An alternative route towards the fabrication of 2D blue phosphorene.

Blue phosphorene (BlueP) is a novel two-dimensional material that shares properties with black phosphorene and is potentially even more interesting for opto-electronic applications because of its layer dependent wide band gap of ≈ 2 to 3 eV and superior charge carrier mobility. It was first fabricated on Au(111), where, however, a network consisting of BlueP subunits and Au-linker atoms is formed. The physical properties of such an arrangement strongly differ from a freestanding BlueP monolayer. Here, we report on the growth of epitaxial BlueP on the Au(100) surface, which is an interesting alternative when aiming at quasi-freestanding BlueP domains. We find two different phosphorus phases by means of scanning tunneling microscopy and distortion-corrected low-energy electron diffraction. In the low coverage regime, we observe a commensurate (2 × 2) phase, whereas for higher coverage, a nearly hexagonal structure is formed. For the latter, the lattice parameters measured via atomically resolved scanning tunneling hydrogen microscopy closely resemble those of freestanding BlueP, and the typical height modulation of the phosphorus atoms is verified in our layers by means of x-ray photoelectron diffraction. We further analyze the chemical and electronic properties of these films by means of x-ray and (angle resolved) ultraviolet photoelectron spectroscopy.

[What future for chest x-ray against ultra-low-dose computed tomography?] / Quel avenir pour la radiographie thoracique face au scanner ultra-low dose ?

Technological improvements, with iterative reconstruction at the foreground, have lowered the radiation dose of a chest CT close to that of a PA and lateral chest x-ray. This ultra-low dose chest CT (ULD-CT) has an image quality that is degraded on purpose, yet remains diagnostic in many clinical indications. Thus, its effectiveness is already validated for the detection and the monitoring of solid parenchymal nodules, for the diagnosis and monitoring of infectious lung diseases and for the screening of pleural lesions secondary to asbestos exposure. Its limitations are the analysis of the mediastinal structures, the severe obesity (BMI>35) and the detection of interstitial lesions. If it can replace the standard chest CT in these indications, all the more in situations where radiation dose is a major problem (young patients, repeated exams, screening), it progressively emerges as a first line alternative for chest radiograph, providing more data at a similar radiation cost.

[Emphysematous pyelonephritis--a rare cause of sepsis]. / Die emphysematöse Pyelonephritis--Seltene Ursache einer Sepsis.

A 66-year old female was admitted to our ICU in septic shock with accompanying signs of gastroenteritis and diabetic-related hyperglycemia. Computer tomography of the abdomen revealed the rare diagnosis of emphysematous pyelonephritis. Immediate nephrectomy led to a favourable outcome in this dramatic case. Although abscess drainage and broad-based antibiotic therapy are generally the first-line therapy today, emergency surgery would seem to be indicated in selected cases.

Baccalaureate nursing education: the framework for holistic home health nursing practice.

The concept of home care has been an intricate domain of professional nursing practice for over 100 years. Home health care as the new frontier in health care delivery, although not new to professional nursing, is an exciting challenge for professional nursing practice. The health care delivery system in the United States has, for the first time, been confronted with the issue of cost containment. Professional nursing has the opportunity to demonstrate to society not only the cost effectiveness of professional nursing services but also the comprehensive scope of professional nursing practice. To meet this challenge, home health nursing care must be delivered by practitioners who are highly skilled and qualified for their positions. Baccalaureate nursing education incorporates public and community health nursing content into the curriculum. Therefore, the baccalaureate degree in nursing should be a prerequisite for practitioners in home, public, and community health settings.

[Tifluadom, a benzodiazepine with opioid-like activity: study of its central mechanism of action in conscious dogs]. / Tifluadom, ein Benzodiazepin mit opioidartigem Wirkcharakter: Eine Untersuchung zum zentralen Wirkmechanismus an wachen Hunden.

A derivative of the 1,4-benzodiazepine series with reported opioid activity was evaluated in regard to its effect on central nervous activity in the awake canine. Additionally a possible benzodiazepine- or opioid-receptor interaction was evaluated by using specific antagonists. In 10 experiments increasing doses of tifluadom (5, 10, 20, 40, 80 micrograms/kg) modified somato-sensory-evoked potentials (SEP) inducing a dose-related latency change (40-80 micrograms/kg) and a suppression (80 micrograms/kg) of the P50-peak. Both effects are interpreted as a modification of stimuli reaching the somatosensory cortex. EEG-spectral analysis was characterized by a dose-related decrease of power in the higher frequency range (13-40 Hz) accompanied by an increase of power in the lower band (0.5-3.5 Hz). This effect was paralleled by deep sedation. The specific benzodiazepine antagonist Ro 15-1788 (240 micrograms/kg) was ineffective in reversing central nervous EEG- and SEP-changes. Naloxone (20 micrograms/kg) induced a short-term (5 min) arousal and a partial reversal of SEP-changes. The specific opioid-kappa-antagonist Mr 2266 (20 micrograms/kg) however, induced a long lasting return of power spectra and SEP-changes back to control. This results suggest that tifluadom, although being structurally a benzodiazepine, interacts with an opioid sub-receptor of the kappa-type, which is known to induce sedation and supraspinal analgesia without respiratory depression.

The unchanged mortality of flail chest injuries.

Six hundred eighty-five patients with major blunt thoracic injuries from 1968 through 1977 were retrospectively studied. This series was compared to a similar series from 1959 through 1964. Between 1964 and 1968 a vastly improved hospital was built, laboratory support improved, pressure-controlled ventilators replaced by volume-controlled ventilators and the trauma service was reorganized. The treatment regimen for flail chest injuries during the last decade evolved from the previous early tracheostomy and prolonged ventilator support to an avoidance of tracheostomy and brief ventilator support. The overall mortality in the present series was 20% compared to 35% for the 1959--1964 series; however, improved mortality occurred only among patients with hemothorax who had one or more major concomitant extrathoracic injuries. The mortality for flail chest injuries did not improve (29.5 vs 35.0%). Mortality was unchanged for isolated flail chest injuries, isolated pneumothorax, isolated hemothorax, and for flail chest injuries, and pneumothorax in patients with concomitant major extrathoracic injuries. In both series deaths from isolated thoracic injuries were rare. It is evident that the continued high mortality for blunt thoracic trauma principally relates to concomitant extrathoracic injuries and that recent treatment innovations have not reduced the mortality of flail chest injuries.

The benzodiazepine (+)-tifluadom (KC-6128), but not its optical isomer (KC-5911) induces opioid kappa receptor-related EEG power spectra and evoked potential changes.

Tifluadom, a benzodiazepine with purported opioid receptor-related analgesic properties, was studied in regard to its acute effects on power spectra of the EEG to demonstrate vigilance changes. Additionally, somatosensory-evoked potentials (SEP) were derived to evaluate its effect on the propagation of impulses in sensory nerve fibers. In order to demonstrate stereospecificity, the two enantiomers of tifluadom (KC-5911 and KC-6128) were given in graded doses (20, 40, 80, 160 micrograms/kg i.v.) to awake, unrestrained and trained dogs at 10-min intervals. KC-6128, but not its optical counterpart KC-5911, induced synchronization of the EEG at 20 micrograms/kg with an increase of power (pW) in the delta (1-4 Hz; +300%), theta (4-8 Hz; +450%), and alpha (8-13 Hz +90%) bands. This was accompanied by a reduction of power in the fast beta domain (13-30 Hz; -95%). Vigilance changes were reflected in the beta/delta quotient which dropped from 3.7 (control) to 0.8 (20 micrograms/kg) and to 0.3 (40 micrograms/kg). A further increase in the dose resulted in saturation. At the highest dose (160 micrograms/kg) there was an additional reduction of the beta/delta quotient to 0.1. In order to unmask the receptor population, possibly mediating the observed changes, a benzodiazepine antagonist and opioid antagonists were given. Ro 15-1788 (240 micrograms/kg) had no effect and naloxone (20 micrograms/kg) induced a short term (5 min) arousal. Only the kappa antagonist Mr 2266 (20 micrograms/kg) induced a reversal of the beta/delta quotient back to 5.5. KC-5911 induced an insignificant drop in the beta/delta quotient which was reversed by Ro 15-1788.(ABSTRACT TRUNCATED AT 250 WORDS)

Global connections in a changing world: Romanian and U.S. nurses unite.

This article describes an international, interdisciplinary, university partnership project to collaborate with health professionals in the city of Cluj-Napoca, Transylvania, Romania, to improve the health status of Romanian workers. Academic and service-based public health nurses from the United States used the model of community competence in outlining the nursing aspect of the project. This model guided the assessment, objectives, collaborative activities, and the outcome evaluation of the project. The dimensions of the model (e.g., commitment, self-other awareness, articulateness, conflict accommodation, management of relations with larger society, and leadership) were used within the context of the political and social environment of the international community.

Spiritual expression and immune status in women with metastatic breast cancer: an exploratory study.

This exploratory study examined relationships between spirituality and immune function in 112 women with metastatic breast cancer. Spirituality was assessed by patient reports of frequency of attendance at religious services and importance of religious or spiritual expression. White blood cell counts, absolute numbers of lymphocytes, T-lymphocyte subsets, and natural killer cells were assessed by flow cytometry. Assessments of natural killer cell activity and delayed-type hypersensitivity responses to skin test antigens provided two measures of functional immunity. In analyses controlling for demographic, disease status, and treatment variables, women who rated spiritual expression as more important had greater numbers of circulating white blood cells and total lymphocyte counts. Upon examination of relationships with lymphocyte subsets, both helper and cytotoxic T-cell counts were greater among women reporting greater spirituality.