Improving care of critically ill patients requires using an interprofessional care model and care standardisation.
Determine whether collaborative patient care rounds in the intensive care unit ...increases practice consistency with respect to common considerations such as delirium prevention, device use, and indicated prophylaxis, among others. Secondary objective to assess whether collaborative interprofessional format improved nursing perceptions of collaboration.
Single centre, pre- and post- intervention design. collaborative patient care rounding format implemented in three intensive care units in an academic tertiary care centre. format consisted of scripted nursing presentation, provider checklist of additional practice considerations, and daily priority goals documentation. measurements included nursing participation, consideration of selected practice items, daily goal verbalisation, and nursing perception of collaboration.
Pre- and post-intervention measurements indicate gains in consideration of eight of thirteen bundle items (p < 0.05), with the greatest gains seen in nurse-presented items. Increases were observed in verbalisation of daily goals (59.8% versus 89.1%, p < 0.0001), nurse participation (83.9% versus 91.8%, p = 0.056), and nurse collaboration ratings (p < 0.0001).
This study describes implementation of collaborative patient care rounds with corresponding increases in consideration of selected practice items, verbalisation of daily goals, and perceptions of collaboration.
The antimalarial trioxanes, exemplified by the naturally occurring sesquiterpene lactone artemisinin and its semi-synthetic derivatives, contain an endoperoxide pharmacophore that lends tremendous ...potency against
Plasmodium parasites. Despite decades of research, their mechanism of action remains unresolved. A leading model of anti-plasmodial activity hypothesizes that iron-mediated cleavage of the endoperoxide bridge generates cytotoxic drug metabolites capable of damaging cellular macromolecules. To probe the malarial targets of the endoperoxide drugs, we studied the distribution of fluorescent dansyl trioxane derivatives in living, intraerythrocytic-stage
Plasmodium falciparum parasites using microscopic imaging. The fluorescent trioxanes rapidly accumulated in parasitized erythrocytes, localizing within digestive vacuole-associated neutral lipid bodies of trophozoites and schizonts, and surrounding the developing merozoite membranes. Artemisinin pre-treatment significantly reduced fluorescent labeling of neutral lipid bodies, while iron chelation increased non-specific cytoplasmic localization. To further explore the effects of endoperoxides on cellular lipids, we used an oxidation-sensitive BODIPY lipid probe to show the presence of artemisinin-induced peroxyl radicals in parasite membranes. Lipid extracts from artemisinin-exposed parasites contained increased amounts of free fatty acids and a novel cholesteryl ester
. The cellular accumulation patterns and effects on lipids were entirely endoperoxide-dependent, as inactive dioxolane analogs lacking the endoperoxide moiety failed to label neutral lipid bodies or induce oxidative membrane damage. In the parasite digestive vacuole, neutral lipids closely associate with heme and promote hemozoin formation. We propose that the trioxane artemisinin and its derivatives are activated by heme-iron within the neutral lipid environment where they initiate oxidation reactions that damage parasite membranes.
A study of the effects of a cavitation bubble on a thin elastic membrane is presented. A cavitation bubble was produced by focusing a high-energy laser beam near an elastic membrane submerged in ...water, which corresponds to conditions often encountered in ophthalmology. The bubble effects on the membrane were studied as a function of distance between the bubble and membrane and laser pulse energy. Recordings of bubble dynamics with an ultra-high-speed camera were performed on both sides of the membrane, providing better insight into the mechanisms of membrane rupture. Observations have revealed distinct bubble behavior regimes with respect to coefficient γ. Cavitation bubbles centered on the membrane produce less damage than bubbles shifted slightly away. Significant damages were observed at intermediate distances between the bubble and membrane after bubble collapse, while weaker interactions were recorded at larger distances with less or no damaging effect to the membrane.
•Observation of bubble dynamics near an elastic membrane with a high-speed camera.•Membrane rupturing caused by a laser-induced bubble.•Observation of different regimes of bubble behavior with respect to parameter γ.•Comparison of bubble effects at different laser pulse energies and values of γ.
Purpose - The purpose of the paper is the elucidation of certain mechanisms of laser material processing in general and laser micro sintering in particular. One major intention is to emphasize the ...synergism of the various effects of q-switched laser pulses upon metal and ceramic powder material and to point out the non-equilibrium character of reaction steps.Design methodology approach - Recent results and observations, obtained in development of "laser micro sintering," are surveyed and analyzed. By breaking down the overall process into relevant steps and considering their possible kinetics, an approach is made towards interpreting specific phenomena of laser micro sintering. Thermodynamics upon heating of the material as well as its photo-electronic response to the incident radiation are considered.Findings - The findings corroborate a model whereby short pulses of high intensity provide non-equilibrium pressure conditions at the location of incidence, that allow for the melting of metal powder with an almost immediate expansion of a plasma and or vapor bulb. Thereby the molten material is condensed and propelled towards the substrate. A final boiling eruption after each pulse is the reason for the morphology of the laser micro-sintered surfaces and can prevent oxidation when the process is conducted under normal atmosphere. In sintering of ceramics, the short pulsed and intensive radiation increases the chance to excite the material even with photon energies below the bandgap value and it lowers the risk of running into a destructive avalanche.Research limitations implications - Owing to the stochastic character of the respective sintering event, that is initiated by each individual pulse, the gathered data are not suitable yet for the formulation of an exact quantitative function between sintering behavior and laser parameters.Practical implications - The qualitative findings yield a good rule of thumb for the choice of parameters in laser sintering on a micrometer scale and the model is conducive for advanced interpretation of other phenomena in laser material processing besides sintering.Originality value - The kinetics and thermodynamics of laser sintering with q-switched pulses are approached by a qualitative explanation. The heterogeneous and non-equilibrium character of the processes is taken into account; this character is often neglected by researchers in the area.
Posttraumatic stress disorder (PTSD) is an independent risk factor for the development of hypertension and cardiovascular disease. Patients with PTSD have heightened blood pressure and sympathetic ...nervous system reactivity; however, it is unclear if patients with PTSD have exaggerated vasoconstriction in response to sympathetic nerve activation that could also contribute to increased blood pressure reactivity. Therefore, we hypothesized that patients with PTSD have increased sensitivity of vascular α
-adrenergic receptors (α1ARs), the major mediators of vasoconstriction in response to release of norepinephrine at sympathetic nerve terminals. To assess vascular α1AR sensitivity, we measured the degree of venoconstriction in a dorsal hand vein in response to exponentially increasing doses of the selective α1AR agonist, phenylephrine (PE), in 9 patients with PTSD (age = 59 ± 2 yr) and 10 age-matched controls (age = 60 ± 1 yr). Individual dose-response curves were generated to determine the dose of PE that induces 50% of maximal venoconstriction (i.e., PE ED
) reflective of vascular α1AR sensitivity. In support of our hypothesis, PE ED
values were lower in PTSD compared with controls (245 ± 54 ng/min vs. 1,995 ± 459 ng/min,
= 0.012), indicating increased vascular α
AR sensitivity in PTSD. The PTSD group also had an increase in slope of rise in venoconstriction, indicative of an altered venoconstrictive reactivity to PE compared with controls (19.8% ± 1.2% vs. 15.1% ± 1.2%,
= 0.009). Heightened vascular α
AR sensitivity in PTSD may contribute to augmented vasoconstriction and blood pressure reactivity to sympathoexcitation and to increased cardiovascular disease risk in this patient population.
Genetic, physiological and pharmacological studies are gradually revealing the molecular basis of chloroquine resistance (CQR) in the malaria parasite,
Plasmodium falciparum. Recent highlights ...include the discovery of a key gene associated with resistance,
pfcrt (
Plasmodium falciparum chloroquine resistance transporter; PfCRT), encoding a novel transporter, and the characterization of global selective sweeps of haplotypes containing a K76T amino acid change within this protein. Little is known about the cellular mechanism by which resistant parasites escape the effects of chloroquine (CQ), one of the most promising drugs ever deployed, due in part to an unresolved mechanism of action. The worldwide spread of CQR argues that investigations into these mechanisms are of little value. We propose, to the contrary, that the reconstruction of the evolutionary and molecular events underlying CQR is important at many levels, including: (i) its potential to assist in the development of rational approaches to thwart future drug resistances; (ii) the stimulation of the use of CQ-like compounds in drug combinations for new therapeutic approaches; and (iii) the consideration of how the CQ-selected genome will function as the context in which current and future drugs will act, particularly in light of the many reports of multidrug resistance. The purpose of this review is to highlight, discuss and in some cases challenge the interpretations of recent findings on CQR. We consider the natural function of the PfCRT protein, the role of multiple genes and “genetic background” in the CQR mechanism, and the evolution of CQR in parasite populations. Genetic transformation techniques are improving in
P. falciparum and continue to provide important insight into CQR. Here, we also discuss more subtle, yet important pharmacological approaches that may have been overlooked in a traditional “gene for drug resistance” way of thinking.
Abstract
Background
Autoantibodies against the glomerular basement membrane (GBM) are important markers in the diagnosis and monitoring of autoimmune glomerulonephritides. Fast and reliable detection ...of these autoantibodies is crucial as anti-GBM disease can progress rapidly with fatal outcome. Here, we investigated the diagnostic performance of a newly developed, standardized anti-GBM chemiluminescence immunoassay (ChLIA).
Methods
The diagnostic performance of the EUROIMMUN Anti-GBM ChLIA (IgG), processed on the EUROIMMUN RA Analyzer 10, was assessed using sera from 67 clinically characterized anti-GBM disease patients and 221 disease controls. Results were compared with those obtained by the EUROIMMUN Anti-GBM ELISA (IgG). Inter-assay concordance, measurement range and interference were determined in a subset of samples.
Results
The ChLIA reached 100% sensitivity at a specificity of 98.6%, while the ELISA was less sensitive (89.6%) and more specific (100%). High qualitative concordance between both assays was evidenced by positive and negative agreement rates of 100% and 95.6%, respectively, and a kappa score of 0.901. The ChLIA showed linearity within a measurement range of 3.8–517.3 CU/mL. Coefficients of variation were calculated as 1.2%–3.3% (intra-lot) and 1.6%–4.2% (inter-lot). No interference was observed for hemolyzed, lipemic or icteric samples.
Conclusion
These validation results demonstrate a high quality of the novel Anti-GBM ChLIA. Given its excellent performance compared to the corresponding ELISA, it represents a promising alternative tool for accurate anti-GBM assessment in routine diagnostic settings with the advantage of rapid turnaround time and fully automated random-access processing. Future studies will address the assay’s suitability for monitoring anti-GBM levels during follow-up.
The genus Isoetes is known for morphological convergence and a relative paucity of useful gross morphological characters for identification. Thus, the chromosome complements of Isoetes spp. are key ...attributes for species delimitation. Like many other plant lineages, polyploidy and reticulate evolution are important drivers of speciation in Isoetes. In the southeastern US Isoetes flora, polyploidy is common. We used a rapid DNA flow cytometry protocol to generate C values for four diploid, one tetraploid, and one hexaploid Isoetes species and conducted preliminary cytological investigations of two communities of Isoetes. Our work showed noteworthy variation in diploid Isoetes 1C values (1.39 to 3.32), including the smallest 1C value reported for the genus, Isoetes melanopoda ssp. silvatica. The hexaploid species, Isoetes microvela had the highest 1C value (4.21), and the tetraploid species evaluated had an intermediate 1C value (3.37). However, based on the variation in diploid 1C values measured, a simple 2×, 4×, 6× ratio of C values was not apparent for diploids, tetraploids, and hexaploids, respectively. All Isoetes taxa measured had significantly different 1C values and homogenous C values were observed in two communities of Isoetes (n = 24). These results indicate that DNA flow cytometry may prove a useful tool for routine Isoetes species identification, systematic work, and population-level surveys of Isoetes ploidy level.
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