Safety and Outcome of Intracranial Pressure Monitor Placement Performed by Trauma Critical Care Surgeons.

INTRODUCTION: The Brain Trauma Foundation advises intracranial pressure monitor placement (ICPM) following traumatic brain injury (TBI) with a Glasgow Coma Scale (GCS) score ≤8 and an abnormal head computed tomographic scan (CT) finding. Prior studies demonstrated that ICPMs could be placed by non-neurosurgeons. We hypothesized that ICPM placement by trauma critical care surgeons (TCCS) would increase appropriate utilization (AU), decrease time to placement (TTP), and have equivalent complications to those placed by neurosurgeons. METHODS: We retrospectively reviewed medical records of adult trauma patients admitted with a TBI in a historical control group (HCG) and practice change group (PCG). Demographics, Injury Severity Score (ISS), outcomes, ICPM placement by provider type, and time to placement were identified. Complications and appropriate utilization were recorded. RESULTS: 70 patients in the HCG and 84 patients in the PCG met criteria for inclusion. Demographics, arrival GCS, ICU GCS, ISS, and admission APACHE II scores were not statistically significant. AU was 7/70 for HCG vs 19/84 in the PCG (P = .04036). Median TTP was 6.5 hours for HCG vs 5.25 for PCG (P = .9308). Interquartile range showed the data clustered around an earlier placement time, 2.3-14.0 hours, in the PCG. Complications between the 2 groups were not statistically significant, 0/7 for HCG vs 5/19 for PCG (P = .2782). DISCUSSION: This study confirms that ICPMs can be safely placed by TCCS. Our results demonstrate that placement of ICPMs by TCCS improves AU and possibly improves TTP.

Sperm membrane dynamics assessed by changes in lectin fluorescence before and after capacitation.

Sperm capacitation is correlated with acquisition of fertilizing ability, and the molecular events underlying this process are only beginning to be understood. A number of membrane changes associated with capacitation have been documented. In this study we used lectin probes to identify changes in glycoprotein localization as a result of capacitation of mouse sperm. Eight lectins (LEA, PSA, PNA, AAA, UEA-1, WGA, STA, and TPA) stained regions of the mouse sperm head, tail, or both. No changes in tail staining patterns were detected when sperm were incubated under capacitating conditions. In contrast, 7 of 8 lectins tested showed clear shifts in staining patterns in the sperm head as a result of incubation under capacitating conditions. When staining patterns were quantified, a distinct heterogeneity within the sperm population was observed. Each lectin displayed 3 distinct staining patterns in both uncapacitated and capacitated sperm samples. The least common pattern represented the acrosome-reacted (AR) pattern, as independently assessed by lectin staining of ionophoretreated sperm that were >95% AR as judged by Coomassie staining. However, a reciprocal shift in the two predominant staining patterns was correlated with capacitation and suggests that changes in distribution of cell surface proteins during capacitation constitute part of the molecular changes which result in changes in sperm function acquired during this process.

Allied health deans' and program directors' perspectives of specialized accreditation effectiveness and reform.

Criticisms, calls for change, and recommendations for specialized accreditation improvement have been made by individuals or groups external to the daily operations of allied health educational programs, frequently as opinion pieces or articles lacking a research foundation. While there is a great deal of concern related to specialized accreditation, little input has been provided from those within, and integral to, allied health educational programs affected by specialized accreditation standards. The purpose of this study was to explore the perspectives of selected allied health deans and program directors regarding specialized accreditation effectiveness and reform. Survey research was used to study perspectives of allied health deans and program directors located in four-year colleges and universities and in academic health centers and medical schools. Surveys were mailed to program directors offering-programs in clinical laboratory sciences and medical technology, nuclear medicine technology, occupational therapy, physical therapy, radiation therapy, and radiography. Simultaneously, allied health deans located within these institutions were surveyed. A total of 773 surveys were mailed and 424 valid responses were received, yielding a response rate of 55%. The results affirmed the role of accreditation as an effective system for assuring quality in higher education. The role of specialized accreditation in improving the quality of allied health programs was clearly articulated by the respondents. Respondents voiced strong opposition to governmental or state-level requirements for accountability and emphasized the vital role of peer evaluators. Significant differences in deans' and program directors' perspectives related to specialized accreditation were evident. Whereas deans and program directors agreed with the purposes of specialized accreditation, they expressed less support for the process and effectiveness, and critique and reform, of specialized accreditation. Within those categories, deans were in greater support of critique and reform efforts related to specialized accreditation, while program directors were more supportive of the purpose, process, and effectiveness of specialized accreditation.

Sonication of mouse sperm membranes reveals distinct protein domains.

Molecular interactions between sperm and zona pellucida (ZP) during mammalian fertilization are not well characterized. To begin to characterize sperm components that are involved in sperm-ZP interactions, we isolated and density fractionated sperm membranes. The membrane fractions recovered from a density fractionation protocol were characterized, and sonication was compared with vortexing for preparation of sperm membranes by examining the distribution of proteins in the membrane fractions obtained from these 2 protocols. Biochemical and microscopic analyses were used to determine the composition of the sonicated membrane fractions, and immunoblotting was used to identify fractions containing some of the previously suggested ZP3 receptors. Transmission electron microscopy revealed that bands 1-3 contained membrane vesicles and band 4 contained axonemal and midpiece fragments. SDS-PAGE revealed that bands 1 and 2 shared many proteins, but band 3 contained a number of unique proteins. Surface labeling with 125I demonstrated that bands 1 and 2 contained the majority of the sperm surface protein markers, whereas band 3 contained minor amounts of surface markers. Lectin-binding characteristics of sperm membrane glycoproteins were used to compare the relative distribution of glycosylated proteins in vortexed or sonicated membrane preparations. These characterizations indicate that sonication enhanced the differential distribution of sperm membrane proteins among the density fractions and suggests that this method is preferable for preparation of membrane fractions to be used for identification of proteins that mediate sperm-egg interactions.