The reproducibility of perceptually regulated exercise responses during short-term cycle ergometry.

The purpose of this study was to assess the reproducibility over four trials of perceptually regulated exercise intensity during short-term cycle ergometry. Recent research has suggested that an improvement in the reproducibility (better agreement) of the exercise output would be observed with a repeated practice using regulatory tools such as Borg's 6 - 20 rating of perceived exertion (RPE) scale. Eighteen healthy active volunteers (nine males, mean age (+/- SD) 24.7 +/- 3.4 yr, and nine females 27.6 +/- 5.4 yr) completed four identical intermittent effort production trials on a cycle ergometer over a period of two - three weeks, with all trials being between three and five days apart. After warm-up, the volunteers were asked to produce four x three-minute bouts of exercise at RPE levels: 13, 15, 9, and 17 (in this order). Power output (W), percentage maximum heart rate reserve (%MHRR), and oxygen consumption (VO(2); ml x kg(-1) x min(-1)) were recorded in the final minute of each bout. Analysis revealed that the 95 % limits of agreement (LoA) between repeated trials did not decrease for the objective markers of exercise intensity, remaining wide throughout. In the worst case comparisons the LoA represented changes (expressed as a proportion of the mean of two trials) of up to 58.3 % in power output (T2 vs. T3 at RPE 9), 65.5 % in % MHRR (T1 vs. T2 at RPE 13) and 36.5 % in VO(2) (T3 vs. T4 at RPE 17). These findings question the use of ratings of perceived exertion to regulate exercise effort. That the reproducibility of effort is also not seen to improve with practice raises doubts about the validity of using the RPE scale to provide training intensities for this type of exercise.

Liquid chromatographic determination of urea in water-soluble urea-formaldehyde fertilizer products and in aqueous urea solutions: collaborative study.

Water soluble urea-formaldehyde (UF) fertilizers, manufactured by complex reaction of urea and formaldehyde, typically contain varying amounts of unreacted urea. A liquid chromatography method for the analysis of urea in these products, and in aqueous urea solutions, was collaboratively studied. An amine chromatography column was used to separate the unreacted urea from numerous UF reaction products present in these liquid fertilizers. Unreacted urea was determined by using external urea standards with UV detection at 195 nm. The standards and test samples were prepared in the mobile phase of 85% (v/v) acetonitrile in water. Ten laboratories analyzed 5 different UF-based commercial products containing unreacted urea in the range of 6 to 17% by weight, and 5 different concentrations of urea in water equivalent to commercial products of that nature. The aqueous urea solutions contained 2-20% urea (w/w). The range of s(R) values for the 5 UF-based commercial fertilizers was 0.49-1.02 and the %RSD(R) was 1.94-6.14. The s(R) range for the 5 urea solutions was 0.10 to 0.79 and the %RSD(R) range was 2.54 to 4.88. The average recovery of urea from the aqueous urea solutions was 96-103%. Therefore, this method is capable of monitoring urea nitrogen manufacturers' label claims and total nitrogen claims in those cases where urea is the sole source of plant food nitrogen. Based on the collaborative study data, the authors recommend this method be approved for AOAC Official First Action status.

The effect of experiential anchoring on the reproducibility of exercise regulation in adolescent children.

In this study, we examined whether a preparatory perceptual 'anchoring' technique would enhance the reproducibility (test-retest reliability) of adolescent children in their ability to self-regulate their exercise output on the basis of their effort perceptions. Forty-one adolescents aged 12.6 +/- 0.7 years (mean +/- s), randomly assigned to either an anchor or non-anchor group, undertook two identical production trials (three 3-min cycle ergometer bouts at levels 3, 6 and 8 of the Children's Effort Rating Table) over 8 days. Before each trial, the anchor group received an experiential (exercise) trial intended to provide a frame of reference for their perceived exertions. The test-retest reproducibility of the heart rates and power outputs produced during the production trials was assessed using intraclass correlation coefficients and 95% limits of agreement analysis. For the anchor group, the intraclass correlation coefficients ranged from 0.68 to 0.81 for heart rate and from 0.39 to 0.86 for power output. For the non-anchor group, they were generally higher: 0.86 to 0.93 and 0.81 to 0.95 for heart rate and power output, respectively. The 95% limits of agreement indicated no marked differences between the two groups in the amount of bias and within-subject error. The results suggest that among these adolescents, the implementation of an experiential anchoring protocol had no positive effect on the reproducibility of their exercise regulation during prescribed cycling.

Measurement of active coagulation factors in Autoplex-T with colorimetric active site-specific assay technology.

Autoplex-T is a partially activated prothrombin complex concentrate used primarily for the treatment of patients expressing factor VIII inhibitors. While Autoplex-T has a demonstrated record of clinical effectiveness, the procoagulant composition of this material has not been reported. This absence of composition data is a reflection of the lack of techniques appropriate for accurately measuring an individual protease such as factor IXa in complex mixtures of similar proteases. The development of Colorimetric Active Site-Specific ImmunoAssay technology (CASSIA) has permitted the accurate analysis of the coagulant enzymes present in Autoplex-T. Ten lots of Autoplex-T were reacted with both biotinylated phenylalanylprolylarginine chloromethylketone and biotinylated glutamylglycylarginine chloromethylketone. Only activated forms of the clotting factors present in Autoplex-T react with the peptide chloromethylketones and were thus separated from the other proteins present in Autoplex-T by adsorption onto streptavidin. The individual proteins bound to streptavidin were then detected with specific antibodies. Mean results from the analysis of ten lots of Autoplex-T (mean values) are as follows: factor Xla, 5.9 nM or 0.8 microg/ml; factor Xa, 46.5 nM or 2.1 microg/ml; factor IXa, 177.8 nM or 11.7 microg/ml; factor VIIa, 68.6 nM or 3.3 microg/ml and factor IIa, 5.3 nM or 0.2 microg/ml. These results are discussed with respect to the mechanism of action of Autoplex-T in the treatment of factor VIII inhibitor patients.

An honors program: directing our future leaders.

Development of future leaders is a priority of nurse educators. In this article an honors program, which was initiated to prepare students who would contribute to nursing science and become effective leaders, is described. The process used to gain faculty and administrative support is highlighted. The discussion also includes specifics regarding recruitment and selection of students and sequencing of courses. Evaluation of the program suggests that graduates assume leadership positions within the profession. Honors programs such as this one help to prepare leaders and scholars for tomorrow.

Seizures and the elderly.

The care of elderly patients with seizure disorders in the critical care unit is an important nursing challenge. The potential that a seizure is an isolated event or one that will require lifelong treatment must be expected. The critical care nurse is in a unique position to help the patient and his or her family as they begin to grapple with the important changes the seizure may bring. The critical care nurse also can assist in the transition from the acute setting to the less acute setting in which the patient and the family will be assisted in developing plans for long-term management of this serious situation.

Importance of health and family variables related to quality of life in individuals with uncontrolled seizures.

Approximately 2.5 million Americans are epileptic, and nearly 150,000 new cases are diagnosed in the United States each year. While seizures are the most common physical symptom of epilepsy, treatment must include far more than medical intervention for seizure control. Virtually all aspects of life are affected by the disorder including personal relationships, employment, perception of self and overall quality of life. A literature review indicates that, while progress is being made in identifying variables which impact quality of life, little consensus exists regarding their nature. No two patients are necessarily alike, nor are their methods of dealing with the disorder necessarily the same. Arguments have been posed which state that age of onset is a factor, as is the degree to which seizures can be controlled. This is not to say, however, that effective interventions cannot be developed to assist patients in dealing not only with the physical manifestations of epilepsy but other common related factors as well. The purpose of this study was to identify those variables which impact quality of life for persons with epilepsy, and in light of the findings, to make recommendations for nursing interventions.

Characteristics of critical care nursing internship programs.

Development of programs to prepare new graduate nurses to work in critical care units has been a priority for nurse educators for many years. Despite the presence of many such internship programs, little data are available about the characteristics of such programs. Results of this study suggest that the development of internship programs designed to prepare new graduate nurses in critical care nursing continues to be a priority. The standards used by these programs are individualized and are often reflective of the unique needs of the institution. Costs of these programs are quite high. Recommendations for future directions based upon the results of the study are offered.

Impact of epilepsy on quality of life.

Epilepsy is a chronic condition with a profound effect on the quality of life. Health, family life, social, community and civic activities, economics and personal development are the major variables associated with quality of life for the person with epilepsy. In this article, a model describing the relationship between these variables and quality of life is presented. This model organizes a comprehensive nursing approach to the patient with epilepsy. A case study analysis approach is used to help further illustrate interactions among the variables. Nursing interventions based upon analysis of the model are suggested.

Evaluation of a critical care nursing internship program.

Many hospitals have developed internship programs to assist in the movement of new graduates into the critical care unit. The purpose of this study was to evaluate an existing critical care nurse internship program. Five research questions were developed to guide the evaluation process. Results suggest that the goals of the program were met. Specific weaknesses in preparation of preceptors and knowledge base of interns were identified. High burnout scores were also identified, suggesting that new graduates may find the experience of working in critical care very stressful. Implications for revisions of the existing program and for others involved in similar programs are discussed.

A national board for nursing certification.

As late as 1988, the term "certification" had no consistent meaning within nursing. By 1991, eight organizations representing over 120,000 certified nurses had joined together to establish the American Board of Nursing Specialties, a group dedicated to assuring consistent and rigorous standards for certifying nursing specialties. Here's how it happened.

Envisioning a National Board of Nursing Specialties: an interview with Jeanette Hartshorn.

The Committee for the National Board of Nursing Specialties was recently established to explore ways of enhancing the professionalization of nursing through a unified approach to strengthening the process for certifying specialty nurses. In this interview, Jeanette Hartshorn, PhD, RN, FAAN, project director of the committee, explains the need for the proposed National Board of Nursing Specialties and the effects the board would have on nursing, certifying organizations, health care providers, and consumers.

The relationship between DNA repair after alkylation damage and in vitro aging in human T-lymphocytes.

In vitro cultures of human peripheral blood lymphocytes, both unstimulated G0 cells as well as phytohemagglutinin (PHA) stimulated cells, have been used in the investigation of DNA repair following different types of damage, including that induced by ultraviolet light, ionizing radiation, and chemical agents. We report here repair of DNA damage in cultured normal human T-lymphocytes after treatment with the alkylating agents, N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) or methanesulfonate (MMS), as measured by the alkaline elution technique. T-lymphocytes cultured with different sources of T-cell growth factors (TCGFs) were shown to have similar repair levels, as measured by loss of single-strand breaks. However, diminished repair was observed with in vitro culture age when T-cells were cultured with PHA and TCGF for a 3-week period. Cell-cycle analysis performed on asynchronously growing cultures indicated that differential repair with in vitro aging was not cell-cycle-related. Fluorescence Activated Cell Sorting (FACS) was used to determine the percentages of CD4+ and CD8+ T-cell subsets present during the in vitro culture periods. Cultures consisted primarily of CD4+ cells until day 20 when the percentage of CD8+ cells increased to approximately 50% of the T-cell population. Neither the absolute percentages of CD4+ and CD8+ cells not the CD4+/CD8+ ratios correlated with repair rates of cultured T-cells. Therefore, the observed decreases in the repair of alkylating agent-induced damage are not due solely to the change in the CD4+/CD8+ ratio.

Critical care nursing in baccalaureate programs.

There is a need to resolve several issues related to inclusion of CCN in the baccalaureate curriculum. These include: (1) the nature of specialist versus generalist preparation; (2) the goals for inclusion of CCN, (as well as content related to any other area of practice which may be considered specialized); (3) the relationship between education and practice, and the responsibilities of each in educating competent practitioners to provide safe care to critically ill patients.

Angiotensin converting enzyme inhibitors.

The angiotensin converting enzyme inhibitors are beneficial to hypertensive patients and those experiencing congestive heart failure. These agents appear to have fewer side effects than many other commonly used agents. Nursing interventions include monitoring for individual responses to the drugs and providing adequate education to ensure the patient's compliance with the drug regime.

DNA repair deficiency for alkylation damage in cells from Alzheimer's disease patients.

We have shown that fibroblasts, lymphocytes and lymphoblasts from patients with Alzheimer's disease (AD) are deficient in the repair of DNA damage induced by the alkylating agents methylmethane sulfonate (MMS) and N-methyl-N'-nitro-N-nitrosoguanidine (MNNG). Unscheduled DNA synthesis and alkaline elution studies of DNA repair using human skin fibroblasts obtained from patients coming to autopsy have shown that the cells from autopsy confirmed cases of AD have lower levels of DNA repair synthesis after exposure to varying concentrations of either MMS or MNNG. Lymphoblasts derived from individuals with dominantly inherited AD have also been used to study DNA repair. Alkaline elution analysis of DNA repair after exposure to 200 uM MMS or 6 uM MNNG indicates that there is significantly less repair in the lymphoblasts from AD patients. When healthy control cell lines repaired and cell lines from AD patients were exposed to MMS or MNNG respectively significantly less repair occurred in the AD cells. After studying five at risk individuals results indicate that cell lines from two of these people have low levels of DNA repair and three lines have normal repair. These findings support the hypothesis of a DNA repair deficiency in familial AD. Monocytes from healthy control subjects and putative AD patients were analyzed for mutant frequency and DNA repair capacity. Results of unscheduled DNA synthesis experiments using monocytes from 7 healthy controls and 9 presumed AD patients indicates that there is a decreased ability of AD cells to repair MMS and MNNG induced DNA damage.

Detection of DNA damage and repair by alkaline elution using human lymphocytes.

The repair of DNA alkylation damage in human cells is poorly understood. We have adapted the alkaline elution technique for use with human peripheral blood lymphocytes in culture. We have also established conditions necessary for short-term culture of human lymphocytes. Lymphocyte growth which can be maintained for up to 30 days is dependent upon irradiated TK6 feeder cells and T-cell growth factor (crude TCGF). The amount of damage induced by a given concentration of methyl methane-sulfonate (MMS) is dependent upon cell number per ml of growth medium. The DNA damage measured, in lymphocytes, by alkaline elution is a composite of single strand breaks and alkali-labile lesions. Repair of this damage after appropriate recovery periods is also detectable. The irradiated feeder TK6 cells do not contribute to the number of strand breaks detected or the amount of recovery after treatment. This method offers a quick and reproducible means of detecting DNA damage and repair in human T-lymphocytes.