The Doctor Can See You Now: A Key Stakeholder Study Into The Acceptability Of Ambulance Based Telemedicine.

Using telecommunications technology it would be possible to link a patient and paramedic to a Doctor in the Emergency Department (ED) at the point of first patient contact. A questionnaire-based study on telemedicine in the pre-hospital environment involving patients, paramedics, doctors and nurses in the ED, was performed to assess if they would want and accept telemedicine in pre-hospital emergency care. When asked 98.5% (55) of patients, 89% (11) of doctors, 76% (14) of nurses and 91% (42) of ambulance personnel saw the potential of an audio-visual link from the pre-hospital environment to the ED. The potential benefits were felt to be in diagnosis of time-dependent illnesses, time management, increased hospital preparedness for incoming patients and increased triage efficiency. Stakeholder enthusiasm for pre-hospital telemedicine must be met with the technological requirements to provide such a service. As noted by one patient a pre-hospital audio-visual link to the ED could be "potentially a life saving service".

A 'pocket guide' to total internal reflection fluorescence.

The phenomenon of total internal reflection fluorescence (TIRF) was placed in the context of optical microscopy by Daniel Axelrod over three decades ago. TIRF microscopy exploits the properties of an evanescent electromagnetic field to optically section sample regions in the close vicinity of the substrate where the field is induced. The first applications in cell biology targeted investigation of phenomena at the basolateral plasma membrane. The most notable application of TIRF is single-molecule experiments, which can provide information on fluctuation distributions and rare events, yielding novel insights on the mechanisms governing the molecular interactions that underpin many fundamental processes within the cell. This short review intends to provide a 'one stop shop' explanation of the electromagnetic theory behind the remarkable properties of the evanescent field, guide the reader through the principles behind building or choosing your own TIRF system and consider how the most popular applications of the method exploit the evanescent field properties.

World-wide genetic differentiation of Eubalaena: questioning the number of right whale species.

Few studies have examined systematic relationships of right whales (Eubalaena spp.) since the original species descriptions, even though they are one of the most endangered large whales. Little morphological evidence exists to support the current species designations for Eubalaena glacialis in the northern hemisphere and E. australis in the southern hemisphere. Differences in migratory behaviour or antitropical distribution between right whales in each hemisphere are considered a barrier to gene flow and maintain the current species distinctions and geographical populations. However, these distinctions between populations have remained controversial and no study has included an analysis of all right whales from the three major ocean basins. To address issues of genetic differentiation and relationships among right whales, we have compiled a database of mitochondrial DNA control region sequences from right whales representing populations in all three ocean basins that consist of: western North Atlantic E. glacialis, multiple geographically distributed populations of E. australis and the first molecular analysis of historical and recent samples of E. glacialis from the western and eastern North Pacific Ocean. Diagnostic characters, as well as phylogenetic and phylogeographic analyses, support the possibility that three distinct maternal lineages exist in right whales, with North Pacific E. glacialis being more closely related to E. australis than to North Atlantic E. glacialis. Our genetic results provide unequivocal character support for the two usually recognized species and a third distinct genetic lineage in the North Pacific under the Phylogenetic Species Concept, as well as levels of genetic diversity among right whales world-wide.

A collaborative end-of-life care curriculum.

Death and dying in America has received limited attention in medical education. The Southern Arizona VA Health Care System and the University of Arizona have collaborated with three nonprofit community hospice programs to develop an end-of-life care curriculum. This formal and comprehensive program is offered as a one-month elective to senior medical students, residents and fellows. The goal of the program is to improve clinical skills in caring for the dying patient and foster research in palliative and supportive care.

Caring: commitment to excellence or condemnation to conformity?

The art of caring to alleviate illness and to promote health is nursing's unique commitment to society and the health-care industry. How this practice is implemented dictates the success or failure of prescribed strategies. In addition, the way in which caring is implemented defines emotional maturity on both a personal and professional level. Several goals to rehabilitate the psychologically codependent person include: Developing an awareness of the origins of codependency and how early family experiences affect subsequent behavior and beliefs about oneself; Identifying the personal price and payoffs for continuing codependent behaviors; The ability to openly express personal needs, wishes, feelings, and opinions while respecting the rights of others; Learning to discriminate between loving/caring and the destructive control of codependency; and The ability to take responsibility for another rather than being responsible to another. Codependent behaviors are prevalent within professional nursing practice, as evidenced by examples provided from three specialty areas in nursing and the fact that women (who are traditionally assigned the cultural role of caring) constitute the majority of professional nurses. Therefore, it is a professional challenge to each nurse to ascertain whether practices are functional or dysfunctional: is the professional interpretation of caring a commitment to excellence or a condemnation to conformity in the unique delivery of health-care practice?

Orienting new trustees to their role.

Since trustees come from various backgrounds, their learning needs reflect both diversity and commonality. Those from the business sector, for example, may be adept at interpreting financial statements yet unable to assess the physician credentialing process. All new trustees, of course, need to become acquainted with the Church's role in health care, the sponsoring group's mission, and current ethical and legal issues in health care. In an actual educational needs assessment for board members with one to three years' service, the need for education was identified in such areas as program planning, quality of care assessment, personnel policies, selection and evaluation of administrators, and third-party payment methods. The administrator, as well as the sponsoring group and the board itself, should encourage new trustees to identify their learning needs and suggest activities to meet those needs. Group discussion, role playing, case studies, and the critical incident approach can be useful in encouraging the learner's active participation. Throughout the educational process, trustees should share responsibility for defining learning goals and for planning, conducting, and evaluating learning activities.

Specimen housing unit for cinemicrographic studies in the vertical plane.

A compact housing unit for low-power (X6 to X50) cinemicrographic studies of microbial specimens in the vertical plane is described. This unit was used successfully to record the development of a "halo" of cells around subsurface colonies of Escherichia coli.