Assessing the effect of case-based teaching compared to lecture-based teaching on students’ knowledge and perceptions in a senior undergraduate dairy cattle management course

Animal science students need to apply the knowledge acquired during their degree program to real-life scenarios in future careers. Little to no research exists evaluating the effects of case-based (CB; material presented as a case study) and lecture-based (LB; material presented as a lecture) teaching in animal science in higher education. The objectives of this study were to determine the effects of CB and LB teaching methods on student performance and to assess students’ attitudes toward CB and LB teaching methods in a senior dairy cattle management course. A cross-over study design was conducted over two course modules (1 = “calf health” and 2 = “lameness”) with a washout period of 2 wk. Students (n = 25) were randomly assigned to CB or to LB in module 1 and received the other method in module 2. Students completed a pre- and post-quiz in each module that consisted of 10 multiple-choice questions and 3 short-answer questions. Three separate linear mixed regression models were used to assess the effect of teaching method (CB or LB; predictor) on three different continuous outcomes for student performance: change (post-score − pre-score) in short-answer quiz scores, change in multiple-choice quiz scores, and the change in total quiz scores. Students completed an attitude assessment after each module that consisted of 8 Likert-scale statements and 2 free-response questions. Data were deidentified, and two researchers blinded to students’ CB or LB status analyzed free responses to identify themes. A logistic regression, which controlled for module and included student as a repeated measure, was used to determine if the proportion of students who agreed (outcome: yes/no) with each Likert-scale statement was different between CB and LB. There was a tendency for CB teaching methods to improve change in multiple-choice quiz scores (P = 0.06). The change in total quiz scores and the change in short-answer quiz scores did not differ between CB and LB groups (P > 0.1). For the survey statements “I enjoyed the teaching method used in this module” and “I wish this teaching method was utilized in more of my classes,” more students in LB agreed than in CB (P < 0.05). The themes preference, perceived benefits, and perceived drawbacks were mentioned in 80%, 44%, and 28% of CB comments, and in 84%, 40%, and 18% of LB comments, respectively, and suggest that students enjoy case studies but prefer to receive information via lecture first.

[External fixator for temporary stabilization of complex periarticular knee fractures]

OBJECTIVE

Temporary stabilization of the knee joint in order to minimize soft tissue strain until definitive surgery is possible.

INDICATIONS

Bicondylar distal femoral and tibial plateau fractures, additional vascular injury, open fractures (second or third degree), severe soft tissue damage, unicondylar fracture with contralateral ligament tear, (open) knee dislocation, polytrauma.

CONTRAINDICATIONS

Unsafe pin placement, severe osteoporosis.

SURGICAL TECHNIQUE

Two femoral and tibial pins are connected by two rods and are spanned over the knee with two additional longitudinal rods via a tube-to-tube clamp. Alternatively, this can be facilitated by a direct connection of two rods in case of anteriorly placed femoral pins. A reasonable distance should be kept to open wounds, the fracture, and later operative approaches. The knee is fixed in 5-15° of flexion.

POSTOPERATIVE MANAGEMENT

Definitive treatment depending on patient well-being and amenable soft tissue.

C-51 Long Term Neuropsychological Follow-Up of Radiation Induced Cognitive Decline (RICD) in Cerebellar Medulloblastoma

Objective

We expanded upon an early case study suggesting long-term, sequential neurocognitive evaluation and academic interventions following pediatric cerebellar medulloblastoma. This five-year-old patient (now forty) has indeed undergone lifespan assessment and clearly benefitted from appropriate interventions to date.

Method

This left-handed, white, male is status post (s/p) gross total resection and whole brain radiation. In adulthood, he developed radiation necrosis with hemorrhage and refractory seizures (s/p right temporal lobectomy). More recently, radiation induced bilateral parietal meningiomas were identified (s/p gamma knife).

Results

We analyzed cognitive, medical/oncological, imaging and interventional data at developmentally meaningful time points and found consistent declines in intellectual skills and cognitive function spanning attention/concentration, processing speed, visual perceptual/organization and visually based learning/memory; however, we noted stabilization and even improvement in important areas. Areas of age-appropriate functioning were noted in expressive vocabulary, verbal abstract reasoning, delayed verbal memory, and problem-solving, among others.

Conclusions

Although some studies have addressed long-term outcomes in pediatric medulloblastoma, we provide a unique perspective to the literature by documenting serial neurocognitive findings in addition to interventions across the lifespan. Our findings suggest that appropriate academic interventions/neurocognitive rehabilitation strategies are in fact meaningful at the individual level and propose that a focus on strengths can improve outcomes. We propose that this previously recommended model of assessment/intervention truly become the available standard of care in all pediatric oncologic populations.

Ionic conductivity of solid polyelectrolyte complexes with varying water content: application of the dynamic structure model

We present a systematic study of the dc conductivity of solid polyelectrolyte complexes (PEC) of type x_PSS PSS·(1 − x_PSS) PDADMA as a function of temperature, and of PSS and water content, respectively. The data are discussed in the framework of the dynamic structure model.

Scaling properties of the shear modulus of polyelectrolyte complex coacervates: a time-pH superposition principle

A novel time-pH superposition principle describes the complex shear moduli in polyelectrolyte complex coacervates.

High-Frequency Conductivity Plateau and Ionic Hopping Processes in a Ternary Lithium Borate Glass

Complete conductivity spectra of a lithium ion conducting glass of composition B2O3-0.56Li2O - 0.45 LiBr have been taken at twelve temperatures from 173 K to 573 K, covering the frequency range from a few Hertz up to about 50 THz. For the first time, a separation of the hopping and vibrational contributions to the spectra has been performed. The resulting frequency dependent hopping conductivity displays a high-frequency plateau similar to those known to exist in crystalline solid electrolytes like RbAg4I5 and Na-β-alumina. In the dispersive regime of the conductivity, there is an increase of the apparent power-law exponent from p = 0.6 to q = 1.3. The spectra are evaluated by combined application of the jump relaxation model and the dynamic structure model. Besides the translational hopping of the lithium ions via the preferred Ā sites, more localized kinds of motion are also detected, viz., hops into the less favoured C̄ sites (and mostly back again) as well as smaller displacements of the ions within their local environment.

MBR technology: a promising approach for the (pre-)treatment of hospital wastewater

Membrane bioreactor (MBR) technology is a very reliable and extensively tested solution for biological wastewater treatment. Nowadays, separate treatment of highly polluted wastewater streams especially from hospitals and other health care facilities is currently under investigation worldwide. In this context, the MBR technology will play a decisive role because an effluent widely cleaned up from solids and nutrients is absolutely mandatory for a subsequent further elimination of organic trace pollutants. Taking hospital wastewater as an example, the aim of this study was to investigate to what extent MBR technology is an adequate 'pre-treatment' solution for further elimination of trace pollutants. Therefore, we investigated - within a 2-year period - the performance of a full-scale hospital wastewater treatment plant (WWTP) equipped with a MBR by referring to conventional chemical and microbiological standard parameters. Furthermore, we measured the energy consumption and tested different operating conditions. According to our findings the MBR treatment of the hospital wastewater was highly efficient in terms of the removal of solids and nutrients. Finally, we did not observe any major adverse effects on the operation and performance of the MBR system which potentially could derive from the composition of the hospital wastewater. In total, the present study proved that MBR technology is a very efficient and reliable treatment approach for the treatment of highly polluted wastewater from hospitals and can be recommended as a suitable pre-treatment solution for further trace pollutant removal.

Time-humidity-superposition principle in electrical conductivity spectra of ion-conducting polymers

We analyze the scaling properties of the ac conductivity spectra of ion-conducting polyelectrolyte complexes of different compositions. Spectra were taken at ambient temperature but at different relative humidities. For the first time, we report on a scaling principle for conductivity spectra termed "time-humidity-superposition principle" in analogy with the well-known time-temperature-superposition principle. This model-free scaling holds for different materials over several decades in frequency. It implies that the hydration is activating ion motion over short and long distances in a similar general way, a concept so far only established for thermal energy.

Association between attendance of day care centres and increased prevalence of eczema in the German birth cohort study LISAplus

BACKGROUND

Day care centre attendance is much more common in East than in West Germany. Although there is evidence that early day care might be protective against atopic diseases, several studies have shown a higher prevalence of childhood eczema in East Germany compared to West Germany.

OBJECTIVES

To compare prevalence and cumulative incidence of eczema in a birth cohort study in East and West Germany and to identify risk factors that are associated with eczema, which might explain regional differences.

METHODS

We used data from the ongoing population-based birth cohort study Influence of Life-style factors on the development of the Immune System and Allergies in East and West Germany Plus the influence of traffic emissions and genetics. In 1997, 3097 children from study areas in East and West Germany were recruited. Cumulative incidence and 1-year prevalences of eczema up to the age of 6 years were determined from yearly questionnaires. Cox regression and generalized estimating equations/logistic regression were used to quantify regional differences and to identify risk factors that might explain them.

RESULTS

Prevalence and incidence of eczema were higher in children living in East Germany than those living in West Germany. We identified 11 risk factors that showed significant regional differences. From these factors, only 'day care attendance during the first 2 years of life' was significantly associated with eczema (odds ratio 1.56, 95% confidence interval CI 1.31-1.86). The regional differences in eczema could be explained by differences in early day care utilization.

CONCLUSION

Day care centre attendance is associated with an increased prevalence and incidence of eczema. Regional differences in eczema prevalence could be explained by regional differences in utilization of early day care.

Full scale membrane bioreactor treatment of hospital wastewater as forerunner for hot-spot wastewater treatment solutions in high density urban areas

Membrane Bioreactors (MBR) are a very attractive option for the treatment of hospital wastewater and elimination of pharmaceuticals in high density urban areas. The present investigation showed that, depending on the substance, between 19% and 94% of the level of antibiotics found in the environment originate from hospitals. Because of their ecotoxic potential, hospital wastewaters can have a significant impact on the environment. The segregation of these wastewaters and their separate treatment at the source can reduce the entry of drugs in waterways and enable water reuse after adequate polishing treatment processes.

Unconventional scaling of electrical conductivity spectra for PSS-PDADMAC polyelectrolyte complexes

For the first time, we analyze ac conductivity spectra of various dried ionically cross-linked polyelectrolyte complexes in terms of the time-temperature superposition principle. The temperature-dependent spectra of some complexes show scaling properties that are distinctly different from the behavior of all other ion-conducting materials reported so far, but in agreement with model predictions by Roling [B. Roling, Phys. Chem. Chem. Phys. 3, 5093 (2001).10.1039/b105094j]. We conclude that the dc conductivity of the investigated PEC is always governed by the Na+ ions, even in complexes with excess of polycations and chloride anions.

Use of statins and incidence of dementia and cognitive impairment without dementia in a cohort study

OBJECTIVE

Evidence of a relation between use of lipid lowering drugs and cognitive outcomes is mixed. This study aimed to test the association between use of statins and incidence of dementia and cognitive impairment without dementia (CIND) over 5 years of follow-up.

METHODS

Data were from a population-based cohort study comprising 1,789 older Mexican Americans. All participants had cognitive and clinical evaluations performed every 12 to 15 months. Participants who fell below specified cutpoints on cognitive tests were then evaluated clinically. Dementia diagnoses were finalized by an adjudication team. A total of 1,674 participants free of dementia/CIND at baseline were included in these analyses. Statin use was verified at each participant's home by medicine cabinet inspection. Cox proportional hazards models were used to evaluate the association between statin use and incidence of dementia/CIND.

RESULTS

Overall, 452 of 1,674 participants (27%) took statins at any time during the study. Over the 5-year follow-up period, 130 participants developed dementia/CIND. In Cox proportional hazards models adjusted for education, smoking status, presence of at least one APOE epsilon4 allele, and history of stroke or diabetes at baseline, persons who had used statins were about half as likely as those who did not use statins to develop dementia/CIND (HR = 0.52; 95% CI 0.34, 0.80).

CONCLUSION

Statin users were less likely to have incident dementia/cognitive impairment without dementia during a 5-year follow-up. These results add to the emerging evidence suggesting a protective effect of statin use on cognitive outcomes.

Direct correlation between nonrandom ion hopping and network structure in ion-conducting borophosphate glasses

We present temperature-dependent conductivity spectra of sodium borophosphate glasses with a varying borate/phosphate ratio but a constant sodium oxide content which can be mapped into time-dependent mean square displacements. For the first time, we show that characteristic lengths of ion transport derived thereof are directly linked to features of network structure, viz., the number of boron oxide tetrahedra. Our results also shed light on the mixed network former effect.

Allergic sensitization and disease in mother-child pairs from Germany: role of early childhood environment

BACKGROUND

Early childhood influences are important for the development of the allergic phenotype. In East Germany, tremendous lifestyle changes took place after 1990 and it can be hypothesized that the allergic phenotypes in mothers and their children are less similar than in West Germany. This was investigated in our study done in mothers and their 6-year-old children from East and West Germany in the year 2000.

METHODS

1,393 mother-child pairs participated. A subgroup of 774 pairs gave blood for the determination of specific IgE. Regional differences in mother-child correlations and in prevalence of mother-child combinations with respect to allergic sensitization and disease were examined by logistic regression analysis.

RESULTS

The adjusted association in positive allergic sensitization between mothers and their children was not significant in East Germany (OR 1.23, 95% CI: 0.68-2.24) but highly significant in West Germany (OR 2.89, 95% CI: 1.73-4.80). The probability for the combination of 'negative' mother and 'positive' child was significantly higher in East than in West Germany.

CONCLUSIONS

Mother-child transmission of atopy predisposition can even be cancelled by environmental changes.

Prognostic relevance of p53 and bcl-2 immunoreactivity for early invasive pT1/pT2 gastric carcinomas: indicators for limited gastric resections?

BACKGROUND

Laparoscopic or endoscopic limited resection is intended to be an additional therapeutic option for the treatment of early gastric cancer. However, tumorbiologic markers to predict the outcome for patients after limited resections are missing. This study therefore investigated the prognostic relevance of p53 and bcl-2 immunoreactivity as well as the percentage of apoptotic tumor cells in early invasive pT1/pT2 tumors managed with standard operations for gastric adenocarcinoma.

METHODS

Histologic slides of 65 pT1/pT2 gastric carcinomas were investigated for bcl-2 and p53 immunoreactivity. For 35 patients, DNA fragmentation of tumor cell nuclei was determined by the terminal uridine 5'-triphosphate (UTP) nick end-labeling (TUNEL) method. Follow-up evaluation of the patients was prospectively documented for 53.4 +/- 4.1 months.

RESULTS

Findings showed that bcl-2 immunoreactivity was associated with tumors of the intestinal type according to Lauren s classification (p = 0.042), and that p53 immunoreactivity was increased in more invasive tumors (pT1 vs pT2 tumors; p = 0.047). Mean survival time was significantly longer for patients with bcl-2-negative tumors (74.3 +/- 6.8 months) than for patients with bcl-2-positive tumors (50.8 +/- 7.6 months; p = 0.024). The percentage of apoptotic tumor cell nuclei did not have prognostic relevance in the population studied and was not associated with several histopathologic parameters or bcl-2 and p53 immunoreactivity. Subgroup analysis indicated that the survival of patients with differentiated G2 and bcl-2-negative/p53-negative tumors was significantly longer (82 +/- 6 months) than the survival of patients with G2 bcl-2- and/or p53-positive tumors (41.8 +/- 12.5 months; p = 0.005), with independent prognostic relevance determined by multivariate analysis (p = 0.024).

CONCLUSION

The data reported indicate that the analysis of bcl-2 and p53 immunoreactivity seems to have prognostic implications for early invasive (pT1/pT2) gastric adenocarcinomas and may subclassify patients for minimally invasive laparoscopic or endoscopic gastric resections.

Dealing with the "always sick" employee

Somatoform disorders occasionally surface in employees and others who, ordinarily unknowingly, are reacting to the stresses in their lives. Somatization is a process by which individuals communicate psychological distress through physical symptoms, thus essentially making themselves ill. However, by learning to recognize the signs of possible somatic problems the manager can apply various strategies to decrease an employee's apparent physical problems and enhance job performance.

Iris yellow spot virus on Onion in New Mexico

Onions are an important crop for New Mexico with 7,700 acres (3,116 ha) harvested in the state in 2003 (3). In 2002, onions of several cultivars were first noticed with diamond-shaped chlorotic or bleached lesions on seed stalks or leaves, typical of those reported for Iris yellow spot virus (IYSV). A more widespread survey of breeding stocks and commercial onion fields revealed similar symptoms on thrips-infested onions in Dona Ana and Rio Arriba counties. Incidence of disease symptoms ranged from <0.5 to nearly 30%. Symptomatic leaves were assayed for the presence of IYSV using enzyme-linked immunosorbent assay (ELISA; Agdia, Elkhart, IN) and antisera acquired from Agdia. Symptomatic leaves from breeding and commercial fields tested positive for IYSV. The virus was transmitted by Thrips tabaci from symptomatic onions to three onion cvs. New Mex Mesa, New Mex Vado, and New Mex Cryspy in growth chamber tests. All three cultivars showed symptoms of IYSV and tested positive for the disease using ELISA. However, New Mex Vado and New Mex Cryspy cultivars each showed 24% infection (4 infected plants of 17 tested) compared with 59% infection (10 infected plants of 17 tested) for New Mex Mesa, suggesting that not all cultivars are equally susceptible to the virus. To our knowledge, this is the first report of IYSV in onions in New Mexico, which has also been reported in the western United States in Idaho, Oregon, Colorado, and Washington (1,2,4). References: (1) L. J. du Toit et al. Plant Dis. 88:222, 2004. (2) J. M. Hall et al. Plant Dis. 77:952, 1993. (3) National Agricultural Statistics Service, On-line publication. USDA, 2004. (4) H. F. Schwartz et al. Plant Dis. 86:560, 2002.

New mixed alkali effect in the ac conductivity of ion-conducting glasses

We have determined the first wide-range conductivity spectra of a mixed alkali glass system, extending from 10(-3) Hz to 1.3 THz. We report on a new mixed alkali effect in the ac conductivity that is evident even if the low-frequency contributions (linked to hopping motions of the mobile cations) are removed from the experimental spectra. From our results we conclude that the nonhopping contributions to the ac conductivity involve both the mobile ions and the glassy network.

"The best thing about the hospitalization was that the nurses kept me well informed" Issues and strategies of client education

The patient had been in an automobile accident and was recuperating from a brain concussion. He was scheduled for 24 h of evaluative procedures to rule out injuries which might require surgery. He had been on a back board for a possible spine injury, had a variety of X-rays, blood work, and an EKG, and had been given oxygen, medication by injection, and intravenous fluid and medication through a pump. A variety of health team members including nurses, physicians, and a surgeon had done assessments and taken a history to assist in the diagnostic process. "The best thing about the hospitalization was the nurses telling me what they are doing and why they are doing it! It was really reassuring to have the procedures explained and to know what is being done and why." "I didn't always know if they were going through the steps to help remind themselves what they were doing or to tell me what they were doing. In either case, it was helpful for me to have information on what was happening." "They answered my questions as best they could. When I asked the nurse adding an IV bag what was in it he said, "Potassium" and he explained that my level was 3.3 when the normal was 3.5 to 5.0. He said that since they didn't know my normal they were giving me potassium just in case I needed it. He knew just what he was talking about and the facts were reassuring." "When I asked him to explain what the injection was, he said it was "Tetanus." He said I could refuse it if I wanted to, that it would probably get sore. However, he said I did have open abrasions and if I had not had one in 10 years it would be a good idea. So understanding this reasoning, I was glad to get the shot." "Patient education is really important. When I was in the hospital 10 years ago I was not given all this information and it really helps! I really appreciate the different approach by the nurses. It is really reassuring."

Impact of epidermal growth factor (EGF) radioreceptor analysis on long-term survival of gastric cancer patients

BACKGROUND

The EGF receptor/ligand system seems to be involved in the regulation of gastric mucosa proliferation and progression of gastric carcinomas.

PATIENTS AND METHODS

EGF receptor levels were quantitatively determined in 47 gastric carcinomas by 125J [EGF] radioreceptor assays in membrane preparations of tumor samples or corresponding adjacent mucosa. Specific receptor binding was determined by the analysis of displacement curves by non-linear least-square regression analysis using an estimated model of 'goodness of fit'.

RESULTS

Increased EGF receptor binding was observed in gastric carcinomas (mean +/- SEM: 11.87 +/- 1.9 fmol/mg protein) in comparison to adjacent normal gastric mucosa ( 5.28 +/- 1.0 fmol/mg protein, p = 0.003). Elevated EGF receptor levels were especially found in more invasive T3/4 carcinomas, tumors with positive lymph nodes, advanced UICC III carcinomas, undifferentiated tumors, carcinomas of the diffuse-type according to Lauren's classification and gastric carcinomas localized distal from the cardia. In histopathologically normal appearing gastric mucosa, EGF-receptor levels were significantly decreased relative to corresponding tumor samples from advanced UICC stages (UICC I vs UICC I/II: p = 0.008) or tumors with low levels of differentiation (G2 vs G3: p = 0.028). Overall survival was significantly reduced in patients with advanced gastric carcinomas according to UICC classification (UICC III vs UICC I/II: 18.8 vs 45.5 months, p = 0.016). A subgroup analysis of gastric carcinomas localized distal from the cardia indicated, that increased EGF-receptor levels were an independent indicator of poor prognosis as determined by univariate (p = 0.020) and multivariate analysis (p = 0.042).

CONCLUSION

Gastric carcinomas with increased EGF receptors might be a possible target for anticancer strategies blocking the EGF receptor/ligand pathway.

The employee who seeks to benefit from being ill

The presence of physical symptoms that do not correlate with a disease process are often frustrating to healthcare professionals, are difficult to diagnose and may consume an inordinate proportion of healthcare resources. However, proper and complete physical and psychological assessment and treatment is becoming increasingly possible and essential. Physical illness may occur concomitantly and sometimes as a result of psychological distress, which has displayed itself in a diagnosed mental illness. In other cases physical symptoms may be caused by unconscious dynamics, and the process becomes the primary presenting mental concern. In other cases the physical illness is part of a conscious process and motivated by the hope of gain. Differentiation between physical symptoms of unconscious and conscious origin is important in selecting the correct response. A manager must first of all be alert for physical symptoms that appear to be consciously motivated, as in a disorder called "malingering." The essential feature of malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding work or obtaining financial compensation. Managers may inadvertently encourage malingering in the workplace by inappropriate responses to employees who present a physical complaint that is consciously motivated for gain. When the manager can recognize this phenomenon as malingering, appropriate managerial intervention can cause this behavior to be controlled and even eliminated and thus enhance productivity.

Antibiotic susceptibility profiles of Escherichia coli strains lacking multidrug efflux pump genes

The contribution of seven known and nine predicted genes or operons associated with multidrug resistance to the susceptibility of Escherichia coli W3110 was assessed for 20 different classes of antimicrobial compounds that include antibiotics, antiseptics, detergents, and dyes. Strains were constructed with deletions for genes in the major facilitator superfamily, the resistance nodulation-cell division family, the small multidrug resistance family, the ATP-binding cassette family, and outer membrane factors. The agar dilution MICs of 35 compounds were determined for strains with deletions for multidrug resistance (MDR) pumps. Deletions in acrAB or tolC resulted in increased susceptibilities to the majority of compounds tested. The remaining MDR pump gene deletions resulted in increased susceptibilities to far fewer compounds. The results identify which MDR pumps contribute to intrinsic resistance under the conditions tested and supply practical information useful for designing sensitive assay strains for cell-based screening of antibacterial compounds.

The health care employee with an "attitude"

Health care managers may encounter employees who seem to have an "attitude." The employee may have a pattern of ingrained, inflexible, maladaptive responses to anxiety indicative of a personality disorder. When the employee has a pervasive sense of self-importance, is preoccupied with fantasies of unlimited success, and requires excessive admiration, a narcissistic personality disorder or traits may be present. Although this individual can cause havoc in the workplace, an alert manager who uses specific management techniques can enable the narcissistic employee to be productive and to be an asset in the work setting. This article provides a look at the etiology, symptoms, and management of the narcissistic employee. When the employee is willing to be assisted, the behavior can be modified and the necessary level of adaptation can occur. This can result in a more productive, less chaotic workplace.

Lung water, hemodynamics and dyspnea before and after valvuloplasty in mitral stenosis

The investigation was to elucidate the role of the reduction of extravascular pulmonary fluid in the immediate symptomatic improvement and its impact on hemodynamics in patients with mitral stenosis treated by percutaneous transluminal valvuloplasty.

METHODS

In a prospective study of 12 patients with severe mitral stenosis extravascular pulmonary fluid volume was determined by a combined dye and thermodilution technique (COLD Z-021(TM) Version 5.x, Pulsion((R))) before and after valvuloplasty. Cardiac output, left atrial pressures, atrial V-waves, diastolic transmitral gradients and their respiratory changes were measured. Dyspnea was assessed by validated questionnaires.

RESULTS

Symptomatic improvement correlated (r=0. 808) with a decrease of extravascular lung water, but not with either an increase or a decrease of cardiac output or left atrial filling pressures. The decrease of the lung water index may be predicted from the lung water index before valvuloplasty, the final left atrial mean pressure and the cardiac index prior to intervention. The change of the mean difference between inspiratory and expiratory mitral gradient demonstrated a significant inverse correlation with the change of mean left atrial filling pressures (r=-0.778) and with extravascular lung water after valvuloplasty (r=-0.871).

CONCLUSION

There is a complex relationship between left atrial filling pressures, extravascular lung water, respiratory changes of gradients, and dyspnea that need further investigation.

Biosynthesis of the lantibiotic mersacidin: organization of a type B lantibiotic gene cluster

The biosynthetic gene cluster (12.3 kb) of mersacidin, a lanthionine-containing antimicrobial peptide, is located on the chromosome of the producer, Bacillus sp. strain HIL Y-85,54728 in a region that corresponds to 348 degrees on the chromosome of Bacillus subtilis 168. It consists of 10 open reading frames and contains, in addition to the previously described mersacidin structural gene mrsA (G. Bierbaum, H. Brötz, K.-P. Koller, and H.-G. Sahl, FEMS Microbiol. Lett. 127:121-126, 1995), two genes, mrsM and mrsD, coding for enzymes involved in posttranslational modification of the prepeptide; one gene, mrsT, coding for a transporter with an associated protease domain; and three genes, mrsF, mrsG, and mrsE, encoding a group B ABC transporter that could be involved in producer self-protection. Additionally, three regulatory genes are part of the gene cluster, i.e., mrsR2 and mrsK2, which encode a two-component regulatory system which seems to be necessary for the transcription of the mrsFGE operon, and mrsR1, which encodes a protein with similarity to response regulators. Transcription of mrsA sets in at early stationary phase (between 8 and 16 h of culture).

Gender differences in leadership in the health professions

The leadership characteristics and behaviors of men and women differ. As increasing numbers of women enter positions of leadership, understanding of these differences can increase the quality and productiveness of relationships in the workplace. This article describes the evolution of women in leadership, gender differences in leadership style, and the way gender may affect behaviors in the workplace.

Caring for elderly patients who have paranoia

Caring for patients with paranoia presents unique challenges. As increasing numbers of potentially paranoid patients are treated, radiologic technologists must understand techniques that increase patient trust and decrease suspiciousness. Understanding the perceived vulnerability of patients with paranoia and implementing appropriate strategies facilitate trust and are key to providing quality care.

[Prognostic significance of apoptosis inducers/inhibitors in stomach carcinoma with/without adjuvant intraoperative radiotherapy (IORT)]

Several studies have tried to improve the surgical results after resection for gastric cancer by different adjuvant therapy protocols, including intraoperative radiotherapy (IORT). Since 1990 we have performed a randomized, prospective trial comparing surgery alone and surgery plus adjuvant IORT to evaluate the role of adjuvant intraoperative radiotherapy in the treatment of curative resected gastric carcinomas. In the present study, p53, bcl-2 immunoreactivity and DNA fragmentation as a typical marker of apoptosis were determined to investigate the predictive value of apoptosis-related factors and the observed response to radiotherapy. Preliminary data indicate that patients with tumors containing increased numbers of apoptotic tumor cells might derive benefit from adjuvant IORT.

FAS/FAE: impact on children

Alcohol is a teratogen and it can cause lasting birth defects called Fetal Alcohol Syndrome (FAS)/Fetal Alcohol Effects (FAE). FAS is one of the leading causes of mental retardation. FAS/FAE can result in a myriad of behavioral, learning and developmental problems. There are estimates of 12,000 new cases of FAS yearly. The school nurse plays an important advocacy and educational role in helping the child with FAS. Family involvement is important for the child with FAS.

Oscillatory corticothalamic response to somatosensory input

We construct a model of the thalamocortical feedback loop using the Random Neural Network model to provide a theoretical explanation for cortical and thalamic damped rapid (circa 60-100 Hz) oscillations which have been observed in lightly anesthesized rats with somatosensory input Nicolelis (1997). Experimental data corroborates the choice of model parameter settings. Model predictions indicate that positive feedback loops and large signaling delays within cortex significantly determine the oscillatory phenomenon and its duration (i.e. its decay), while positive feedback from cortex to thalamus is needed to exhibit oscillations in thalamus.

[Risk factors and pathogenic microorganisms in patients with insufficient esophagojejunostomy after gastrectomy]

It was the aim of the study to find by retrospective analysis of data from totally gastrectomized patients risk factors for the development of esophago-jejunal anastomotic leakage, that may be avoidable or influenced therapeutically.

PATIENTS AND METHODS

The study design was retrospective involving 838 patients with total gastrectomy for gastric cancer from the years 1973-1993. In 134 cases leakage of the esophago-jejunostomy occurred. The relative risk for the development of leakage associated with individual parameters was determined by comparing the data from 704 patients without leakage to the data from 134 patients presenting with this complication. For a subgroup of 86 patients with anastomotic leakage microbiological data of swabs taken from the anastomoses were available, which were evaluated with respect to potentially pathogenic bacilli.

RESULTS

The overall leakage rate of esophago-jejunal anastomoses was 15.9% (n = 134). The mortality rate during this time period amounted to 14.3%. Leakage was a most highly significant factor for mortality (p = 0.0001). Significant risk factors for leakage of the esophago-jejunostomy were tumors of the cardia, splenectomy, a duration of operating time of more than 5 hours and manual suture technique compared to stapler anastomoses. Tumor unrelated associated disease, tumor stage and a history of other preexisting gastric diseases were not associated with an increased relative risk. At the time of the initial clinical manifestation of leakage the following pathogenic bacilli could be isolated from leaking anastomoses with decreasing incidence: E. coli, S. aureus, Proteus mirabilis, Pseudomonas aeruginosa, Klebsiella pneumoniae a.o. The bacterial spectrum has not changed during the observation period of 20 years.

SUMMARY

With the exception of the choice of suture techniques the identified clinical risk factors cannot be avoided or influenced therapeutically due to a lack of potentially curative treatment alternatives. In contrast potentially pathogenic bacilli associated with leakage can be prevented from coming in contact with anastomoses thereby preventing infection and leakage.