younger women in whom the abdominal approach would previously be indicated, but extra caution is advised when this technique is first introduced to a gynaecological service.
PURPOSE: This study assessed whether a specific association exists between atypical nevi and germ cell tumors (GCT). METHODS: A prospective comparison was performed on a cohort of 129 unselected patients with GCT and a series of 153 healthy men. Three or more of the following criteria were required for diagnosis of multiple atypical nevi: greater than 5 mm in diameter; variegated color, often speckled black/brown, with irregularly distributed pigmentation; irregular outline or indistinct border; and at least three such lesions. RESULTS: Prevalences for multiple atypical nevi in patients with GCT and in healthy controls were 37% and 15%, respectively (P < .01). Two patients with these lesions also had documented malignant melanoma. In contrast, 16% of patients with GCT had a history of testicular maldescent (the most common known risk factor), compared with 5% of healthy controls (P < .01). CONCLUSION: Multiple atypical nevi occur with a statistically significant increased prevalence in patients with GCT as compared with healthy controls, and constitute one of the most common known clinical associations with this malignancy. These data may be of relevance for our understanding of the biology of GCT and of malignant melanoma, in the design of screening programs for testis cancer, and in the follow-up evaluation of patients with each of these disorders.
A number of studies have suggested that educators overestimate the prevalence of learning disabilities in the schools. In this study, we found that 339 first- and second-year education students estimated the prevalence of learning disabilities to be four times higher than the upper limits of prevalence established by experts. Given that mislabelling students as 'learning disabled' may have negative consequences for them, the meaning, etiology, and prevalence of students' learning problems should be addressed by training institutions.
This study is both an evaluation of patients' perceptions of a diabetes clinic for under-25 year olds, and an assessment of experiences in transferring from a paediatric clinic. Sixty-nine patients with Type 1 diabetes (74% of the total clinic), including 41 females, completed evaluations of the clinic and recall of experiences in transfer. Mean age on transferring clinic was 15.9 (range 12-20) years. Paediatricians were perceived to emphasise family and social life, school or work progress; adult physicians tended to stress the risk of long-term complications, importance of exercise and need to maintain strict levels of glycaemic control. Our data suggest that transition to adult care can generally be achieved non-traumatically, but patients may perceive some difficulty because of different emphases and treatment advice favoured by paediatricians and adult physicians.