[Health education in transplant patients and their families in an intensive care unit]. / Educación para la salud en el paciente trasplantado y su familia en una unidad de cuidados intensivos.

Health Education (HE) is extremely important in transplant patients and their families in order to promote suitable self-care in this new stage of life. Intensive Care Units offer various opportunities by nurses in order to improve their Health Education. This process could start in this unit where the interaction between nurse and family is constant. The HE of transplant patient includes three dimensions: Knowledge: information about self-care in order to have a healthy way of life, and getting some information on how to reduce anxiety in patients and their families; Skills: as regards the abilities to properly apply the Health Education, where the families are really important; and finally Attitudes: ambivalent attitudes that are experienced by transplant patients. The objective is to describe the level of development of HE for critical transplant patients and their families from Intensive Care Units. A non-systematic literature review was performed in Pubmed and CINHAL data bases. In conclusion, it is emphasised that the skill of the HE nurse in an Intensive Care Units is important to promote lifestyles appropriate to the cognitive, affective, and psychomotor needs of transplant patients. Its implementation entails positive effects on clinical outcomes of the patient, decreased morbidity and mortality, costs, and health resources.

Training nursing students in motivational interviewing for alcohol misuse: A mixed method study.

BACKGROUND: Motivational interviewing led by nurses has been demonstrated to be effective in reducing alcohol consumption among university students. However, most of these professionals feel that they lack the competence necessary for motivational interviewing due to a lack of formal training in the nursing curriculum. OBJECTIVES: To design, implement and evaluate a motivational interviewing training course for alcohol misuse in an undergraduate nursing curriculum and to explore students' experiences with this course. DESIGN: A mixed-methods study involving a descriptive comparative quantitative design and qualitative focus group interviews with nursing students. SETTINGS: An elective nursing course in a Spanish university. PARTICIPANTS: A total of 21 fourth-year nursing students. METHODS: The course was developed as a twelve-week, two-hour course. It comprised three modules covering the concepts, tools and skills associated with motivational interviewing for alcohol misuse. Quantitative and qualitative data were collected after the completion of the course to evaluate the training received by students; these data were categorized using Kirkpatrick's model. The quantitative results included students' satisfaction, knowledge, skills and attitudes, which were measured using an ad hoc questionnaire, a multiple-choice exam, and two rater-based assessments (the Peer Proficiency Assessment instrument and an evidence-based checklist). Qualitative focus groups were used to explore students' experiences of the entire programme. RESULTS: Students' satisfaction with the course was rated 9 out of 10, highlighting the usefulness and adequacy of the course content. The quantitative and qualitative results both indicated that all students acquired the knowledge necessary to perform motivational interviewing and significantly improved their motivational interviewing microskills. Only half of the students reached the level of proficiency in two of the three ratios calculated. The three main themes identified pertained to the learning atmosphere, module methodologies, and students' self-perceptions of competence. Finally, the students reported having transferred their learning to clinical practice. CONCLUSION: A course on motivational interviewing for alcohol misuse positively influences nursing students both personally and in terms of their future professional work by improving their knowledge, skills, attitudes and self-perceived competence.

NURSES' knowledge, skills and personal attributes for providing competent health education practice, and its influencing factors: A cross-sectional study.

AIM: To explore nurses' knowledge, skills and personal attributes for competent health education practice and their association with potential influencing factors. BACKGROUND: Clinical nurses are expected to perform effective health education interventions, but they do not feel competent. The self-assessment of the health education competence and its conditional factors is paramount for professional development. DESIGN: A cross-sectional study. METHODS: A total of 458 clinical nurses from two health specialized centers in Spain participated in this study. Data were collected using the Nurse Health Education Competence Instrument and a second self-report questionnaire from January to February 2019. Descriptive statistics, t-test, analysis of variance, Pearson's and Spearman's correlation and multiple linear regression were used to analyse the data. The STROBE guideline was used RESULTS: The mean scores of the knowledge (70.10 ± 15.11), skills (92.14 ± 15.18) and personal attributes scales (32.32 ± 5.89) were found to be low to moderate. The main influencing factors for the health education implementation were lack of education and training (71.4%), lack of time (67.5%) and high workload (67.3%). Nurses with higher educational level and perceived self-efficacy for competently providing health education, more extensive professional experience and previous training in health education rated higher in knowledge, skills and personal attributes. Age and years of experience were negatively correlated with knowledge scores, but positively with the rest of domains of the competence and self-efficacy. The regression models for the overall health education competence's domains were significant (p < 0.001) with R2 values ranging from 28.0% to 49.3%. Self-efficacy, previous health education training and working in intensive care units were found to be significant in all cognitive, psychomotor and attitudinal scales. CONCLUSION: Clinical nurses reported on some skills and personal attributes for health education practice, but they seem to lack health education knowledge necessary for a competent practice. This study suggested that effective education and training and supportive organizational cultures are key to enhance nurses' health education competence. Identifying nurses' educational needs on the main domains of the competence and its intrinsic/extrinsic influential factors may assist in both planning and organizing tailored training strategies and in promoting appropriate environments to support a high-quality health education practice TWEETABLE ABSTRACT: Nurses' knowledge, skills and attitudes about health education competence are low to moderate. Training and organizational support are key.

Highly selective and compact tunable MOEMS photonic crystal Fabry-Perot filter.

The authors report a compact and highly selective tunable filter using a Fabry-Perot resonator combining a bottom micromachined 3-pair-InP/air-gap Bragg reflector with a top photonic crystal slab mirror. It is based on the coupling between radiated vertical cavity modes and waveguided modes of the photonic crystal. The full-width at half maximum (FWHM) of the resonance, as measured by microreflectivity experiments, is close to 1.5nm (around 1.55 microm). The presence of the photonic crystal slab mirror results in a very compact resonator, with a limited number of layers. The demonstrator was tuned over a 20nm range for a 4V tuning voltage, the FWHM being kept below 2.5nm. Bending of membranes is a critical issue, and better results (FWHM=0.5nm) should be obtained on the same structure if this technological point is fixed.

Lack of desensitization of catecholamine-induced lipolysis in fat cells from trained and sedentary women after physical exercise.

A study was designed to assess whether a period of physical exercise (100 min; 60% of maximal aerobic power), known to promote sympathetic nervous system activation, had a functional impact on human fat cell responsiveness to catecholamines and beta-agonists. The lipolytic activity of isolated sc fat cells was measured before and after a period of exercise in trained and sedentary women with a similar body mass index values [20.4 +/- 0.5 (+/- SE) and 21.3 +/- 0.5 kg/m2] and an equivalent mean fat cell volume (0.216 +/- 0.022 vs. 0.278 pm 0.026 nL). Before exercise, compared with those of sedentary women, the adipocytes of trained women had greater lipolytic responsiveness to catecholamines and beta-agonists; moreover, dibutyryl cAMP had greater lipolytic efficiency on the adipocytes of the trained women. These results suggest that the differences in responsiveness of the adipocytes from sedentary and trained women are due to functional differences at a postreceptor level of the lipolytic cascade. The lipolytic (beta-adrenergic) and antilipolytic (alpha 2-adrenergic) responses of the adipocytes from both groups did not change after the period of physical activity. These results demonstrate, whatever the physical condition of the subjects, that desensitization of beta- and alpha 2-adrenergic responsiveness does not occur after a period of intense physical activity which promotes physiological activation of the sympathetic nervous system.

Response of fat cells to growth hormone (GH): effect of long term treatment with recombinant human GH in GH-deficient adults.

GH deficiency impairs lipid metabolism in adults, but little is known about the direct effect of GH on adipose tissue in humans. First, the in vitro response of fat cells to GH in five GH-deficient adults was studied; second, it was investigated whether 6-month recombinant human GH (rhGH) administration modifies this response. Biopsies of fat were obtained from the periumbilical region before and after rhGH administration. The response of the collagenase-isolated fat cells to various concentrations of GH was assessed by glycerol release, measured by bioluminescence. Before treatment, GH induced a lipolytic activity from the adipocytes, which became significantly higher after 6 months of treatment. Thus, this study provides evidence for an intrinsic lipolytic activity of GH in GH-deficient adults and for its improvement after long term rhGH administration.

Adipose tissue lipolysis and hormone-sensitive lipase expression during very-low-calorie diet in obese female identical twins.

Eight pairs of obese female monozygotic twins were subjected to a 4-week, very-low-calorie diet (VLCD) that induced a decrease in mean body mass index from 32.9 +/- 1.1 to 29.7 +/- 1.1 kg/m2. Infusion of the beta-adrenergic agonist, isoproterenol, induced an increase in plasma levels of nonesterified fatty acids and glycerol that was more pronounced during than before VLCD. sc fat biopsies were obtained before and during VLCD to study adipocyte lipolysis. beta-adrenergic sensitivity was moderately improved during VLCD. Basal and stimulated lipolyses, and hormone-sensitive lipase activity and protein levels were increased during VLCD. Before VLCD, intrapair resemblance was found for basal and stimulated lipolysis rates. In response to the treatment, intrapair resemblance was observed for basal lipolysis and for lipolysis stimulated with agents acting on plasma membrane receptors. These results suggest that the increase of basal lipolysis during VLCD is caused by an increase of hormone-sensitive lipase expression. They support the notion that the genotype may play a role in regulating the changes of adipose tissue lipolysis rates observed during VLCD.

Detection of differentially expressed gelatinase A in metastatic and non-metastatic subpopulations of tumor cells by target RNA arbitrarily primed polymerase chain reaction (TRAP-PCR).

We have developed a novel procedure called Targeted RNA AP-PCR (TRAP-PCR) to quantitatively measure specific mRNA expression. The target mRNA is reverse transcribed using a specific primer and PCR is performed under low stringency conditions to generate a rich fingerprint-type band pattern. In this situation multiple sequences are coamplified with the targeted sequence. The amplification is carried out in a competitive fashion and is, in consequence, quantitative. We have applied this technique to determine Gelatinase A (Gel A) mRNA expression in the MXT mouse mammary carcinoma system. TRAP-PCR analysis using primers for Gel A produced a reproducible fingerprint including one major band whose identity was confirmed to be Gel A cDNA. Highly metastatic MXT subclones show an increased Gel A expression. Results were confirmed by Northern blot and protein activity (gelatin zymography). TRAP-PCR is a simple, sensitive and specific technique to comparatively quantify mRNA expression and requires less template than conventional methods.

Effect of physical training in humans on the response of isolated fat cells to epinephrine.

Endurance training helps muscle tissue oxidize lipids and therefore helps conserve glycogen. It was thought interesting to find out if, in addition to this preferential use of fatty acids by muscle tissue, there is an increase in the capacity of adipose tissue to mobilize lipids. So the response to epinephrine of collagenase-isolated fat cells obtained after biopsies of fat performed in the periumbilical region of 10 trained marathon runners (T) and 10 sedentary subjects (S), all males, was studied in vitro. Glycerol release, chosen as adipocyte lipolysis indicator, was measured by bioluminescence. Lipolysis was studied with increased epinephrine concentration. This caused a significant increase in lipolysis only in the T subjects. The dose-response curves were significantly different for T and S subjects at 10(-6) M and above (P less than 0.05). To determine the modification mechanisms observed, lipolysis with isoproterenol and epinephrine plus propranolol were studied. Isoproterenol significantly increased lipolysis in both groups. The dose-response curves were significantly different at 10(-7) M (P less than 0.01) and above. In both groups, epinephrine plus propranolol significantly decreased lipolysis without distinction between T and S. It is concluded that in male subjects endurance training increases the sensitivity of subcutaneous abdominal adipose tissue to the lipolytic action of epinephrine; this effect seems to be related to an increased response of the beta-adrenergic pathways.

Lipolytic response of fat cells to catecholamines in sedentary and exercise-trained women.

It has been shown that adipose tissue lipolytic activity is increased in endurance-trained subjects. In women, adipose tissue is extensive and it was thought interesting to confirm that endurance training increases the capacity of female adipose tissue to mobilize lipids, and moreover to more fully understand the mechanisms involved. So, biopsies of fat were obtained from the periumbilical region of 13 trained female runners (T) and 17 sedentary women (S) and the in vitro response to catecholamines of the collagenase-isolated fat cells was studied. Glycerol release, chosen as adipocyte lipolysis indicator, was measured by bioluminescence for various epinephrine and norepinephrine concentrations. In both groups, these substances provoked an increase in lipolysis, but the response was significantly higher in T. In both groups, isoproterenol increased the lipolytic activity above basal concentrations at 10(-8) M and above. Lipolytic activity in T was significantly higher (P less than 0.01) than the S control at 10(-7) M and above. Epinephrine plus propranolol decreased lipolysis in both groups, but at 10(-5) M, lipolytic activity was significantly lower in S than in T (P less than 0.05). It is concluded that in female subjects, endurance training increases the sensitivity of subcutaneous abdominal adipose tissue to the lipolytic action of catecholamines; this effect seems to be related both to a decreased efficiency of the alpha 2-adrenergic pathway and to an increased efficiency of the beta-adrenergic pathway. This latter effect seems to take place at a step beyond the receptor-adenylate cyclase system in the lipolytic cascade.

Effect of carbohydrate ingestion on adipose tissue lipolysis during long-lasting exercise in trained men.

To study whether sucrose administration acts on lipid mobilization during prolonged exercise, we used subcutaneous abdominal adipose tissue microdialysis in eight well-trained subjects submitted at random to two 100-min exercises (50% maximal aerobic power) on separate days. After 50 min of exercise, the subjects ingested either a sucrose solution (0.75 g/kg body wt) or water. By using a microdialysis probe, dialysate was obtained every 10 min from the subjects at rest, during exercise, and during a 30-min recovery period. During exercise without sucrose, plasma and dialysate glycerol increased significantly. With sucrose, the response was significantly lower for dialysate glycerol (P < 0.05). Plasma free fatty acid level was lower after sucrose than after water ingestion (P < 0.05). With water ingestion, plasma catecholamines increased significantly, whereas insulin fell (P < 0.05). With sucrose ingestion, the epinephrine response was blunted, whereas the insulin level was significantly increased. In conclusion, the use of adipose tissue microdialysis directly supports a lower lipid mobilization during exercise when sucrose is supplied, which confirms that the availability of carbohydrate influences lipid mobilization.

Optimisation of a silicon/silicon dioxide substrate for a fluorescence DNA microarray.

This paper presents a comprehensive theory and experimental characterisation of the modulation of the fluorescence intensity by the construction of optical interferences on oxidised silicon substrates used for DNA microarrays. The model predicts a 90-fold variation of the fluorescence signal depending on the oxide thickness. For a Cy3 dye, the signal is maximal for a 90 nm oxide thickness corresponding to a 7.5-fold enhancement with respect to a standard glass substrate. For experimental validation of the model, we have prepared Si/SiO2 substrates with different parallel steps of decreasing oxide thicknesses on the same sample using a buffered oxide etch (BOE) etching process after thermal oxidation. The SiO2 surface has been functionalized by a silane monolayer before in situ synthesis of L185 oligonucleotide probes. After hybridisation with complementary targets, the variations of the fluorescence intensity versus oxide thickness are in very good accordance with the theoretical model. The experimental comparison against a glass substrate shows a 10-fold enhancement of the detection sensitivity. Our results demonstrate that a Si/SiO2 substrate is an attractive alternative to standard glass slides for the realisation of fluorescence DNA microarrays whenever detection sensitivity is an important issue.

Absence of arterial hypertension despite chronic plasma noradrenaline elevation: evidence for down-regulation of alpha-adrenoceptors. A case report.

A 44 year old-healthy female presented chronic and stable high levels of plasma noradrenaline (NA) without any major change in adrenaline. The diagnosis of phaeochromocytoma was discarded. These increased levels of NA offered an unique opportunity to investigate under in vivo conditions a putative regulation of alpha-adrenoceptors by this endogenous catecholamine. Infusion rates of exogenous NA up to 0.74 micrograms/kg per min were unable to induce any change in blood pressure (or heart rate) in the subject, In contrast, in normotensive controls, an increase in blood pressure (+ 15 mm Hg) was observed with 0.39 micrograms/kg per min. The magnitude of yohimbine-induced increase in plasma NA was similar in the subject and in the controls. Platelet alpha 2-adrenoceptors evaluated by specific [3H]-yohimbine binding showed a significantly lower level in the subject when compared to controls. The results show that a sustained increase in plasma NA is able to induce down-regulation of alpha-adrenoceptors. This down-regulation can explain the lack of arterial hypertension despite the increased sympathetic tone.

Transforming growth factor release by human tumor cell lines and their interactions with other growth factors.

We have studied the production of transforming growth factor (TGF) by several human tumor cell lines and their interactions with exogenously added epidermal growth factor (EGF) and insulin. TGF-like activities were present in all the conditioned media tested. The clonogenic capacity of the tumor cell lines had no correlation with the TGF-like activity production. EGF and insulin had a promoting colony-forming activity on tumor cells but this effect was not additive. Moreover, an inverse statistically significant correlation (-0.817, p less than 0.05) was found between the response to exogenous EGF and the EGF or TGF-alpha production by tumor cell lines. The EGF receptor (EGF-R) was not detected in any of the melanomas studied, nor in breast adenocarcinoma cell lines which were producers of EGF or TGF-alpha.

Cardio-respiratory changes during the onset of head-down tilt.

BACKGROUND: During spaceflight, changes in the cardiovascular system and in pulmonary mechanics take place but no apparent impairment of respiratory function occurs. However, little is known about the first hours in microgravity. HYPOTHESIS: The changes occurring at the same time in the cardiovascular and pulmonary systems could interact and lead to a transient impairment of blood gases at the onset of microgravity. METHODS: Cardiovascular and respiratory changes were studied during 6 degrees head-down tilt (HDT), a now well-known method for simulation of microgravity. After a baseline standing position, 10 men were exposed to 4 h of 6 degrees HDT. Hemodynamic parameters were measured by thoracic electrical bioimpedance. Ventilatory parameters were studied by spirographic measurements and mass spectrometer analysis of expired gases. Arterial blood parameters were analyzed by specific electrodes. RESULTS: Immediately after tilting, stroke volume and cardiac output increased, as measured by thoracic bio-impedance, while heart rate and thoracic fluid index decreased. Blood gas analysis showed hypercapnia, acidosis and a tendency to hypoxia. These changes were related to hypoventilation shown by the decrease in minute ventilation. After usually less than 30 min, all the parameters reached a steady state. Return to the standing position provoked reverse variations with orthostatic intolerance in 4 subjects. CONCLUSION: Marked changes in both the cardiovascular and respiratory systems occur within the first minutes of HDT (i.e., transition to simulated microgravity).

[Gas-liquid chromatography in microbiological diagnosis]. / Apport de la chromatographie gaz-liquide au diagnostic microbiologique.

With gas-liquid chromatography, it is possible to detect chemical compounds which are specific of micro-organisms: either metabolic products, or structural components. This technique permits to simplify the diagnosis: it is the case for anaerobic bacteria, where the analysis of the fermentation acids produced in a 48 hours liquid culture enables to rapidly establish the diagnosis, at least as far as the genus is concerned. It may also increase the accuracy of the diagnosis by searching such or such metabolite or structural component which are specific of a species or a sub-species. Some authors have already determined automatic systems of bacterial identification; these systems are based on a computer analysis of the chromatographic profile of cellular fatty acids. Finally it is important to emphasize that liquid-gas chromatography may markedly shorten the delay of identification by allowing, in some cases, a direct diagnosis in pathological samples.