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PubMed1998

Outpatient parenteral antimicrobial therapy as an alternative to hospitalization.

Outpatient parenteral antimicrobial therapy (OPAT) has evolved because of advances in antibiotics and the advent of new technology. It provides a cost-effective means of treating seriously infected patients away from hospital. Virtually any infection can be treated on an outpatient basis and several treatment programmes have been designed. Housebound patients can be visited by a nurse who will supervise administration; infusion centres, set up in a clinic or a doctor's office, provide on-hand medical staff and the benefit of a medical facility; self-administration provides autonomy for patient and family and is the least costly. Given the cost-cutting environment in which healthcare now operates worldwide, it is important that OPAT must develop its own procedures and guidelines for quality assurance. For OPAT to work away from the controlled environment of the hospital, it is essential that physicians, nurses and pharmacists adapt to new medical environments and work with the patient to ensure that care is maintained to a high standard.

Ambulatory Care↗
PubMed2006

The unexpected benefits of Sarbanes-Oxley.

In the wake of a series of gross corporate abuses around the turn of the century, Congress passed Sarbanes-Oxley, which was intended to make corporate governance more rigorous, financial practices more transparent, and management criminally liable for lapses. The first year of implementation was costly and onerous, far more so than companies had been led to expect. In the view of a few open-minded firms, however, the second year of compliance turned out to be not only less costly and less onerous (as doing something for the second time usually turns out to be), but a source of valuable insights into operations, which management has translated into improved efficiencies and cost savings. The areas of improvement go well beyond technical statutory compliance. They include a strengthened control environment; more reliable documentation; increased audit committee involvement; better, less burdensome compliance with other statutory regimes; more standardized processes for IT and other functions; reduced complexity oforganizational processes; better internal controls within partner companies; and more effective use of both automated and manual controls. The result is not only shareholder protection, the official purpose of the act, but also enhanced shareholder value. More than a year since the first deadline arrived, Sarbanes-Oxley still inspires fear--of enforcement actions, of the stock market's reaction to a deficiency, and of personal liability. Fear can be a powerful generator of upstanding conduct. But businesses run on discovering and creating value. Companies need to start viewing Sarbanes-Oxley as an ally in that effort.

Accounting↗
PubMed1987

Age-dependent responses to 2-acetylaminofluorene in BALB/c female mice.

In order to evaluate the influence of age on 2-acetylaminofluorene (2-AAF) carcinogenesis, female BALB/c mice were fed diets containing 500 ppm 2-AAF for 6 mo, starting at 1, 7, or 13 mo of age. Groups of mice were killed immediately, 3 or 6 mo after termination of treatment, or were allowed to complete their life span. Mice corresponding to the age of each sacrifice group of the 2-AAF-treated mice and a life-span group were also included as controls. The study was moved to a different animal room area after 25 wk into the study. Thus, certain treatment groups were replicated to evaluate the impact of the change in environment. Controls and the young 2-AAF-treatment group killed at 7 mo of age were replicated twice in the new animal room at 6-mo intervals. Similarly, controls and the mid-aged treatment group killed at 13 mo of age were repeated once in the new animal room. This resulted in mice of each age/treatment group being treated simultaneously in the same room and killed as soon as treatment was stopped. The main histopathologic responses to 2-AAF were observed in the urinary bladder, liver, and mammary glands. In all three replicates urinary bladder hyperplasia was less severe when young mice were treated than when mid-aged or old mice were treated. In contrast, there was no clear influence of age on bladder tumorigenesis, although replicate variation in this response was very great. Tentatively one also may conclude that (1) sensitivity to the induction of mammary tumorigenesis by 2-AAF increased with the age of mice at the time of treatment, and (2) old mice were sensitive to induction of liver karyomegaly and cytoplasmic and nuclear inclusions, while young and mid-aged mice were resistant to this influence. Perhaps the most important conclusion to be made from this study is that replicate variation, probably due to environmental factors, may result in false conclusions concerning age sensitivity to a carcinogen if differing age groups are not treated simultaneously and/or key parts of an experiment are not replicated to eliminate the possibility of an influence of environmental factors or nonrandom assignment of animals to age groups.

2-Acetylaminofluorene↗
PubMed1994

The ability to perform closed chest compressions in helicopters.

Critically ill patients are often transported by air ambulances. Although these patients are likely to require cardiopulmonary resuscitation (CPR) during transport, the effects of the air medical transport environment on CPR efficacy have never been studied. A manikin model was used to assess the ability of flight nurses to perform effective chest compressions while in flight and when stationery on the helipad. The results demonstrate that flight nurses were able to perform chest compressions as effectively in the in-flight setting as in the stationary setting. Chest c compressions performed in the BK-117 helicopter were as effective as those performed in the control environment, but compressions performed in the BO-105 were significantly less effective than controls. In conclusion, in a manikin model, chest compressions are substandard in the BO-105 helicopter because of the limited space available in the aircraft.

Air Ambulances↗
PubMed1984

Tobacco withdrawal symptoms: an experimental analysis.

This study was a prospective examination of tobacco withdrawal symptoms in a controlled environment. Smokers (N = 27) were hospitalized for a 7-day period during which a battery of tests was administered. Smokers were assigned to either an experimental group (N = 20) or a control group (N = 7). Subjects in the experimental group smoked ad libitum for a 3-day baseline period and then underwent 4 days of tobacco deprivation. Subjects in the control group continued to smoke ad libitum throughout the study. Of the 37 measures of tobacco withdrawal employed in this study, nine showed significant changes following tobacco deprivation. These changes include decreased heart rate and increased caloric intake, weight, craving for tobacco, confusion, depression-dejection, number of awakenings, duration of awakenings, and increased poor concentrations as observed by others.

Adult↗
PubMed2006

The 3-dimensional construction of the average 11-year-old child face: a clinical evaluation and application.

PURPOSE: This article describes construction of the average face and its application in the clinical environment. SUBJECTS AND METHODS: A total of 72 children, mean age 11.8 years, were selected for the study. Laser-scanned images of the subjects were obtained under a reproducible and controlled environment with 2 Minolta Vivid 900 (Minolta, Osaka, Japan) optical laser-scanning devices assembled as a stereo pair. A set of left and right scanned images was taken for each subject and each scan took an average of 2.5 seconds. These scanned images were processed and merged to form a composite 3-dimensional soft tissue reproduction of the subjects using commercially-available reverse modeling software. The differences in facial morphology were measured using shell deviation color maps. The average face was used to compare differences between male and female groups and 3 subjects with craniofacial anomalies. RESULTS: The difference between the average male and female face was 0.460 +/- 0.353 mm. The areas of greatest deviation were at the zygomatic area and lower jaw line, with the males being more prominent. The results of the surface deviation between the subjects with craniofacial anomalies were significant. CONCLUSIONS: The construction of the average face provides an interesting perspective into measuring changes in groups of patients and also acts as a useful template for the comparison of craniofacial anomalies.

Cephalometry↗
PubMed1995

Attitude to treatment and direction of interest of forensic mental health nurses: a comparison with nurses working in other specialties.

The attitudes of nurses working within forensic psychiatry are often perceived as being custodially oriented. Working on this commonly held assumption the authors hypothesized that nurses working within a physically controlled environment such as a Regional Secure Unit would hold more conservative/biological attitudes toward treatment, and would be more 'object'-oriented (as opposed to 'psychologically' oriented) than those working in less physically controlled clinical areas. [For the purpose of this paper the term 'Regional Secure Unit' is used to describe the medium secure facilities that were included in this study, although one of the units did not serve a wholly regional function.] This paper outlines a study that attempted to examine this hypothesis. A total of 84 nurses from three clinical specialties (Regional Secure Units, Acute Admission Wards and Drug Dependence Units) completed the Attitude to Treatment Questionnaire (ATQ) and the Direction of Interest Questionnaire (DIQ) (Caine et al. 1981). Each nurse also completed a demographic information questionnaire, supplying details of age, professional experience and educational attainment. The results indicate no significant differences on measures used between specialty groups. Significant positive correlations were found between age and conservatism on the ATQ, and between ATQ conservatism and DIQ object centredness. Implications of these results are discussed and suggestions for future research are made.

Attitude of Health Personnel↗
PubMed2003

Can virtual reality be used to investigate persecutory ideation?

The use of virtual reality permits individuals' reactions to standard controlled environments to be studied. It may therefore provide a means for understanding the interpretations of experience relevant to clinical disorders. The use of this technology for understanding persecutory ideation has not been investigated. A pilot study was undertaken to examine whether individuals have persecutory thoughts about virtual reality characters under controlled conditions and if there are factors that predict the occurrence of such thoughts.Twenty-four nonclinical participants entered a neutral virtual environment that contained computer-generated people. The participants completed dimensional assessments of items related to psychiatric symptoms and their thoughts about the virtual characters. Positive views about the virtual characters were common. However, a number of participants had ideas of reference and ideas of persecution about the virtual characters. Individuals who had persecutory thoughts about the virtual characters had significantly higher levels of interpersonal sensitivity and anxiety. The study provides direct evidence that individuals attribute mental states to virtual reality characters. Important for the study of clinical phenomena, some individuals have thoughts of a persecutory nature about virtual characters. Additionally, the findings indicate that feelings of interpersonal vulnerability and anxiety may directly contribute to the development of persecutory ideation in response to essentially neutral contexts. Virtual reality may prove to be a valuable methodology for developing an understanding of persecutory ideation.

Adult↗
PubMed1997

Structure of potato tubers formed during spaceflight.

Potato (Solanum tuberosum L. cv. Norland) explants, consisting of a leaf, axillary bud, and small stem segment, were used as a model system to study the influence of spaceflight on the formation of sessile tubers from axillary buds. The explants were flown on the space shuttle Columbia (STS-73, 20 October to 5 November 1995) in the ASTROCULTURE (TM) flight package, which provided a controlled environment for plant growth. Light and scanning electron microscopy were used to compare the precisely ordered tissues of tubers formed on Earth with those formed during spaceflight. The structure of tubers produced during spaceflight was similar to that of tubers produced in a control experiment. The size and shape of tubers, the geometry of tuber tissues, and the distribution of starch grains and proteinaceous crystals were comparable in tubers formed in both environments. The shape, surface texture, and size range of starch grains from both environments were similar, but a greater percentage of smaller starch grains formed in spaceflight than on Earth. Since explant leaves must be of given developmental age before tubers form, instructions regarding the regular shape and ordered tissue geometry of tubers may have been provided in the presence of gravity. Regardless of when the signalling occurred, gravity was not required to produce a tuber of typical structure.

Culture Techniques↗
PubMed2006

Situated cognition and cognitive apprenticeship: a model for teaching and learning clinical skills in a technologically rich and authentic learning environment.

The acquisition of a range of diverse clinical skills is a central feature of the pre-registration nursing curriculum. Prior to exposure to clinical practice, it is essential that learners have the opportunity to practise and develop such skills in a safe and controlled environment under the direction and supervision of clinical experts. However, the competing demands of the HE nursing curriculum coupled with an increased number of learners have resulted in a reduced emphasis on traditional apprenticeship learning. This paper presents an alternative model for clinical skills teaching that draws upon the principles of cognitive apprenticeship [Collins, A., Brown, J.S., Newman, S., 1989. Cognitive Apprenticeship: teaching the crafts of reading, writing and mathematics. In: Resnick, L.B. (Ed.) Knowing. Learning and Instruction: Essays in Honor of Robert Glaser. Lawrence Erlbaum Associates, New Jersey, pp. 453-494] and situated cognition within a technologically rich and authentic learning environment. It will show how high quality DVD materials illustrating clinical skills performed by expert practitioners have been produced and used in conjunction with CCTV and digital recording technologies to support learning within a pedagogic framework appropriate to skills acquisition. It is argued that this model not only better prepares the student for the time they will spend in the practice setting, but also lays the foundation for the development of a clinically competent practitioner with the requisite physical and cognitive skills who is fit for purpose [UKCC, 1999. Fitness for Practice: The UKCC Commission for Nursing and Midwifery Education. United Kingdom Central Council for Nursing Midwifery and Health Visiting, London].

Attitude of Health Personnel↗
PubMed1997

A Two-Dimensional X-ray Scattering System for In-Situ Time-Resolving Studies of Polymer Structures Subjected to Controlled Deformations.

A two-dimensional X-ray scattering system developed around a CCD-based area detector is presented, both in terms of hardware employed and software designed and developed. An essential feature is the integration of hardware and software, detection and sample environment control which enables time-resolving in-situ wide-angle X-ray scattering measurements of global structural and orientational parameters of polymeric systems subjected to a variety of controlled external fields. The development and operation of a number of rheometers purpose-built for the application of such fields are described. Examples of the use of this system in monitoring degrees of shear-induced orientation in liquid-crystalline systems and crystallization of linear polymers subsequent to shear flow are presented.

Journal Article↗
PubMed2003

Radiofrequency treatment weakens the fatigue characteristics of rabbit anterior cruciate ligament.

OBJECTIVE: To evaluate the radiofrequency treatment applied to an intact anterior cruciate ligament, and to quantify the mechanical effects of controlled cyclic loading (simulating activities of daily living) post-treatment. DESIGN: An in vitro radiofrequency energy application to the rabbit anterior cruciate ligament and cyclic loading of the treated ligament. BACKGROUND: Effect of cyclic loading on the radiofrequency treated ligament in a controlled environment is not known. METHODS: In the treatment group radiofrequency treatment was applied to an intact ligament and then the ligament was cyclically loaded for 3000 cycles, and stretched-to-failure. Control group was similar to treatment, except that the radiofrequency treatment was not applied. The cyclic loading (approximately 6% tensile strain) was kept below the injury threshold of the rabbit anterior cruciate ligament and was designed to simulate loading post-treatment. A relaxation test (5% constant strain for 180 s) was used to compare the results at different steps in the experiment; within each group and between the two groups. RESULTS: Relaxation force increased in the treatment group (average 108% of intact, P<0.05), but decreased after the cyclic loading (average 71% of intact, P<0.05). There were significant differences in the force-deformation-failure curves between the treatment and control groups: average treated ligament failed at 59% and 57% of the control values respectively for the deformation and force (P<0.05). CONCLUSIONS: Using radiofrequency treatment makes rabbit anterior cruciate ligament weaker following cyclic loading. RELEVANCE: The radiofrequency treatment weakens the anterior cruciate ligament, and therefore, it perhaps should be protected until healing and adaptation restore its full strength.

Activities of Daily Living↗
PubMed2002

Colonization of the developing rhizosphere of sugar beet seedlings by potential biocontrol agents applied as seed treatments.

AIMS: Poor colonization of the rhizosphere is a major constraint of seed treatment biological control. The objectives of this study were to; examine the colonization of the rhizosphere of sugar beet seedlings by selected rhizobacteria; determine the influence of the host rhizosphere and percolating water on the distribution of the bacteria; and deliver two biological control agents (BCAs) by co-inoculation. METHODS AND RESULTS: Rifampicin-resistant bacterial strains (Rif +) applied as single treatments to seed sown in columns of field soil produced persistent populations of 5-9 log10 cfu g-1 in the infection court of the damping-off pathogen Aphanomyces cochlioides in a controlled environment. However, isolates varied in their ability to colonize the lower rhizosphere. Percolating water significantly increased the colonization of the upper rhizosphere. Bacterial populations in the soil profiles of "non-rhizosphere" controls declined markedly with time. There was no interaction between the two selected BCAs applied as a seed treatment mixture. CONCLUSIONS: The distribution of the bacteria resulted primarily from root colonization although percolating water may modify the colonization profiles. Co-inoculation of the sugar-beet rhizosphere is a viable proposition. SIGNIFICANCE AND IMPACT OF THE STUDY: Potential BCAs were successfully delivered to the known infection court of A. cochloides and persisted for the infection period. This bioassay can be used as a tool for the selection of BCAs for field trials.

Bacillus megaterium↗
PubMed1999

Pre- and post exercise echocardiography in horses performing treadmill exercise in cool and hot/humid conditions.

We hypothesised that exercise in a hot and humid environment would affect echocardiographic indices of cardiac dimensions and function more than exercise in a cool environment. M-mode echocardiograms were obtained in 5 clinically normal horses before, and at 0, 10, 30 and 60 min after a treadmill exercise test. The test was performed in a controlled environment at 20 degrees C/40% relative humidity (RH) and again at 30 degrees C/80% RH. All the horses completed the exercise test in cool conditions, but only one horse completed the exercise test in the hot/humid environment. The relaxation time index (RTI) correlated significantly and inversely with heart rate (HR). Heart rate was increased and RTI was decreased immediately after exercise in cool conditions. HR recovery appeared to be prolonged following exercise in hot/humid conditions. Post exercise RTI was significantly decreased in hot/humid environment. In hot/humid conditions, the left ventricular internal dimensions measured in diastole and systole (LVIDd, LVIDs) were reduced following exercise and continued to fall throughout the 60 min after exercise. The left ventricular fractional shortening (FS%) was lower than resting levels immediately after exercise in hot/humid conditions. Significant decreases were found in LVIDs and LVIDd, which may reflect a reduction in preload arising from dehydration or re-distribution of blood throughout the recovery period following exercise in the hot/humid environment. It was concluded that echocardiography was a useful tool in assessing cardiac responses to exercise in different climates.

Aerobiosis↗
PubMed2001

Hyperthermia and central fatigue during prolonged exercise in humans.

The present study investigated the effects of hyperthermia on the contributions of central and peripheral factors to the development of neuromuscular fatigue. Fourteen men exercised at 60% maximal oxygen consumption on a cycle ergometer in hot (40 degrees C; hyperthermia) and thermoneutral (18 degrees C; control) environments. In hyperthermia, the core temperature increased throughout the exercise period and reached a peak value of 40.0 +/- 0.1 degrees C (mean +/- SE) at exhaustion after 50 +/- 3 min of exercise. In control, core temperature stabilized at approximately 38.0 +/- 0.1 degrees C, and exercise was maintained for 1 h without exhausting the subjects. Immediately after the cycle trials, subjects performed 2 min of sustained maximal voluntary contraction (MVC) either with the exercised legs (knee extension) or with a "nonexercised" muscle group (handgrip). The degree of voluntary activation during sustained maximal knee extensions was assessed by superimposing electrical stimulation (EL) to nervus femoralis. Voluntary knee extensor force was similar during the first 5 s of contraction in hyperthermia and control. Thereafter, force declined in both trials, but the reduction in maximal voluntary force was more pronounced in the hyperthermic trial, and, from 30 to 120 s, the force was significantly lower in hyperthermia compared with control. Calculation of the voluntary activation percentage (MVC/MVC + EL) revealed that the degree of central activation was significantly lower in hyperthermia (54 +/- 7%) compared with control (82 +/- 6%). In contrast, total force of the knee extensors (MVC + force from EL) was not different in the two trials. Force development during handgrip contraction followed the same pattern of response as was observed for the knee extensors. In conclusion, these data demonstrate that the ability to generate force during a prolonged MVC is attenuated with hyperthermia, and the impaired performance is associated with a reduction in the voluntary activation percentage.

Adult↗
PubMed2005

Cryoelectron microscopy of liposomes.

A thin aqueous film of suspended lipid vesicles?micelles is the object of choice for vitrification and subsequent study by cryoelectron microscopy. Just prior to vitrification, a thin film (compare with a soap film) is vulnerable to heat and mass exchange. Preparation of thin films in a temperature- and humidity-controlled environment is essential to prevent osmotic and temperature-induced alterations of the lipid structure, as will be explained in this chapter. Further automation of the preparative procedure by automatic blotting and PC control over the timing of critical steps (including vitrification) may further assist in the reproducible throughput of high-quality specimens. By cryotomography, taking a tilt series under low-dose conditions, a three-dimensional reconstruction of the specimen can be analyzed.

1,2-Dipalmitoylphosphatidylcholine↗
PubMed1981

Arousal of sexual and aggressive contact by exposure to stressors in albino rats.

Since certain forms of aggressive and sexual activity are associated with elevated adrenal steroid activity, the hypothesis explored here was whether subjection to a stressful environment which is known to elevate adrenal output would arouse both sexual and aggressive behavior. Accordingly, 24 male Sprague-Dawley rats were subjected to either physical restraint and heat or a nonstress control environment for 13 days. Following this treatment Ss were tested for sexual and aggressive behavior. As predicted, the stressed Ss showed increased levels of ano-genital sniffing of an estrus female, as well as increased intermale aggressiveness.

Aggression↗