ABSTRACT
The heavy fermion paramagnet UTe2 exhibits numerous characteristics of spin-triplet superconductivity. Efforts to understand the microscopic details of this exotic superconductivity have been impeded by uncertainty regarding the underlying electronic structure. Here we directly probe the Fermi surface of UTe2 by measuring magnetic quantum oscillations in pristine quality crystals. We find an angular profile of quantum oscillatory frequency and amplitude that is characteristic of a quasi-2D Fermi surface, which we find is well described by two cylindrical Fermi sheets of electron- and hole-type respectively. Additionally, we find that both cylindrical Fermi sheets possess considerable undulation but negligible small-scale corrugation, which may allow for their near-nesting and therefore promote magnetic fluctuations that enhance the triplet pairing mechanism. Importantly, we find no evidence for the presence of any 3D Fermi surface sections. Our results place strong constraints on the possible symmetry of the superconducting order parameter in UTe2.
ABSTRACT
BACKGROUND: Despite recent studies failing to demonstrate the value of routine chest radiography (CXR) in the initial evaluation of the febrile neutropenic patient with cancer, this screening test is advocated by some experts. We evaluated the benefits of CXR for early diagnosis of pulmonary infection at St. Jude Children's Research Hospital (SJCRH) with emphasis on early recognition of mould infections. PATIENTS AND METHODS: We reviewed the courses of 200 consecutive febrile neutropenic pediatric patients to determine if routine CXR at initial evaluation was useful in the identification of clinically occult pneumonia. We also reviewed all cases of proven or probable mould infections from the opening of SJCRH in 1962 until 1998 when routine CXR was no longer practiced in our institution to identify cases that were first recognized by routine CXR. RESULTS: Of 200 febrile neutropenic patients, pulmonary abnormalities consistent with pneumonia were detected by routine CXR in only five patients without pulmonary signs or symptoms. In only one case was a change in management considered. Of the 70 patients with pulmonary mould infection identified from 1962 to 1998, routine CXR was performed in 45 patients at the onset of a febrile, neutropenic episode in which a mould infection was diagnosed. Routine CXR was pivotal in the recognition of the mould infection in only two cases over this 36-year period. CONCLUSION: CXR is warranted in the evaluation of the newly febrile neutropenic pediatric oncology patient only when respiratory signs or symptoms are present.
Subject(s)
Fever , Fungi , Lung/diagnostic imaging , Mycoses/diagnostic imaging , Neutropenia , Pneumonia/diagnostic imaging , Adolescent , Adult , Child , Child, Preschool , Early Diagnosis , Female , Humans , Infant , Male , Medical Audit , Radiography , Young AdultABSTRACT
The acute care nurse practitioner (ACNP) is a unique advanced practice nursing role that has expanded since the first national certification examination became available in 1995. This article reports on the results of year 2 of an annual survey of ACNPs as part of a 5-year longitudinal study exploring ACNP role development. Responses from 545 ACNPs 2 years after national certification reveal continued development and challenges in practice. Role components continue to highlight the comprehensive care model of ACNP practice in terms of coordination of patient care, interactions with family members, consultation, and discharge planning. Important issues identified by participants including the need for clinical experience, the importance of negotiation, and networking also are discussed.
Subject(s)
Nurse Practitioners , Nurse's Role , Humans , Interprofessional Relations , Longitudinal Studies , Professional Practice Location , Salaries and Fringe Benefits , United StatesABSTRACT
The monitoring of outcomes is an essential component in evaluating healthcare, yet in critical illness, outcome assessments can be challenged by several factors. These factors include changing acuity levels, recurrent illness, readmission to hospitals, and patient attrition. Additional issues, particularly for elderly patients, include selecting appropriate outcome measures, overcoming barriers to patient recruitment for research, and using retention measures. This article explores issues in conducting outcomes research in acute care and uses a longitudinal prospective panel research study of elderly patients after critical illness as an example. Strategies are discussed that can be used in elderly subjects to facilitate accurate data collection in acute care outcomes research.
Subject(s)
Critical Care/organization & administration , Geriatric Nursing/organization & administration , Outcome Assessment, Health Care/methods , Acute Disease , Aged , Humans , Nursing Administration ResearchABSTRACT
This article reports on the results of an ongoing survey among acute care nurse practitioners (ACNPs) as part of a 5-year longitudinal study in progress exploring role aspects and issues in practice of this new practitioner in advanced practice nursing. The role of the ACNP is progressing, and responses from 619 ACNPs 1 year after they sought national certification reveal continued role development and role challenges, along with increased independence, autonomy, and confidence in practice. Implications for ACNP educational programs and suggestions for those contemplating pursuing an ACNP position as reported by study participants are also discussed.
Subject(s)
Acute Disease/nursing , Job Description , Nurse Practitioners/organization & administration , Adult , Certification , Data Collection , Employment/statistics & numerical data , Female , Humans , Job Satisfaction , Longitudinal Studies , Male , Middle Aged , Nurse Practitioners/education , Nurse Practitioners/psychology , Surveys and Questionnaires , United States , WorkloadABSTRACT
The measurement of outcomes has become an important component of evaluating health care. Although it is clear that measuring outcomes is necessary to establish the effectiveness of advanced practicing nursing, which outcome measures to use and how to conduct an effective outcomes assessment remain unclear. The purpose of this article is to present an overview of advanced practice nursing outcomes research, review outcome measures important to advanced practice nurses (APNs), and discuss sources of outcome measures and instruments that can be used by APNs to establish the effectiveness of the role.
Subject(s)
Nurse Clinicians/standards , Nurse Practitioners/standards , Nursing Evaluation Research/organization & administration , Outcome Assessment, Health Care/organization & administration , Acute Disease/nursing , Data Collection , HumansSubject(s)
Abnormalities, Multiple/surgery , Hematometra/diagnostic imaging , Hematometra/surgery , Kidney/abnormalities , Uterus/abnormalities , Abnormalities, Multiple/diagnostic imaging , Child , Drainage/methods , Female , Hematometra/complications , Humans , Kidney/diagnostic imaging , Laparoscopy , Postoperative Complications/surgery , Ultrasonography , Uterus/diagnostic imaging , Vaginal Diseases/complicationsABSTRACT
A new approach was used to test the readiness of an HA-coated implant for commencement of prosthetic procedures after two months of bone healing in humans. A torquing device was used for clinical measurement of the shear resistance of the supporting bone. It was found that the bone was capable of resisting a shear force just slightly greater than that which was necessary to produce displacement of implants placed in dog femurs with a comparable bone-healing period and with healing to full maturity. This report suggests that it may be feasible to uncover HA-coated implants after two months of bone healing.
Subject(s)
Dental Implants , Hydroxyapatites , Osseointegration , Dental Stress Analysis , Humans , Materials Testing , Rotation , Tensile Strength , Time FactorsABSTRACT
1. The purpose of the study was to see whether the rate of rise of alveolar PCO2 (PA, CO2) in expiration was directly proportional to the rate of pulmonary elimination of CO2 (VCO2) in man in the steady state. 2. Alveolar ventilation at rest and during exercise in man was calculated from the difference between total ventilation and dead space ventilation, and from the ratio of the rate of pulmonary CO2 elimination to the mean expired alveolar CO2 (total) fraction. The results were indistinguishable. In agreement with other workers' findings alveolar ventilation changed in direct proportion to the rate of carbon dioxide elimination, confirming the isocapnia of exercise ventilation in man. 3. The rate of rise of expiratory alveolar PCO2 in individual breaths has been obtained by two methods. In the first, a pattern of respiration with constant expiratory flow in each breath brought expiratory alveolar profiles to the outermost end of the airway. In the second method, the early part of the alveolar PCO2 during normal expiration was calculated from airway PCO2 and expired volume. 4. The data obtained with both methods show that, in the steady state, expiratory alveolar PCO2 rises at a rate which is directly proportional to the rate of CO2 production.
Subject(s)
Carbon Dioxide , Pulmonary Alveoli/physiology , Respiration , Female , Humans , Male , Partial Pressure , Physical Exertion , Pulmonary Ventilation , Respiratory Dead Space , Tidal Volume , Time FactorsABSTRACT
Eight patients with chronic severe asthma, poorly controlled by conventional doses of inhaled bronchodilator, were treated with high-dose inhaled terbutaline (4 mg four times daily), via either wet nebulisation of terbutaline respirator solution, or by tube-spacer aerosol, using cannisters delivering 1 mg terbutaline per metered dose. All patients improved objectively and subjectively on these higher dosage regimens during both day and night. A trial of high-dose inhaled beta2 sympathomimetic therapy should be considered in any patient with chronic severe asthma who fails to obtain benefit from standard doses of inhaled bronchodilator.
Subject(s)
Asthma/drug therapy , Terbutaline/administration & dosage , Aerosols , Aged , Female , Humans , Male , Middle Aged , Respiratory Therapy/instrumentation , Terbutaline/therapeutic useABSTRACT
The mechanisn of hydrolysis of acetylsalicylate during absorption from the gastrointestinl tract has been investigated by identification, quantitation, and purification of a hydrolase from gastric mucosal homogenates. The hydrolase was found to be a soluble, cytosolic enzyme with a pH optimum in the slightly alkaline range, pH 8.6 Acetylsalicylate hydrolase activity was purified from the 100,000 g supernatant fraction by differential (NH4)2SO4 fractionation followed by DEAE-cellulose ion-exchange chromatography and Sephadex or Sephacryl gel filtration. The activity could also be fractionated on hydroxylapatite. The Sephadex-purified fraction containing peak enzyme activity gave a single protein band on SDS-polyacrylamide gel electrophoresis. The molecular weight of the acetylsalicylate hydrolase was 66,400 based on SDS-polyacrylamide gel electrophoresis of the Sephadex-purified enzyme and 59,000 based on gel filtration. By use of the technique described, acetylsalicylate hydrolase can be purified over 100-fold to a specific activity of 10.6 mumol . mg-1 . min-1.
Subject(s)
Aspirin/metabolism , Carboxylic Ester Hydrolases/isolation & purification , Gastric Mucosa/enzymology , Animals , Chromatography, DEAE-Cellulose , Electrophoresis, Polyacrylamide Gel , Hydroxyapatites , In Vitro Techniques , L-Lactate Dehydrogenase/metabolism , Molecular Weight , RabbitsABSTRACT
A 27-year-old woman with a long history of scleroderma developed megacolon and severe fecal vomiting as a result of intestinal atony. Evacuation of fecal impaction with water-soluble contrast enema resulted in prompt relief of fecal vomiting and gradual return of bowel function.
