Induction Mapping of the 3D-Modulated Spin Texture of Skyrmions in Thin Helimagnets.

Envisaged applications of Skyrmions in magnetic memory and logic devices crucially depend on the stability and mobility of these topologically nontrivial magnetic textures in thin films. We present for the first time quantitative maps of the magnetic induction that provide evidence for a 3D modulation of the Skyrmionic spin texture. The projected in-plane magnetic induction maps as determined from in-line and off-axis electron holography carry the clear signature of Bloch Skyrmions. However, the magnitude of this induction is much smaller than the values expected for homogeneous Bloch Skyrmions that extend throughout the thickness of the film. This finding can only be understood if the underlying spin textures are modulated along the out-of-plane z direction. The projection of (the in-plane magnetic induction of) helices is further found to exhibit thickness-dependent lateral shifts, which show that this z modulation is accompanied by an (in-plane) modulation along the x and y directions.

Hospitalised cancer patients' perceptions of individualised nursing care in four European countries.

The aim of this study was to describe hospitalised cancer patients' perceptions of individualised care in four European countries and compare these perceptions using the patients' socio-demographic characteristics and the Individualized Care Scale. The patients' socio-demographic characteristics used were: education, age, gender, type of hospital admission, previous hospitalisation and hospital length of stay. The Individualized Care Scale has two parts (1) nurses' support of individuality and (2) patients' receipt of individuality. Data (n = 599) were collected in Cyprus (n = 150), Finland (n = 158), Greece (n = 150) and Sweden (n = 141). Multivariate analysis of variance models were constructed and differences in perceptions of individualised care were analysed using the patients' socio-demographic characteristics as covariates. The level of support for individuality and receipt of individualised care was reported as moderate and good respectively. Generally, the highest assessments were made by the Swedish respondents and the lowest by those in Greece. This study revealed some between-country differences in patients' perceptions of care individualisation. These differences, for example, conceptual, educational, based in clinical practice or in the health organisation, require further research. Enquiry into the individualised care perceptions of health care providers and the families of cancer patients would also be useful.

Stabilized Skyrmion Phase Detected in MnSi Nanowires by Dynamic Cantilever Magnetometry.

Using dynamic cantilever magnetometry we measure an enhanced skyrmion lattice phase extending from around 29 K down to at least 0.4 K in single MnSi nanowires (NWs). Although recent experiments on two-dimensional thin films show that reduced dimensionality stabilizes the skyrmion phase, our results are surprising given that the NW dimensions are much larger than the skyrmion lattice constant. Furthermore, the stability of the phase depends on the orientation of the NWs with respect to the applied magnetic field, suggesting that an effective magnetic anisotropy, likely due to the large surface-to-volume ratio of these nanostructures, is responsible for the stabilization. The compatibility of our technique with nanometer-scale samples paves the way for future studies on the effect of confinement and surfaces on magnetic skyrmions.

Collaboration between hospital and primary care nurses: a literature review.

BACKGROUND: Nurses play an important role in the treatment and care of adults in both hospital and primary health care working within complex and fragmented organizational systems. As the nature of health care changes and hospital and primary care sectors become more closely associated, nurses in both sectors have an obligation to increase their collaboration. AIMS: This study aimed to increase the understanding of collaboration between nurses working with adults in hospital and primary health care, and to facilitate the future measurement of this collaboration. METHODS: A literature review was undertaken in July and August 2013 using CINAHL and MEDLINE databases from the earliest to August 2013. The searches produced 4951 citations that were reduced to 22 articles for review using a four-step inclusion strategy. Inductive content analysis was used to analyse the data. RESULTS: It is suggested that collaboration is a process that contains (1) collaboration precursors: the opportunity to participate, knowledge and shared objectives; (2) elements of collaboration: competency, awareness and understanding of work roles and interaction; and (3) processes and outcomes: the events or behaviours that are the consequences of the collaboration between hospital and primary healthcare nurses. CONCLUSIONS: The results indicate that collaboration between hospital and primary healthcare nurses is an important and integral part of the work of nurses and a process consisting of several predictable issues leading to useful care outcomes. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Current healthcare changes make it a requirement for hospital and primary healthcare nurses to collaborate when working with adults to continue to meet the needs of patients. The findings of this study can be used to improve collaboration in practice and to devise research to improve collaboration between hospital and primary healthcare nurses.

Molecular subtype and tumor characteristics of breast cancer metastases as assessed by gene expression significantly influence patient post-relapse survival.

BACKGROUND: We and others have recently shown that tumor characteristics are altered throughout tumor progression. These findings emphasize the need for re-examination of tumor characteristics at relapse and have led to recommendations from ESMO and the Swedish Breast Cancer group. Here, we aim to determine whether tumor characteristics and molecular subtypes in breast cancer metastases confer clinically relevant prognostic information for patients. PATIENTS AND METHODS: The translational aspect of the Swedish multicenter randomized trial called TEX included 111 patients with at least one biopsy from a morphologically confirmed locoregional or distant breast cancer metastasis diagnosed from December 2002 until June 2007. All patients had detailed clinical information, complete follow-up, and metastasis gene expression information (Affymetrix array GPL10379). We assessed the previously published gene expression modules describing biological processes [proliferation, apoptosis, human epidermal receptor 2 (HER2) and estrogen (ER) signaling, tumor invasion, immune response, and angiogenesis] and pathways (Ras, MAPK, PTEN, AKT-MTOR, PI3KCA, IGF1, Src, Myc, E2F3, and ß-catenin) and the intrinsic subtypes (PAM50). Furthermore, by contrasting genes expressed in the metastases in relation to survival, we derived a poor metastasis survival signature. RESULTS: A significant reduction in post-relapse breast cancer-specific survival was associated with low-ER receptor signaling and apoptosis gene module scores, and high AKT-MTOR, Ras, and ß-catenin module scores. Similarly, intrinsic subtyping of the metastases provided statistically significant post-relapse survival information with the worst survival outcome in the basal-like [hazard ratio (HR) 3.7; 95% confidence interval (CI) 1.3-10.9] and HER2-enriched (HR 4.4; 95% CI 1.5-12.8) subtypes compared with the luminal A subtype. Overall, 25% of the metastases were basal-like, 32% HER2-enriched, 10% luminal A, 28% luminal B, and 5% normal-like. CONCLUSIONS: We show that tumor characteristics and molecular subtypes of breast cancer metastases significantly influence post-relapse patient survival, emphasizing that molecular investigations at relapse provide prognostic and clinically relevant information. CLINICALTRIALS.GOV: This is the translational part of the Swedish multicenter and randomized trial TEX, clinicaltrials.gov identifier nct01433614 (http://www.clinicaltrials.gov/ct2/show/nct01433614).

Proteomics analysis of melanoma metastases: association between S100A13 expression and chemotherapy resistance.

BACKGROUND: Disseminated cutaneous malignant melanoma (CMM) is commonly unresponsive to standard chemotherapies, and there are as yet no predictive markers of therapy response. METHODS: In the present study we collected fresh-frozen pretreatment lymph-node metastasis samples (n=14) from melanoma patients with differential response to dacarbazine (DTIC) or temozolomide (TMZ) chemotherapy, to identify proteins with an impact on treatment response. We performed quantitative protein profiling using tandem mass spectrometry and compared the proteome differences between responders (R) and non-responders (NR), matched for age, gender and histopathological type of CMM. RESULTS: Biological pathway analyses showed several signalling pathways differing between R vs NR, including Rho signalling. Gene expression profiling data was available for a subset of the samples, and the results were compared with the proteomics data. Four proteins with differential expression between R and NR were selected for technical validation by immunoblotting (ISYNA1, F13A1, CSTB and S100A13), and CSTB and S100A13 were further validated on a larger sample set by immunohistochemistry (n=48). The calcium binding protein S100A13 was found to be significantly overexpressed in NR compared with R in all analyses performed. CONCLUSIONS: Our results suggest that S100A13 is involved in CMM resistance to DTIC/TMZ.

Nurses' knowledge about venous leg ulcer care: a literature review.

INTRODUCTION: There is an increasing prevalence of venous leg ulcers coinciding with increasing older people populations. They are therefore important health problems, which restrict daily activities and incur high costs. BACKGROUND: Efficient and comprehensive nursing care for people with venous leg ulcers requires knowledge of causes, presentations and characteristics, the effects that venous leg ulcers have on individuals and nursing care with evidence-based treatment. AIM: To identify the gaps between nurses' demonstrated knowledge of venous leg ulcers and the related nursing care treatment with evidence-based nursing care. METHOD: A computerized search using MEDLINE, CINAHL the COCHRANE LIBRARY was conducted. RESULTS: The initial search yielded 174 citations from which 16 relevant articles were included in this review. Four themes in venous leg ulcer nursing care emerged demonstrating nurses' knowledge gaps: assessment, physiology and the healing process, nursing care and dressings, and compression treatment. CONCLUSION: This review suggests that there is a lack of knowledge related to venous leg ulcer physiology, the healing process and how this influences care and treatment. Nurses may not be using the evidence base sufficiently well to support ulcer healing and patient well-being. IMPLICATIONS FOR NURSING AND HEALTH POLICY: There is a need for a positive work culture development and ongoing educational programmes aimed at improving nurses' knowledge of venous leg ulcer treatment and care, which address the themes within the results of this review.

Development and application of multi-proxy indices of land use change for riparian soils in southern New England, USA.

Understanding the effects of land use on riparian systems is dependent upon the development of methodologies to recognize changes in sedimentation related to shifts in land use. Land use trends in southern New England consist of shifts from forested precolonial conditions, to colonial and agrarian land uses, and toward modern industrial-urban landscapes. The goals of this study were to develop a set of stratigraphic indices that reflect these land use periods and to illustrate their applications. Twenty-four riparian sites from first- and second-order watersheds were chosen for study. Soil morphological features, such as buried surface horizons (layers), were useful to identify periods of watershed instability. The presence of human artifacts and increases in heavy metal concentration above background levels, were also effective indicators of industrial-urban land use periods. Increases and peak abundance of non-arboreal weed pollen (Ambrosia) were identified as stratigraphic markers indicative of agricultural land uses. Twelve 14C dates from riparian soils indicated that the rise in non-arboreal pollen corresponds to the start of regional deforestation (AD 1749 +/- 56 cal yr; mean +/- 2 SD) and peak non-arboreal pollen concentration corresponds to maximum agricultural land use (AD 1820 +/- 51 cal yr). These indices were applied to elucidate the impact of land use on riparian sedimentation and soil carbon (C) dynamics. This analysis indicated that the majority of sediment and soil organic carbon (SOC) stored in regional riparian soils is of postcolonial origins. Mean net sedimentation rates increased -100-fold during postcolonial time periods, and net SOC sequestration rates showed an approximate 200-fold increase since precolonial times. These results suggest that headwater riparian zones have acted as an effective sink for alluvial sediment and SOC associated with postcolonial land use.

In situ ground water denitrification in stratified, permeable soils underlying riparian wetlands.

The ground water denitrification capacity of riparian zones in deep soils, where substantial ground water can flow through low-gradient stratified sediments, may affect watershed nitrogen export. We hypothesized that the vertical pattern of ground water denitrification in riparian hydric soils varies with geomorphic setting and follows expected subsurface carbon distribution (i.e., abrupt decline with depth in glacial outwash vs. negligible decline with depth in alluvium). We measured in situ ground water denitrification rates at three depths (65, 150, and 300 cm) within hydric soils at four riparian sites (two per setting) using a 15N-enriched nitrate "push-pull" method. No significant difference was found in the pattern and magnitude of denitrification when grouping sites by setting. At three sites there was no significant difference in denitrification among depths. Correlations of site characteristics with denitrification varied with depth. At 65 cm, ground water denitrification correlated with variables associated with the surface ecosystem (temperature, dissolved organic carbon). At deeper depths, rates were significantly higher closer to the stream where the subsoil often contains organically enriched deposits that indicate fluvial geomorphic processes. Mean rates ranged from 30 to 120 microg N kg(-1) d(-1) within 10 m versus <1 to 40 microg N kg(-1) d(-1) at >30 m from the stream. High denitrification rates observed in hydric soils, down to 3 m within 10 m of the stream in both alluvial and glacial outwash settings, argue for the importance of both settings in evaluating the significance of riparian wetlands in catchment-scale N dynamics.

Identifying riparian sinks for watershed nitrate using soil surveys.

The capacity of riparian zones to serve as critical control locations for watershed nitrogen flux varies with site characteristics. Without a means to stratify riparian zones into different levels of ground water nitrate removal capacity, this variability will confound spatially explicit source-sink models of watershed nitrate flux and limit efforts to target riparian restoration and management. We examined the capability of SSURGO (1:15 840 Soil Survey Geographic database) map classifications (slope class, geomorphology, and/or hydric soil designation) to identify riparian sites with high capacity for ground water nitrate removal. The study focused on 100 randomly selected riparian locations in a variety of forested and glaciated settings within Rhode Island. Geomorphic settings included till, outwash, and organic/alluvial deposits. We defined riparian zones with "high ground water nitrate removal capacity" as field sites possessing both >10 m of hydric soil width and an absence of ground water surface seeps. SSURGO classification based on a combination of geomorphology and hydric soil status created two functionally distinct sets of riparian sites. More than 75% of riparian sites classified by SSURGO as organic/alluviumhydric or as outwash-hydric had field attributes that suggest a high capacity for ground water nitrate removal. In contrast, >85% of all till sites and nonhydric outwash sites had field characteristics that minimize the capacity for ground water nitrate removal. Comparing the STATSGO and SSURGO databases for a 64000-ha watershed, STATSGO grossly under-represented critical riparian features. We conclude that the SSURGO database can provide modelers and managers with important insights into riparian zone nitrogen removal potential.

Determination of etoposide in human plasma and leukemic cells by high-performance liquid chromatography with electrochemical detection.

This paper describes a high-performance liquid chromatographic method with electrochemical detection for the determination of etoposide levels in plasma, total and non-protein bound concentration, and in leukemic cells. The precision for between-runs (n=6) was 7.0, 4.9, and 9.5%, the accuracy was 3.7, 7.1 and 6.3%, and within-runs precision (n=6) was 3.9, 2.9 and 5.1% for total plasma, non-protein bound plasma fraction and leukemic cells, respectively. The correlation coefficients (R2) were 1.00 for all calibration curves. These assays have been applied to analyze samples from one patient with acute myelogenous leukemia during 24 h after i.v. infusion of etoposide (100 mg/m2).

Use of iron monocarboxylates in the two-step preparation of poly(ester-urethane)s.

Five different iron monocarboxylates were used as catalysts in the two-step preparation route of lactic acid based poly(ester-urethane)s (PEU). In the first step, a hydroxyl-terminated poly(lactic acid) prepolymer was prepared, which in the second step was linked with 1,6-hexamethylene diisocyanate. The resulting polymers were characterized by titration, size exclusion chromatography, differential scanning calorimetry, and nuclear magnetic resonance spectroscopy, and the mechanical properties were tested as well. Iron monocarboxylates proved to be efficient catalysts in the preparation of a hydroxyl-terminated prepolymer (lowest acid number obtained: 0.08). The same catalyst systems proved also to be highly efficient in the linking step yielding a high molar mass PEU. Semicrystalline PEUs could be prepared at 160 and 180 degrees C by using the iron acetate of different oxidation state. PEU prepared at 200 degrees C was amorphous, which could be related to racemization during the polycondensation. By using the fluorinated iron acetate amorphous PEUs was prepared at all reaction temperatures. The molar mass of the prepolymers and the PEUs increased as a function of the polycondensation temperature for all catalysts used. The highest weight-average molar masses (M(w)) were obtained by using the fluorinated iron acetate.

Plasma pharmacokinetics of etoposide (VP-16) after i.v. administration to children.

The pharmacokinetics of etoposide (VP-16), a semi-synthetic derivative of podophyllotoxin, were studied in 16 pediatric patients (median age 8.3 years; range 4 months to 22 years) including two girls with Down's syndrome (DS). The drug was administered as infusions (1-3 h) in a wide range of doses (9-322 mg, corresponding to 32-210 mg/m2). The area under the plasma concentration versus time curve (AUC), dose normalized by the body surface area, was independent of age, while AUC normalized by the dose in mg/kg increased with increasing age of the patients. The interpatient variability of AUC, normalized for the dose in mg/m2, was 23% (CV) compared to 32% (CV) normalized for the dose in mg/kg. The terminal half-life time was 4.1 h (median value; range 2.0-7.8 h). The pharmacokinetics of etoposide in children with DS and chromosomally normal children were very similar with regard to systemic drug exposure and plasma half-life time. From the pharmacokinetic point of view it was therefore not necessary to make any dose modifications in the two girls with DS. The two DS patients did not experience any enhanced degree of toxicity from their etoposide treatments. The results support that dosing of etoposide to children should be based on body surface area.

Factors affecting the validity of the standard blood pressure cuff.

Fifty-eight patients, 31 women and 27 men, with a wide range of upper arm circumferences (20-43 cm), ages (16-82 years) and body mass indices (16-55 kg m-2) were studied. The direct blood pressure was measured in the brachial artery in one arm and simultaneously the indirect pressure was measured in the other arm using a large standard cuff (rubber bag 12 x 35 cm). The mean intra-arterial blood pressure was (systolic/diastolic) 137 +/- 25 mmHg (SD)/76 +/- 10 mmHg. With the cuff the mean blood pressure was 134 +/- 23 mmHg/85 +/- 11 mmHg. The cuff significantly underestimated the systolic blood pressure (3.2 +/- 11.4 mmHg, range -25-30 mmHg) while the diastolic pressure was overestimated significantly (8.8 +/- 8.5 mmHg, range -32-14 mmHg). The direct/indirect blood pressure difference correlated significantly to the intra-arterial systolic and diastolic pressures (systolic/diastolic; r = 0.44, P = 0.0006/r = 0.36, P = 0.0062), but only to the auscultatory diastolic pressure (r = -0.02, P = 0.9/r = -0.45, P = 0.0004). The direct/indirect difference correlated significantly to the arm circumference (r = -0.33, P = 0.01/r = -0.30, P = 0.02) as did the diastolic direct/indirect difference to pulse rate (r = 0.34, P = 0.009). Age did not correlate significantly to the direct/indirect blood pressure difference in this study (r = -0.02, P = 0.9/r = -0.10, P = 0.5). It can be concluded that in addition to the ratio between the arm circumference and the width of the cuff (rubber bag), there are other sources of systematic errors of indirect blood pressure measurement, in particular pulse rate and the level of indirect blood pressure. If corrections could be made with regard to these variables, it is obvious that the reliability of the indirect method, especially when used in epidemiological contexts, would increase.

Improved accuracy of indirect blood pressure measurement in patients with obese arms.

We studied 20 patients with moderate to severe obesity (body mass index 37 +/- 8 kg/m2) with obese arms (arm circumference 37 +/- 4 cm). Their blood pressure was measured directly in the brachial artery in one arm and simultaneously indirectly in the other arm using either a large standard cuff (rubber bag 12 x 35 cm) or a new cuff (the Tricuff, Pressure Group AB, Stockholm) containing three rubber bags of different sizes, which automatically selected the appropriately sized bag in relation to arm circumference. Both cuffs showed a significant overestimation of the diastolic blood pressure (standard cuff 13 mm Hg, P < .001, Tricuff 6 mm Hg, P < .01). The error of the standard cuff was significantly greater than that of the Tricuff (P < .001). The differences in systolic blood pressure between the intraarterially and the indirectly measured results were small (0.2 to 3 mm Hg) and not statistically significant with either cuff. The new Tricuff offered an advantage as compared to a large standard cuff in terms of a lesser overestimation of the diastolic blood pressure. In practical terms, this should lead to a reduction in the overestimation of diastolic hypertension in obese individuals.

Is blood pressure measurement with a standard cuff reliable?

This study compares blood pressures measured with a standard cuff (rubber bag 12 x 35 cm) with concomitantly measured intra-arterial pressures in 48 subjects. With the standard cuff, and using a diagnostic cut-off limit for diastolic hypertension of 90 mmHg, 15/48 patients were found to be hypertensive, whereas only 4/48 had intraarterial pressure above 90 mmHg. Thus, the specificity of the non-invasive method was only 75%. If higher diagnostic cut-off limits were used, e.g. 95 mmHg, specificity increased to 84%, and with lower cut-offs specificity was 63% for 85 mmHg and 52% for 80 mmHg. A specificity of only 75% is very poor for a method commonly used in screening examinations and may lead to considerable over-diagnosis of mild hypertension.

The reliability of auscultatory measurement of arterial blood pressure. A comparison of the standard and a new methodology.

In 48 individuals with a wide range of arm circumferences blood pressure measured indirectly with two different cuffs was compared to direct intraarterial measurements. The two cuffs were a standard size cuff (12 X 35 cm) and a newly developed cuff, containing three rubber bags of different sizes, which automatically selects the appropriately sized bag in relation to arm circumference (Tricuff, Pressure Group AB, Sweden). The Tricuff correctly placed 42 of the 43 patients in the "normotensive" range, ie, diastolic blood pressure less than 90 mm Hg, whereas the standard cuff put only 33 of 44 patients in this range (P less than .005). The discrepancy was not only due to the expected better performance in patients with obese arms, but also in the subgroup of patients with arms in the range 22 to 31 cm, in which group both cuffs would measure blood pressure with a 12 cm wide rubber bag. The number of correctly identified "normotensive" patients was noticeably higher with the Tricuff than with the standard cuff (30/31 v 25/32, P = .053). The better specificity of the new cuff thus offers an improvement over the standard cuff. There are several potential clinical advantages of this, mainly that the risk of erroneously labelling normotensive individuals as hypertensive is reduced.