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At least 109 records · Page 6Linked to original sources
PubMed1993

Peritoneal dialysis catheter exit-site care: results of an international survey.

A survey was developed to determine the prevalence of specific components of postoperative and chronic peritoneal catheter exit-site care procedures. Surveys were mailed to approximately 1800 participants of the 1991 Peritoneal Dialysis Conference; 585 surveys (80.6% from the United States and 96% from adult units) were analyzed. The most frequent components of postoperative exit-site care were the use of prophylactic antibiotics, daily dressing changes, procedures limited to specially trained staff, use of sterile technique, povidone iodine and hydrogen peroxide as cleansing agents, and gauze dressings. The most frequent components of chronic exit-site care procedures were daily care done with shower or bathing, antibacterial or pure soap for cleansing, hydrogen peroxide only as needed, catheter stabilization, dressings optional, and gauze dressings when used. Twice daily exit care, change in cleansing agent, and topical antibiotics were recommended for inflamed or infected exit sites. There were significant differences between the United States and other locations, particularly in the type of cleansing agent, use of hydrogen peroxide, and use of dressings for chronic care. Pediatric programs (all located in the United States or Canada) differed somewhat from adult programs in North America. Pediatric patients and their families were significantly more likely to be trained to do postoperative dressing changes and significantly less likely to perform exit-site care at the time of showering or bathing.

Adult↗
PubMedDate not supplied

Use of exit examinations: a criterion for graduation?

This study sought to measure the use of exit examinations in nursing schools at Historically Black Colleges and Universities (HBCU). Fifteen participants from HBCU nursing schools throughout the United States were surveyed to determine current practices related to exit exams. Overall, fourteen schools (93.33%) used an exit exam at the end of their nursing program. However, 73.33% of the participants (11 schools) reported it was mandatory for students to pass the exam as a requirement for graduation. Almost 47% of the participants (7 schools) reported the use of the exit exam was related to NCLEX-RN pass rates, while others reported identification of student needs as the primary reason for using an exit exam. Most participants were very helpful by sharing their innovations. While this small study provided some information on the use of exit examinations, more research is needed to substantiate both the appropriateness and usefulness of their use in baccalaureate degree nursing programs.

Black or African American↗
PubMed2005

Smaller inner ear sensory epithelia in Neurog 1 null mice are related to earlier hair cell cycle exit.

We investigated whether co-expression of Neurog 1 and Atoh 1 in common neurosensory precursors could explain the loss of hair cells in Neurog 1 null mice. Analysis of terminal mitosis, using BrdU, supports previous findings regarding timing of exit from cell cycle. Specifically, we show that cell cycle exit occurs in spiral sensory neurons in a base-to-apex progression followed by cell cycle exit of hair cells in the organ of Corti in an apex-to-base progression, with some overlap of cell cycle exit in the apex for both hair cells and spiral sensory neurons. Hair cells in Neurog 1 null mice show cell cycle exit in an apex-to-base progression about 1-2 days earlier. Atoh 1 is expressed in an apex-to-base progression rather then a base-to-apex progression as in wildtype littermates. We tested the possible expression of Atoh1 in neurosensory precursors using two Atoh 1-Cre lines. We show Atoh 1-Cre mediated beta-galactosidase expression in delaminating sensory neuron precursors as well as undifferentiated epithelial cells at E11 and E12.5. PCR analysis shows expression of Atoh 1 in the otocyst as early as E10.5, prior to any histology-based detection techniques. Combined, these data suggest that low levels of Atoh 1 exist much earlier in precursors of hair cells and sensory neurons, possibly including neurosensory precursors. Analysis of Atoh 1-Cre expression in E18.5 embryos and P31 mice reveal beta-galactosidase stain in all hair cells but also in vestibular and cochlear sensory neurons and some supporting cells. A similar expression of Atoh 1-LacZ exists in postnatal and adult vestibular and cochlear sensory neurons, and Atoh 1 expression in vestibular sensory neurons is confirmed with RT-PCR. We propose that the absence of NEUROG 1 protein leads to loss of sensory neuron formation through a phenotypic switch of cycling neurosensory precursors from sensory neuron to hair cell fate. Neurog 1 null mice show a truncation of clonal expansion of hair cell precursors through temporally altered terminal mitosis, thereby resulting in smaller sensory epithelia.

Animals↗
PubMed2002

Coordinated regulation of M phase exit and S phase entry by the Cdc2 activity level in the early embryonic cell cycle.

In the early embryonic cell cycle, exit from M phase is immediately followed by entry into S phase without an intervening gap phase. To understand the regulatory mechanisms for the cell cycle transition from M to S phase, we examined dependence on Cdc2 inactivation of cell-cycle events occurring during the M-S transition period, using Xenopus egg extracts in which the extent of Cdc2 inactivation at M phase exit was quantitatively controlled. The result demonstrated that MCM binding to and the initiation of DNA replication of nuclear chromatin occurred depending on the decrease of Cdc2 activity to critical levels. Similarly, we found that Cdc2 inhibitory phosphorylation and cyclin B degradation were turned on and off, respectively, depending on the decrease in Cdc2 activity. However, their sensitivity to Cdc2 activity was different, with the turning-on of Cdc2 inhibitory phosphorylation occurring at higher Cdc2 activity levels than the turning-off of cyclin B degradation. This means that, when cyclin B degradation ceases at M phase exit, Cdc2 inhibitory phosphorylation is necessarily activated. In the presence of constitutive synthesis of cyclin B, this condition favors the occurrence of the Cdc2 inactivation period after M phase exit, thereby ensuring progression through S phase. Thus, M phase exit and S phase entry are coordinately regulated by the Cdc2 activity level in the early embryonic cell cycle.

Animals↗
PubMed2000

How do substrates enter and products exit the buried active site of cytochrome P450cam? 1. Random expulsion molecular dynamics investigation of ligand access channels and mechanisms.

Cytochrome P450s form a ubiquitous protein family with functions including the synthesis and degradation of many physiologically important compounds and the degradation of xenobiotics. Cytochrome P450cam from Pseudomonas putida has provided a paradigm for the structural understanding of cytochrome P450s. However, the mechanism by which camphor, the natural substrate of cytochrome P450cam, accesses the buried active site is a long-standing puzzle. While there is recent crystallographic and simulation evidence for opening of a substrate-access channel in cytochrome P450BM-3, for cytochrome P450cam, no such conformational changes have been observed either in different crystal structures or by standard molecular dynamics simulations. Here, a novel simulation method, random expulsion molecular dynamics, is presented, in which substrate-exit channels from the buried active site are found by imposing an artificial randomly oriented force on the substrate, in addition to the standard molecular dynamics force field. The random expulsion molecular dynamics method was tested in simulations of the substrate-bound structure of cytochrome P450BM-3, and then applied to complexes of cytochrome P450cam with different substrates and with product. Three pathways were identified, one of which corresponds to a channel proposed earlier on the basis of crystallographic and site-directed mutagenesis data. Exit via the water-filled channel, which was previously suggested to be a product exit channel, was not observed. The pathways obtained by the random expulsion molecular dynamics method match well with thermal motion pathways obtained by an analysis of crystallographic B-factors. In contrast to large backbone motions (up to 4 A) observed in cytochrome P450BM-3 for the exit of palmitoleic acid, passage of camphor through cytochrome P450cam only requires small backbone motions (less than 2.4 A) in conjunction with side-chain rotations. Concomitantly, in almost all the exit trajectories, salt-links that have been proposed to act as ionic tethers between secondary structure elements of the protein, are perturbed.

Bacterial Proteins↗
PubMed2000

How do substrates enter and products exit the buried active site of cytochrome P450cam? 2. Steered molecular dynamics and adiabatic mapping of substrate pathways.

Three possible channels by which substrates and products can exit from the buried active site of cytochrome P450cam have been identified by means of random expulsion molecular dynamics simulations. In the investigation described here, we computed estimates of the relative probabilities of ligand passage through the three channels using steered molecular dynamics and adiabatic mapping. For comparison, the same techniques are also applied to investigate substrate egress from cytochrome P450-BM3. The channel in cytochrome P450cam, for which there is the most supporting evidence from experiments (which we name pathway 2a), is computed to be the most probable ligand exit channel. It has the smallest computed unbinding work and force. For this channel, the ligand exits between the F/G loop and the B' helix. Two mechanistically distinct, but energetically similar routes through this channel were observed, showing that multiple pathways along one channel are possible. The probability of ligand exit via the next most probable channel (pathway 3), which is located between the I helix and the F and G helices, is estimated to be less than 1/10 of the probability of exit along pathway 2a. Low-frequency modes of the protein extracted from an essential dynamics analysis of a 1 ns duration molecular dynamics simulation of cytochrome P450cam with camphor bound, support the opening of pathway 2a on a longer timescale. On longer timescales, it is therefore expected that this pathway becomes more dominant than estimated from the present computations.

Bacterial Proteins↗
PubMed2001

Clinical and genetic analysis of Staphylococcus aureus nasal colonisation and exit-site infection in patients undergoing peritoneal dialysis.

Few data exist regarding the clonal identity of Staphylococcus aureus (SA) that colonises the nostrils and causes exit-site infections in peritoneal dialysis patients. Nasal and exit-site swabs were taken monthly from 41 patients undergoing peritoneal dialysis, and a genetic analysis of SA isolates was performed by pulsed-field-gel electrophoresis. When SA was identified at the exit-site, the clonal identity of nasal and exit-site isolates was demonstrated. In 50% of the SA carriers, nasal isolates were genetically constant over time; in the other 50% a change of colonising SA strains was observed. The risk of exit-site infection was identical in both groups.

Adult↗
PubMed1993

Exit dose measurements by portal film dosimetry.

Portal in vivo dosimetry is a very attractive tool for patient dose measurements because of the large amount of information that portal film systems can easily collect, once positioned at the exit surface of the patient. The first step in the verification of the reliability of portal films as in vivo dosimeters is the evaluation of the agreement between exit patient dose profiles and optical density profiles measured on the portal film. We checked the possibilities for exit dose measurements of a commercial portal film system (Film Kodak X-Omat V and Localization Kodak Cassette) verifying the agreement between relative exit doses (measured by ionization chamber and film dosimetry, calculated by our treatment planning system (Cadplan Dosetek)) and relative optical densities on portal films in cubic homogeneous and inhomogeneous, cylindrical and humanoid phantoms. In particular, a good agreement (mean difference in absolute value: 2%) between optical densities and calculated exit doses for the Rando phantom were found, once the optical densities values are corrected for an inverse square correction factor, taking into account the variation of the profile of the phantom.

Absorptiometry, Photon↗
PubMed2006

Zfh1, a somatic motor neuron transcription factor, regulates axon exit from the CNS.

Motor neurons are defined by their axon projections, which exit the CNS to innervate somatic or visceral musculature, yet remarkably little is known about how motor axons are programmed to exit the CNS. Here, we describe the role of the Drosophila Zfh1 transcription factor in promoting axon exit from the CNS. Zfh1 is detected in all embryonic somatic motor neurons, glia associated with the CNS surface and motor axons, and one identified interneuron. In zfh1 mutants, ventral projecting motor axons often stall at the edge of the CNS, failing to enter the muscle field, despite having normal motor neuron identity. Conversely, ectopic Zfh1 induces a subset of interneurons--all normally expressing two or more "ventral motor neuron transcription factors" (e.g. Islet, Hb9, Nkx6, Lim3)--to project laterally and exit the CNS. We conclude that Zfh1 is required for ventral motor axon exit from the CNS.

Animals↗
PubMed1995

Vortex vein exit sites. Scleral coordinates.

PURPOSE: The authors determined the frequency and scleral coordinates of vortex vein exit sites in 46 autopsy eyes to provide topographic data that will enable surgeons to locate these vessels more precisely. METHODS: Forty-six autopsy eyes were examined under a dissecting microscope to measure the frequency of vortex veins and the cord lengths between the vortex vein scleral exit sites and the limbus, rectus muscle insertions, and oblique muscle insertions. RESULTS: Data from this study showed that 32 (70%) of the 46 individual eyes studied had more than four vortex veins. The number of second or third vortex veins found in the nasal quadrants was significantly higher than the number found in the temporal quadrants (P < 0.01). Statistical analyses of the measurements provided mean values for distances between vortex vein scleral exit sites and the three nearest extraocular muscle insertions; these positions among eyes were found to be relatively uniform (standard deviation, 0.7-2.5 mm). CONCLUSION: The authors suggest that the majority of adult eyes encountered by a surgeon will have more than four vortex vein exit sites and that more vortex veins may be expected in the nasal quadrants than in the temporal quadrants. This study delineates the locations of vortex vein exit sites so that surgeons can reliably predict their surface positions to avoid vessel laceration and its ensuing complications.

Anthropometry↗
PubMed1997

Bevelling in exit gunshot wounds in bones.

The analysis of trauma to the skeleton is an important aspect of forensic case work, but most major pathology references devote limited attention to this topic. The aim of this paper is to analyze bevelling in exit gunshot wounds from a series of 14 cases with 17 exit wounds. Assessment of bevelling was made by measuring the endocranial and ectrocranial size of the wound, locating the most pronounced bevelling, and determining if there is a correlation between the direction of bevelling and the direction of shooting. The results indicate outward bevelling of exit wounds in nearly two thirds of cases. No bevelling was observed in the orbits, sphenoid, and in some cases, the occipital and parietal bones. Internal bevelling of exit wounds was not found in this series. Bevelling may be partly understood using a glass model. The inconsistent correlation of the direction of bevelling in exit wounds with the direction of shooting leads to the conclusion that this characteristic cannot be relied upon to determine the direction of fire.

Adult↗
PubMed1998

Gunshot wounds to the skull: comparison of entries and exits.

Specific features usually allow recognition of entrance and exit wounds in bones. Exits are often more irregular, and usually larger than entrances. The aim of this paper is to compare the size of 17 entrance and exit gunshot wounds from a series of 13 forensic cases. The results of this work confirm the usually accepted fact that exit wounds in bones tend to be larger than the entrances resulting from the same shot. In all but one case the exits were larger than the entrances in this study. Though the bullet loses velocity after penetrating, the ballistic behavior (deformation and instability of the projectile) explains this tendency.

Forensic Anthropology↗
PubMed2005

Proton exit channels in bovine cytochrome c oxidase.

Cytochrome c oxidase (CcO) is the terminal transmembrane enzyme of the respiratory electron transport chain in aerobic cells. It catalyzes the reduction of oxygen to water and utilizes the free energy of the reduction reaction for proton pumping, a process which results in a membrane electrochemical proton gradient. Although the structure of the enzyme has been solved for several organisms, the molecular mechanism of proton pumping and proton exit pathways remain unknown. In our previous work, the continuum electrostatic calculations were employed to evaluate the electrostatic potential, energies, and protonation state of bovine cytochrome c oxidase for different redox states of the enzyme. A possible mechanism of oxygen reduction and proton pumping via His291 was proposed. In this paper, using electrostatic calculations, we examine the proton exit pathways in the enzyme. By monitoring the changes of the protonation states, proton affinities, and energies of electrostatic interactions between the titratable groups in different redox states of CcO, we identified the clusters of strongly interacting residues. Using these data, we detected four possible proton exit points on the periplasmic side of the membrane (Lys171B/Asp173B, His24B/Asp25B, Asp51, and Asp300). We then were able to trace the proton exit pathways and to evaluate the energy profiles along the paths. On the basis of energetic considerations and the conservation of the residues in a protein sequence, the most likely exit pathway is one via the Lys171B/Asp173B site. The obtained results are fully consistent with our His291 model of proton pumping, and provide a rationale for the absence of proton leaking in CcO between the pumping strokes.

Animals↗
PubMed1993

When to fix it and when to leave: relationships among perceived control, self-efficacy, dissent, and exit.

Using a sample of hospital nurses, the author tested the hypothesis that both self-efficacy and perceived control over decision making contribute to individuals' willingness to engage in reformist dissent when faced with injustice and to their intentions to exit. Reformist dissent is defined as dissent that occurs within the confines of an organization's rules and norms. Perceived control over decision making was expected to be positively related to willingness to engage in reformist dissent and to be inversely related to exit. Because it was expected that both dissent and exit require confidence, self-efficacy was predicted to be positively related to both dissent and exit. Control was positively related to willingness to dissent and inversely related to exit. Self-efficacy, however, predicted only dissent. Implications for worker well-being and retention are discussed, and directions for future research and theory development are offered.

Adult↗
PubMed2001

Staphylococcal peritonitis in continuous ambulatory peritoneal dialysis: colonization with identical strains at exit site, nose, and hands.

To evaluate the relationship of nasal or skin Staphylococcus carrier status with identical strains and the development of staphylococcal peritonitis, 59 consecutive peritonitis episodes in patients using a twin-bag system for continuous ambulatory peritoneal dialysis from a single dialysis center were prospectively studied. Dialysate samples and exit-site, nose, and nail swabs from patients and their dialysis partners were obtained on the same day for culture. When bacteria belonging to the same species of the Staphylococcus genus were isolated from dialysate and at least one extraperitoneal anatomic site, pulsed-field gel electrophoresis typing was performed. The bacterial strains isolated from catheter exit site, nose, or nails of each patient and his or her dialysis partner were classified as identical or different. Twenty-seven of the 59 peritonitis episodes (46%) were caused by staphylococci. Nineteen of these 27 patients carried the same Staphylococcus species causing the peritonitis episode at the exit site, nose, or nails, but only 17 patients (63%) carried an identical strain. Four of 5 dialysis partners carried the same Staphylococcus species causing the peritonitis episode at nose or nails, but the strain was identical for only 3 dialysis partners (60%). Four patients and 1 dialysis partner carried unrelated strains of the Staphylococcus species causing the peritonitis episode. The most frequently colonized site with strains identical to that causing the peritonitis episode was the catheter exit site, followed by nose and nails. This finding may be clinically relevant because eradication of Staphylococcus aureus colonizing the catheter exit site may be more important and have a greater likelihood of success than maneuvers directed to more distant locations.

Carrier State↗
PubMed2002

Topical antifungal treatment cures exit-site fungal infection.

Exit-site fungal infection, although rarely reported, may be a critical complication in patients on peritoneal dialysis. There is no optimal treatment of exit-site fungal infection. We report four cases of exit-site infection with Candida parapsilosis. Four-week treatment with topical sulconazole cream was administered. Fungal infection was cured in all patients but followed by exit-site bacterial infection in two patients. The topical application of sulconazole cream is recommended for exit-site fungal infection.

Administration, Topical↗
PubMed2006

Unilateral treatment exit: a failure of retention or a failure of treatment fit?

This article highlights perceived weaknesses in the current understanding of unilateral client exit from alcohol and other drug psychosocial treatment. It is argued that unilateral client exit is typically interpreted as a "failure of retention" when it could equally be interpreted as a "failure of treatment fit"; that is, the failure to deliver treatment optimally suited to actual client attendance. The results from an exploratory study conducted within a failure of treatment fit framework are presented. This study explored the possibility that short-term outpatient alcohol and other drug (AOD) treatment attendance may be an intentional service use strategy and that short-term attendees may exit AOD treatment as satisfied, successful, consumers. Standardized questionnaires were administered to clients (n = 109) starting a new treatment episode between June-August 2003 at admission and two-months post admission. Questionnaires explored the accuracy of client estimates of future appointment attendance, the reasons for short-term service exit, the satisfaction and outcome ratings of short-term clients, and the extent to which these compared with their longer-term peers. Findings suggest short-term treatment attendance is not an intentional service use strategy. However, despite attending fewer appointments than intended, most short-term participants reported significant levels of service satisfaction and problem improvement, and at a level comparable with their longer term peers. Problem-improvement was endorsed as the number one reason for short-term service exit. Implications for treatment delivery are discussed in light of these findings.

Adult↗
PubMedDate not supplied

Disaffiliation, substance use, and exiting homelessness.

This study tested whether social affiliation was associated with exits from homelessness for a county-wide probability sample of 397 homeless adults who were followed over a 15-month period culminating in 1992. For the total sample, support from family or friends and service use were related to an increased likelihood of exiting from homelessness. Surprisingly, exits from homelessness were associated with social affiliation (i.e., support from family/friends and services use) only among homeless adults who did not have current substance-use disorders. This relationship did not hold for those with current substance-use disorders. Findings suggest that homeless adults without current substance-use disorders may be better able to engage services and support from family/friends to exit homelessness than homeless adults who have current substance-use disorders. Perhaps service providers who are targeting homeless adults with substance-use disorders and want to help them exit homelessness need to emphasize initiating substance-use treatment before addressing other issues.

Adult↗