The agreement of the endoscopic Modified Lund-Kennedy scoring in a clinical research group: An observational study.

OBJECTIVES: The main objective was to prove the robustness of the modified Lund-Kennedy staging system and its use in the clinical research group. Secondary objectives were to evaluate the physicians' homogeneity, identify outliers with an unacceptable agreement and define factors for questionable agreement within the group of raters. MATERIAL AND METHODS: Anonymized endoscopic photos of patients with chronic rhinosinusitis were assessed by independent raters from a clinical research group. The level of agreement between raters was calculated using intra-class correlation and weighted kappa coefficient. Clusters of similarity were identified using Inter-Item Correlation Matrix. The weighted kappa coefficient was calculated for the most homogeneous group and outliers. Age, sex, consultancy years, combined clinical and research work assessed by 5 senior peers were also statistically compared between raters. RESULTS: Intraclass-correlation coefficients were 0.75 and 0.95 for respectively single and average measures. Single measures value for most homogenous raters was 0.97 (weighted kappa 0.88, (P<0.001). One outlier with less research work score had an unacceptable agreement for single measures coefficient values with the 2 most homogenous raters (respectively 0.59, weighted kappa 0.15, P=0.32 and 0.57, weighted kappa 0.197, P=0.32). Pooled groups were similar in age (P=0.3), sex (P=0.1) and consultancy years (P=0.2) but significantly differentiated in peer-assessed clinical and research work score (P<0.001). CONCLUSION: Even with a perfect overall agreement, careful examination of correlation matrix revealed an obvious outlier with less than ideal performance. The method may be helpful when studies using endoscopic staging system are designed to involve researchers from different backgrounds. When exploring the most common factors, education and clinical experience play a paramount role.

Energy enhancement of the target surface electron by using a 200 TW sub-picosecond laser.

One order of magnitude energy enhancement of the target surface electron beams with central energy at 11.5 MeV is achieved by using a 200 TW, 500 fs laser at an incident angle of 72° with a prepulse intensity ratio of 5×10-6. The experimental results demonstrate the scalability of the acceleration process to high electron energy with a longer (sub-picosecond) laser pulse duration and a higher laser energy (120 J). The total charge of the beam is 400±20 pC(E>2.7 MeV). Such a high orientation and mono-energetic electron jet would be a good method to solve the problem of the large beam divergence in fast ignition schemes and to increase the laser energy deposition on the target core.

Self-amplified photo-induced gap quenching in a correlated electron material.

Capturing the dynamic electronic band structure of a correlated material presents a powerful capability for uncovering the complex couplings between the electronic and structural degrees of freedom. When combined with ultrafast laser excitation, new phases of matter can result, since far-from-equilibrium excited states are instantaneously populated. Here, we elucidate a general relation between ultrafast non-equilibrium electron dynamics and the size of the characteristic energy gap in a correlated electron material. We show that carrier multiplication via impact ionization can be one of the most important processes in a gapped material, and that the speed of carrier multiplication critically depends on the size of the energy gap. In the case of the charge-density wave material 1T-TiSe2, our data indicate that carrier multiplication and gap dynamics mutually amplify each other, which explains-on a microscopic level-the extremely fast response of this material to ultrafast optical excitation.

A new hazard of cornstarch, an absorbable dusting powder.

Cornstarch is currently the only powder used in the manufacture of surgical and examination gloves. The purpose of this study was to determine if cornstarch damages local tissue defenses in contaminated wounds. It was found that in contaminated wounds, cornstarch enhanced the growth of bacteria and elicited exaggerated inflammatory responses as measured by wound induration. As a result of this investigation, we do not recommend the use of gloves with cornstarch powders.

Student clinical experiences in shelters for battered women.

This article describes the critical social problem of wife battering and clinical experiences for student nurses in shelters for battered women. The argument is presented that due to increasing frequency and severity, nurses must become more aware of and effective in caring for battered women and their children. In keeping with the call from nursing leaders and health care reformers, the shelter clinical experience provides students with an opportunity to shift from a focus on high technology to community-based primary care. Students are able to function as advocates, advisers, case managers, and health care teachers, and to focus on broad concerns of daily living problems. Lindeman's four recommendations for teaching in clinical settings were used as a framework for this article.

Gas-fired gravity floor furnace contact burns.

Infants and toddlers are at particular risk for contact burns from the registers of gas-fired floor furnaces. We report 11-month-old and 12-month-old boys who sustained the classic grid-like pattern of burns to their skin after contracting the registers of gas-fired floor furnaces. The depth of these burns were judged to be partial thickness and healed without the application of skin grafts. Manufacturers must devise safe registers for gas-fired furnaces that will not cause contact burn injuries.

Modification of TNF-alpha pharmacokinetics in SA-1 tumor-bearing mice.

Fibrosarcoma-SA-I-tumor-bearing mice were treated s.c. in the vicinity of tumors (peri-tumorally) or intravenously, with recombinant human TNF-alpha lacking 1 to 3 amino acids from N-terminal part (TNF-alpha Nv3). Tumor growth delay, observed after both routes of TNF-alpha Nv3 application, was statistically significant, though a better anti-tumor effect was achieved after peri-tumoral application. TNF-alpha Nv3 serum levels were determined in these animals and compared with TNF-alpha Nv3 serum levels in healthy animals, which were treated with TNF-alpha Nv3 either s.c. or i.v. The peak serum levels of TNF-alpha Nv3 applied peri-tumorally/s.c. were significantly higher in tumor-bearing than in healthy mice, whereas smaller differences in peak serum levels were found after i.v. application, which might correlate with anti-tumor activity. Whatever the route of application, TNF-alpha Nv3 elimination from the serum of tumor-bearing mice was slower than that in healthy animals. Also, comparison of TNF-alpha Nv3 pharmacokinetic parameters for tumor-free and sarcoma- or melanoma-bearing mice has demonstrated that the pharmacokinetics of TNF-alpha Nv3 are modified in tumor-bearing animals.

Empowerment support with adult female survivors of childhood incest: Part II--Application of Orem's methods of helping.

This report addresses the integration and application of empowerment support with Orem's methods of helping, which include (1) providing a developmental environment, (2) psychological support, (3) guiding another, and (4) teaching another. Empowerment support is viewed as basic helping methods (supportive psychotherapy) for the psychiatric nurse to use with adult female survivors of childhood incest.

Empowerment support with adult female survivors of childhood incest: Part I--Theories and research.

This report is concerned with the concept of empowerment support as a nursing intervention that facilitates the development of mastery, competence, self-worth, and control in the adult female survivor of childhood incest. Empowerment support has been derived from Orem's theory of nursing system. In that theory, empowerment support is encompassed in particular "methods of helping." Theories and research that relate to incest trauma and empowerment support are discussed from an interdisciplinary perspective.

The effect of food and metoclopramide on the pharmacokinetics and side effects of bromocriptine.

The effect of food and metoclopramide on the pharmacokinetics of bromocriptine was investigated in 7 healthy subjects. Plasma concentrations of bromocriptine were measured by radioimmunoassay after a single oral dose of 7.5 mg bromocriptine. Maximal plasma concentrations of bromocriptine were slightly lower when the drug was given after breakfast. Bioavailability of the drug was not significantly reduced by food nor by metoclopramide pre-treatment. Side effects of bromocriptine were considerably reduced by metoclopramide pre-treatment (0.5 mg/kg); the decrease was about 83% as estimated from Table II.

[Pharmacokinetics of Teolin 300 tablets and Teotard 350 capsules in asthma patients]. / Farmakokinetika tableta Teolin 300 i kapsula Teotard 350 u astmaticara.

Pharmacokinetics of tablets Teolin 300 (TT) and capsules Teotard 350 (TC) was studied in 7 asthma patients. Serum theophylline concentrations (SCT) were measured in 2-h intervals over 2 consecutive days for each theophylline formulation. A randomized, crossover design was used. In 12-h one dose of TT was absorbed 89.76 +/- 32.76% (means +/- SD) and TC 83.76 +/- 49.48%; between them there were statistically no differences. Amplitudes of SCT (AMP) were in the range 0.31 to 2.7 and mean 24-h SCT in the range 19.8 to 119.3 mumol/L. AMP were reproducible only to TT (r = 0.97, p less than 0.001). Fourier's harmonic analysis applied to mean SCT disclosed statistically significant 12-h oscillations only for TT (p less than 0.05). Continuous therapy with slow-release theophylline should always be monitored with measurements of SCT which should be interpreted by pharmacokinetics data of applied sustained theophylline formulation.

Resolving incest experiences through inpatient group therapy.

1. Yalom's "curative factors" provide a helpful "here and now" model for inpatient group therapy with incest survivors. 2. Psychiatric nurses are in an excellent position to identify female patients who have been sexually abused and to establish and conduct therapy groups for these women. 3. Preparation of women for the group by the therapist is an essential prerequisite for successful integration into the group. 4. During hospitalization, some of the women may experience brief psychotic episodes, suicidal ideation, self-mutilation, and increased depression, which may preclude group attendance for brief periods. However, these experiences will provide ongoing opportunities for exploration of group feelings of anger, helplessness, despair, and alienation.