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Small-angle neutron scattering from large unilamellar vesicles: an improved method for membrane thickness determination.
Small-angle neutron scattering (SANS) measurements were performed on large unilamellar vesicles (LUVs) in order to investigate solute effects on membrane properties. Although SANS is a well established technique for the measurement of membrane thickness in unilamellar vesicles, earlier measurements have depended on approximate treatments of the scattering function and have suffered from effects of multilamellarity or difficulty in sample preparation. More recent studies of temperature induced thickness changes in DPPC LUVs which have included explicit treatment of the full scattering function were complicated by disparities between the predicted and measured scattering curves. Here, we reexamine theoretical descriptions of SANS from LUVs. Motivated by our observations, we then introduce a new method for interpretation of SANS data, which we compare to established techniques and apply to our measurements.
Quantitative analysis of intramembrane particle (IMP) distribution on biomembranes after freeze-fracture preparation by a computer-based technique.
An improved method for the quantitative analysis of intramembrane particles (IMPs) on freeze-fracture faces of biomembranes is described. The analysis provides, first, the number of IMPs per 1 micrometer2, second, the coefficient of dispersion (CD) of unweighted and weighted (i.e. the finite size is taken into consideration) IMP distribution, and, third, the diameters of IMPs. Additional data for further statistical evaluation are also derived. These data make it possible to numerically describe and characterize fracture faces of a membrane in a defined physiological state. They allow for comparison of normal membranes with experimentally induced alterations of the same specimen in other experiments, and for observation of differences between normal and malignant cells. Furthermore, such an analysis provides the basis for a dynamic interpretation of biomembrane components seen on the static freeze-fracture micrographs. With this numerical analysis, descriptive terms for IMP distribution such as 'random', 'aggregated' or 'clustered', which cannot be evaluated or verified, are avoided. The method, based on the Poisson statistic which provides a means for the description of different particle density distributions, is described. The validity of the method is demonstrated on artificially generated pictures and by an analysis of erythrocyte membranes before and after spectrin depletion.
Waiting for a thoracic transplant in Eurotransplant.
The prospects of patients on the thoracic waiting list are governed by the chance of receiving an organ in time and by the outcome of the transplantation. The former probability is determined by a triad of disease severity, resource size and allocation rules. The aim of this study was to provide an objective description of the distributional effects of the thoracic allocation system in Eurotransplant. It appears that the interpretation of waiting-list outflow indicators is not straightforward and that it is difficult to assess the fairness of an organ allocation system in the framework of changing donor-organ availability. The timing of listing for heart transplantation can substantially be improved; whether this is also true for lung transplantation cannot be determined from the available data. Allocation schemes cannot solve the problem of organ shortage; a shift of attention toward collaboration with procurement professionals is needed.
Health care system accessibility. Experiences and perceptions of deaf people.
BACKGROUND: People who are deaf use health care services differently than the general population; little research has been carried out to understand the reasons. OBJECTIVE: To better understand the health care experiences of deaf people who communicate in American Sign Language. DESIGN: Qualitative analyses of focus group discussions in 3 U.S. cities. PARTICIPANTS: Ninety-one deaf adults who communicate primarily in American Sign Language. MEASUREMENTS: We collected information about health care communication and perceptions of clinicians' attitudes. We elicited stories of both positive and negative encounters, as well as recommendations for improving health care. RESULTS: Communication difficulties were ubiquitous. Fear, mistrust, and frustration were prominent in participants' descriptions of health care encounters. Positive experiences were characterized by the presence of medically experienced certified interpreters, health care practitioners with sign language skills, and practitioners who made an effort to improve communication. Many participants acknowledged limited knowledge of their legal rights and did not advocate for themselves. Some participants believed that health care practitioners should learn more about sociocultural aspects of deafness. CONCLUSIONS: Deaf people report difficulties using health care services. Physicians can facilitate change to improve this. Future research should explore the perspective of clinicians when working with deaf people, ways to improve communication, and the impact of programs that teach deaf people self-advocacy skills and about their legal rights.
Classification of death in patients under antiarrhythmic treatment.
In the evaluation of antiarrhythmic treatment, total mortality and total cardiac mortality are the only endpoints difficult to misclassify. End-stage cardiac failure competes with "suddenness" in many instances of sudden arrhythmic death. This observational study reports on 23 deaths in a group of 129 patients under antiarrhythmic treatment. In the 21 cases of cardiac death, with respect to the notion "sudden arrhythmic death," classification was problematic in 6 patients. According to different interpretations, the number of deaths listed as "sudden" could vary between one and six. A concise description of cause and circumstances of death, is presented.
Schizophrenia in early adolescence. A study illustrated by long-term cases.
The purpose of this paper is to draw attention to schizophrenias starting in early adolescence, before age 15. Diagnosis may be difficult because such early manifestations may differ from the classical schizophrenias and from the traditional subgroups. The authors caution against a too liberal interpretation of normal problems in adolescence. In comment on the literature, particular weight is placed on descriptions of schizophrenias in adolescence. Some typical early manifestations of schizophrenia are described including, among other traits, depressive states and sociopathic behaviour. Key symptoms such as thought disturbances or flattening of affect may be lacking. Five long-term cases were chosen. None was classified in childhood as infantile borderline. A diagnosis of schizophrenia was made in adolescence. In the cases where Schneider's criteria are not fulfilled, other hard evidence of schizophrenia is given. Emphasis is placed on the importance of early diagnosis.
A model of acoustic interspeaker variability based on the concept of formant-cavity affiliation.
A method is proposed to model the interspeaker variability of formant patterns for oral vowels. It is assumed that this variability originates in the differences existing among speakers in the respective lengths of their front and back vocal-tract cavities. In order to characterize, from the spectral description of the acoustic speech signal, these vocal-tract differences between speakers, each formant is interpreted, according to the concept of formant-cavity affiliation, as a resonance of a specific vocal-tract cavity. Its frequency can thus be directly related to the corresponding cavity length, and a transformation model can be proposed from a speaker A to a speaker B on the basis of the frequency ratios of the formants corresponding to the same resonances. In order to minimize the number of sounds to be recorded for each speaker in order to carry out this speaker transformation, the frequency ratios are exactly computed only for the three extreme cardinal vowels [i, a, u] and they are approximated for the remaining vowels through an interpolation function. The method is evaluated through its capacity to transform the (F1,F2) formant patterns of eight oral vowels pronounced by five male speakers into the (F1,F2) patterns of the corresponding vowels generated by an articulatory model of the vocal tract. The resulting formant patterns are compared to those provided by normalization techniques published in the literature. The proposed method is found to be efficient, but a number of limitations are also observed and discussed. These limitations can be associated with the formant-cavity affiliation model itself or with a possible influence of speaker-specific vocal-tract geometry in the cross-sectional direction, which the model might not have taken into account.
Modeling the metabolism of idarubicin to idarubicinol in rat heart: effect of rutin and phenobarbital.
Since the severe cardiotoxicity of anthracyclines has been attributed to the intramyocardial formation of C-13 alcohol metabolites, the kinetics of cardiac metabolite formation and disposition as well as the effect of carbonyl reductase inhibitors are of specific interest. This study was designed to investigate the effect of rutin and phenobarbital on the pharmacokinetics of idarubicin (IDA) and its conversion to idarubicinol (IDOL) in the single-pass perfused rat heart. After infusion of IDA (0.5 mg) during 1min, the venous outflow concentrations of IDA and IDOL were measured up to 80 min in the presence and absence of rutin and phenobarbital. A kinetic model was developed to help to interpret the concentration profiles in terms of compartmentation of IDOL formation and to estimate parameters quantitatively descriptive of the transport and biotransformation processes. Rutin and phenobarbital significantly reduced the residual amount of IDOL in heart to 64 and 47% of control, respectively. Pharmacokinetic modeling of the data revealed that IDOL is generated in two different compartments, besides the tissue compartment characterized by saturable uptake, also the compartment that accounts for the quasi-instantaneous initial distribution process is involved. The efflux rate constant of IDOL, k(21,IDOL,) was much smaller than that of IDA. Rutin and phenobarbital significantly reduced IDOL production. Additionally, phenobarbital competitively inhibited the saturable uptake of both IDA and IDOL (increase in apparent Michaelis constants). Reanalysis of data obtained in previous experiments showed that P-glycoprotein inhibitors (verapamil and amiodarone) reduced IDOL uptake in a similar way as already shown for IDA. The present study further supports the utility of pharmacokinetic modeling in identifying sites of drug interactions within the heart.
Cerebral vasculitis associated with acute post-streptococcal glomerulonephritis.
The following is a case study involving a 13-year-old girl who presented initial symptoms of an upper respiratory infection. One week later she experienced a short seizure and hours later a grand mal seizure. MRI examination of the brain demonstrated multiple changing abnormal foci of increased density in white and gray matter suggestive of a vasculitic inflammatory pattern. As a result of proteinuria and red cell casts on urinalysis, a renal biopsy was performed resulting in a diagnosis of acute post-streptococcal glomerulonephritis (APSGN). We concluded on the basis of the MRI that vasculitis was secondary to APSGN. The following paper is a description of our findings in this case and a review of the literature supporting this new interpretation of CNS disease due to APSGN.
Vertebral body infarction as a confirmatory sign of spinal cord ischemic stroke: report of three cases and review of the literature.
BACKGROUND: Acute spontaneous spinal cord syndromes often remain etiologically ambiguous despite extensive diagnostic efforts. In the previous literature five cases are described with acute spinal cord syndromes interpreted as spinal cord ischemic strokes because of association with vertebral body infarctions on MRI. CASE DESCRIPTIONS: Three cases are presented, and the literature is reviewed. In addition to an extensive diagnostic battery including an initial MRI without pathological signs, follow-up MRI at different time intervals from the onset of symptoms showed T2 hyperintense signals in vertebral bodies. Patient 1, who had plaques in the abdominal aorta, had suffered a thoracolumbar spinal infarction; this and a concomitant infarction of the left portion of T-12 could be demonstrated on follow-up MRI on day 12. Patient 2, who had incomplete transverse spinal artery syndrome below T-3, had an abnormal signal at the T-2 level of the spinal cord on follow-up MRI on day 5; this was one segment above infarction of the dorsal area of T-3, corresponding to the ascending course of the medullary artery. The spinal cord of patient 3, who had a posterior spinal artery syndrome below T-11, was unremarkable on follow-up MRI on day 14, but a T2 hyperintense signal was noted in the dorsal area of T-10. CONCLUSIONS: Vertebral body infarction represents the only confirmatory sign for the otherwise exclusionary diagnostic procedure for spinal cord ischemic stroke and must be searched for on follow-up MRI as a key to correct diagnosis.
The meaning of being a senior: phenomenological research and interpretation with Parse's theory of nursing.
The purpose of this article is to report findings from a phenomenological analysis on the meaning of being a senior. Six hundred narrative stories written by older Canadians on their personal experiences in later life were analyzed using the operations of the van Kaam phenomenological method. Seven common elements were created to capture the shared meaning about being a senior contained in the narratives. The seven elements when linked together formed the central finding of the study in a structural definition. The structural definition arising in this study is: Being a senior means engaging the now while rolling with the vicissitudes of life as refined astuteness surfaces a buoyant unburdening. It is as though shifting rhythms propel discovery through grateful abiding in wondering awareness as anticipation of new possibles enlivens connectedness and altruistic commitments affirm self amidst the retrospective pondering of everydayness. This definition was interpreted from Parse's theoretical perspective in order to expand the knowledge base of nursing science. Descriptive expressions from the narratives were linked with major concepts from Parse's theory. Implications for research and practice are specified. Discussion includes comparison of the findings with other qualitative investigations exploring the meaning of aging with older persons in the United States, Germany, Britain, and Nepal.
[Procedure guidelines for dynamic renal scintigraphy].
This procedure guideline describes the procedures for dynamic renal scintigraphy with (99m)Tc-MAG3, (123)I-hippuran and (99m)Tc-DTPA. Common clinical applications as well as a detailed description of the procedure are given. It also includes explanations and hints concerning the analysis, evaluation, interpretation, and presentation of the findings.
Measuring the variability of prescription use in patients with HIV infection or AIDS. The contribution of a French hospital longitudinal database.
This study is based on a sample of 937 patients with HIV infection or AIDS who were treated in 5 French hospitals. It sets out to describe the prescription of antiretroviral and prophylactic drugs used in treating such patients and, aims to interpret the various treatment strategies used. The study showed the contribution of longitudinal data in the descriptive analysis of patient follow-up, given the evolving nature of the illness. The Principal Components Analysis method allowed the temporal and quantitative aspects of the data, as well as their combination with qualitative variables, to be taken into account. The results revealed the stability over time of the choice of prescriptions, and allowed joint prescription/substitution phenomena between drugs to be evaluated. At the same time, the study provided evidence for a "site' effect, which showed that the heterogeneity of professional practice is not solely the result of differences in patients or in severity of the illness.
A survey of academic and industry professionals regarding the preferred skillset of graduates of medical informatics programs.
Identification of the skills needed by graduates of medical informatics masters degree programs is needed so that students will know what is desired in the workplace and curriculum designers can assure that courses cover relevant areas. We conducted a mail survey of representatives of the informatics job market to discover what they think is most important. A survey instrument was designed after analyses of job ads and curricula in the U.S. and interviews with representative employers. The survey was mailed to 1000 randomly selected members of AMIA and HIMMS plus EMR vendors. Respondents were asked to rank skills and groups of skills according to perceived utility. The results indicate higher rankings for organizational and interpersonal skills than for more technical credentials. Statistical analysis indicates the existence of relatively few underlying constructs to the skill list.
[Historical reminiscences: the schizophrenic psychosis of the Empress of Mexico (author's transl)].
Quite a number of reports have been published on psychotic developments in the mental make-up of kings and rulers, especially during the past century. Particularly remarkable is the great interest which has been evinced to date on the fate of King Ludwig II of Bavaria. On the other hand, the tragedy of the Belgian Princess Charlotte, who was Empress of Mexico for a few years by the side of her husband, Maximilian of Austria, is hardly known. I could not find anything about her in psychiatric literature, but there are numerous biographical hints in books on history dealing with the dramatic episode of the short-lived Mexican empire. I found some of the most essential information on the personality and psychosis of Empress Charlotte in the book written by Countess H. de Reinach-Foussemagne. The following description is necessarily sketchy and should be considered as a preliminary report to a more comprehensive interpretation of Charlotte's personality.
Questions from practice: a basis for research.
Occupational health nurses in clinical practice are in an excellent position to identify unanswered questions that affect the health and well being of employees. Once these questions have been asked, the occupational health nurses may proceed with structured research to find answers. The research begins with a thorough review of existing literature to learn the background of the issue and clearly define a research question. This question is then framed conceptually to guide the study. The theoretical framework may be supported or refuted by the research project. The study method is dictated by the research question and the theoretical framework. Two basic research methods are intervention and descriptive studies. Intervention studies, with treatment and control groups, attempt to show differences between groups when one receives a certain treatment and the other group does not. Descriptive studies generally survey attitudes or activities, then test for associations. Data analysis is determined by the type of study and type of data collected. Descriptive statistics generate frequencies and correlations; inferential statistics yield stronger information about associations of the variables. Interpretation of research findings must include consideration of threats to validity. Internal validity allows the investigator to state with confidence that the intervention was responsible for the difference between the groups. External validity allows for generalizability of the findings to other populations. The purpose of nursing research is to advance the discipline of nursing. Research refines nursing theories and guides practice. It is through research that occupational health nurses gain confidence to alter procedures and provide interventions that have been shown to be effective.
[Helicobacter pylori: a scientific paradigm?].
It is analyzed from a historic philosophic view, the role which takes the discovery of the Helicobacter pylori as an example like the way scientists proceed to build the scientific knowledge. The method for the philosophic interpretation of this find is based on the proposal of Thomas Kuhn who offers a historical description of the way, that science is taking form and developing. It is concluded that in the discovering of the Helicobacter pylori and its theoretical implying concept and therapeutic would adapt nowadays a "Mini Paradigm" scientific and which would be in presence of a great step for the creation of a new scientific paradigm. So it's worth to say in the introduction of a scientific resolution in the conception, explanation and action to follow for the community of specialists and the common people respect to the chronic gastritis, duodenal ulcers and other similar ones.