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PubMed2005

Microbial passage in low pressure membrane elements with compromised integrity.

The main objective of this study was to evaluate microbial passage through membrane elements with various levels of compromised integrity while installed within full-scale UF/MF systems. Challenge tests were performed for this purpose with the microbial contaminant surrogates Bacillus subtilis spores at two drinking water treatment plants. The experimental units used were one of several parallel racks part of each plant in which one of the elements was installed with various levels of compromised integrity achieved by precutting several hollow fibers and inserting removable pin-plugs atthe corresponding ends of the broken fiber segments. The UF rack was operated with 38 elements online (the rack has 50 elements) and was designed for an inside-out operation, and the MF rack included 50 elements and was operated in an outside-in mode (with a permeate outlet at one fiber end only). Spore removals observed for both the UF and MF racks with all precut fibers plugged were equal to or greater than 99.9992%, and as expected the removal efficiency deteriorated with an increasing number of unplugged fibers. Predictions made with a model based on the use of the Hagen-Poisseuille equation for laminar flow and the Darcy-Weisbach expression for turbulent flow inside broken fibers were found to provide an adequate conservative representation of experimental results. Additional simulations performed with the verified model revealed the occurrence of a greater microbial passage for an inside-out configuration compared to an outside-in mode. A lower microbial passage was predicted for the outside-in element configuration with one permeate outlet as compared to an element with permeate outlets at both fiber ends. The model offers a useful tool that together with other considerations such as membrane fouling, cleaning, and durability would assist in the selection of low-pressure membrane element configuration.

Bacillus subtilis↗
PubMed2004

Probing the limits of the Derjaguin approximation with scanning force microscopy.

We have measured the interaction force between a silicon nitride scanning force microscopy (SFM) probe and the basal plane of highly oriented pyrolitic graphite as a function of pH and ionic concentration in aqueous solutions. Forces in the range +/- 50 pN were reconstructed from measured signals using dynamical analysis of the cantilever. We modeled the force-separation data using a flat plate electric double-layer interaction and assumed the Derjaguin approximation to adapt the flat plate geometry for the SFM probe shape. Measured forces were well modeled by the theory at high ionic concentrations (10 and 100 mM), where Debye lengths were 3.0 and 0.96 nm, respectively. The theory failed to model forces at a lower ionic concentration (1 mM), where the Debye length was 9.6 nm. To investigate this, we calibrated the SFM probe geometry using blind reconstruction and obtained an apex radius of 7 nm. This value suggested that failure of the theory was due to an invalidation of the Derjaguin approximation at long Debye lengths, where the characteristic length scale for the interaction was larger than the size of the SFM probe. The errors were reduced by replacing the Derjaguin approximation with a surface element integration. The result experimentally demonstrates the limitations of the Derjaguin approximation for predicting interactions of nanoscale colloids.

Graphite↗
PubMed2001

"Transcend": initial outcomes from a posttraumatic stress disorder/substance abuse treatment program.

This paper describes the development of a comprehensive treatment program for combat veterans diagnosed with posttraumatic stress disorder (PTSD) and substance abuse (SA). Outcome data are presented on 46 male patients who completed treatment between 1996 and 1998. The treatment approach, defined by a detailed manual, integrates elements of cognitive-behavioral skills training, constructivist theory approaches, SA relapse prevention strategies, and peer social support into a group-focused program. The Clinician-Administered PTSD Scale (CAPS) and the Addiction Severity Index (ASI) were used to assess treatment effectiveness at discharge and 6- and 12-month follow-up. Significant symptom changes revealed on CAPS and ASI scores at discharge and follow-up are analyzed. Discussion focuses on hypotheses regarding treatment effectiveness, study limitations, and suggestions for further research.

Comorbidity↗
PubMed2002

In a secular spirit: strategies of Clinical Pastoral Education.

The Clinical Pastoral Education (CPE) model for the provision of spiritual care represents the emergence of a secularized professional practice from a religiously-based theological practice of chaplaincy. The transformation of hospital chaplaincy into "spiritual care services" is one means by which religious healthcare ministry negotiates modernity, in the particular forms of the secular realm of biomedicine and the pluralism of the contemporary United States healthcare marketplace. "Spiritual" is a label strategically deployed to extend the realm of relevance to any patient's "belief system:" regardless of his or her religious affiliation. "Theological" language is recast as a tool for conceptualizing the "spiritual lens:' Such moves transform chaplaincy from a peripheral service, applicable only to the few "religious" patients, into an integral element of patient care for all. Such a secularized professional practice is necessary to demonstrate the relevance and utility of spiritual care for all hospital patients in an era of cost-containment priorities and managed care economics.

Chaplaincy Service, Hospital↗
PubMed2003

Statistical and consensus-based strategies for grouping consumers in mental health level-of-care schemes.

Mental health Level-of-Care schemes differ in the emphasis placed on statistically based versus consensus-based strategies for delineating consumer groups. Statistical strategies define groups on the basis of empirical distinctions within the caseload. Consensus strategies group consumers according to an a priori framework of consumer characteristics determined by experts to differentiate the appropriate types and intensities of service. This article compares the performance of two grouping strategies-one statistical and one consensus-on three criteria: programmatic relevance, measurement adequacy, and homogeneity of consumer groups. It explores the advantages of integrating elements of each strategy.

Consensus↗
PubMed1991

The how and why of what went where in apparent motion: modeling solutions to the motion correspondence problem.

A model that is capable of maintaining the identities of individuated elements as they move is described. It solves a particular problem of underdetermination, the motion correspondence problem, by simultaneously applying 3 constraints: the nearest neighbor principle, the relative velocity principle, and the element integrity principle. The model generates the same correspondence solutions as does the human visual system for a variety of displays, and many of its properties are consistent with what is known about the physiological mechanisms underlying human motion perception. The model can also be viewed as a proposal of how the identities of attentional tags are maintained by visual cognition, and thus it can be differentiated from a system that serves merely to detect movement.

Attention↗
PubMed1986

Inhibition of 5-aminoimidazole-4-carboxamide ribotide transformylase, adenosine deaminase and 5'-adenylate deaminase by polyglutamates of methotrexate and oxidized folates and by 5-aminoimidazole-4-carboxamide riboside and ribotide.

With the use of a continuous spectrophotometric assay and initial rates determined by the method of Waley [Biochem. J. (1981) 193, 1009-1012] methotrexate was found to be a non-competitive inhibitor, with Ki(intercept) = 72 microM and Ki(slope) = 41 microM, of 5-aminoimidazole-4-carboxamide ribotide transformylase, whereas a polyglutamate of methotrexate containing three gamma-linked glutamate residues was a competitive inhibitor, with Ki = 3.15 microM. Pentaglutamates of folic acid and 10-formylfolic acid were also competitive inhibitors of the transformylase, with Ki values of 0.088 and 1.37 microM respectively. Unexpectedly, the pentaglutamate of 10-formyldihydrofolic acid was a good substrate for the transformylase, with a Km of 0.51 microM and a relative Vmax. of 0.72, which compared favourably with a Km of 0.23 microM and relative Vmax. of 1.0 for the tetrahydro analogue. An analysis of the progress curve of the transformylase-catalysed reaction with the above dihydro coenzyme revealed that the pentaglutamate of dihydrofolic acid was a competitive product inhibitor, with Ki = 0.14 microM. The continuous spectrophotometric assay for adenosine deaminase based on change in the absorbance at 265 nm was shown to be valid with adenosine concentrations above 100 microM, which contradicts a previous report [Murphy, Baker, Behling & Turner (1982) Anal. Biochem. 122, 328-337] that this assay was invalid above this concentration. With the spectrophotometric assay, 5-aminoimidazole-4-carboxamide riboside was found to be a competitive inhibitor of adenosine deaminase, with (Ki = 362 microM), whereas the ribotide was a competitive inhibitor of 5'-adenylate deaminase, with Ki = 1.01 mM. Methotrexate treatment of susceptible cells results in (1) its conversion into polyglutamates, (2) the accumulation of oxidized folate polyglutamates, and (3) the accumulation of 5-aminoimidazole-4-carboxamide riboside and ribotide. The above metabolic events may be integral elements producing the cytotoxic effect of this drug by (1) producing tighter binding of methotrexate to folate-dependent enzymes, (2) producing inhibitors of folate-dependent enzymes from their tetrahydrofolate coenzymes, and (3) trapping toxic amounts of adenine nucleosides and nucleotides as a result of inhibition of adenosine deaminase and 5'-adenylate deaminase respectively.

AMP Deaminase↗
PubMed1999

Clinical risk management: principles of consent and patient information.

Clinical Risk Management and its integral elements form part of the foundation of 'Clinical Governance'. An important principle within Clinical Risk Management is that of consent and patient information which, in a changing climate of complaint and litigation, means that it is essential that clinicians have a sound understanding of its importance. This paper provides a structured understanding of the background and practice of consent and patient information. With such knowledge clinicians can help patients achieve a better understanding of what they are undertaking, and so reduce the risk of complaint and litigation. This paper discusses the topics of: current indemnification, ethics, law, the information content required for consent, duration of consent, who should take consent, capacity to give consent, mental incapacity, and details of how to perform risk assessment. However, areas applicable to the Mental Health Act have been excluded.

Advance Directives↗
PubMed1999

Physiotherapy for the prevention of articular contraction in haemophilia.

The idea of prevention and preventative care is not new. History and culture have given us many examples of the importance of physical well-being and the prvention of illness and disease. The ancient societies of China focused on the balance of Yin and Yang in promoting health; Greece and Rome valued the importance of health and physical culture; the earliest Hebrew societies documented the importance of diet and dietary restrictions as a means towards good health. Through this century health professionals have advocated the importance of preventive care as an integral element of the quality of health. Haemophilia is a life-long condition with a high potential towards disability, handicap and impairment if not adequately treated. It is therefore essential that those with haemophilia are taught the importance of physical fitness at an early age as a means of preventing articular contractures. Physiotherapy is of great importance in this field, especially in third-world countries where the supply of replacement products are scarce or non-existent.

Adult↗
PubMed1994

Time for clients: temporal aspects of community psychiatric nursing.

Time is an integral element in all actions, organizations and relationships. Temporality has an effect on people's lives, and in turn people manipulate temporality as a means of imposing social order. From a semiotic perspective the amount of time spent on an action and the timing of its conveys messages about such things as importance and status. This holds equally true of organizations as well as individuals. This paper concentrates on a community psychiatric nursing department, its staff and clients. Sections of speech taken from interviews with nurses and clients are presented and discussed from the perspective of temporality to show how relationships are managed on an individual level and how work is organized around different client groups at an organizational level.

Attitude of Health Personnel↗
PubMed1999

Considering the nature of intersubjectivity within professional nursing.

The notion of intersubjectivity raises fundamental epistemological and ontological questions concerning how individuals come to know one another and how that knowing affects action. Within the sphere of professional nursing, relationship, as an intersubjective process between individuals, constitutes an integral element of professional nursing practice. Understanding the notion of relationship in terms of an intersubjective process is frequently laden with difficulty due to the polarization of intersubjectivity within either a traditional scientific position or a human science perspective. Reconciliation of both ways of knowing, however, may allow nurses to bring forward a broader base and scope of information to appreciate the experience of others. This article examines some of the notions of intersubjectivity and proposes an alternative understanding.

Humans↗
PubMed1999

Problem-based learning versus lecture-based learning in a course of basic pharmacology: a controlled, randomized study.

Since its first implementation in a medical programme at McMaster University, Canada, problem-based learning (PBL) has become a well-established means of teaching and learning medicine. Extensive research has been conducted and a number of strengths of the method are well supported. Several items, however, remain unclear although there is evidence that no relevant difference exists in factual knowledge among students from PBL and traditional curricula, a controlled, randomized study has not been conducted to address this issue. The Medical Faculty of the University of Cologne is in the process of integrating elements of PBL into its curriculum. In the spring term of 1997, after seven semesters of experience with PBL supplementing the traditional course of basic pharmacology, we did for the first time use PBL instead of the lecture-based course (LBL) and conducted a controlled prospective study to determine the effects of this intervention. One-hundred and twenty-three students were randomly assigned to either PBL (n = 63), with tutorial groups of up to nine students, or to the traditional, lecture-based course (n = 60). Analysis of the results of both groups in the examination of basic pharmacology, consisting of multiple-choice and short-essay questions, revealed similar scores with a tendency favouring PBL students in the category of short-essay questions. Hence, it seems clear that PBL does not imply a disadvantage in terms of factual knowledge. Students considered PBL to be an effective learning method and favoured it over the lecture format. Furthermore, students reported positive effects of PBL in terms of use of additional learning resources, interdisciplinarity, team work and learning fun.

Education, Medical, Undergraduate↗
PubMed2006

The role of low-molecular-weight heparins as supportive care therapy in cancer-associated thrombosis.

Venous thromboembolism (VTE) is a common complication of malignant disease, affecting approximately 1 in 200 cancer patients. Oncology nurses are instrumental in identifying patients with cancer at high risk of venous thromboembolism. Risk factors include: stage of disease, chemotherapy, the patient's degree of immobility, a history of recent surgery, and the presence of a central venous catheter. The treatment of venous thromboembolism in patients with cancer usually involves a sequential combination of unfractionated heparin or low-molecular-weight heparin (LMWH), followed by oral warfarin or LMWH. LMWHs are an alternative to warfarin for secondary prophylaxis and long-term treatment. LMWH is given by subcutaneous injection, does not require hospitalization for administration or routine laboratory monitoring. Recent clinical trial results have shown that LMWH use is associated with improved survival in cancer patients with relatively good prognoses. Patients receiving any anticoagulant therapy should be monitored for signs of pulmonary embolism or bleeding and intravenous sites (if present) should be monitored for oozing. Appropriate patient selection, a carefully constructed treatment plan, extensive patient education, and regular patient contact are integral elements for the nursing care of patients with cancer-associated thrombosis treated in the outpatient setting.

Anticoagulants↗
PubMed2000

Bending a habit: critical social theory as a framework for humanistic nursing education.

Nursing education is currently experiencing a transition away from a focus on behavioral outcomes and toward a focus which better reflects the humanistic, caring aspects of nursing. Nursing educational content and process must reflect this changing focus of healthcare, which itself is transgressing away from the inherent objectivism of acute care toward the more humanistic elements integral to community building. This paper studies this movement from behaviorism to humanism in nursing education and assumes its foundations in the tenets of critical social theory. The roots of critical social theory are examined, followed by an overview of the changes occurring within nursing education today.

Behaviorism↗
PubMed2001

Role of medical students in microsurgery research.

Microsurgery is an integral element in many surgical specialties, as well as an important technique for surgical research. Student participation in microsurgery research programs can be a source for both high quality training in skills and for research contributions. In this article, the authors review their experience in developing general principles for setting up medical student microsurgery research programs, and analyze the research output and career choices made by the students who have participated.

Adult↗
PubMed2003

Standardization of procedures and structures for risk evaluation in Germany--the work of the Risk Commission.

Risk evaluation in Germany is characterized by the uncoordinated involvement of various governmental and non-governmental institutions, by lacking transparency, by mingling of scientific risk assessment and political risk management, and by unsatisfactory public participation. Within the frame of the German Environmental Health Action Program the Ministers of Health and the Environment established a commission to develop recommendations for the reorganization of procedures and structures for risk evaluation within health-orientated environmental protection in the Federal Republic of Germany. The Risk Commission recently published its first report. It recommends strict separation of risk assessment and risk management; implementation of a clear procedural framework, risk communication as an integrated element of the whole process of risk evaluation and finally the establishment of two permanent co-ordinating institutions.

Communication↗
PubMed1991

Use of electron microprobe x-ray analysis for determination of low calcium concentrations across leaves deficient in calcium.

An electron microprobe with wavelength-dispersive x-ray spectrometry (WDS) was found to be useful for the determination of Ca concentrations in leaf tissue deficient in Ca. WDS effectively detected Ca concentrations as low as 0.2 mg/g dry wt in the presence of high levels of K and Mg (120 and 50 mg/g dry wt, respectively). Leaf specimens were prepared for analysis by quick-freezing in liquid nitrogen and freeze-drying at -20 degrees C to maintain elemental integrity within the tissue. Because dry material was analyzed, sample preparation was simple and samples could be stored for long periods before analysis. A large beam diameter of 50 gm was used to minimize tissue damage under the beam and analyze mineral concentrations within several cells at one time. Beam penetration was between 50 and 55 microns, approximately one-third of the thickness of the leaf. For analysis of concentrations in interveinal areas, analyses directed into the abaxial epidermis were found most useful. However, because of limited beam penetration, analyses of veinal areas would require use of cross sections [correction of crosssections]. Solid mineral standards were used for instrument standardization. To prevent measurement errors resulting from differences between the matrix of the mineral standards and the analyzed tissue, concentrations in leaves were corrected using gelatin standards prepared and analyzed under the same conditions. WDS was found to be useful for documenting that very low Ca levels occur in specific areas of lettuce leaves exhibiting the Ca deficiency injury termed tipburn.

Calcium↗
PubMed2002

How clinicians in neonatal care see the introduction of neonatal nurse practitioners.

UNLABELLED: The aim of this study was to investigate the views of UK clinicians in neonatal care who were working with nurses trained as neonatal nurse practitioners (NNPs). A questionnaire survey was used with a total sample of senior clinicians in the 66 neonatal units with one or more qualified NNPs. The main outcome measures were type and frequency of response, and similar data from NNPs were used to make comparisons. Data were returned from 57 of the 66 clinicians contacted (86%). NNP clinical practice as perceived by them was largely similar to that recorded by NNPs, though the clinicians expected more NNP involvement in some procedures (inserting central venous lines, umbilical arterial catheters, chest drains and peripheral arterial cannulae) than was actually found. Perceptions of the NNP role were similar, though the clinicians were significantly less likely to see taking a case-load, conducting a ward round, accepting outside referrals and taking charge of emergency transfers as integral elements. Reflections on the utilization of NNPs in neonatal care and the impact on junior medical staff education referred to NNPs filling gaps, a reduction in the intensity of work, improvements in training and in the quality of care. CONCLUSION: The introduction of NNPs is seen positively from the perspective of clinicians working alongside them in neonatal care. The development of similar models of care in countries where the introduction of NNPs is being considered is likely to be similarly supported.

Attitude of Health Personnel↗