Supporting the scholar role in intensive care nursing.

This study investigates how future informatics applications can support and challenge intensive care nurses (ICU nurses) to grow and learn continuously. To this end a research-and-design tool is introduced which is based on a model of the nursing process that starts from the idea that a nurse fulfills three different roles: the role of practitioner (using information immediately to base actions upon), the role of scholar (using information later on to learn from) and the role of human (coping with stress and dealing with emotions). In this paper the focus is on the scholar role. Twenty-eight intensive care staff members from six different hospitals were asked to recount an imposing experience from the perspective of each role. Regarding the scholar role, the participants mentioned 77 learning strategies they adopt for individual as well as organizational learning. Individual learning concerned reflection on former patient cases, reflection on current patient cases to anticipate a change in the patient's condition and reflection on personal behavior and decisions. Organizational learning concerned reflection on former patient cases. Examples of specific strategies were formal team evaluations focused on procedure and understanding the perspective of team members, being present at autopsies, and giving feedback on the nursing skills of colleagues. Based on these strategies design implications are defined for future nursing informatics applications, which will be presented.

Acquiring basic endoscopy skills by training on the GI Mentor II.

BACKGROUND: Achieving proficiency in flexible endoscopy requires a great amount of practice. Virtual reality (VR) simulators could provide an effective alternative for clinical training. This study aimed to gain insight into the proficiency curve for basic endoscope navigation skills with training on the GI Mentor II. METHODS: For this study, 30 novice endoscopists performed four preset training sessions. In each session, they performed one EndoBubble task and managed multiple VR colonoscopy cases (two in first session and three in subsequent sessions). Virtual reality colonoscopy I-3 was repeatedly performed as the last VR colonoscopy in each session. The assignment for the VR colonoscopies was to visualize the cecum as quickly as possible without causing patient discomfort. Five expert endoscopists also performed the training sessions. Additionally, the performance of the novices was compared with the performance of 20 experienced and 40 expert endoscopists. RESULTS: The novices progressed significantly, particularly in the time required to accomplish the tasks (p < 0.05, Friedman's analysis of variance [ANOVA], p < 0.05, Wilcoxon signed ranks). The experts did not improve significantly, except in the percentage of time the patient was in excessive pain. For all the runs, the performance of the novices differed significantly from that of both the experienced and the expert endoscopists (p < 0.05, Mann-Whitney U). The performance of the novices in the latter runs differed less from those of both the experienced and the expert endoscopists. CONCLUSIONS: The study findings demonstrate that training in both VR colonoscopy and EndoBubble tasks on the GI Mentor II improves the basic endoscope navigation skills of novice endoscopists significantly.

A newly designed ergonomic body support for surgeons.

BACKGROUND: One of the main ergonomic problems during surgical procedures is the surgeon's awkward body posture, often accompanied by repetitive movements of the upper extremities, increased muscle activity, and prolonged static head and back postures. In addition, surgeons perform surgery so concentrated that they tend to neglect their posture. These observations suggest the advantage of supporting the surgeon's body during surgical procedures. This study aimed to design a body support and to test its potential. METHODS: The optimum working condition for a surgeon is a compromise between the spine and arm positions and the level of effort and fatigue experienced performing a procedure. The design vision of the Medisign group has led to the development of an ergonomic body support for surgeons that is suitable for use during both open and minimally invasive procedures. The feasibility of the newly designed ergonomic body support was assessed during seven surgical procedures. Electromyography (EMG) was performed for back and leg muscles using the body support in an experimental setting. RESULTS: Six of seven participating surgeons indicated that the body support was comfortable, safe, and simple to use. The EMG results show that supporting the body is effective in reducing muscle activity. The average reduction using chest support was 44% for the erector spinae muscle, 20% for the semitendinosus muscle, and 74% for the gastrocnemius muscle. The average muscle reduction using semistanding support was 5% for the erector spinae, 12% for the semitendinosus muscle, and for 50% for the gastrocnemius muscle. CONCLUSION: The results of this study imply that supporting the body is an effective way to reduce muscle activity, which over the long term may reduce physical problems and discomfort. Additionally, the product supports the surgeon in his natural posture during both open and minimally invasive procedures and can easily be adapted to the current layout of the operating theater.

Distribution and depletion of flubendazole and its metabolites in edible tissues of guinea fowl.

1. We measured the distribution and depletion of residues of flubendazole and its major metabolites in breast muscle, thigh muscle and liver of guinea fowls during and after oral administration of the veterinary medicine Flubenol 5% at two doses. 2. The guinea fowls were treated orally with normal feed, medicated at doses of 56 and 86 mg per kg feed for 7 successive days. Afterwards, depletion was observed for 8 d. Just before slaughter, body weights were measured. Thigh muscle, breast muscle and liver of three female and three male birds were sampled. The concentrations of the flubendazole-derived residues were determined by a liquid chromatographic-mass spectrometric method. 3. The highest residue concentrations were obtained for the reduced metabolite. With the therapeutic dose, the maximum mean residue concentrations obtained for this compound in thigh muscle, breast muscle and liver were 312, 288 and 1043 microg/kg, respectively. The values for flubendazole, the parent molecule, were 114, 108 and 108 microg/kg, respectively. The residues of the hydrolysed metabolite were negligible in the sampled muscle tissues. After 24 h of depletion, the sum of the residues of parent and metabolites in muscle tissue still exceeded 50 microg/kg. After 8 d of depletion, flubendazole-derived residues at low concentrations could still be measured in both muscle tissues and liver. Generally, the disposition of residues in breast and thigh muscle was comparable. 4. The European Union has not established a maximum residue limit (MRL) for flubendazole in edible tissues of guinea fowl. In contrast, the existing MRLs for other bird species are expressed as the sum of parent flubendazole and its hydrolysed metabolites. An estimated withdrawal period of three days will assure residue safety in the edible tissues of guinea fowl treated with flubendazole at therapeutic dose. After this withdrawal period following treatment of the guinea fowl, the residues were approximately constant, very low and far below the established safe MRL level for other bird species.

Determination of flubendazole and its metabolites in eggs and poultry muscle with liquid chromatography-tandem mass spectrometry.

The optimization of a quantitative and sensitive LC-MS/MS method to determine flubendazole and its hydrolyzed and reduced metabolites in eggs and poultry muscle is described. The benzimidazole components were extracted from the two matrices with ethyl acetate after the sample mixtures had been made alkaline. The HPLC separation was performed on an RP C-18 column with gradient elution, using ammonium acetate and acetonitrile as mobile phase. The analytes were detected after atmospheric pressure electrospray ionization on a tandem quadrupole mass spectrometer in MS/MS mode. The components were measured by the MS/MS transition of the molecular ion to the most abundant daughter ion. The overall extraction recovery values for flubendazole, the hydrolyzed metabolite, and the reduced metabolite in eggs (fortification levels of 200, 400, and 800 microg kg(-1)) and muscle (fortification levels of 25, 50, and 100 microg kg(-1)) were, respectively, 77, 78, and 80% and 92, 95, and 90%. The trueness (fortification levels of 400 and 50 microg kg(-1), respectively, for eggs and muscle), expressed as a percentage of the added values for these analytes, was, respectively, 89, 100, and 86 and 110, 110, and 98%. The proposed MS detection method operating in the MS/MS mode is very selective and very sensitive. The limits of detection for flubendazole and its hydrolyzed and reduced metabolites in egg and muscle were, respectively, 0.19, 0.29, and 1.14 microg kg(-1) and 0.14, 0.75, and 0.31 microg kg(-1). The limits of quantification were, respectively, 1, 1, and 2 microg kg(-1) and 1, 1, and 1 microg kg(-1). The discussed method was applied to a pharmacokinetic study with turkeys. Residue concentrations in breast and thigh muscle of turkeys orally treated with flubendazole were quantified. Medicated feed containing 19.9 and 29.6 mg kg(-1) flubendazole was provided to the turkeys for seven consecutive days. For the trial with the recommended dose of 19.9 mg kg(-1), one day after the end of the treatment, the mean sum of the flubendazole plus hydrolyzed metabolite residue values in thigh and breast muscle declined to below the maximum residue limit (50 microg kg(-1)) and were, respectively, 36.6 and 54.1 microg kg(-1). The corresponding values with the higher dose of 29.6 mg kg(-1) were, respectively, 101.7 and 119.7 microg kg(-1).

Development and validation of a liquid chromatography-electrospray tandem mass spectrometry method for mebendazole and its metabolites hydroxymebendazole and aminomebendazole in sheep liver.

A quantitative liquid chromatography-electrospray tandem mass spectrometry method for the determination of mebendazole and its hydrolysed and reduced metabolites in sheep liver has been developed and validated. The benzimidazole substances were extracted with ethyl acetate after the sample mixture had been made alkaline. The HPLC separation was performed on a reversed-phase C18 column with gradient elution using a mobile phase consisting of water containing 0.1% formic acid and acetonitrile. The analytes were detected after atmospheric pressure electrospray ionization on a tandem quadrupole mass spectrometer in MS-MS mode. The components were measured by the MS-MS transitions of the molecular ion to the two most abundant daughter ions. The detection limits are lower than 1 microg kg(-1). For this application, the validation limit was set at 50 microg kg(-1). The examined validation parameters were in accordance with the permitted tolerances ranges stipulated in the proposed new European validation criteria for residue surveillance. For the three analytes, the overall recovery was higher than 90%. The RSD for the repeatability ranged from 5 to 11%. The range for the within-laboratory reproducibility was between 2 and 17%. The decision limits for mebendazole, the hydrolysed and the reduced metabolite were 56.6, 61.8 and 64.2 microg kg(-1), respectively. The detection capabilities for these substances were 60.0, 86.1 and 90.9 microg kg(-1), respectively.

Validation of HPLC method of analysis of tetracycline residues in eggs and broiler meat and its application to a feeding trial.

HPLC with ion-pairing chromatography and diodearray detection at 355 nm was used to determine tetracycline antibiotics in eggs and broiler meat. The analytical methods were optimized and validated. The mean recovery values for oxytetracycline for eggs and for tetracycline for breast meat were 76%. The within-day precision ranged from 8.0 to 11.8% for oxytetracycline in eggs and from 6.1 to 15.5% for tetracycline in breast meat. The between-day precision was 4.8% and 5.0% respectively for oxytetracycline in eggs and tetracycline in breast meat. The limit of detection and the limit of quantitation for oxytetracycline in eggs were 2.2 and 13.0 ng/g respectively. These limits for tetracycline in breast meat were 10.5 and 20.9 ng/g respectively. Residue values of tetracycline antibiotics in eggs and broiler meat were determined after oral administration of medicated feed. Medicated feed with 840 mg/kg oxytetracycline was provided to laying hens for seven successive days. Two days after the administration was stopped, the mean oxytetracycline residue value in the eggs was already lower than the Maximum Residue Limit (MRL)-level and reached 118 ng/g. Broilers were supplied with medicated feed containing 480 mg/kg tetracycline for seven successive days. Four days after the administration was stopped, the mean tetracycline residue value in breast meat decreased below the MRL and was 86 ng/g.

Dynamic contrast perception assessed by pattern masking.

The perceived contrast of a pulsed grating varies markedly with the exposure duration and spatial frequency of the grating. We studied dynamic changes in perceived grating contrast with a pattern-masking paradigm. We measured masking of a brief, localized test pattern (a D6 stimulus, 30 ms in duration) by fixed-contrast cosine grating patterns of varying duration (50-500 ms). The cosine mask pattern had spatial frequency of either 1 or 6 cycles per degree (cpd) at a contrast of 0.3. The D6 test pattern was centered on a light bar of the mask and was either positive peak contrast (same-polarity test and mask) or negative peak contrast (opposite-polarity test and mask). In Experiment 1, the test and mask had simultaneous onset. With a 6-cpd mask, the same-polarity test-threshold elevation versus mask-duration function increases monotonically. For a 1-cpd mask, the same-polarity threshold-mask-duration function is nonmonotonic, with peak masking effect produced by a grating pulse of 80-100 ms. These masking effects are closely congruent with known dynamic contrast effects. With negative tests, masking-duration functions are elevated from same-polarity functions and are essentially similar in shape for 1- and 6-cpd masks. The elevated thresholds suggest inhibitory interaction between ON and OFF pathways, with a similar time course across spatial frequency. In Experiment 2, the D6 test was delayed from mask onset by 33 ms. Positive contrasts only were employed. For 1-cpd stimuli, the delay of test greatly reduced masking at all mask durations and eliminated the nonmonotonic function. This suggests that for low-spatial-frequency patterns, perceived contrast is determined by an early peak component of the neural response. But for 6-cpd stimuli, masking of the delayed test was somewhat greater at all mask durations, consistent with a gradually increasing underlying neural response to the grating. Finally, in Experiment 3, same-polarity masking effects at both spatial frequencies were replicated with negative-contrast test and mask (OFF pathway mediation). This indicates that the ON and OFF pathways have similar response dynamics.

Continuous assessment of perceptual image quality.

The study addresses whether subjects are able to assess the perceived quality of an image sequence continuously. To this end, a new method for assessing time-varying perceptual image quality is presented by which subjects continuously indicate the perceived strength of image quality by moving a slider along a graphical scale. The slider's position on this scale is sampled every second. In this way, temporal variations in quality can be monitored quantitatively, and a means is provided by which differences between, for example, alternative transmission systems can be analyzed in an informative way. The usability of this method is illustrated by an experiment in which, for a period of 815 s, subjects assessed the quality of still pictures comprising time-varying degrees of sharpness.

Identification of Brucella spp. by using the polymerase chain reaction.

The application of two synthetic oligonucleotides as probes and as primers in the polymerase chain reaction is presented for a specific, sensitive, and quick identification of Brucella spp. The specific oligonucleotide sequences were chosen on the basis of a 16S rRNA sequence alignment between Brucella abortus and Agrobacterium tumefaciens.

[Eugen Bleuler (1857-1939) and psychoanalysis]. / Eugen Bleuler (1857-1939) und die Psychoanalyse.

The relationship of Eugen Bleuler with psychoanalysis can be characterized as a history of overture and distance. In previous literature this relationship has been mainly studied from a historical and biographical point of view. In this article the authors review the history of Bleuler's attitude toward psychoanalysis from an ideengeschichtlich point of view. They distinguish and argue three periods. 1896-1906: the initial period was one of overt appreciation and positive rapprochement; 1906-1911: Bleulers initial positive attitude is more and more thwarted by fundamental theoretical disagreement and by his opposition against Freud's group building strategy; from 1912 on, Bleuler clearly dissociates himself from psychoanalytic theory and movement. An interpretation of this evolution is given in terms of personal and above all of theoretical incompatibility.