Caring for patients with brain tumor: the patient and care giver perspectives.

BACKGROUND: Patients with brain tumors form a heterogeneous group in terms of clinical presentation and pathology. However, the impact of the disease on patients' families is often more homogenous and frequently quite profound. A considerable body of literature is available on the management of brain tumors and recently, the National Institute for Clinical Excellence has developed guidelines on the care of brain tumor patients that should improve the overall outcome for the patient from both the disease and psychological aspects. OBJECTIVES: An increasing number of studies have attempted to address the impact of the disease on the care givers and relatives of these patients, but few have considered the problem simultaneously from both the patient's and care giver's perspective. In this study, we analyzed the psychosocial and general health of brain tumor patients and related this to the care givers. MATERIALS AND METHODS: This is a questionnaire-based postal survey of 168 patients and their relatives. We examined how the health and psychological well-being of the caregiver may affect the quality of care. RESULTS: There is significant physical, social, and psychosocial morbidity associated with caring for brain tumor patients. Patients worry about their care givers and this constitutes additional stress for the patient. CONCLUSIONS: No constructive and lasting improvement can be made to the quality of life of patients with brain tumor until the health and welfare of their care givers are factored into the care package. With better service to the patient, it is hoped that the burden of care will lighten for the care givers.

Humidity and illumination organic semiconductor copper phthalocyanine sensor for environmental monitoring.

In this investigation properties of organic semiconductor copper phthalocyanine (CuPc) capacitive humidity and illumination sensors were studied. Organic thin film was deposited by vacuum evaporation on a glass substrate with silver surface-type electrodes to form the Ag/CuPc/Ag sensor. The capacitance of the samples was evaluated at room temperature in the relative humidity range of 35-92%. It was observed that capacitance of the Ag/CuPc/Ag sensor increases with increase in humidity. The ratio of the relative capacitance to relative humidity was about 200. It is assumed that in general the capacitive response of the sensor is associated with polarization due to absorption of water molecules and transfer of charges (electrons and holes). It was observed that under filament lamp illumination of up to 1,000 lx the capacitance of the Ag/CuPc/Ag photo capacitive detectors increased continuously by 20% as compared to dark condition. It is assumed that photo capacitive response of the sensor is associated with polarization due to transfer of photo-generated electrons and holes. An equivalent circuit of the Ag/CuPc/Ag capacitive humidity and illumination sensor was developed. Humidity and illumination dependent capacitance properties of this sensor make it attractive for use in humidity and illumination multi-meters. The sensor may be used in instruments for environmental monitoring of humidity and illumination.

Post-treatment of a slaughterhouse wastewater: stability of the microbial community of a sequencing batch reactor operated under oxygen limited conditions.

Slaughterhouse wastewater is a complex effluent with an important content of organic nitrogen. After an anaerobic treatment where most of the organic matter is removed, the nitrogen, remains as ammonium and post-treatment of the effluent is necessary. Sequencing batch reactor (SBR) technology has been developed to completely remove nitrogen in one single reactor combining aerobic and anoxic stages. Under oxygen limited conditions only nitrite is produced with concomitant energy saving. The stability and diversity of the microbial community from a nitrifying denitrifying SBR operated under oxygen limited conditions were studied using molecular and respirometric methods. The AOB (ammonia oxidizing bacteria) community was relatively stable Nitrosomonas being the dominant genera although Nitrosospira and Nitrosococcus were detected in low proportions. Nitrite oxidizing bacteria were out competed during the operation under oxygen-limited conditions. After an increase of the DO in the reactor Nitrobacter spp were detected suggesting that they remained in the system. Changes in the AOB and denitrifying communities were observed after the DO increase. Sedimentation problems were detected during operation, this could be related to the predominance of Thauera spp detected by FISH and T-RFLP.

The impact of care on carers of patients treated for aneurysmal subarachnoid haemorrhage.

Over the last decade there has been an increasing awareness that psychosocial problems may persist in patients who have made apparently good recoveries after aneurysmal subarachnoid haemorrhage (ASAH). The caregivers of these patients are often relatives and it is becoming apparent that these carers frequently suffer psychosocial stress with associated morbidity. Previous studies have looked primarily at patients and few have included carers. We exclusively studied carers using simple validated questionnaires. We measured the effect on general and psychosocial health of the carers of patients treated for ASAH, 2-3 years after discharge. The majority of the carers (88.1%) were close relatives; 53.8% were experiencing social or emotional stress and 46.4% of these felt completely overwhelmed. The level of stress correlated positively with management complications, but not site of aneurysm or other aspects of treatment. We conclude that there is an argument for priority assistance for those carers predicted to be vulnerable to stress.

Putting portfolios in their place.

This paper discusses the use of portfolios in nursing education and sets this in an international context. It argues that the assessment of clinical competence in the practice setting is inherently problematic, as recognized in certain recent policy documents, and evaluates the role that portfolios can play. A number of theoretical approaches to the definition and use of portfolios are discussed, and particular attention is paid to their reliability and validity as assessment tools. The paper concludes by arguing that there is a need for further research into the credibility, reliability and validity of this approach to the assessment of nurses' competence.

Spiritual coping strategies: a review of the nursing research literature.

AIMS OF THE PAPER: This paper reviews some of the limited nursing research-based literature, orientated towards the use of spiritual coping strategies in illness. This review aims at identifying those spiritual coping strategies used by the believers and nonbelievers followed by implications for holistic nursing care. LITERATURE SEARCH: The CINAHL and MEDLINE CD Rom databases were searched, identifying literature published from 1975 onwards which amounted to 187 articles. The majority of the literature traced were found anecdotal with only few studies investigating directly spiritual coping strategies. Following scrutiny of the available articles, only five research studies explored directly the spiritual coping strategies used in various illness, four of which were conducted in USA and one in UK. Because of the small scale research studies, generalization of the findings of this review is limited to the samples used. THEORETICAL BACKGROUND: Research suggests that spiritual coping strategies, involving relationship with self, others, Ultimate other/God or nature were found to help individuals to cope with their ailments. This may be because of finding meaning, purpose and hope, which may nurture individuals in their suffering. Spirituality is oftenly referred by literature as being synonymous with religiosity. Thus the use of spiritual coping strategies is restricted to individuals who hold religious beliefs. However, the definition of spirituality indicates that this concept is broader than religiosity. The theories on stress-coping (Folkman & Lazarus 1984) and the numinous experience (Otto 1950) outline the rationale for the use of these strategies which are applicable to both the believers and nonbelievers. IMPLICATIONS: This review suggests that the onset of illness may render the individual, being a believer or nonbeliever to realize the lack of control over his/her life. However the use of spiritual coping strategies may enhance self-empowerment, leading to finding meaning and purpose in illness. This implies that holistic care incorporates facilitation of various spiritual coping strategies to safeguard the wholeness and integrity of the patients.

Birth order, sibling investment, and fertility among Ju/'Hoansi (!Kung).

Birth order has been examined over a wide variety of dimensions in the context of modern populations. A consistent message has been that it is better to be born first. The analysis of birth order in this paper is different in several ways from other investigations into birth order effects. First, we examine the effect of birth order in an egalitarian, small-scale, kin-based society, which has not been done before. Second, we use a different outcome measure, fertility, rather than outcome measures of social, psychological, or economic success. We find, third, that being born late in an egalitarian, technologically simple society rather than being born early has a positive outcome on fertility, and fourth, that number of older siblings and sibling set size are even stronger predictors of fertility, especially for males.

The outer parts of the mycobacterial envelope as permeability barriers.

The permeability of mycobacteria to substances in their environment is controlled by the properties of their envelopes. Two special features are important: an outer lipid barrier based on a monolayer of characteristic mycolic acids and a capsule-like coat of polysaccharide and protein. The mycolate layer prevents entry of small hydrophilic molecules, which obtain access to the cell by way of pore-forming proteins resembling porins of Gram-negative bacteria. More lipophilic molecules can diffuse through the lipid layer. The capsule probably impedes access by macromolecules; in intracellular pathogenic species it forms the electron-transparent zone that separates the bacterium from the membrane of the host phagosome. The structure of the outer lipid barrier seems common to all mycobacteria, fast- and slow-growing, but the capsule is more abundant in slow-growing species, a group which includes all the important mycobacterial pathogens. Mycobacteria secrete proteins into their environment, which are likely to be important in the pathogenesis of mycobacterial diseases. Knowledge of how these proteins, and the polysaccharides of the capsule, cross the outer lipid barrier is minimal at present. It is likely that proper knowledge of mycobacterial permeability will enable new approaches to treatment of mycobacterial disease.

Expression of a gene for a porin-like protein of the OmpA family from Mycobacterium tuberculosis H37Rv.

An open reading frame in the genomic database of Mycobacterium tuberculosis H37Rv was identified as having homology with an outer membrane protein. We found that the gene specified a protein belonging to the OmpA family, which includes some porins of gram-negative organisms. The gene was amplified by PCR and cloned into Escherichia coli. Overexpression of the gene was toxic to the host, but limited amounts could be purified from cells before growth ceased. A truncated gene devoid of the code for a presumed signal sequence was well expressed, but the protein had no pore-forming activity in the liposome swelling assay. However, the intact protein, OmpATb, behaved as a porin of low specific activity, with a pore diameter of 1.4 to 1.8 nm, and was also active in planar lipid bilayers, showing a single-channel conductance of 700 pS. The protein had a molecular mass of about 38 kDa in sodium dodecyl sulfate-polyacrylamide gel electrophoresis. A polyclonal rabbit antiserum raised to the truncated protein recognized a protein of similar molecular mass in detergent extracts of broken M. tuberculosis cells. Reverse transcription-PCR confirmed that the gene for OmpATb was expressed in M. tuberculosis cells growing in culture. Comparison of the purified protein with that in the detergent-extracted preparation using liposomes and planar lipid bilayers showed that the two materials had similar pore-forming properties. OmpATb is different from either of the mycobacterial porins described so far. This is the first report of a porin-like molecule from M. tuberculosis; the porin is likely to be important in controlling the access of hydrophilic molecules to the bacterial cell.

The debates emerging from the literature surrounding the concept of spirituality as applied to nursing.

This paper explores three debates surrounding the growing concept of spirituality as applied to nursing: 'Spirituality: in pursuit of conceptual and theoretical unity'; 'The demise of spirituality and the rise of secularism within nursing'; and 'Spirituality: a unifying force at the foundation of holistic philosophy'. The debates reveal the complex and diverse nature of spirituality suggesting that there is no single authoritative definition. The debates challenge the nursing profession to develop a definition of spirituality which is broad enough to accommodate the uniqueness of all individuals.

The envelope layers of mycobacteria with reference to their pathogenicity.

The review discusses current knowledge of the biosynthesis, composition and arrangement of the mycobacterial envelope, describes the biological activities of the constituents and considers how these activities may be relevant to the pathology of mycobacterial disease. The envelope possesses three structural components: plasma membrane, wall and capsule. Although the major biomolecules occurring in each of these parts are known, the distribution of numerous minor substances is poorly understood; an attempt has been made to assign them to particular positions on rational grounds. The plasma membrane appears to be a typical bacterial membrane but, though vital to the mycobacterium, probably plays little part in pathological processes. The wall partly resembles a Gram-positive wall, but is unusual in having a layer of lipid (mycolate esters) which is probably arranged to form a permeability barrier to polar molecules. The capsule, whose chemical composition has only recently been recognized, consists of polysaccharide and protein with traces of lipid; the arrangement of these components is imperfectly understood. Constituents of all parts of the envelope have biological activities which may be relevant. The likely importance of these activities in the overall effect of the envelope is considered.

Venous gas embolism--a comparison of carbon dioxide and helium in pigs.

PURPOSE: The use of helium for insufflation during laparoscopic surgery avoids hypercarbia and acidosis associated with absorbed CO2, but the effects of helium gas embolism are unknown. We compared the effects of CO2 with He gas embolism on survival, haemodynamic variables, oxygenation, and ventilation in pigs. METHODS: Anaesthetized juvenile pigs were given progressively larger boluses of either CO2 (n = 5) or He (n = 4) into the right atrium. Measurements of haemodynamic variables, oxygenation, and PETCO2 were made before and after each gas injection. RESULTS: All animals survived injection of 300 ml CO2 while no animal survived more than 120 ml He (P < 0.01). Mean arterial pressure decreased more after 60 ml He (99 +/- 14 to 44 +/- 20 mmHg) than after 60 ml CO2 (110 +/- 12 to 88 +/- 14 mmHg, P < 0.001). Cardiac output did not change at any injection volume. The PETCO2 decreased more after 60 ml He (30 +/- 2 to 3 +/- 6 mmHg) than after 60 ml CO2 (35 +/- 3 to 30 +/- 3 mmHg, P < 0.001). Only the He group showed a decrease in PaO2 (190 +/- 51 to 68 +/- 22 mmHg at 60 ml, P < 0.05). CONCLUSION: Helium gas embolism has a greater deleterious effect than CO2 gas embolism on survival, MAP, PETCO2, and PaO2. These different effects of gas embolism should be recognized when considering the use of helium or other insoluble gases for abdominal laparoscopic insufflation.

The spiritual dimension: why the absence within nursing curricula?

This article explores the complex barriers which may have prevented the formal integration of the spiritual dimension within programmes of nurse education in the UK. These barriers have been termed intrinsic (arising from within the educational institutions themselves) and extrinsic (reflecting society's and individuals' values, beliefs and cultural norms). It is argued that these barriers have slowed down curriculum innovation and change, preventing the spiritual dimension from receiving due recognition within programmes of nurse education.

Galactosamine in walls of slow-growing mycobacteria.

Galactosamine was found consistently as a minor component of the envelope of five species of slow-growing mycobacteria, including all the major human pathogens, but not three rapid-growing species. The amino sugar was a component of the arabinogalactan of the cell wall skeleton, and occurred at the level of about one residue per arabinogalactan chain. Its amino group was in the free, un-N-acetylated state. Examination of oligosaccharides released by partial acid hydrolysis of arabinogalactan by fast atom bombardment-MS and gas chromatography-MS identified a series of oligoarabinans, each possessing one GalN unit, linked to position 2 of arabinose. It is proposed that the GalN residues occur as stub branches of 1-->5-linked arabinose chains in the arabinogalactan. Possible functions of GalN are discussed.

Cultural correlates of self perceived health status among Chinese elderly.

This study examines self-perceived physical and mental health among 213 Chinese elderly who visited the Geriatric Outpatient Clinic of Beijing Hospital, the People's Republic of China. The study hypothesizes that cultural factors, specified by family relations, along with demographic factors, number of diseases, economic well-being, and living conditions have a significant impact on subjects self-perceived health status. Pearson correlation, linear and logistic regression analyses are performed. Results indicate that age, number of diseases, perceived family respect, neighborhood relations, and percentage of income spent on rent are significant predictors of self-perceived physical health. These same factors plus preference to live with a son and personal monthly income are significant predictors of self-perceived mental health. Socio-cultural implications of these findings are examined.

Compromise, massive encouragement and forcing: a discussion of mechanisms used to limit the choices available to the older adult in hospital.

This paper gives a partial account of the findings of a qualitative research project concerning the quality of life of older people in nursing homes and hospital wards. Using strategies of ethnographic interview and hermeneutical analysis, 14 older people and 11 nurses were asked to discuss issues relating to the quality of life. Nursing staff said that older people should be treated as individuals. In practice, this meant that they should be given freedom of choice in matters concerning the conduct of their daily lives. Paradoxically, some nurses were also prepared to describe a range of tactics by which they deny older people choice in various circumstances. These tactics are (i) coming to a compromise; (ii) massive encouragement; and (iii) forcing. The ways in which the staff justify these tactics are examined and evaluated.