Breakthrough in purification of fossil pollen for dating of sediments by a new large-particle on-chip sorter.

Particle sorting is a fundamental method in various fields of medical and biological research. However, existing sorting applications are not capable for high-throughput sorting of large-size (>100 micrometers) particles. Here, we present a novel on-chip sorting method using traveling vortices generated by on-demand microjet flows, which locally exceed laminar flow condition, allowing for high-throughput sorting (5 kilohertz) with a record-wide sorting area of 520 micrometers. Using an activation system based on fluorescence detection, the method successfully sorted 160-micrometer microbeads and purified fossil pollen (maximum dimension around 170 micrometers) from lake sediments. Radiocarbon dates of sorting-derived fossil pollen concentrates proved accurate, demonstrating the method's ability to enhance building chronologies for paleoenvironmental records from sedimentary archives. The method is capable to cover urgent needs for high-throughput large-particle sorting in genomics, metabolomics, and regenerative medicine and opens up new opportunities for the use of pollen and other microfossils in geochronology, paleoecology, and paleoclimatology.

Prevalence of diabetic foot syndrome and its risk factors in the UK.

OBJECTIVE: To determine the prevalence of diabetic foot syndrome (DFS) and its risk factors (diabetic neuropathy, peripheral vascular disease, open wounds and mycoses of the feet) at GP practices in the UK in 2008. METHOD: We searched the IMS Disease Analyzer database, which stores representative information on approximately 4.2 million patients. All documented diagnoses of diabetes mellitus in 2008, based on either ICD-10 (international classification of diseases) codes or free text comments from doctors, were analysed. RESULTS: Data from 34,198 patients with type 2 diabetes (47.1% female, mean age 66.1 years [SD 15.1], mean diabetes duration 7.4 years [SD 5.1]) and 2,576 patients with type 1 diabetes (43.2% female, mean age 39.2 years [SD: 18.0], diabetes duration 11.0 years [SD: 6.1]) were analysed. DFS was registered in 7.6% (95% CI: 6.6-8.6) of patients with type 1 diabetes and 8.5% (95% CI: 8.2-8.8) with type 2 diabetes. Many more patients were at high risk of developing DFS, with diabetic neuropathy, diabetic angiopathy, foot mycoses and/or open wounds of the feet. CONCLUSION: Results from this analysis of one of the large representative databases show that even though the prevalence of DFS among patients with diabetes mellitus is relatively low, the prevalence of its main risk factors is high. Preventive efforts should target these risk factors.

Characteristics of diabetic patients visiting a podiatry practice in Germany.

OBJECTIVE: To describe the foot characteristics of diabetic patients attending a podiatry practice for their first consultation. The objective was to determine how effectively diabetic foot ulcers are being prevented in primary care. METHOD: All diabetic patients who presented at a podiatry practice between 2006 and 2008 for their first consultation were analysed. Anonymous data were obtained from the standard patient anamnesis sheet completed by the podiatrist. These included results of patient interviews and examinations. RESULTS: A total of 230 diabetic patients (93.9% had type 2 diabetes mellitus and 6.1% had type 1) were analysed. The mean age was 67.7 years (+/- 10.8). Just under half (47.4%) were female. The mean duration of diabetes was 12.6 years (+/- 10.5) years. 70.4% of the patients had diabetic neuropathy (confidence intervals: 64.5-76.3), of whom 73.2% already had resting foot pain or strain foot pain while walking. 58.3% of the patients had toenail mycosis, and of these 38.1% had the infection in all 10 toenails. Most of the patients had at least one foot deformities (89.6% splayfoot and 37.0% flatfoot). 40.2% had no sensation to microfilament testing on either their right or left foot toes. The overall mean vibration sensation test threshold was 3.7 (+/- 2.3). CONCLUSION: While there is a structure and strategy for the primary and secondary prevention of the diabetic foot ulcers, its delivery is often ineffective. This audit shows that, in Germany, the detection and prevention of diabetic foot problems in podiatric practices happens far too late.

Contemporary management of aortic branch compromise resulting from acute aortic dissection.

PURPOSE: In an earlier report, we documented the incidence and impact of aortic branch compromise complicating acute aortic dissection (AD) over a 21-year interval (1965-1986). In the current study, management of peripheral vascular complications (PVCs) of AD over the past decade was reviewed. METHODS: Medical records of patients treated for AD over the interval January 1, 1990, to December 31, 1999, were reviewed. Patients with branch compromise confirmed with radiography or operation and patients with spinal cord ischemia that was based on results of a physical examination defined the study group. Comparisons between subgroups with and without PVC over a 30-year interval were analyzed with the chi(2) test. RESULTS: A total of 187 patients (101 proximal and 86 distal) were treated for AD over the study interval. A total of 53 (28%) of these patients had clinical evidence of organ or limb malperfusion (7 cerebral, 3 upper extremity, 5 spinal cord, 11 mesenteric, 12 renal, and 24 lower extremity [sites inclusive]), and one of three (17 patients) of these underwent specific peripheral vascular intervention. The remaining 65% (36) of the PVC group had complete or partial malperfusion resolution after central aortic therapy (medical or surgical) alone. Open techniques for treating PVC included aortic fenestration (9), femorofemoral grafting (2), and aortofemoral grafting (1). All had favorable outcomes with no mortality. Endovascular procedures in five patients included abdominal aortic fenestration (3) or stenting of the renal (2), mesenteric (2), and iliac (1) arteries with clinical success in three patients and two deaths. The in-hospital mortality rate for the entire group of 187 patients was 18% (15% for proximal aortic operation, 8% in medically treated patients). The presence of aortic branch compromise was not a statistically significant predictor of the patient mortality rate (23% with and 16% without; P =.26). Overall mortality rate in the current study (18% vs 37%; P =.000006) and the mortality rate with PVC (23% vs 51%; P =.001), in particular with mesenteric ischemia (36% vs 87%; P =.026), decreased significantly when compared with prior experience. CONCLUSIONS: The overall mortality rate from AD during the past decade has decreased significantly. Similar trends were noted in patients with PVCs, a previously identified high-risk subgroup. Increased awareness and prompt, specific management of PVCs, in particular when visceral ischemia is present, have contributed to improved outcomes in patients with AD.

Use of pain assessment tools: is there a preference?

The burn nursing Delphi study identified pain management as the most important area of burn nursing research. The question, "What is the best method to measure the pain of the patient with burns?" ranked in the top 10% of the nursing research priorities and is the research question of this study. The most commonly used pain assessment tools were determined in a 1994 survey of burn centers. Of those that responded, 67% used the Visual Analog Scale and 43% used an adjective scale. Forty patients were enrolled in this prospective, multicenter study. Visual analog and color scales were used during a 3-day cycle and word and faces scales were used during another 3-day cycle. Pain levels were assessed twice each day, once during a quiet time and then again immediately after a painful activity. At the end of each 3-day cycle the patient was asked which tool he or she preferred. At the completion of the study period the patient was asked to select the overall most preferred tool for pain assessment. Although this study indicates that patients prefer the faces and color scales to the most commonly used visual analog and adjective scales, further research is needed to determine the potential impact of preferred tools on pain intervention. The results may also lead burn centers to re-evaluate current selection of pain assessment tools.

A program evaluation approach to drug administration education.

To evaluate the education of undergraduate nursing students in drug administration, the faculty of La Salle University School of Nursing structured a program evaluation plan using a curriculum map. Faculty track the cognitive, affective, and psychomotor skills involved in drug administration. For example, all clinical nursing courses and the pharmacology course contain dosage and intravenous solution calculations in didactic material and tests. Program evaluation of the outcomes of medication administration education is continuous throughout the curriculum.

Oxygen consumption of calvarial bone cells in vitro.

Tissues with tortuous and narrow diffusion pathways and cells that are remote from blood vessels nonetheless can show high metabolic activity of which the underlying bases (transport mechanisms) are not fully understood. In one such bone tissue, the O2 consumption was measured by analyzing the decrease in the partial pressure of oxygen (Po2) in a closed chamber containing calvarial fragments from adult guinea pigs (250-400 g) or from neonatal rats and guinea pigs. The O2 consumption of fragments from adult guinea pigs amounted to 0.05, 0.066, and 0.095 ml/100 g* minute at 24, 27, and 36.5 degrees C, respectively. When the temperature exceeded 43 degrees C, O2 consumption irreversibly stopped. Both antimycin A and rotenone, which block the respiratory chain, reduced O2 consumption to approximately 20% of control values. O2 consumption was significantly higher in neonatal animals (0.369 ml/100 g* minute at 27 degrees C) and could be blocked completely by antimycin A. On the basis of the high consumption of O2 by bone cells, we hypothesize that specialized transport systems, i.e., gap junctions, are required to provide a sufficient supply of nutrients to cells in osseous tissue.

Caring for self: becoming a self-reflective nurse.

Grounded in teaching experiences with nursing students, Dewey's educational philosophy, principles of adult learning, and phenomenologic perspectives, the article presents a model of self-reflection discovered in the educational/learning process of caring for self. Self-reflection as a process is operationalized as a bending back of attention and a focus on self to uncover silence and meanings or essences of personal and professional experience. Critical outcomes of this process are increased awareness, increased depth and breadth of understanding, and expanded consciousness. The thesis that self-reflection is a critical process in caring for others is presented. The background for the work and the nursing course where students develop a clinical experience of caring for self are discussed. The article includes graphic representations of the reflective process and proposes that, through caring for self, transformation in caring experiences is possible.

High yield fermentation and purification of Tendamistat disulphide analogues secreted by Streptomyces lividans.

In our studies of structure-function correlation of polypeptides we used Tendamistat (TM), an alpha-amylase-inhibitor of Streptomyces tendae, as a model to investigate the influence of different mutants on the expression and secretion of the protein. In addition, we examined the influence of replacing the two disulphide-bridges that stabilize the two-loop structure of the whole protein. The single mutants C27S, C27T, C45A, the double mutants C11A/C27A, C11A/C27S, C11A/C27T, C11A/C27L, C45/C73A and the fourfold mutant C11A/C27A/C45A/C73A were prepared. The mutated TM gene was expressed in S. lividans TK 24, which secretes the active form of the inhibitor into the culture medium. Compared with the wild-type, the double-mutated TM derivatives show an increase in secreted protein by a factor of two to ten. In contrast, the single-mutated inhibitor analogues show the reverse effect. In order to examine the influence of temperature and culture media on the production of protein derivative we used the most unstable C11A analogue. Our expression studies at 10, 19, 28 and 37 degrees C established 19 degrees C as the optimal temperature for production of the protein derivatives. The correlation between the stability and secretion of TM is discussed in the context of our knowledge of protein translocation in bacteria. Based on these experiments we optimized the fermentation parameters, isolated TM analogous on a large scale, and verified them.

Infrared spectroscopic studies on the phosphatidylserine bilayer interacting with calcium ion: effect of cholesterol.

Fourier transform infrared (IR) spectroscopic studies of phosphatidylserine/cholesterol/Ca2+ complexes are reported using the synthetic phosphatidylserines (PS) 1,2-dioleoyl-sn-glycero-3-phospho-L-serine (DOPS), 1-palmitoyl-2-oleoyl-sn-glycero-3-phospho-L-serine (POPS), and 1,2-dimyristoyl-sn-glycero-3-phospho-L-serine (DMPS). IR spectra reveal that cholesterol does not significantly alter the binding nature of Ca2+ to PS molecules; Ca2+ binds to the phosphate ester group of PS in the presence of cholesterol up to 50 mol% as in the case of pure PS bilayers. However, the IR data indicate that the presence of cholesterol induces disorder of the acyl chain packing, increases the degree of immobilization of the interfacial and polar regions, and increases the degree of dehydration of the PS/Ca2+ complexes.

Evaluation of cardiac arrests managed by paramedics.

The effectiveness of cardiac resuscitations by Cincinnati paramedics was monitored for one year. The outcome of every arrest was assigned to one of four categories: dead on arrival, died in the emergency department, died in the hospital or discharged alive, and each patient was followed until death or discharge from a hospital. Of the 147 people in the study group, 22 left the hospital alive, a long-term success rate of 15%, and another 26 died during hospitalization, 18% of the study population. This data is comparable to success rates reported by other prehospital care systems. Furthermore, this data indicates approximately 15% of people who have cardiac arrests outside of a hospital can survive through prompt intervention by trained personnel.