Factors behind why nursing students do not recognize patient needs occurring while confirming intravenous infusion even when they observe them: A comparative descriptive design study.

BACKGROUND: Novice nurses are often unable to watch their surroundings closely when concentrating on their work or recognize them even when observing them closely. However, factors behind this have not been previously explored. OBJECTIVES: The purpose of this study was to clarify why nursing students did not recognize the patient's needs while checking an infusion. DESIGN: A comparative, descriptive design study. SETTINGS: The mock hospital room was set up in a training room of the School of Nursing, University A using partitions. The participants checked an infusion under experimental conditions, and we confirmed whether they recognized the patient's needs, which were signs of discomfort such as "uncomfortable posture," "disheveled pajamas," and "creased sheets." PARTICIPANTS: A total of 43 students participated, including second- and third-year students of the School of Nursing, University A. METHODS: The subjects confirmed in an interview whether they had recognized the needs. Their observational behaviors toward the patient and surroundings were measured with an eye mark recorder. Working memory capacity and mental load were measured with Japanese versions of Reading Span Test (RST) and NASA Task Load Index (NASA-TLX). RESULTS: Seventeen students recognized the patient's needs. Twelve (70.6%) recognized them when entering the room, with no significant differences in their watching behaviors between the Cognitive and Non-cognitive Groups. RST results were significantly high in Non-cognitive Group (P < .02), and only temporal demand among the sub-items of NASA-TLX presented high. CONCLUSIONS: The nursing students who did not recognize the patient's needs while checking an infusion were watching the patient in the same way as the students who did recognize the patient's needs. We presumed that the factors for being unable to recognize were an over-focus on checking on infusion and time pressure.

KAGUYA observation of global emissions of indigenous carbon ions from the Moon.

Carbon is a volatile element that has a considerable influence on the formation and evolution of planetary bodies, although it was previously believed to be depleted in the Moon. We present observations by the lunar orbiter KAGUYA of carbon ions emitted from the Moon. These emissions were distributed over almost the total lunar surface, but amounts were differed with respect to lunar geographical areas. The estimated emission fluxes to space were ~5.0 × 104 per square centimeter per second, which is greater than possible ongoing supplies from the solar wind and micrometeoroids. Our estimates demonstrate that indigenous carbon exists over the entire Moon, supporting the hypothesis of a carbon-containing Moon, where the carbon was embedded at its formation and/or was transported billions of years ago.

Emergence and Characterization of Acute Coronary Syndrome in Adults After Confirmed or Missed History of Kawasaki Disease in Japan: A Japanese Nationwide Survey.

Background: Acute coronary syndrome (ACS), which is emerging in adults long after confirmed (followed-up or lost-to-follow), or missed Kawasaki disease (KD), is poorly characterized. Methods and Results: A Japanese retrospective nationwide hospital-based questionnaire survey of ACS during 2000-09 was conducted to characterize such patients. Among a total of 67 patients (median age 35, male 76%) recruited, low conventional coronary risks (≤1/6) was noted in 75%, a diagnosis of ST-elevation and myocardial infarction or cardiac arrest in 66%, medication before ACS in 22% (warfarin in 4%), and no prior history of acute myocardial infarction in 94%. One-month mortality was 19%. KD diagnosis was made in 32 during acute illness (Group A), in which 17 were lost to follow, and retrospectively in the other 35 from coronary imaging at ACS (Group B). Group A developed ACS at lower coronary risks (≤2/5 in 87 vs. 65% in group B, p = 0.043) at a younger age (26.5 vs. 40 yo, p < 0.001). In group A, followed-up patients developed ACS under medication before ACS (87 vs. 0% in lost-to-follow patients, p < 0.001) for giant aneurysm in culprit lesions (69 vs. 29%, p = 0.030). One-month mortality was comparable between groups A and B, and between patients followed-up and lost-to-follow in group A. The culprit lesion in group A was characterized by the association of an aneurysm ≥6 mm in acute KD (100%), lack of significant stenosis (61%) or giant aneurysm (50%) in the long-term (median interval 16 y), and the presence of intravascular ultrasound-derived calcification at ACS (86%). Conclusions: The present retrospective nationwide questionnaire survey demonstrated nationwide emergence of initial ACS in young adults at low coronary risks, who are followed-up or lost-to-follow after confirmed KD and initial coronary aneurysms ≥6 mm.

Detection of Pediatric Pulmonary Arterial Hypertension by School Electrocardiography Mass Screening.

Rationale: To detect pulmonary arterial hypertension (PAH) at any early stage is a promising approach to optimize the outcome. Objectives: To investigate the impact of school ECG-based screening on detecting idiopathic or heritable (I/H)-PAH in the general pediatric population. Methods: This was a nationwide survey of patients with I/H-PAH newly diagnosed at 3 months to 18 years of age in Japan during 2005-2012. Measurements and Main Results: Eighty-seven eligible patients (age range, 1-16 yr) were recruited. Among 68 (78%) patients diagnosed at greater than or equal to 6 years of age (the age of the first ECG-based screening), 28 (41%) were detected by the ECG-based screening (screening group) and 40 (59%) were recognized by their symptoms (n = 37) or coincidental occasions (n = 3; nonscreening group). In the screening group, the proportion of patients in World Health Organization functional class I/II at diagnosis was higher (96% vs. 60%; P < 0.001), plasma brain natriuretic peptide level was lower (149 ± 290 vs. 398 ± 559 pg/ml; P = 0.045), and 6-minute-walk distance was longer (420 ± 109 vs. 327 ± 104 m; P < 0.001) than the nonscreening group, despite similar values in mean pulmonary artery pressure (58 ± 17 vs. 61 ± 17 mm Hg; P = 0.42) and pulmonary vascular resistance index (18 ± 8 vs. 21 ± 11 Wood units ⋅ m2; P = 0.24) between groups. The proportion of patients on intravenous epoprostenol at the final visit was lower in the screening group than the nonscreening group (14% vs. 50; P = 0.004). Conclusions: These findings suggest that the ECG-based screening detects a unique subpopulation of pediatric patients with I/H-PAH that is associated with already established pulmonary hypertension but without obvious right heart failure and warrants investigating the prognostic significance of this system.

[Association of lung volume with shunt size in Starnes' procedure in neonates with severe Ebstein's anomaly].

Our modification of Starnes' procedure reduces right ventricular volume using only "suture plication" to improve surgical outcomes. However, shunt size in the procedure varies widely between patients. As this may be related to small lung volume, we estimated lung volume in each patient using computed tomography (CT).Since 2007, we have performed Starnes' procedure in 4 patients. Preoperative cardiothoracic ratio was 89±4.5%. Age and body weight at operation were 4.3±2.6 days and 2.6±0.2 kg, respectively. Anatomic slices 3 mm thick were acquired in transverse planes by CT. Total lung volume was calculated by accumulating those slices. Total lung volume and lung volume/body weight were 97.2±34.1 ml, 36.8±11.5 ml/kg, respectively. In one patient, a 3 mm prosthetic graft was needed to place a clip to regulate blood flow. Another patient required an additional shunt. The patient with the smallest lung volume required treatment with an extracorporeal lung-assistance device. Chest X-rays of neonates with severe Ebstein's anomaly usually show a "wall-to-wall" heart. However, lung volume varies widely between patients. Estimation of lung volume using CT is useful. In patients with smaller lung volume, a larger shunt than usual may be required to obtain the necessary pulmonary blood flow.

Rapid changes in the electrical state of the 1999 Izmit earthquake rupture zone.

Crustal fluids exist near fault zones, but their relation to the processes that generate earthquakes, including slow-slip events, is unclear. Fault-zone fluids are characterized by low electrical resistivity. Here we investigate the time-dependent crustal resistivity in the rupture area of the 1999 Mw 7.6 Izmit earthquake using electromagnetic data acquired at four sites before and after the earthquake. Most estimates of apparent resistivity in the frequency range of 0.05 to 2.0 Hz show abrupt co-seismic decreases on the order of tens of per cent. Data acquired at two sites 1 month after the Izmit earthquake indicate that the resistivity had already returned to pre-seismic levels. We interpret such changes as the pressure-induced transition between isolated and interconnected fluids. Some data show pre-seismic changes and this suggests that the transition is associated with foreshocks and slow-slip events before large earthquakes.

Clinical features of adult patients with Eisenmenger's syndrome in Japan and Korea.

BACKGROUND: There are few articles on mortality and morbidity of adult patients with Eisenmenger's syndrome (ES) in the current era when disease targeting therapy (DTT) has been available. METHODS AND RESULTS: 198 patients (a median age 35 years, 64% female) with ES who visited the 16 participating institutes in Japan and Korea from 1998 to 2009 were enrolled. Clinical data during adulthood were collected from each institutional chart and analyzed centrally. During a median follow-up of 8 years, 30 patients died including 14 sudden deaths. 89 patients took oral medication of DTT and clinical improvement was observed in 54 of them. However, survival rate in patients taking DTT was not different from those without (87% vs 84%, p=0.55). When the clinical data in between first and last clinic visits were compared in 85 patients, the patients with NYHA >/=III increased from 24% to 48% (p<0.001), SpO2 decreased from 89% to 85% (p=0.008) and hematocrit increased from 51.4% to 52.9% (p=0.04). Non-survivors had poorer NYHA function class, lower body weight (BW), lower body mass index (BMI), and higher serum level of Cr at the first visits than survivors. CONCLUSIONS: Long term survival and clinical status of adult patients with ES remains unsatisfactory even in the current era of DTT. Poor NYHA functional class, low BW, low BMI and high serum level of Cr were related to mortality. DTT therapy improved clinical status in many patients with Eisenmenger's syndrome, but no significant impact on survival could be shown.

Germline gain-of-function mutations in RAF1 cause Noonan syndrome.

Noonan syndrome is characterized by short stature, facial dysmorphia and a wide spectrum of congenital heart defects. Mutations of PTPN11, KRAS and SOS1 in the RAS-MAPK pathway cause approximately 60% of cases of Noonan syndrome. However, the gene(s) responsible for the remainder are unknown. We have identified five different mutations in RAF1 in ten individuals with Noonan syndrome; those with any of four mutations causing changes in the CR2 domain of RAF1 had hypertrophic cardiomyopathy (HCM), whereas affected individuals with mutations leading to changes in the CR3 domain did not. Cells transfected with constructs containing Noonan syndrome-associated RAF1 mutations showed increased in vitro kinase and ERK activation, and zebrafish embryos with morpholino knockdown of raf1 demonstrated the need for raf1 for the development of normal myocardial structure and function. Thus, our findings implicate RAF1 gain-of-function mutations as a causative agent of a human developmental disorder, representing a new genetic mechanism for the activation of the MAPK pathway.

Two-stage procedure for pulmonary vascular obstructive disease in Down syndrome with congenital heart disease.

BACKGROUND: Down syndrome patients are characterized by early progression of pulmonary vascular obstructive disease because of insufficient thickness of the pulmonary arterial media. For those with congenital heart disease (CHD) associated with pulmonary hypertension (PH), a 2-stage procedure of pulmonary artery banding (PAB) and then intracardiac repair (ICR) in early infancy is performed to prevent such pulmonary vascular diseases in early infancy. METHODS AND RESULTS: The subjects were 16 patients with Down syndrome who underwent lung biopsy during PAB and ICR. PAB was planned to be performed in early infancy and ICR approximately 1 year later. Efficacy of the 2-stage procedure was retrospectively examined with reference to pulmonary vascular disease and pulmonary diseases. The index of pulmonary vascular disease at PAB fulfilled the indication for ICR, and it was significantly lower at ICR than at PAB (p=0.0469); furthermore, PAB prevented progression of pulmonary diseases. CONCLUSIONS: The results of the lung biopsies support the safety of the 2-stage procedure and show that it is effective for Down syndrome patients with CHD and PH.

Simulations of a quasi-Taylor state geomagnetic field including polarity reversals on the Earth Simulator.

High-resolution, low-viscosity geodynamo simulations have been carried out on the Earth Simulator, one of the fastest supercomputers, in a dynamic regime similar to that of Earth's core, that is, in a quasi-Taylor state. Our dynamo models exhibit features of the geodynamo not only in spatial and temporal characteristics but also in dynamics. Polarity reversals occurred when magnetic flux patches at high latitudes moved poleward and disappeared; patches with reversed field at low and mid-latitudes then moved poleward.