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Systematic reviews: gatekeepers of nursing knowledge.

The past few decades have seen a considerable increase in the number of available health care products and interventions. This growth has been matched by a similar expansion in the health care literature. As a result of these factors, the demand for evidence to support practice is growing, but finding the best evidence is becoming increasingly difficult. In response, the use of systematic reviews is increasing and they are starting to replace the primary research as the basis for health care decisions. To date, these reviews have focused predominantly on effectiveness and so have been limited to randomized controlled trials. As a result of this, the interpretive, observational and descriptive research methods that are utilized by nursing have commonly been either excluded from the review or are classified as 'low level' evidence. To address this, nursing must participate in the development of systematic review methods that better answer the questions posed by the profession.

Attitude of Health Personnel↗

Enhanced histopathology of the spleen.

The spleen is the largest secondary lymphoid organ, is considered the draining site for compounds that are administered intravenously, and is therefore considered an important organ to evaluate for treatment-related lesions. Due to the presence of B and T lymphocytes, the immunotoxic effects of xenobiotics or their metabolites on these cell populations may be reflected in the spleen. Therefore it is one of the recommended organs to evaluate for enhanced histopathology of the immune system. The two major functional zones of the spleen are the hematogenous red pulp and the lymphoid white pulp (periarteriolar sheaths, follicles and marginal zones). For enhanced histopathology, these splenic compartments should be evaluated separately for changes in size and cellularity, and descriptive rather than interpretive terminology should be used to characterize any changes (Haley et al., 2005). Moreover, germinal center development within the lymphoid follicles should be noted as increased or decreased.

Animals↗

Enhanced histopathology of the thymus.

The thymus is a primary or central lymphoid organ in which T lymphocytes undergo differentiation and maturation autonomously within the cortex, without the need for antigenic stimulation, and it is essential for the normal development and function of the immune system. The thymus has been shown to be a sensitive target organ following exposure to immunotoxicants and endogenous corticosteroids, and a decrease in size or weight is often one of the first noted measures of compound-induced effects with cortical lymphocytes (thymocytes) being especially susceptible. Therefore, changes in thymus histopathology and architecture are considered to be of particular relevance for immunotoxicity screening. The separate compartments in each lymphoid organ should be evaluated separately and descriptive rather than interpretive terminology should be used to characterize changes within those compartments (Haley et al., 2005). Therefore, enhanced histopathological evaluation of the thymus involves the determination of the size and cellularity of the cortex and medulla, which should be noted separately. Other changes to evaluate include, but are not limited to, increased lymphocyte apoptosis, lymphocyte necrosis, cortex:medulla ratio and an increase or decrease in the epithelial component of the thymus.

Animals↗

Enhanced histopathology of the bone marrow.

Changes in bone marrow cellularity can be an indicator of systemic toxicity and, therefore, bone marrow should be included in the battery of tissues examined for enhanced histopathology. However, the majority of changes in the bone marrow that are observed in toxicology studies are a response to hematological changes or lesions elsewhere in the body. For this reason, a consideration of all tissue changes in the body is required in order to differentiate toxic effects versus physiological responses in the bone marrow. While enhanced histopathology involves evaluation of the separate compartments in each lymphoid organ using descriptive rather than interpretive terminology, bone marrow is unique in that it lacks specific compartments. Furthermore, identification of erythroid, myeloid, megakaryocytic, and stromal cells, plus adipose tissue and hemosiderin-laden macrophages, can be accomplished from conventional H&E-stained sections, but conclusive identification of lymphoid lineage cells is not likely. This limits the extent of initial enhanced histopathology on bone marrow and argues for the use of cytological preparations for more comprehensive assessment of potential immunomodulatory effects.

Animals↗

Enhanced histopathology of mucosa-associated lymphoid tissue.

The secretory epithelial surfaces of the body are a major route of entry for potentially pathogenic substances. The organized mucosal lymphoid tissues that are found within the gastrointestinal and respiratory tracts are therefore particularly important as a first line of defense against harmful compounds. The major function of these mucosa-associated lymphoid tissues (MALT) is to initiate local IgA immune responses, which are then passed on to draining lymph nodes. For enhanced histopathology, the separate compartments of each lymphoid tissue should be evaluated separately for changes in size and lymphocyte cellularity and descriptive rather than interpretive terminology should be used to characterize any changes. The organization of MALT is similar to that of lymph nodes with B-cell-rich follicles and T-cell-rich interfollicular areas. Therefore, these two compartments should be evaluated separately for changes in size and lymphocyte cellularity and the germinal center development within lymphoid follicles should be evaluated as well.

Animals↗

Enhanced histopathology of the lymph nodes.

Routine histopathology of lymphoid organs is the cornerstone in the identification of immunotoxic and immunomodulatory compounds. Enhanced histopathology is a systematic approach that can be used to further characterize, both qualitatively and semi-quantitatively, the immunomodulatory effects that may occur within both primary and secondary lymphoid organs. The lymph nodes are the major route of entry for antigens and pathogens, via the afferent lymph flow, and they can be sensitive indicators of compounds with regional or systemic immunomodulatory/toxic effects and should therefore be included in the battery of lymphoid organs to evaluate for enhanced histopathology. As with all lymphoid organs, the separate compartments should be evaluated independently and descriptive rather than interpretive terminology should be used to characterize changes within those compartments. This data, in conjunction with gross findings, clinical pathology and changes in organ weight (i.e., thymus), will enable the pathologist to determine if a significant effect on the immune system is present. Moreover, this data may enable the pathologist to determine the critical site or compartment in the targeted tissue, provide some indication of target cell population (B or T cell) and characterize a dose-response relationship.

Animals↗

Prediction of Individual Muscle Forces Using Lagrange Multipliers Method - A Model of the Upper Human Limb in the Sagittal Plane: I. Theoretical Considerations.

Analytical solutions of indeterminate problems formulated for biomechanical models with more than one degree of freedom (DOF) are rarely found. This paper is an extension of the investigations of a 1 DOF model (Raikova, 1996, J. Biomechanics, 763-772) for a more complex 3 DOF model. The proposed model of the human upper limb is in the sagittal plane and includes ten muscle elements, four of them being two-joint ones. The formulated optimization task is solved analytically using the method of Lagrange multipliers. It is supposed that the optimization function is complex but can be approximated by a weighted sum of the squared muscle forces, where the nature of the weight factors of the muscles are unknown. The proposed computational algorithm for determination of the unknown individual muscle forces and joint reactions is easily implemented and may be extended without difficulties for more DOF and muscles. The aim is to establish a means of investigation of the possible weight coefficients for different modelled situations, which will help in searching for their physiological interpretation and analytical description.

Journal Article↗

An example of using mixed models and PROC MIXED for longitudinal data.

Longitudinal data, or data that are repeated measurements on various subjects across time, are commonplace in biostatistical studies. The general linear mixed model is a useful statistical tool for analyzing such data and drawing meaningful inferences about them. This paper discusses some of the most common mixed models and fits them to a prototypical example involving repeated measures on blood pressure. Computer implementation is via the MIXED procedure in the SAS System, and code descriptions and output interpretations accompany the example.

Clinical Trials as Topic↗

A strengthening programme for weak associations.

The strength of a causal association depends on the relative prevalence of other component causes for the same disease. Weak associations may sometimes be strengthened by restricting attention to people at low risk. This technique may lead to fewer subjects to study, but nevertheless may provide more information by which to evaluate a causal relation. A second method for strengthening associations is to reduce non-differential misclassification, which tends to dilute associations. Increasing the specificity of measurement for exposure, disease, and the timing between causal action and disease onset should produce stronger associations that are easier to interpret and more descriptive of the underlying causal mechanism.

Epidemiologic Methods↗

Admission whole-blood transcriptomic characterization of a neutrophil-predominant systemic immune response in patients with acute traumatic brain injury.

BACKGROUND: Acute traumatic brain injury (TBI) is accompanied by systemic immune responses, but their whole-blood transcriptomic features at hospital arrival remain incompletely characterized. We aimed to characterize these features in patients with acute TBI compared with healthy controls. METHODS: In this single-center prospective observational study, we performed whole-blood RNA sequencing on hospital-arrival samples from 42 patients with acute TBI and 21 healthy controls. Analyses included differential expression (limma-voom; FDR < 0.05, |log2FC| > 0.7), functional enrichment, Ingenuity Pathway Analysis, CIBERSORTx LM22 deconvolution, and per-sample neutrophil degranulation signature scoring. RESULTS: Differential expression analysis identified 996 upregulated and 863 downregulated genes, with marked upregulation of inflammation-, innate immunity-, and neutrophil-related genes including DUSP1, HMGB2, MMP9, and S100A8. Canonical pathways with positive IPA z-scores included Neutrophil degranulation, Neutrophil Extracellular Trap Signaling Pathway, and Toll-like Receptor Signaling; upstream regulators included TNF, IL1B, IFNG, and STAT3. Deconvolution identified 7 of 22 differing subsets (q < 0.05), with relatively higher myeloid and lower lymphoid fractions in TBI. The Neutrophil degranulation signature score correlated with Injury Severity Score within TBI (Spearman &#x3c1; = +0.55; q < 0.001). CONCLUSIONS: Admission whole-blood transcriptomics characterized a neutrophil-predominant systemic transcriptional response in patients with acute TBI. This response was also evident among patients without major extracranial injury and was associated with total ISS. However, because the study lacked an appropriately matched non-TBI trauma comparator, the findings should be interpreted as a descriptive characterization of a systemic injury response accompanying TBI and do not establish a TBI-specific molecular signature or mechanism.

gene expression↗

Quantitative NMR characterization of long-range chain dynamics prior to reptation: polyethylene-oxide

The thorough analysis of the transverse magnetic relaxation of protons, attached to highly entangled polyethylene-oxide chains in the melt, reveals two striking chain-length dependent properties; these are interpreted from the description (reminiscent of the Rouse model) of the long-range chain dynamics supposed to occur prior to the reptation motion. Experimental results are well matched by this specific NMR approach which accounts for the novel properties and provides the monomeric friction coefficient and the terminal relaxation time, over the molecular weight range 65K to 760K.

Journal Article↗

The occurrence of hyaline cytoplasmic inclusions in the nerve cells of the hypoglossal nucleus in human autopsy material.

Among 440 adults (ranging in age from 41 to 99 years) who were examined for hyaline cytoplasmic inclusions (HCI) within cells of the hypoglossal nuclei of the medulla oblongata, HCI were found in 75 (17.0%). No definite correlation was noted between HCI and specific diseases. The morphological and histochemical descriptions and pathological interpretation as well as frequency of HCI as reported in the literature were reviewed. There was no evidence that the presence of HCI was related to a specific disease, ages or sex.

Adult↗

Aggression and withdrawal as social schemas underlying children's peer perceptions.

This study examined the ability of children of different ages to encode and retrieve from memory descriptions of aggressive and withdrawn behavior displayed by hypothetical peers. 90 children from the first, third, fifth, and seventh grades (aged 6-7, 8-9, 10-11, 12-13, respectively) listened to behavioral descriptions of a hypothetical aggressive and a hypothetical withdrawn boy and subsequently reported their recollections for these descriptions. Differences across grade level were found in the number of behaviors correctly recalled for the withdrawn boy but not for the aggressive boy. At the first grade, children recalled fewer descriptions of withdrawn behavior than of aggressive behavior. However, recall for withdrawal increased significantly across grade level, such that at grades 5 and 7, subjects recalled more descriptions of withdrawn than of aggressive behavior. Such differences across grade level in children's ability to encode descriptions of withdrawn behavior into memory and subsequently to retrieve the descriptions accurately were interpreted as evidence of the emerging importance of social withdrawal as a social-cognitive schema underlying children's social perceptions.

Aggression↗

Radial retroiridal linear pigmentation.

Radial retroiridal pigmented lines found on the peripheral anterior capsule of the lens have been interpreted since their description by Vogt as remnants of the tunica vasculosa retroiridalis (membrana capsulopupillaris). They were found in nearly 5% of adults. A control examination of 1108 children and juveniles failed to reveal a single example. They are therefore thought to be caused by pigment released from the posterior layers of the iris, particularly near the pupillary border in old age, as a result of constant abrasive movements of the iris on the anterior surface of the lens.

Adolescent↗

Forum on osmosis. IV. More on osmosis and diffusion.

A brief summary is presented of the Gibbsian view of chemical drives and of its mechanical interpretation, including a description of the "diffusion force" that arises from an interplay between fluctuations and dissipation. Osmotic flows are shown to be driven by diffusion forces acting at the membrane interface, and not by the effects of Hammel and Scholander's "solvent tension."

Chemical Phenomena↗

Negotiating the tension between policy and reality: exploring nurses' communication about organizational wrongdoing.

This article explores the ways in which registered nurses communicate about organizational wrongdoing. Critical incidents were gathered from over 200 registered nurses. Through the phenomenological process of description, reduction, and interpretation, 5 themes emerged as central to responses of policy violations and personal ethics in the workplace: (a) perceptions of wrongdoing, (b) upholding the ideals of the profession, (c) clarity and evidence of wrongdoing, (d) consequences of reporting, and (e) workplace dynamics. The interpretative findings focus on how these themes are united by a tension that nurses face in terms of adhering to policy while attempting to manage the realities of their everyday professional lives. A discussion of these findings, including how they relate to existing and future research and practice, is offered.

Communication↗

Congruence of the MCMI-II and MCMI-III in cocaine dependence.

This study compared the MCMI-II and MCMI-III among 40 urban, poor, cocaine abusers in outpatient treatment. The mean group profiles had strikingly similar relative elevations on the Antisocial, Narcissistic, Aggressive-Sadistic, Alcohol Dependence, and Drug Dependence scales. However, the MCMI-III group profile was significantly lower in magnitude compared with the MCMI-II. Interval and rank-order correlations were moderate to low for most scales, and 90% of participants produced discrepant 2-point codetypes between the 2 tests. These results suggest that clinicians working in substance abuse settings should perhaps adjust MCMI-III profile elevations upward on most scales (particularly on the personality disorder scales) when comparing results to extant normative data and should use caution when referencing MCMI/MCMI-II interpretive manuals for descriptive correlates of MCMI-III scales and codetypes.

Adult↗

Lingual vascular canals of the interforaminal region of the mandible: evaluation with conventional tomography.

The presence of lingual vascular foramina and canals in the interforaminal region may increase the risk of surgical complications during implant placement, bone grafting procedures and osteodistraction. Oral and maxillofacial radiologists should recognize this anatomical variant and include a description in their interpretative report to inform the referring clinician of the potential for surgical complications.

Angiography↗