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Paving the way: stepping stones to evidence-based nursing.

Evidence-based practice is an emerging paradigm in health care. This paper outlines the main features of this paradigm and its potential value to nursing. Evidence-based practice is based on a conceptual framework that examines the extent of evidence available in support of particular clinical practices. The Quality of Evidence Ratings adapted by the National Health and Medical Research Council (NHMRC) from the United States Preventive Services Task Force are discussed, and the strengths and weaknesses of different categories of evidence are highlighted. Potential barriers to implementation of research into practice are identified. The authors suggest that legal, ethical, economic and humane imperatives oblige nursing to develop evidence-based practice as one of several viable contributions to nursing knowledge. Suggestions for analysing current research and for the planning of the direction of future nursing research are made.

Diffusion of Innovation↗

An ESID case study at the federal level.

The D (dissemination) phase of the ESID model has been often overlooked in our efforts to create innovative and widespread social change. The process of replicating successful social innovations is both a prerequisite for dissemination (in order to assess the consistency of effects) and an obvious outcome of a successful dissemination effort. Fidelity, the extent to which a replicated program is implemented in a manner consistent with the original program model, is an important dimension of replication. This study was designed to provide empirical data related to three questions. Can complex social programs be implemented with fidelity? How much fidelity is appropriate or desired? What are the organizational dynamics of adoption with fidelity? Data were collected from grantees of a national replication initiative funded by the Center for Substance Abuse Prevention. Data suggest that high fidelity can be achieved, at least in the context in which programs are mandated to do so as part of the funding agreement and are given technical assistance in achieving fidelity. Secondly, programs perceived high fidelity as having positive effects on the program and its participants, a finding consistent with a limited assessment of the relationship of program outcomes and fidelity. Finally, much was learned about the human and organizational dynamics of replicating with fidelity. Implications for policy and direction regarding replication are discussed.

Diffusion of Innovation↗

A primate model for the study of tonic pain, pain tolerance and diffuse noxious inhibitory controls.

A primate model of cold pressor pain is described in which the animal itself initiates all trials, may terminate painful stimuli at any time, and controls the duration of the experimental session, thus avoiding the inadvertent administration of intolerable pain stimuli. Pain tolerance time varies directly with stimulus intensity and is sensitive to motivational factors. This model will facilitate the study of endogenous pain-modulatory pathways and the assessment of analgesic treatments in animals.

Adaptation, Physiological↗

Deuterium off-resonance rotating frame spin-lattice relaxation of macromolecular bound ligands.

Deuterated 3-trimethylsilylpropionic acid binding to bovine serum albumin was used as a model system to examine the feasibility and limitations of using the deuterium off-resonance rotating frame spin-lattice relaxation experiment for the study of equilibrium ligand-binding behavior to proteins. The results of this study demonstrate that the rotational-diffusion behavior of the bound species can be monitored directly, i.e., the observed correlation time of the ligand in the presence of a protein is approximately equal to the correlation time of the ligand in the bound state, provided that the fraction of bound ligand is at least 0.20. The presence of local ligand motion and/or chemical exchange contributions to relaxation in the bound state was inferred from the observation that the correlation time of the bound ligand was somewhat smaller than the correlation time characterizing the overall tumbling of the protein. An approximate value for the fraction of bound ligand was obtained from off-resonance relaxation experiments when supplemental spin-lattice or transverse relaxation times were employed in the analysis. Incorporation of local motion effects for the bound species into the theoretical relaxation formalism enabled the evaluation of an order parameter and an effective correlation time, which in conjunction with a wobbling in a cone model, provided additional information about ligand motion in the bound state.

Animals↗

Capillary transport of H2 gas generated locally in renal tissue.

Previous measurements by microspheres have shown a higher blood flow in outer cortex and a lower blood flow in inner cortex than found by diffusible tracers. During vasodilation microspheres have indicated a disproportionate increase in deep cortical blood flow, whereas diffusible tracer distributions remained unchanged. These discrepancies could possibly be explained by a variable net inward transport of diffusible tracers in postglomerular vessels, the transport existing in control, but disappearing during vasodilation. To test this hypothesis H2 gas was produced electrolytically for 1 s at a platinum electrode in midcortex and the resulting gas concentration curve measured polarographically at two electrodes placed above and below the source. Analysis of a mathematical model showed that the ratio of the curve maxima at the two electrodes (Cmo/Cmi) would best reveal a radial net transport. Average Cmo/Cmi at 25 positions in 7 clamped dog kidneys was close to unity, but rose to 1.24 at control flow. During acetylcholine infusion Cmo/Cmi rose to 1.68. Local washout rates at the two electrodes increased equally. Calculations indicated a small outwardly directed net transport in control (3 X 10(-4) cm/s), becoming slightly reinforced during vasodilation (5 X 10(-4) cm/s). Thus the control transport direction is opposite to the hypothesis, and the change during vasodilation was estimated to be too small to explain the disparity between diffusible tracer uptake and microsphere distribution in control. H2 concentration maximum was obtained earlier under control flow than in the clamped kidney, indicating an increase in apparent D of the gas in tissue from 3 X 10(-5) cm2/s to 5 X 10(-5) cm2/s, probably due to mixing of H2 gas in the capillary net work.

Acetylcholine↗

Features of apparent nonchemiosmotic energization of oxidative phosphorylation by alkaliphilic Bacillus firmus OF4.

Oxidative phosphorylation by extremely alkaliphilic Bacillus species violates two major predictions of the chemiosmotic hypothesis: the magnitude of the chemiosmotic driving force, the delta p (electrochemical proton gradient), is too low to account for the phosphorylation potentials observed during growth at pH 10.5 without using a much higher H+/ATP stoichiometry than used during growth at pH 7.5, and artificially imposed diffusion potentials fail to energize ATP synthesis above about pH 9.5 (Guffanti, A. A., and Krulwich, T. A. (1989) Annu. Rev. Microbiol. 43, 435-463). To further examine the latter observation, large valinomycin-mediated potassium diffusion potentials were imposed across starved cells of Bacillus firmus OF4 at various pH values from pH 7.5 to 10.5. As the external pH increased above pH 8, there was a sharp decrease in the rate of ATP synthesis in response to an imposed diffusion potential. The rate of ATP synthesis fell to zero by pH 9.2 and 9.4, respectively, in the presence and absence of a small inwardly directed Na+ gradient. Electrogenic Na+/H+ antiport and Na+/alpha-aminoisobutyric acid symport proceeded at substantial rates throughout. When synthesis was energized by an electron donor, cells under comparable conditions synthesized ATP at rapid rates up to pH 10.5. The proton transfers that occur during respiration-dependent oxidative phosphorylation at pH 10.5 may depend upon specific complexes. Cells grown at pH 7.5, which have one-third the levels of the caa3-type terminal oxidase, and slightly lower levels of certain other respiratory chain complexes than pH 10.5-grown cells, support only low rates of ATP synthesis at pH 10.5, although energy-dependent symport and antiport rates are comparable with those in pH 10.5-grown cells. A model is presented for oxidative phosphorylation by the alkaliphilic Bacillus that involves a nonchemiosmotic direct intramembrane transfer of protons from specific respiratory chain complexes to the F0 sector of the ATPase, whereas remaining respiratory chain complexes extrude protons into the bulk to generate the bulk potential required both for ATP synthesis and other bioenergetic work. A pK-regulated gate or a delocalized proton pathway that fails to work above pH 9.5 are suggested as possible features that account for the loss of efficacy of a bulk-imposed diffusion potential in energizing ATP synthesis above pH 9.4.

Adenosine Triphosphate↗

Simulation study of the intercompartmental fluid shifts during hemodialysis.

Hypotension is the most frequent complication during hemodialysis. An important cause of hypotension is a decrease in the intravascular volume. In addition, a decrease in plasma osmolality may be a contributing factor. Modeling of sodium and ultrafiltration (UF) may help in the understanding of underlying relationships. We therefore simulated, in a mathematical model, the intercompartmental fluid shifts during standard hemodialysis (SHD), diffusive hemodialysis (DHD), and isolated ultrafiltration (IU). We analyzed the relative theoretical effect of hydration status, dialysate sodium concentration, the initial plasma concentrations of sodium and urea, and tissue permeation to solutes on the magnitude and direction of intracellular and intravascular volume changes. This theoretical analysis shows that the transcellular fluid shifts taking place during hemodialysis treatment are, to a great part, due to inhomogeneous distribution of regional blood flow and tissue fluid volumes. During hemodialysis treatment, the cellular fluid shifts in tissue groups with relatively high perfusion and small volume occur from the intra- to the extracellular spaces. However, the fluid shift in tissue groups with a low perfusion and large volume takes place in the opposite direction. The UF volume and rates, and the size of the sodium (Na+) gradient between the dialysate and blood side of the dialyzer membrane are the most important factors influencing the fluid shifts. Higher UF volumes and flow rates cause an increasing decline in the plasma volume in both SHD and IU. High dialysate sodium concentration (150 mEq L(-1)) helps plasma refilling slightly when compared with a normal dialysate sodium concentration (140 mEq L(-1)). However, a high dialysate sodium concentration is associated with a high plasma sodium rebound, which in turn may lead to interdialytic water intake resulting from thirst and may cause increased weight gain and hypertension.

Body Fluids↗

Revisiting the Münch pressure-flow hypothesis for long-distance transport of carbohydrates: modelling the dynamics of solute transport inside a semipermeable tube.

A mathematical model of the Münch pressure-flow hypothesis for long-distance transport of carbohydrates via sieve tubes is constructed using the Navier-Stokes equation for the motion of a viscous fluid and the van't Hoff equation for osmotic pressure. Assuming spatial dimensions that are appropriate for a sieve tube and ensuring suitable initial profiles of the solute concentration and solution velocity lets the model become mathematically tractable and concise. In the steady-state case, it is shown via an analytical expression that the solute flux is diffusion-like with the apparent diffusivity coefficient being proportional to the local solute concentration and around seven orders of magnitude greater than a diffusivity coefficient for sucrose in water. It is also shown that, in the steady-state case, the hydraulic conductivity over one metre can be calculated explicitly from the tube radius and physical constants and so can be compared with experimentally determined values. In the time-dependent case, it is shown via numerical simulations that the solute (or water) can simultaneously travel in opposite directions at different locations along the tube and, similarly, change direction of travel over time at a particular location along the tube.

Algorithms↗

Complex patterns in reactive microemulsions: self-organized nanostructures?

In a reverse microemulsion consisting of water, oil (octane), an anionic surfactant [aerosol OT (AOT)], and the reactants of the oscillating Belousov-Zhabotinsky (BZ) reaction, a variety of complex spatiotemporal patterns appear. These include traveling and standing waves, spirals that move either toward or away from their centers, spatiotemporal chaos, Turing patterns, segmented waves, and localized structures, both stationary and oscillatory. The system consists of nanometer-sized droplets of water containing the BZ reactants surrounded by a monolayer of AOT, swimming in a sea of oil, through which nonpolar BZ intermediates can diffuse rapidly. We present experimental and computational results on this fascinating system and comment on possible future directions for research.

Computer Simulation↗

The ring of the rhodopsin chromophore in a hydrophobic activation switch within the binding pocket.

The current view that the beta-ionone ring of the rhodopsin chromophore vacates its binding pocket within the protein early in the photocascade has been adopted in efforts to provide structural models of photoreceptor activation. This event casts doubt on the ability of this covalently bonded ligand to participate directly in later stages involving activation of the photoreceptor and it is difficult to translate into predictions for the activation of related G protein-coupled receptors by diffusable ligands (e.g. neurotransmitters). The binding pocket fixes the formally equivalent pair of ring methyl groups (C16/C17) in different orientations that can be distinguished easily by (13)C NMR. Solid-state NMR observations on C16 and C17 are reported here that show instead that the ring is retained with strong selective interactions within the binding site into the activated state. We further show how increased steric interactions for this segment in the activated receptor can be explained by adjustment in the protein structure around the ring whilst it remains in its original location. This describes a plausible role for the ring in operating a hydrophobic switch from within the aromatic cluster of helix 6 of rhodopsin, which is coupled to electronic changes within the receptor through water-mediated, hydrogen-bonded networks between the conserved residues in G protein-coupled receptors.

Animals↗

Population-based public health interventions: innovations in practice, teaching, and management. Part II.

The Intervention Wheel is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. The Intervention Wheel, previously known as the Public Health Intervention Model, was originally introduced in 1998 by the Minnesota Department of Health, Section of Public Health Nursing (PHN). The model has been widely disseminated and used throughout the United States since that time. The evidence supporting the Intervention Wheel was recently subjected to a rigorous critique by regional and national experts. This critical process, which involved hundreds of public health nurses, resulted in a more robust Intervention Wheel and established the validity of the model. The critique also produced basic steps and best practices for each of the 17 interventions. Part I describes the Intervention Wheel, defines population-based practice, and details the recommended modifications and validation process. Part II provides examples of the innovative ways that the Intervention Wheel is being used in public health/PHN practice, education, and administration. The two articles provide a foundation and vision for population-based PHN practice and direction for improving population health.

Benchmarking↗

Ischemic rats as a model in the study of the neurobiological role of human beta-amyloid peptide. Time-dependent disappearing diffuse amyloid plaques in brain.

Brains from patients with Alzheimer's disease contain diffuse and senile amyloid plaques. Using an experimental model, we have addressed the issue whether diffuse plaques of amyloid persist, develop with time, or both, in rats injected with human beta-amyloid-(1-42)-peptide for 3 and 12 mon after brain ischemia. Rats receiving beta-amyloid peptide for 3 months after brain ischemia demonstrated widespread diffuse amyloid plaques in hippocampus and cerebral cortex. Neuronal, glial, ependymal, endothelial and pericyte cell bodies were observed filled with beta-amyloid peptide. No staining was observed in control brains. In the group alive 1 year no deposition of human beta-amyloid peptide was observed, too. Direct evidence that diffuse amyloid plaques can disappear in the brain is thus provided for the first time.

Alzheimer Disease↗

Spinodal decomposition in thin films: molecular-dynamics simulations of a binary Lennard-Jones fluid mixture.

We use molecular dynamics (MD) to simulate an unstable homogeneous mixture of binary fluids (AB), confined in a slit pore of width D. The pore walls are assumed to be flat and structureless and attract one component of the mixture (A) with the same strength. The pairwise interactions between the particles are modeled by the Lennard-Jones potential, with symmetric parameters that lead to a miscibility gap in the bulk. In the thin-film geometry, an interesting interplay occurs between surface enrichment and phase separation. We study the evolution of a mixture with equal amounts of A and B, which is rendered unstable by a temperature quench. We find that A-rich surface enrichment layers form quickly during the early stages of the evolution, causing a depletion of A in the inner regions of the film. These surface-directed concentration profiles propagate from the walls towards the center of the film, resulting in a transient layered structure. This layered state breaks up into a columnar state, which is characterized by the lateral coarsening of cylindrical domains. The qualitative features of this process resemble results from previous studies of diffusive Ginzburg-Landau-type models [S. K. Das, S. Puri, J. Horbach, and K. Binder, Phys. Rev. E 72, 061603 (2005)], but quantitative aspects differ markedly. The relation to spinodal decomposition in a strictly two-dimensional geometry is also discussed.

Journal Article↗

Uncovering of intracellular water in cultured cells.

The complexity of biologic tissues, with multiple compartments each with its own diffusion and relaxation properties, requires complex formalisms to model water signal in most magnetic resonance imaging or magnetic resonance spectroscopy experiments. In this article, we describe a magnetic susceptibility-induced shift in the resonance frequency of extracellular water by the introduction of a gadolinium contrast agent to medium perfusing a hollow fiber bioreactor. The frequency shift of the extracellular water (+185 Hz at 9.4 T) uncovers the intracellular water and allows direct measurement of motional and relaxation properties of the intracellular space. The proposed method provides a unique tool for understanding the mechanisms underlining diffusion and relaxation in the intracellular space.

Animals↗

Expression of lysostaphin in HeLa cells protects from host cell killing by intracellular Staphylococcus aureus.

The Staphylococcus aureus-specific cell wall endopeptidase lysostaphin was used as a model for an intracellular acting bactericidal antibiotic. HeLa cells were transfected with an expression vector directing the heterologous expression of lysostaphin in the cytoplasm. Expression, subcellular localization and enzymatic activity of lysostaphin were investigated by immunoblotting, fluorescent microscopy and agar diffusion assays. Both transiently and stably transfected HeLa cells showed a strong expression of active lysostaphin. After infection with S. aureus, the intracellular number of S. aureus and the host cell viability were determined. This staphylolytic activity resulted in a strong reduction of intracellular S. aureus in a time- and dose-dependent manner. Furthermore, host cells expressing lysostaphin became protected from S. aureus-induced cell death. Our data demonstrate the potential of intracellularly acting cell-wall active drugs or antibiotics that kill S. aureus without causing harm to the infected host cells.

Cytoplasm↗

A mechanistic model for eukaryotic gradient sensing: spontaneous and induced phosphoinositide polarization.

The crawling movement of cells in response to a chemoattractant gradient is a complex process requiring coordination of various subcellular activities. Although a complete description of the mechanisms underlying cell movement remains elusive, the very first step of gradient sensing, enabling the cell to perceive the imposed gradient, is becoming more transparent. The increased understanding of this step has been driven by the discovery that within 5-10 s of applying a weak chemoattractant gradient, membrane phosphoinositides such as PIP(3) localize at the front end of the cell. It is currently believed that the gradient sensing mechanism is precisely the mechanism leading to this localization. We have formulated a reaction-diffusion model based on the phosphoinositide cycle which predicts various responses of motile cells in addition to the phosphoinositide polarization induced by chemoattractant gradients. The responses include: (a) Polarized sensitivity wherein a polarized cell responds to a change in the direction of the gradient by turning its existing front. (b) Spontaneous polarization wherein cells polarize in a random direction even if the surrounding chemoattractant concentration is uniform. (c) Unique localization which refers to the formation of a unique polarity even in the face of multiple chemoattractant sources. The above responses preclude the hypothesis that the cell merely amplifies the external signal. Our model indicates that the cell must be viewed as a system that nonlinearly processes chemoattractant inputs. We show in particular that these seemingly complex dynamics can be explained very simply in terms of the instabilities and wavefront dynamics that are characteristic of the activator-inhibitor class of models.

Animals↗

Mobility measurement by analysis of fluorescence photobleaching recovery kinetics.

Fluorescence photobleaching recovery (FPR) denotes a method for measuring two-dimensional lateral mobility of fluorescent particles, for example, the motion of fluorescently labeled molecules in approximately 10 mum2 regions of a single cell surface. A small spot on the fluorescent surface is photobleached by a brief exposure to an intense focused laser beam, and the subsequent recovery of the fluorescence is monitored by the same, but attenuated, laser beam. Recovery occurs by replenishment of intact fluorophore in the bleached spot by lateral transport from the surrounding surface. We present the theoretical basis and some practical guidelines for simple, rigorous analysis of FPR experiments. Information obtainable from FPR experiments includes: (a) identification of transport process type, i.e. the admixture of random diffusion and uniform directed flow; (b) determination of the absolute mobility coefficient, i.e. the diffusion constant and/or flow velocity; and (c) the fraction of total fluorophore which is mobile. To illustrate the experimental method and to verify the theory for diffusion, we describe some model experiments on aqueous solutions of rhodamine 6G.

Biological Transport↗

Structure-activity relationships of mineral dusts as heterogeneous nuclei for ammonium sulfate crystallization from supersaturated aqueous solutions.

Mineral inclusions, present in aqueous atmospheric salt droplets, regulate crystallization when relative humidity decreases by providing a surface for heterogeneous nucleation and thus reducing the critical supersaturation. Although laboratory studies have quantified these processes to some extent, the diverse atmospheric mineralogy presents more chemical systems than practically feasible for direct study. Structure--activity relationships are necessary. To that end, in the present work the interactions of ammonium sulfate with corundum, hematite, mullite, rutile, anatase, and baddeleyite were studied by diffuse reflectance fourier transform infrared spectroscopy (DRIFTS) and by epitaxial modeling. The spectroscopic results show that shifts in sulfate peak positions due to chemisorption are not a correlative indicator of the efficacy of heterogeneous nucleation. In contrast, epitaxial modeling results of unreconstructed surfaces explain the sequence of critical supersaturations for constant particle size. If validated by further work, this computer modeling method would provide an important structure--activity tool for the estimation of heterogeneous nucleation properties of the atmospheric mineralogy.

Aluminum Oxide↗